Ever noticed those guys who pitch at bike racking covered head to toe in compression gear?
Of course you have. The better question is: are they overcompensating or are they on to something?
We caught up with Dr. Laura Redman MBChB, MMed, FCS (SA) Cert. Vasc Surgery (we know right!) who practices out of Christian Barnard hospital and is a thoroughly published and internationally awarded vascular surgeon, to shine some light on some of the myths and benefits of compression technology in the medical and sporting worlds.
So Doc, the big question we’re all here for: compression garments or not?
From an evidence point of view, which is how we have to practice medicine, there’s not enough evidence to say it absolutely works for everything but it has shown positive results in terms of recovery. It has shown significant benefit though in cycling and the end point of that is, in my opinion, it most likely has got a lot of benefit and will show that with more detailed studies.
In the medical world we use compression for lymph drainage and vein problems. Of these, in my opinion, I think the most relevant in sports men and women is the effect on the lymphatics as it is probably this that is enhancing recovery by eliminating products of muscle break down and oxidative stress.
I think it has a significant potential to enhance venous flow which ultimately may have more effects on performance, however, garments likely need to be more refined and specific for this.
You can cover just about your entire body in compression gear, where should we be focusing?
Definitely the most relevance will be in the legs because your Lymphatic and Venous return is working against gravity and the longer you are on your feet the more volume (of blood) you’re putting into the leg, the more you need to get out.
We call the calf muscles the ‘ Vein heart" because it needs to actively pump to return blood to the heart and lungs for more oxygen. We look at ejection fraction, how much blood you’re getting out, of the calf muscle and when that weakens people have less blood output back to the heart and they’ll get swelling. The compression gurus did a study on sports people looking at compression socks for ejection fraction from the calf pump and they showed the most effect was with inelastic compression and the tighter you go around the calf.
But there is obviously a limit because the tighter you go around the leg you’re going to stop perfusion of the micro-circulation, so you can’t just go an wrap your leg in something extra tight. They (gurus) have recommended further studies for sports and how to get individualised garments for specific areas, looking at calf pump function and looking at lymph drainage for recovery - there are thus a combination of effects that may have effect wearing garments during a race, after, or both.
Should we be using compression pre-race, while racing, or post-race?
While there is still research that needs to be done, some studies suggest that there is actually some benefit to using compression technology during your race. One particular study indicated improved time trial performance on the bike while wearing com
pression garments. They should reduced recovery and enhance lymph flow which will help move products of muscle breakdown.
In terms of wearing compression post-race it will help recovery, even the machines we use for lymphedema have been considered sports recovery. Although we don't typically use them for that, the idea is that you’re enhancing lymphatic flow. There are some more intense machines advocated for that, but any sort of drainage of the legs is likely to be beneficial.
The concept is that you’re clearing toxins that you’ve formed and as extreme athletes you do have higher oxidative stress, so you do need more clearance than somebody who hasn’t done all that exercise.
While we’ve got you, there have been a handful of triathletes who have suffered from DVTs, can you tell us a little more about those?
A DVT (Deep Vein Thrombosis) is a clot in the deep venous system classically of the legs. You would be aware if you have a severe one if you get sudden acute leg pain and swelling usually with redness and if it has gone to the heart or lungs one may get shortness of breath. It’s treated as an emergency. The risk of having it is not so much in the leg but when it goes into the heart or lungs which you can die from it. You also don’t want a clot to be sitting in your leg for long because it can damage the valves and lead to long term problems of the leg.
Athletes are at higher risk due to dehydration, if you’re on steroids or other drugs, potentially some anatomical changes which may be as a result of exercise, and repeated trauma which was the case for a well known athlete who had a DVT in her foot.
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