Walk into any sporting goods department store and you’ll see a growing trend: compression technology is everywhere. What started out as simple spandex is now a multi-million dollar market, and it’s starting to evolve beyond just a tight outfit for superheroes. Compression is big business, but does the science support some of the current trends? Currently, compression technology is entering the wellness space for those individuals who are not training for Olympics or trying to recover from knee surgery. Thus, the question remains: is compression here to stay?
Classifying the Squeeze: What is Compression?
Compression technology is mystifying at first glance for several reasons, and even the science behind it can be misleading. The clash of the latest research and marketing can frustrate even elite coaches who are desperately trying to keep up with the latest innovations with sports apparel and training recovery devices. When one mentions compression in conversation, an associated array of images and definitions create much confusion.
Ask a runner about compression and they may mention the latest Under Armor spandex pant, but a NBA player may bring up the Squid Compression System as his tool for therapy. Visit a progressive CrossFit box and one may see several Voodoo Floss bands on the floor, used for both training and self-therapy. Lastly, talk to someone who just had surgery to their ACL and Game Ready might come to mind. Compression technology ranges in scope, from a pair of socks all the way to the futuristic products that are disrupting the wearables space.
Voodoo Floss Bands- Photo Credit Rogue Fitness
In simple terms, compression is this: applying circumferential pressure to the body with fabric or medical materials. The expected outcome of creating a restriction of blood flow is that an acute physiological response will help heal the body. Hundreds of studies have looked at compression garments and medical devices that rhythmically squeeze the limbs, but the latest sport science research is hinting that much of the results are in fact placebo effects, especially with regard to the garments worn by athletes. Another problem with garments is that comfort as a measureable value is murky at best—just what measurements are considered valid by science remains up in the air.
How Science Evaluates Recovery with Blood Analysis
Defining physiological recovery is tricky, since many different biological systems are intertwined and respond differently to the stresses of exercise and training. The most common way to measure muscular breakdown is using the biomarker CK (Creatine Kinase), a known indicator of muscle damage. The problem with interpreting CK is that repair and recovery don’t trend perfectly; so as a substance clears the body, whether or not the body is repaired is still unknown.
Other biomarkers like cortisol, a useful measurement of body stress, including mental and emotional strain, are also not strong enough proxies to confidently conclude whether or not muscles are repairing. The science on recovery is still in its nascent stages, and while blood analysis is a gold standard for measuring muscle tissue damage, its role in measuring recovery remains a relative enigma in the current literature.
With enough other data, including the information on training loading that some professional teams are collecting, clever deductions can be made to see if the body is, in fact, coming back to baseline.
Above is the NormaTec Recovery system used in every professional league across the globe. The system is one of the most widely used devices to help cope with the grind of elite sport.
A straightforward approach to testing recovery is to monitor actual performance changes before and after training, in addition to monitoring biomarkers. Performance testing cuts through the unnecessary interpretation and adding biomarkers shows possible reasons for how and why restoration or recovery happened. A New Zealand study years ago questioned what type of biological system was really recovered when looking at muscle power after NormaTec treatments. Research showed that jumping performance wasn’t restored after the pneumatic compression session with a product costing over a thousand dollars—so how can an expensive high tech spandex pant improve recovery?
The truth may come from other measurements, since compression involves more than just blood flow. Many research findings on extreme compression methods, that go beyond a tight running pant into a near tourniquet experience, called occlusion training, suggests that something may be happening internally in the body. Some research on occlusion training hints at changes on the cellular and genetic level, beyond just an ischemic response to the muscle.
Training with Voodoo floss bands does not initiate recovery, but some physical therapists, especially those in the CrossFit market, believe that this training method can help repair the body by compressing it beyond comfortable levels. Like sport taping, research hasn’t yet seen anything concrete within the literature, and many experts warn that this practice is an accident waiting to happen.
What about the Lymphatic System and the Brain?
Two years ago, I flew down to Florida to investigate the Cadillac of compression treatments, the NormaTec Recovery system, with track athletes on the Swedish National team. Using a shotgun method of seeing all possible ways the body recovers it turned out that lymph, as well as blood, is likely the mechanism for improved recovery. Athletes are constantly looking for an edge, and the anecdotal evidence was too strong to pass it off as just a gimmick.
Above is the data from Dr. Sands who was at the USOC Recovery Center who investigated the use of NormaTec with a large amount of Olympic athletes. He found that the device reduced pain with instrument measurements using an algometer.
I measured actual lymph flow of various systems over the years (not an easy task), and came to the conclusion that the natural pumping action of walking and running that helps to move free proteins from damaged muscle was mimicked by the device.
Athletes and even some weekend warriors are pushing themselves so hard, a casual jog is not practical and passive milking of the limbs may be a necessary alternative. Other measurements of restoration have been seen using smartphone apps that employ Heart Rate Variability measurements, and the NormaTec increased recovery beyond the simple benefits that come from lying down in a resting position.
Recent science suggests that the lymphatic system, a much less studied part of the body compared to the cardiovascular system, might be signaling the brain somehow. The rich network of lymph vessels work from movement, and instead of a heart to pump fluid through, much of the transport originates from simple human locomotion. One can make a good case that many of the reported (subjective) feelings of recovery are actually the central nervous system responding to improvements in lymph flow.
There are other, less known factors that may be the real reason why athletes love treatments of pneumatic compression: it produces similar, opiate-like effects of oxytocin, neurotensin, and orexin. Some research on massage and other therapies are leading to changes in how we view the autonomic nervous system, but little of it looks at endorphins and other markers of pleasure. As of yet, no published research on the effects of pneumatic compression on humans has shown that it increases the “feel good” hormones, but some private studies are very promising.
It remains up to the scientific community and many of the companies that make compression devices and other wearable options, to collaborate and show how pleasure systems of the body may be tapped into for healing.
Can too much recovery hurt in the long run?
Recent research points to the observation that the body naturally responds to signals from stress to adapt and recover properly . Recovery is a tricky juggle when it has the potential to impair the natural adaption process by muting internal signals that trigger growth and improvement. The main problem with all of the research is that it looks at unrealistic populations or study designs that are not representative of the unholy levels of trauma professional athletes endure to entertain fans. Research on ice baths—a misnomer as the tub of cold water is about 50 degrees Fahrenheit—demonstrates that training adaptations will impair the recovery process to muscle. Why are professional teams still taking the cold plunge after years of knowing this?
The unfortunate reality is that modern sport is no longer a game or competition of who is the best athlete, but rather of who is the most durable and can survive. The athletes that win with longer and more demanding seasons are usually crowned the champions. Compression treatments, like ice, may be needed to manage reported soreness, not repair muscle or tendons. Athletes are training and competing multiple times a day, thus making science question whether their research properly represents what athletes actually endure during a season.
Identifying the optimal amount of inflammation and the right genes “turned on” is the next frontier in exercise and human performance, and compression may be used as a tool to help modulate the right environment when the body is experiencing an out of control wildfire.
A logical takeaway is this: cold therapies and compression options may incite a temporary response of perceived pleasure that induces a favorable environment to move athletes through a difficult training period. Compression may help the average baby boomer create a mental distraction from the aches and pains of soreness. How much is placebo? That is a valid argument for any tactile product, but the real question is one of the value of physical touch and how the body responds.
Wonderful research on premature babies proves that the simple touch of a human is enough to prompt significant positive changes in stress hormone levels; how this relates to comfort and compression is yet unknown. Wear-patterns and studies on simple garments and foot attire is big business, since even a simple shirt’s comfort will make or break a brand. TITIN, a weight vest that combines multiple functions values the importance of comfort and their spokesman shared the following:
“TITIN offers a premier line of hypergravity training tools not matched on the market. TITIN's 3 tool in one technology with the hydrogel inserts, thermal therapy, and compression provides an optimal feel of comfort, while training in additional weight. Majority of TITIN customers state that don't feel extra burden do to the comfort, but definitely notice the gains they are making while training in the TITIN Force System.”
Like a comfortable mattress helping sleep, comfort in this modern age of sport seems to be the right avenue to head down when it comes to increasing relaxation responses to the body—resembling a wearable mediation experience, similar to a Float Tank. Measuring comfort and how that changes muscle tone and internal chemistry is the new “space race” for apparel and compression companies.
The Future of Compression: Wearable and Smarter
Companies are investing heavily in compression technology and gearing up for the 2016 Olympics in Rio, the prime event for sports performance. Similar to TITIN, some companies are going from portable to truly mobile systems. Companies are focusing on making the devices part of the body, using equipment and innovations one would find on an astronaut and making them for regular people looking to deal with the challenges of aging. Compression is here to stay; expect more natural and sleeker-looking options that are ever more affordable for the average consumer.
What the future holds specifically isn’t clearly known, but it can be distilled into the four trends we identify with firsthand at InsideTracker. They are:
Companies will connect more to smartphones and smartwatches via Bluetooth to keep prices low and remove unnecessary hardware. The computing power and value of just having a convenient remote using an app is simply logical.
Professional athletes will have recovery data measured as part of their vitals to see changes in the readiness to train or compete. This includes GPS tracking devices, fatigue monitoring, and of course muscle function and status.
The aging population is the new target “athlete.” Years ago, the executive athlete was the new athlete; now grandma is expecting the same innovations.
Equipment will use artificial intelligence to detect when recovery is appropriate and when to switch modalities. Instead of one therapy option, the systems not mentioned in this article are providing a menu of sensory choices like vibration and stimulation, including electrical options.
All of the above mentioned points will serve to disrupt the market with the promise of cheaper, consumer-friendly solutions that rival options currently available to hospitals and in elite sport. The best way to know if a product is good for you is to look at the research freely available and be your own experiment; measure the same biomarkers that the research leverages. Personalize and validate what is being worn externally by exploring what is happening to your body on the inside.