NORMATEC COMPRESSION RECOVERY BOOTS
The Science Behind Compression Technology For Performance Recovery
Kevin Masson MS, CSCS, NSCA-CPT, USAW
Does Compression Help Expedite Recovery?
Compression garments are quickly becoming very popular for both gym users and athletes alike, for aesthetics, comfort and also their aid in recovery. For the athlete, the crucial point is that compression garments can help them to recover much quicker from their activities, thus promoting better performance. It has been identified that compression garments can help to improve the awareness of joints, blood flow, removal of waste products, better running economy, reduce swelling quickly, decrease muscle soreness after exercise and reduce muscle oscillations. At the same time, they do not appear to have any negative impact on performance.
Intensive periods of training and competitions can cause damage to the muscles, leading to a condition known as DOMS – Delayed Onset of Muscle Soreness (1). Because of this, techniques to encourage and enhance recovery are growing fast, and compression garments are now leading the way (2).
What Are Compression Garments?
Compression garments are a form of clothing that are tight and compressive. They are usually made from nylon and elastin, two materials that are designed for enhancing recovery. Athletes wear these garments to try to improve their performance and to make recovering from exercise much faster. The belief is that these garments can improve performance and recovery time based on these influences:
They reduce post-exercise edema
They increase the removal of waste products
They increase local blood flow
They reduce the perception of DOMS
They decrease the amount of concentrated creatine kinase
They decrease muscle vibration or oscillation
They increase joint awareness or proprioception
They increase perfusion
They increase levels of oxygen in the muscles
They raise skin temperature
They reduce the perception of fatigue
How Does This Work?
When compression is applied to certain parts of the body, provided it is accurate and balanced, the blood flow is accelerated. This provides your working muscles with an increase in oxygen, and that, in turn, boosts your performance. Improvements in blood flow also help the body to remove lactic acid, along with other metabolic waste and this allows you to work at a higher level of performance for longer. Finally, more oxygen in the blood decreases the effects of DOMS and speeds up the repair process of your muscles.
The human circulatory system is made up of two components – venous blood flow and arterial blood flow. The heart and lungs pump oxygenated arterial blood at high systolic pressure, usually greater than 120mmHg. Provided the compression garments are fitted correctly, they will have no significant impact on this flow.
Venous blood is a different matter; it is not oxygenated because it offloads the nutrients and oxygen into the active muscles as it passes through the capillaries. Its pressure is much lower, at less than 20mmHg. Venous veins have one-way valves that allow blood to flow back to your heart but not away from it. Contractions in the muscles push the blood to the heart, the venous return mechanism, and compression garments will do the same thing.
A Different Kind of Compression Technology
NormaTec is the number one provider of rapid recovery systems (5), and they use a different method of compression. With their systems, they aim to put recovery at the heart of training for athletes and, to that end, have developed the PULSE Recovery system. This is a dynamic device that is designed to aid recovery and rehabilitation post-exercise and consists of a control unit with attachments that go on the hips, the arms or the legs. These systems use compressed air, which massages the limbs, get fluids mobilized and speed up recovery using a Pulse Massage Pattern.
This pattern involves three techniques:
Pulsing – Rather than using standard compression techniques of squeezing, which is known as static compression, pulsing mimics how the muscles pump your arms and legs, getting fluids moving, as well as metabolites, out of your limbs post-workout.
Gradients – Lymphatic vessels and veins have got one-way valves in them that stop backflow of fluid. In the same way, the NormaTec Pulse technology utilizes holding pressures that stop the fluids from being forced to go the wrong way. Rather than the pressure tapering off, this system delivers the maximum amount of pressure to each zone.
Distal Release – Many compression technologies use static compression, and this can interfere with the normal flow of your circulation system. NormaTec uses Sequential Pulse technology, and this will release the holding pressures as soon as they are not needed, thus aiding in the prevention of backflow. When the hold pressure is released in each zone as quick as possible, the limbs get the maximum amount of rest time without any long pauses between the compression cycles.
Intermittent Pneumatic Compression
Intermittent pneumatic compression (IPC) technology is now used to reduce limb edema and to decrease the risks of deep vein thrombosis. Use in athletic arenas has not been that widely used so far but it is beginning to gain traction because of the mechanism used. Arterial and venous blood flow is increased through the use of compression cuffs, which are inflated periodically, which has proven to be useful in athletic cooldown activities. It also assists in removing the waste products, such as lactic acid, which results in a lower risk of injury and a decrease in DOMS.
The cuffs used are in the form of boots, gloves or sleeves along with an air pump. The sleeve, glove or boot is placed around the limb that needs the treatment and is connected to the air pump via pressure lines. When the pump is activated, it will push air into the chambers on the sleeve, etc. to put pressure on the limb tissues. This forces the lymph, blood and other fluids out of the limb. Then, after a short period, the pressure is decreased so that blood can flow back.
The main aim of this device is to push the blood out of the deep veins and, provided the valves in these veins are working correctly, the blood is proximally displaced. Then the compression sieve is deflated and the veins will refill with blood. Intermittent compressions ensure that the venous blood keeps moving as it should.
There are two modes of intermittent compression:
Peristaltic – These devices use compression sleeves that have separate inflation chambers. These put pressure on the limb at individual points rather than the whole limb. When one chamber has deflated, the next will inflate and go to work; this carries on through each chamber.
Sequential – A sequential compression device or SCD also uses compression sleeves that have separate areas for inflation. These are squeezed on the limb in a kind of ‘milking’ action, with the distal areas inflating, followed by the other pockets in sequence.
The range of intermittent pressure is from 0 to 240 mmHg, which is six times more than a traditional compression sock. And because both Peristaltic and Sequential devices have medical support and backup, they are being used a lot more by professionals.
SKINS Compression Technology
Skins are an Australian company (6) that has produced compression garments that take multiple readings while the human body is moving (i.e., in workout or competition). The technology lies in the fabric used in the garments; warp knitted with high quality, very fine yarn. These garments do not have any natural stretch to them; the spandex combination provides the optimal level of elasticity and compression that is controlled entirely. A float line in between each knitted loop ensures optimal moisture management and multiple yarns are used to stop the material running if it gets snagged and to increase the strength.
SKINS use two different types of compression technology in their garments:
Dynamic Gradient – The compression garments use a technology that measures the compression levels of the muscles while they are moving. Traditionally, these levels are measured when the athlete is at a standstill; now they can determine what level of compression is required for each muscle group while static, in movement and after a workout. The muscles change shape as more oxygenated blood flows through them and dynamic gradient technology works out where the compression is required, at the time it is required, in order to keep the athlete comfortable, prevent injury and maximize the circulatory benefits, ensuring oxygen goes where it is needed, and lactic waste buildup is reduced. Plus, you get the benefit of fewer other metabolic wastes building up.
Engineered Gradient – Engineered gradient compression technology provides the right level of surface pressure to certain parts of the body, enhancing the circulation and pushing oxygenated blood to where it’s needed – into the muscles. Again, because the circulation is improved, the level of metabolic wastes and lactic acid are much lower. This compression technology is built into their compression socks.
This unique system in that the compression is delivered during the workout rather than afterward, thus reducing recovery time. There are three levels of compression technology in their garments:
Level 1 – this provides a mild compression squeeze over the entire part of the body covered by the garment, but does not deliver intensive compression.
Level 2 – this provides more intensive compression to the muscles and is used primarily by endurance athletes or for high-intensity sports use to reduce the risk of injury. It is also used for post-workout compression.
Level 3 – this is known as strategic compression and doesn’t increase the compression squeeze; instead, it is a focused and dynamic squeeze that targets key muscle groups such as the calves, glutes, quads, triceps, and biceps. It is also used for post-workout and has been designed for overnight wearing, for long flights and in between sporting events. It has been shown to increase the recovery rate significantly.
Do Compression Garments Work?
Yes, to a certain extend. There is plenty of documentation in peer review journals about DOMS after hard exercise, but it still isn’t correctly understood what drives the phenomena. The theory is that it is a combination of inflammatory response and muscle fiber disruption. The inflammatory response follows damage to the tissues after a hard training session, and it involves an increase in swelling to osmotic pressure – this is what causes the pain. Compression garments may well reduce this swelling, thus reducing the pain and the response by using the veinous return system.
CK or creatine kinase is a biomarker for damage to the muscles and compression garments, or other compression technologies have been shown to be very effective in decreasing the concentration of CK, resulting in less being released into the blood (3). This leads to better waste product removal and faster muscle tissue repair.
Compression garments may also provide improvements to proprioception, or awareness of joint position because the external pressure acts on skin receptors as well as reducing oscillations or vibrations in the muscle while exercising (4). This leads to less damage to the muscle tissue and less fatigue in the muscles, thus aiding recovery time post-workout. This technology is also used similarly by the popular tape company, Rocktape.
How to apply Compression Therapy
Now that you know the science behind each technology, it’s time to apply it.
Compression Boots – The easiest application but not the cheapest one would be to invest in compression boots or arms as a post-workout recovery tool. Strap them on and just relax for 20 to 30 mins in either mode sequential or peristaltic, this will allow flushing of lactic acid and other metabolic waste faster.
Massage Therapy – Another effective way would be to get a sport massage by a massage therapist that is trained in deep tissue or neuromuscular massage. Any type of moderate pressure will move an acidic environment to a lower Ph level, but while the therapist will work on a lymphatic type of massage to get rid of metabolic waste, neuromuscular massage release tight muscles and trigger points that cause pain.
Of course, if you are not a professional athlete these two options are a little costly, and not every facility has access to compression garments. So here are some solutions for you:
Compression Clothing – Training in compression clothes, improves sensory feedback and proprioception, it also may make you look like a super hero so that’s cool from an aesthetic point of view. Althougth not as effective as the other technology for recovery, keeping the clothing after training may aid with inflammation.
Dr. John Rusin’s Supine Positional Parasympathetic Breathing – Sometimes the simplest way is often the best way. By laying supine on the floor in a 90-90 position or legs up against a wall (L shape) work on your breathing to calm yourself and let gravity do the work. Recovery breathing is about the position and setup. The passive positioning of the arms and legs help with centralized drainage of lymphatic fluid. The spine remains in a relatively neutral position to reduce the threat-response to the body. You basically get your body as comfortable as possible for the goal of reversing the CNS response from training.
Final Thoughts on Compression and Recovery
There is very little research that proves all the benefits some companies claim. Research is still ongoing with compression garments, and other technologies are also evolving. Right now, it is clear to a certain degree that compression garments can have some positive effects on post-workout recovery. Most importantly compression technologies research does not show any negative impact on performance and can continue to be used by anyone who is exercising, training, or is an athlete, in order to help optimize recovery time.
However, research is showing that the later technologies, those that do not rely on static compression, are providing better results in improving proprioception, local blood flow, better removal of waste products, in many cases, reducing the amount of waste product built up in the first place and can also change running economy – the use of sub-maximal oxygen whilst exercising. They prove useful for keeping swelling down, decreasing soreness in the muscles after exercising, and are proving to be a recommended tool for enhanced recovery after a workout.
It is important to remember that all athletes and sports enthusiasts are different; everybody is affected differently during exercise, and not one garment or other type of compression technology will be right for every case. If in doubt, then medical assistance and advice should be sought before attempting any compression technology, be it a sock, boots or the kind of technologies offered by any leading technological brands.