Do compression socks work?

In this article I discuss what compression socks are and how they work. I also take a closer look at the current research to find out if, like the manufacturers claim, they can truly help you perform and recover better.

Do compression socks work?

In this article:

How compression socks work

Compression socks are thought to work in 3 ways:

It improves your circulation

As you know, your heart is the main pump that circulates your blood through your body. It pumps freshly oxygenated blood into your arteries, circulating it all the way to the tips of your fingers and toes.

Thanks to the forceful action of the heart, it’s relatively easy for the blood to reach your limbs where your muscles and cells use the oxygen and nutrients in the blood. But it’s a lot harder work for the blood to find its way back to the heart again – especially if it has to flow up your leg against gravity. The further the blood is away from the heart, the weaker the pump-effect.

That’s why the blood flows back to the heart through veins that have one way valves that stops the blood from running back down (it’s a bit like a canal system with locks). Your muscles (especially your calf muscles) can also act as pumps when they contract during exercise, helping to pump the blood back to the heart.

Have you ever noticed how your ankles swell if you sit for a very long time e.g. on a bus or aeroplane? That’s because the lack of movement (muscles pumping) allows your blood and fluid to pool in your ankles and feet.

Research have shown that graduated compression socks (that are tighter at the bottom and looser at the top) can increase your venous blood flow and stop the blood from pooling in your limbs. For athletes this may mean that they can recover faster as they would get rid of the waste products from exercise more quickly, their muscles would get more oxygen and that they would have less swelling in their muscles (exercise always cause a bit of swelling due to micro-trauma).(2,9,10)

It improves lymph drainage

Compression garments also improve lymph drainage. Your lymph vessels transports waste products away from the cells and dumps it back into the blood so that it can be excreted in your urine. If you can improve your lymph drainage you can usually also improve recovery and healing.(2)

It protects your muscles

It has also been suggested that compression garments may help to protect muscles during exercise by reducing the impact forces on the muscles which in turn helps to reduce exercise induced inflammation, swelling and muscle damage.(7)

So in theory, compression socks seem to potentially hold a lot of benefit for athletes but what does the research say? Do they provide any clear performance and recovery benefits when tested on athletes?

Can compression socks improve your performance?

The research is not very clear on whether compression garments can improve performance. It appears that different athletes may benefit in different ways from compression socks. Here are some of the findings:

Slower athletes may benefit more from a circulatory effect

In studies where they looked at blood flow, it was shown that compression socks improved the blood flow in the calf but only when participants exercised at a very low level e.g. walked slower than 6km/hour or cycled at less than 120W. Their circulator systems did not seem to gain anything from wearing compression socks when they exercised at higher intensities.

Remember that I mentioned above that the calf muscles, when they contract, can act as a pump to pump blood back to the heart? The researchers think that this calf-pump effect becomes so efficient when you exercise at higher intensities that compression socks don’t really offer any additional benefits to the circulatory system.(9)

Runners

A group of researchers (3) recently collected all the studies performed on runners to see if wearing compression stockings while running held any benefits for them. They found that it did not seem to influence running performance (times for a half marathon, 15-km trail running, 5- and 10-km runs and 400-m sprint), oxygen uptake, blood lactate concentrations or heart function.

They did, however, find some positive effects. Time to exhaustion (how quickly the runners got tired) and running economy were improved in the group of runners that wore the compression socks while their blood markers also showed that they had less muscle damage and inflammation after exercise.

Football players

Full length compression tights (compared to shorts or socks) were found to work best to reduce the amount of muscles damage and inflammation that players sustained during a match.(7)  So if your aim is to reduce muscle damage during exercise, you may want to consider wearing more comprehensive compression garments than just socks.

The compression tights below looked like good value for money when I searched on Amazon. But I must admit that I prefer to just wear compression calf sleeves in the summer.

Do compression socks help you recover quicker?

Yes, the research is a lot clearer on the benefits that compression garments hold for recovery.

DOMS

Multiple studies have shown that compression socks can reduce the pain you feel after exercise (DOMS).(2,3) This is most likely due to it allowing you to get rid of waste products more quickly. There is strong evidence that shows that compression socks improves your circulation to your muscles if you wear them after exercise or at rest.(6)

Fatigue

Athletes who use compression garments consistently report feeling less tired during recovery.(2,3)

Strength, power, endurance

A common way to test how long an athlete takes to recover is to see how long it takes them to regain their full strength, power and endurance that they had before the training session or competition. Athletes who use compression garments appear to show a quicker recovery for strength and power and to a lesser extent endurance when compared to athletes who don’t wear them.(1)

Type of exercise

It seems that the more damaging the exercise is, the greater the recovery benefits are that you’ll get from wearing compression socks or tights. For instance, a much greater recovery effect has been found after strength training versus running or cycling.(1)

The products below had good reviews on Amazon. Again, I prefer the calf sleeves because I like to wear my own socks.

Are compression socks able to prevent injuries?

We don’t know yet. I could only find one study that tried to investigate this, but it was unfortunately not a very good study.

The researchers sent out a questionnaire to 203 trail runners and asked them about their training, if they used compression socks when training and how many injuries they accumulated during the season.(8) They found that the group of trail runners who wore the compression socks while training reported significantly fewer injuries. The problem with this research is that we can’t really tell if this difference was purely down to the compression garments as it could just as easily have been down to training, fitness or experience.

Some important things to consider

More is not always better. Compression socks that are too tight can actually cut off your circulation and have the opposite effect. (9)

Researchers have found that compression socks don’t always produce the amount of compression that they claim to provide even if you select them according to the manufacturer’s guidelines. Differences of between 3% and 20% from the target pressure has been reported. (5)

I would suggest that you don’t worry too much about it. Select the size according to the manufacturer’s guidelines and make sure that they feel firm but not uncomfortable when you wear them. They’re too tight if they cause your muscles to cramp or hurt.

If you spend a lot of time standing during the day, you may benefit more from compression socks than other athletes. Gravity will make it much harder for your blood to flow back to your heart and compression can help you overcome this and recover better.

Varicose veins affects your circulation and tends to allow your blood to pool more in your limbs. This means that athletes with varicose veins will likely benefit more from compression socks than others.

Let me know if you have any questions. Remember, you can also join my Facebook Group to ask any injury related questions and watch livestreams on injury prevention topics.

Best wishes

Maryke

Sports physiotherapist

References:

Brown F, Gissane C, Howatson G, et al. Compression garments and recovery from exercise: a meta-analysis. Sports Med 2017;47(11):2245-67.
Dupuy O, Douzi W, Theurot D, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue and inflammation: a systematic review with meta-analysis. Frontiers in physiology 2018;9:403.
Engel FA, Holmberg H-C, Sperlich B. Is there evidence that runners can benefit from wearing compression clothing? Sports Med 2016;46(12):1939-52.
Hill J, Howatson G, van Someren K, et al. Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine 2014;48(18):1340-46. doi: 10.1136/bjsports-2013-092456
Hill J, Howatson G, van Someren K, et al. PRESSURES EXERTED BY COMMERCIALLY AVAILABLE LOWER LIMB COMPRESSION GARMENTS. British Journal of Sports Medicine 2014;48(7):608-08. doi: 10.1136/bjsports-2014-093494.131
Lee DC, Lee SW, Khaw K, et al. Haemodynamic responses of wearing low-pressure sports compression tights during an orthostatic challenge in healthy individuals. Journal of Science and Medicine in Sport 2017
Marqués-Jiménez D, Calleja-González J, Arratibel-Imaz I, et al. Influence of different types of compression garments on exercise-induced muscle damage markers after a soccer match. Research in Sports Medicine 2018;26(1):27-42.
Ménétrier A. THE USE OF THE ELASTIC COMPRESSION TO DECREASE THE RISK OF INJURY. British Journal of Sports Medicine 2014;48(7):638-38. doi: 10.1136/bjsports-2014-093494.211
Peseux M, Muzic J, Bouhaddi M, et al. Changes in Tissue Oxygen Saturation with Well-and Tight-Fitted Compression Sleeves During an Incremental Exercise on Treadmill. Asian Journal of Sports Medicine 2017;8(4)
Stanek JM. The effectiveness of compression socks for athletic performance and recovery. Journal of sport rehabilitation 2017;26(1):109-14.

Maryke is an expert sports physiotherapist who provides online physio consultations using Skype. She is registered with the Chartered Society of Physiotherapy as well as the Health and Care Professions Council.