General Considerations for Compression Garments in Sports: Applied Pressures and Body Coverage

Abstract

Compression garments are popular among competitive and recreational athletes alike. The debate about the efficacy of compression garments in sport is similarly popular, spanning the scientific literature, public press, social media, and the sports field itself. In this chapter we aim to assist both researchers and the general reader by discussing the core elements of the compression garment story. First, we consider compression—the applied pressures and factors influencing those pressures. Knowing the applied pressures in vivo and characteristics of the pressures during use are important for building a clearer idea about what aspects of sports performance and recovery are affected by compression garments and why. Second, we consider garments—that, like other clothing, compression garments cover and interact with the body, establish a microenvironment, and influence variables such as heat and moisture exchanges. Understanding characteristics of the garments themselves can be useful for aiding interpretation of certain physiological and psychological effects, including heat balance, comfort, and wearer acceptability. We hope that the detail here helps the reader to contextualise and critically evaluate research on compression garments in sport.

Full text

This is an Author’s version of the accepted manuscript. Please cite the published version.
MacRae BA, Laing RM, Partsch H (2016) General Considerations for Compression Garments in Sports:
Applied Pressures and Body Coverage. In Engel F and Sperlich B (eds.) Compression Garments in Sports:
Athletic Performance and Recovery. Springer International Publishing Switzerland, pp 1-32.
The definitive version (DOI 10.1007/978-3-319-39480-0_1) is available online at
http://link.springer.com/chapter/10.1007/978-3-319-39480-0_1
General Considerations for Compression Garments in
Sports: Applied Pressures and Body Coverage
Braid A. MacRae1,2, Raechel M. Laing3, Hugo Partsch4
Affiliations:
1 Laboratory for Protection and Physiology, Empa—Swiss Federal Laboratories for Materials Science
and Technology, St. Gallen, Switzerland
2 Exercise Physiology Laboratory, Institute of Human Movement Sciences and Sport, ETH Zurich—
Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
3 Clothing and Textile Sciences, University of Otago, Dunedin, New Zealand
4 Hugo Partsch, Emeritus Professor, Medical University of Vienna, Vienna, Austria
Abstract. Compression garments are popular among competitive and recreational athletes alike. The
debate about the efficacy of compression garments in sport is similarly popular, spanning the scien-
tific literature, public press, social media, and the sports field itself. In this chapter we aim to assist
both researchers and the general reader by discussing the core elements of the compression garment
story. First, we consider compression—the applied pressures and factors influencing those pressures.
Knowing the applied pressures in vivo and characteristics of the pressures during use are important
for building a clearer idea about what aspects of sports performance and recovery are affected by
compression garments and why. Second, we consider garments—that, like other clothing, compres-
sion garments cover and interact with the body, establish a microenvironment, and influence variables
such as heat and moisture exchanges. Understanding characteristics of the garments themselves can
be useful for aiding interpretation of certain physiological and psychological effects, including heat
balance, comfort, and wearer acceptability. We hope that the detail here helps the reader to contextu-
alise and critically evaluate research on compression garments in sport.

1 Introduction
1.1 Scope
Compression garments have been widely adopted for use in sporting contexts. The types of garments
available vary and include those that cover the torso and the arms in full or part, the lower-body from
the waist in full or part, and those that cover specific limb-segments only (e.g. sleeves, socks, and
stockings). While the type of garments used and the time of wearing them can vary by sport, personal
preference, and intended purpose, a common feature is that all compression garments apply pressure
to and cover body surfaces. These two components—applied pressures and body coverage—are the
focus of this chapter. We hope that the detail here helps the reader to contextualise and critically
evaluate research on compression garments in sport.
Applied pressures. A fundamental assumption underpinning compression garment use is that the
pressures applied to the body are important in some way. During use, these pressures can be influ-
enced by garment properties (e.g. garment dimensions, garment construction, properties of the con-
stituent fabrics and how these change over time) and characteristics of the underlying body segment
(e.g. body dimensions, tissue type, and changes related to posture and movement). Irrespective of
whether specific pressures, a general range of pressures, or simply some pressure is ultimately re-
quired for a particular outcome, actually knowing what those pressures are and the characteristics
during use are essential for integrating and interpreting the literature and making useful recommen-
dations for athletes.
Body coverage. Considerations about compression garments from the perspective of a layer of cloth-
ing that covers the body are introduced. Here, we include information that attempts to bridge the
sport sciences with some of the wider clothing and textile sciences.
1.2 Pressure and coverage characteristics.
Since early studies in sporting contexts (e.g. Berry and McMurray 1987; Carling et al. 1995; Kraemer et
al. 1996; Kraemer et al. 1998a; Kraemer et al. 1998b), a considerable body of research has accumulated
investigating various applications (during sport, during recovery) and types of compression garments
(different applied pressures and body sites covered). For the purpose of gauging the status of aspects
relating to pressures and body coverage in the sport sciences, we characterised the literature from a
~5-year period (2011–Jan 2016; Table 1). (Note that this search period applies only for the data pre-
sented in Table 1, not for the chapter as a whole.) Over this period, 78% of studies investigated effects
during exercise, and 29% during recovery from exercise. Lower limb compression has been the most
common with 81% of studies including the leg (calf) and 48% including the thigh, while comparatively

few have investigated upper-body effects (<16% for each torso, upper arm, and forearm; Table 1).
While the applied pressures were often reported, these pressures were measured only in approximate-
ly one of every three studies.
Table 1. Information from located studies (n=58, 2011–Jan 2016) in which compression garments were
used during or following exercise.a
Variable
Yes (%)
No (%)
Not clear (%)
Body sites compressed
Torso
12
88
–
Upper arm
16
83
2
Forearm
14
83
3
Thigh
48
48
3
Leg (calf)
81
17
2
Applied pressures
Pressures reported
74
26
–
Pressures measured in vivo by authors
34
66
–
Other garment information reported
Placebo garment used b
28
72
–
>1 compression condition (including placebo) c
43
55
2
>1 compression condition (excluding placebo) c
22
76
2
No garment/normal clothing as a control
78
22
–
Comment on how participants sized
78
22
–
Fibre type reported
53
47
–
Any fabric properties reported
5
95
–
a A 5-year period was used because, assuming that pressure measurement is becoming more common, the
inclusion of older studies may inflate the percentage not measuring the applied pressures; see Appendix 1
for a details about the search
b As reported as being a placebo garment in the article and may have been another type of garment or the
same garment in a bigger size; in some instances the placebo was the control condition and in others it was
simply a different condition of compression (i.e. one with less pressure)
c Placebo conditions have been reported both included and excluded as a separate condition of compression
because it is plausible that placebo garments are, in effect, low-level compression garments
2 Compression garments and the applied pressures
2.1 Establishing applied pressures
Sporting compression garments are smaller in dimensions than the corresponding body sites to be
covered. During donning and use, the garment and its constituent fabric, yarns, and fibres/filaments
are subjected to mechanical forces acting over an area (stress), which cause deformation, observable as
extension (strain). Thus, compression is a product of the interaction between the body (e.g. tissue and
surface curvature) and the forces involved with garment strain (Troynikov et al. 2013). Some indica-
tion of how interface pressures actually influence the underlying tissue pressures can be gained from
Table 2 (Murthy et al. 1994; Giele et al. 1997; Uhl et al. 2014): note that modelling indicates heterogene-
ous pressure distributions are likely within a limb cross-section (Dubuis et al. 2012).

Table 2. Effects of external compression on subdermal and intramuscular pressuresa
Site
Body position
Interface pressure,
mmHg
Subdermal pressure (Δ
from baseline), mmHg
Intramuscular pressure
(Δ from baseline), mmHg
Medial mid-calf b
NR
No compression
6 (0)
36
22 (16)
Posterior calf b
NR
No compression
-3 (0)
66
24 (27)
Medial lower calf b
NR
No compression
1 (0)
59
31 (30)
Medial calf c
Supine
No compression
11 (0)
IMP in medial
10
13 (2)
gastrocnemius
20
25 (14)
30
36 (25)
40
43 (32)
Standing
No compression
32 (0)
10
41 (9)
20
50 (18)
30
60 (28)
40
68 (36)
Mid-calf d
Supine
No compression
8 (0)
IMP in soleus
16 ± 1 (L1)
21 (13)
20 ± 1 (L2)
25 (17)
Standing
No compression
37 (0)
19 ± 1 (L1)
56 (19)
23 ± 1 (L2)
55 (18)
Walking:
Contraction
No compression
152 (0)
23 ± 1 (L1)
162 (10)
26 ± 1 (L2)
174 (22)
Oscillation e
No compression
161 (0)
11 ± 1 (L1)
153 (-8)
11 ± 1 (L2)
164 (3)
Running:
Contraction
No compression
226 (0)
24 ± 1 (L1)
254 (28)
29 ± 1 (L2)
245 (19)
Oscillation e
No compression
242 (0)
13 ± 1 (L1)
263 (21)
14 ± 1 (L2)
245 (3)
Δ, change; NR, not reported; IMP, intramuscular pressure; L1, ‘level 1’; L2, ‘level 2’
a Subdermal and intramuscular pressures are reported as absolute values with the change from baseline (no
compression) reported in parentheses; change scores are calculated from group means. Standard deviation
is presented where possible but omitted from subdermal and intramuscular pressures for clarity of presen-
tation
b n=1 leg, compression applied using a “pressure garment” (Giele et al. 1997)
c n=10 legs from 5 participants, compression applied using a blood pressure cuff and measured at the medi-
al calf at widest girth (Uhl et al. 2014)
d n=11 legs from 11 participants, compression applied using ‘level 1’ and ‘level 2’ ankle-to-knee elastic com-
pression garments (Murthy et al. 1994); note that the original article reports data for both elastic and inelas-
tic compression but only data from the elastic garments are reported here
e Oscillation represents the difference between peak and relaxation pressures

An example of fabric from a commercially available sporting compression garment is shown in Figure
1, imaged at 35 times magnification using a scanning electron microscope. In this case, it can be seen
that filaments (fibres of indefinite length) are used to form yarns, which have then been knitted to
form the fabric structure. Textile fibres are classified according to their origin and chemical composi-
tion (International Organization for Standardization 2012; International Organization for
Standardization 2013a). For sporting compression garments, the constituent fibres/filaments are often
elastane (branded versions of this include Lycra® and spandex) and polyamide (nylon) or polyester.
This particular example (Figure 1) was reported by the manufacturer as being 76% nylon and 24%
elastane.
Figure 1. Scanning electron microscope images of the fabric from a common sporting compression
garment at X35 magnification; fabric outer (A) and inner (B) surfaces as used in the garment.
A B
A reasonable level of fabric extension and fabric elasticity (recovery following extension) will facilitate
garment donning, wearer comfort, range of motion, and generic garment sizing. Extension character-
istics will also influence the way the applied pressures respond when the volume or curvature of the
underlying body segment changes. The related property of compression garment ‘stiffness’ is rele-
vant here and is defined in the context of medical compression hosiery as the increase in compression
pressure per 1 cm increase in leg circumference (Comité Européen de Normalisation 2001). While this
definition is somewhat arbitrary and, at face value, applicable only to the lower body, understanding
the relevance of garment stiffness can be of use for the sport sciences. (Note that stiffness is also used
to describe fabrics in terms of resistance to bending and this is not the usage here; stiffness for com-
pression garments or compression devices, as defined (Comité Européen de Normalisation 2001) and
widely used (Partsch et al. 2006a), can be thought of as the outcome of a compression material’s re-

sistance to extension.) As an example, stiffer garments versus those that are less stiff, exhibit greater
changes in pressure following a change in position of the leg (Partsch 2005; Partsch and Mosti 2013) or
arm (Hirai et al. 2010) and higher peak pressures during muscle contractions in the leg (Partsch and
Mosti 2013) or arm (Hirai et al. 2010). For this reason, both the applied pressures in resting state and
how the pressures change during use are each important to understand.
2.2 Measuring applied pressures
2.2.1 In vitro
There are various in vitro approaches for classifying medical compression products (e.g. see Partsch et
al. 2006b; Hegarty-Craver et al. 2015) and, in principle, these or similar approaches can also be used
for sporting compression garments. Advantages of in vitro measurements include widespread char-
acterisation of garments under comparable conditions (assuming the same test method is used) and
the ability to systematically assess effects of fabric properties or garment characteristics (e.g. Kumar et
al. 2013). These approaches help understand aspects of the applied pressures, however, the principal
interest is ultimately the applied pressures when worn by people.
2.2.2 In vivo
Measurement. We strongly encourage researchers to measure the applied pressures in vivo. Approx-
imately three quarters of studies over a ~5-year period reported applied pressures but only one third
reported actually measuring these (Table 1). While other characteristics are also relevant to report
where possible (e.g. see section 3.3), applied pressures should be viewed as a minimum requirement
and equivalent to reporting other information such as participant height, mass, age, and trained sta-
tus.
The pressures applied by compression garments are typically measured at the interface between the
skin and the garment. Some pressure measuring systems have been evaluated (e.g. Flaud et al. 2010;
McLaren et al. 2010; Partsch and Mosti 2010; Brophy-Williams et al. 2013). Shape, composition, and
distribution of tissues comprising the underlying body segment can influence pressures measure-
ments (Thomas 2003; Moffatt 2008; Dubuis et al. 2012), and if a sensor is placed over a bony protrusion
or tendon, for example, greater localised loadings can be induced. The applied pressures have been
shown to vary not only by position along a limb, but also around its circumference depending on the
local curvature (Liu et al. 2005; Liu et al. 2007; Sperlich et al. 2013a; Miyamoto and Kawakami 2014;
Sperlich et al. 2014).

Existing guides for stocking materials and the lower limb are available in the literature (Comité
Européen de Normalisation 2001; Partsch et al. 2006a). Depending on garment coverage and research
question, the sites of the area at which the Achilles tendon changes into the medial calf muscle (B1),
the calf at its maximum girth (C), and the mid-thigh (F) seem appropriate to use as convention with
sports compression as including one or a number of key sites consistent among studies ensures more
direct comparisons. Other sites can be added according to research interest. Thus, specific measure-
ment location (e.g. medial, lateral, anterior, posterior) and participant position should also be clearly
described (Partsch et al. 2006a). Fewer, but still some studies in which the applied pressures of upper-
body sites were measured exist (e.g. Williams and Williams 1999; Bochmann et al. 2005; Damstra and
Partsch 2009; MacRae et al. 2012; Sperlich et al. 2014). The relative merit of particular sites on the up-
per body are less clear than that for the lower body, however, the same detail of noting location and
participant position should be employed.
Reasoning. From the perspective of interpreting any outcome effects of compression in sport, under-
standing the applied pressures in the cohort studied is crucial. For example, if beneficial effects for a
particular measure are not observed, is it because compression has no effect? Or could it be that the
pressures applied by those garments were too low, or too high? Similarly, if there are discrepancies
among studies investigating a certain variable, are differences in the applied pressures or areas co m-
pressed possible explanations? Irrespective of whether different levels of applied pressures are im-
portant or unimportant, knowing the pressures in the first place is a requirement to conclude either
way.
The ‘intended’, in vitro, and/or manufacturer-reported pressures are, at present, insufficient for esti-
mating the in vivo pressures for two reasons. First, they have been a mixed guide in the past for
group means (e.g. Liu et al. 2005; Partsch et al. 2006b; Beliard et al. 2015), and second, there will be in-
herent inter-person variability with generic sizing (Hill et al. 2015). Even custom-made garments are
subject to potentially relevant variation.
In a rare study from the sport sciences with both custom-made garments and investigator-measured
pressures, compression shorts (covering the thigh from waist to above the knee) were made and fitted
using the measured thigh girth (Sperlich et al. 2013a). Pressure at the thigh at maximum girth was
aimed to be 35 mmHg. For the four measurement sites (rectus femoris, vastus lateralis, vastus medial-
is, biceps femoris) the group means (n=6 participants) were 35, 37, 36, and 39 mmHg, respectively,
with corresponding pressure ranges of 31–39, 33–41, 29–44, 36–42 mmHg, respectively (coefficient of
variation, 5–17%). Some variation in the applied pressures will always be expected, but the point is

that an estimate, unmeasured by the authors (e.g. ‘20 mmHg at the calf’), while arguably better than
no measurement, overlooks variation. If a range is reported (e.g. ’16-22 mmHg at the calf’) but not
measured, the method used to attain that estimate should be reported otherwise the reader has little
ability to judge the quality of that information. For example, source ‘X’ may have generated estimates
by extensive in vivo testing using a range of athletic populations (in which case you would then also
expect an indication of variation) while source ‘Y’ may have used rigid cylinders paired with one
garment size, or worse, just guessed.
2.3 Sizing
Sizing systems can be created using a variety of methods ranging from trial and error to statistical
analysis of anthropometric data (e.g. Laing et al. 1999), and are traditionally based on (or reduced to)
one or a number of key dimensions (Chun-Yoon and Jasper 1993; Ashdown 1998).
As mentioned already with custom-made garments, generically sized sporting compression garments
can vary appreciably in the pressures they apply, even when fitted according to the manufacturer’s in-
structions (Hill et al. 2015). For pressures at the anterior thigh and medial calf at maximum girth, val-
ues ranged from 4–17 mmHg and 10–25 mmHg at the thigh and calf, respectively, for males (n>26)
and from 5–13 mmHg and 10–19 mmHg, respectively, for females (n=24). This is unsurprising given
that the proportional size and shape of individuals will also likely vary (Surhoff 2014). What is inter-
esting, however, is that among a subgroup of 29 men all wearing a size medium lower-body compres-
sion garment, there were no significant correlations between anthropometric variables, including
thigh and calf girths, and the measured applied pressures at the thigh and calf (Hill et al. 2015).
It may be that sizes (e.g. small, medium, large) are themselves arbitrary. Assuming it is some aspect
of the applied pressures that is important for compression-related effects, the sizes are simply a vehi-
cle to help fit an individual with particular applied pressures. Hill and colleagues (2015) demonstrat-
ed that particular ‘intended’ pressures, based on the work of Watanuki and Murata (1994), were often
not met with correctly fitted garments. In extension of this work, it would be interesting to know
whether an existing size range could be used to achieve particular pressures at particular sites by fit-
ting garments by trial and error according to the resultant applied pressures instead (i.e. irrespective
of given size). Measurement of the applied pressures would be required, which makes this more dif-
ficult outside a research setting. The other, and critical, difficulty with this approach is: what pres-
sures are actually required for sport and in which circumstances do they apply?

2.4 What applied pressures?
Even with indication that compression garments can be useful in some sporting situations (Born et al.
2013; Hill et al. 2014a; Marqués-Jiménez et al. 2016), there appears to be a less cohesive story about
what pressures are actually necessary (Beliard et al. 2015). There is appreciable diversity among po-
tential compression-related effects and conditions of use (e.g. physiological or performance measures,
body site, type of sport, use during sport or during recovery). It seems unlikely that one particular
pressure profile will best suit all desired applications and outcomes (e.g. resting supine versus upright
exercise; venous versus arterial haemodynamic effects). Thus, the influence of particular pressures
across outcomes requires clarification. For these reasons, it would be surprising if manufacturers and
distributors of sporting compression garments have a clear idea about what pressures are required
and why.
2.4.1 What pressures—an example using compression effects on leg haemodynamics
Sport presents a challenging set of conditions for understanding the effects of compression garments
on haemodynamics. With respect to particular applied pressures, a pervasive example includes the
concept of graduated compression and effects on haemodynamics. The dogma is that we need higher
values distally and lower pressures proximally. Such pressure gradients are still an important quality
criterion for the so-called graduated elastic compression stockings (e.g. Comité Européen de
Normalisation 2001; Deutsches Institut für Gütesicherung und Kennzeichnung 2008), the basic con-
cept being that higher pressures over the calf than over the ankle could impede rather than augment
venous flow. However, while this may have some importance in the horizontal position in which
compression pressure may actually lead to some venous narrowing, such effects are less likely in the
upright position let alone during exercise. Indeed, compression stockings of 20–30 mmHg, for exam-
ple, were found to reduce the internal diameter of posterior tibial and peroneal veins (versus without
stockings) in healthy people in a supine position, however these effects were not present when stand-
ing upright (Lord and Hamilton 2004).
Perhaps pressures remain too low to have demonstrable venous haemodynamic effects when upright
(Partsch and Partsch 2005; Partsch et al. 2010) and during activity like moderate or high-intensity or-
thostatically stressful exercise. Central cardiovascular effects were investigated using conventional
‘elastic’ compression garments and athletic cohorts during submaximal running (Sperlich et al. 2011)
and cycling (MacRae et al. 2012) and neither group found evidence for benefits from the compression
garments used. Sperlich and colleagues (2011) used five separate conditions, four with knee-high
socks applying different levels of compression (~14, 23, 32, and 39 mmHg at the calf at maximum
girth) and one condition without compression. Cardiac output, stroke volume, and heart rate were

similar during exercise irrespective of condition and may implicate the dominating influence of mech-
anisms like the calf muscle pump. There is some indication, however, that compression may influence
cardiovascular strain during lower-intensity exercise. Lovell et al. (2011) investigated the effects of
lower-body compression (waist to ankle; ~20 mmHg at the ankle and 15 mmHg at the calf) on various
cardiorespiratory variables during multi-stage running at different intensities. During the two active
recovery stages (6 km/h), heart rate was significantly lower by ~4–5 beats/min in the compression con-
dition versus regular running shorts. However, no differences in heart rate were observed at the other
running intensities (10 km/h and 85% peak oxygen uptake).
Especially during sporting activities, rhythmic muscle contractions will lead to fluctuations in the ap-
plied pressures (see next section). The pressure amplitudes depend on the consistency of the moving
tissue, on changes of the local body configuration, and on the stiffness of the compression device.
Simply increasing the pressure applied by ‘elastic’ compression garments would lead to unpleasant
and even painful feelings of constriction, thereby decreasing comfort and wearer acceptance (Liu et al.
2008), especially during rest. On the other hand, relatively inelastic compression which does not need
to increase the resting pressure, but which is able to increase the pressure in the standing position and
during walking, is an approach that has already shown promise in both patient (e.g. Mosti et al. 2008)
and healthy (Partsch and Mosti 2013) cohorts (Figure 2).
Figure 2. Interface pressures at the medial calf at maximum girth during rest in the lying position, re-
peated dorsiflexion while lying, standing, and walking. Below-knee sport compression stockings (top
panel) and compression stockings with the addition of an inelastic (i.e. ‘stiff’) strap applied lightly
over the midcalf (bottom panel). Data are from Partsch and Mosti (2013).

Stiff, low-yielding wraps superimposed over a sport stocking may increase the pressure peaks consid-
erably, even without major changes in the supine resting pressures. External pressures of more than
50–60 mmHg may occur on the lower leg during walking or running which are high enough to inter-
mittently overcome the local intravenous pressure, thereby exerting hemodynamic effects. By mag-
netic resonance imaging (MRI) in the standing position, it could be shown that wrapping the calf with
inelastic material (over a conventional sport stocking) increased the pressure to 42 mmHg which led to
a narrowing of all lower leg veins, while the sport stocking alone exerting 23 mmHg had practically
no influence on venous diameters (Partsch and Mosti 2013). Such venous narrowing is a prerequisite
for a haemodynamic effect. By measuring the calf pump function during a standardised walking test
in healthy sports people, a significant increase of the ejection fraction could be demonstrated with ad-
dition of the inelastic wrap and contrasts that of the conventional stocking alone, which did not show
improvement (Partsch and Mosti 2013).
Such compression systems may capitalise on the calf region being where veins are forming a kind of
dense sponge. Indeed, the idea that ‘progressive’ below-knee pressure is more effective than conven-
tional (‘degressive’) graduated pressure was demonstrated in venous patients by showing a higher in-
crease of ejection fraction compared to graduated pressure (Mosti and Partsch 2011). Miyamoto and
Kawakami (2015) also challenged the convention of graduated compression by showing that pressure
at the calf seemed to be more important (than the graduation of ankle-calf pressure) for reducing sur-
rogates of muscle fatigue when compression garments were worn by healthy subjects during 30 min
treadmill running. Unfortunately, the pressures were not measured by the authors and were instead
as reported by the manufacturer.
Briefly, augmentations of arterial inflow have been demonstrated with compression of the forearm
during rest and low-intensity handgrip exercise (13–23 mmHg; Bochmann et al. 2005) and leg during
rest (30–40 mmHg; Mayrovitz and Larsen 1997; Mayrovitz 1998). However, reductions of blood flow
in the thigh muscles have also been demonstrated with compression following high-intensity exercise
(~37 mmHg; Sperlich et al. 2013a). While there is more to learn about the effects of compression on ar-
terial haemodynamics, indications are that effective pressures are not necessarily equivalent to those
that benefit venous haemodynamics when upright.
Although not exhaustive, these examples help demonstrate that the concept of broadly applicable ap-
plied pressures and pressure profiles is unlikely, particularly for encompassing all forms of sport and
recovery, and that further insight may be gained by challenging the status quo.

2.5 Posture and movement
Posture and movement influence the pressures applied as shown with compression stockings (e.g.
Wildin et al. 1998; Wertheim et al. 1999; Liu et al. 2007) and sports compression garments (McLaren et
al. 2010; MacRae et al. 2012; Brophy-Williams et al. 2014). An example of the real-time influence of
movement can be seen in Figure 3, showing interface pressures during cycling exercise while wearing
full-body sports compression garments.
Figure 3. Example of applied pressures in vivo during cycling exercise for sports compression gar-
ments fitted according to the manufacturer’s recommendations. Dashed vertical lines superimposed
on the thigh and calf traces are to indicate that they are out of phase. Data are from MacRae et al.
(2012).
As mentioned, the extent to which the applied pressures change with posture and movement will also
be related to garment stiffness (Partsch 2005; Hirai et al. 2010; Partsch and Mosti 2013). The implica-
tions here are that the fabric/garment stiffness may be altered according to desired end-characteristics:
an increase in stiffness will, for example, exhibit greater peak pressures during contraction of the un-
derlying muscle while ‘elastic’ garments will show lesser changes (Figure 2). Different body sites may
have different requirements relating to pressure dynamics.

2.6 Different applied pressures
Blinding and placebo garments. Blinding participants is difficult with compression garment re-
search, and this is especially so with participants who regularly use compression garments (Driller
and Halson 2013a). No compression or normal garments (e.g. regular running shorts and ankle-length
socks) are commonly used as a comparison condition (~78% of studies; Table 1) with attempted place-
bo garments used less commonly (~28%). Even if placebo garments are noticeably less tight, there can
still be merit in controlling for body coverage.
Note that placebo garments, even ‘non-compressive’ tights, typically do still apply some pressure. For
example, de Glanville and Hamlin (2012) reported a mid-calf pressure of 14.7 ± 2.5 mmHg with full-
length lower body compression garments and 5.7 ± 0.9 mmHg at that same site with the placebo gar-
ment. These pressures, while low, could still be enough to confound a ‘no compression’ condition.
For example, it could be shown that so-called placebo stockings were able to reduce occupational leg
swelling in the evening (Partsch et al. 2004). Thus, terms like ‘no compression’ should be used cau-
tiously. Approaches investigating ‘different levels of compression’ are also worth considering versus
placebo garments per se (e.g. Ali et al. 2010; Miyamoto et al. 2011; Sperlich et al. 2013b). A view on
blinding (or the lack thereof) from a practical or non-mechanistic standpoint could be that placebo ef-
fects, if found, are effects nonetheless.
Different levels of pressure. The applied pressures can vary by garment size, although the signifi-
cance of this can depend on the type of garment (Brophy-Williams et al. 2014). Further, the extent to
which different sizes differ in applied pressures can be of less practical significance than the difference
between garment types. In a hypothetical example, for garment type ‘A’ there may be 5 mmHg dif-
ference between the group means of correctly sized and over-sized garments (e.g. 15 and 10 mmHg,
respectively), but a difference of 15 mmHg between garment types ‘A’ and ‘B’, each correctly sized (15
and 30 mmHg, respectively). This is another reason why knowing the applied pressures is important
beyond simply knowing the size itself. There are examples where changing the level of compression
does have demonstrable physiological effects (e.g. Mayrovitz 1998; Bochmann et al. 2005), although
such pressure-intensity effects in sport are often overshadowed by a lack of effect in the first place
(e.g. Ali et al. 2010).
2.7 Changes in pressure with wear and repetitive use
Seemingly little is known about the maintenance of applied pressures in vivo with use for sport. Con-
siderations here include issues of short-term deformation, due to mechanical forces associated with
one wear period (Manshahia and Das 2014), and longer-term deformation and degradation, due to

mechanical forces associated with repetitive wear and laundering and via prolonged exposure to
agents such as ultraviolet light, sweat, and detergent.
Sporting compression garments are extended (‘stretched’) when they are worn, both during the don-
ning process and once in place. Thus, these garments will be exposed to a combination of sustained
and variable stress and strain over the duration of a period of wear. When materials such as fibres
and fabrics are subjected to constant strain (i.e. when extended and held at a particular length and
width, and multi-axially, as in the case of compression clothing), the stress can gradually decay with
time (Morton and Hearle 2008). This phenomenon is known as stress relaxation (Walker 1993). In a
variable strain environment below the breaking extension, such as cycles of extension and recovery
during movement, a fibre or fabric will typically increase in length until it reaches a stable limiting
value (Morton and Hearle, 2008).
The observed strain in fabrics is usually comprised of a combination of elastic, viscoelastic, and per-
manent components of deformation (Nikolic and Mihailovic 1996). True elastic deformation is ‘instan-
taneously’ reversible when the applied force is removed, viscoelastic deformation is where the strain
is time-dependent, and the permanent component is both time-dependent and irreversible (Walker
1993). The strain in compression garments associated with the stress of wear will depend on a multi-
tude of factors, including properties and characteristics of the fibres (e.g. inter-atomic and intermolec-
ular bonds), yarns (e.g. bending rigidity) and the fabric (e.g. stitch length and density, inter-yarn fric-
tion, and residual tensions from the knitting process) (Morton and Hearle 2008; Karimi et al. 2009).
In one study, Faulkner and colleagues (2013) reported in vivo pressures before and following a 400-m
running performance test. There were two conditions for compression garments: full-length lower-
body garments (hip to ankle) or a combination of compression shorts (hip to knee) with calf compres-
sion sleeves (ankle to knee). Six of the eight sites where the applied pressures were measured indicat-
ed a significant main effect of time (P<0.05): for the full-length garment and the garment combination,
the changes at these sites were decreases of 0.8–2.3 and 0–1.7 mmHg, respectively, from pre- to post-
exercise (calculated from reported group means). A seventh site, the gluteal, showed a significant de-
crease with the full-length garment only (by 1.2 mmHg). In this study there were no effects of either
compression condition versus regular running shorts for 400 m performance or 100 m split times,
heart rate, or blood lactate profiles (Faulkner et al. 2013). Thus, the practical significance of any
changes in pressure is hard to judge given the lack of pressure effect in the first place. Moreover, alt-
hough statistically significant, the changes in pressures were (on average) typically small. Further in-
vestigation of changes in applied pressures with use over longer wear sessions (e.g. endurance exer-

cise or during recovery) or with multiple wear sessions is warranted. In any such studies there is also
justification for including pressure measurements at multiple time points to assess when (or if) pres-
sure stabilise.
In previously unpublished work, fabric samples were cut from commercially available sporting com-
pression garments in areas with no seams (see Appendix 2 for more detail). In brief, fabrics were then
subjected to extension and recovery cycling (repeated multi-axial ‘stretching’) using a laboratory ten-
sile tester fitted with a hemispheric head and pre-loaded to 0.5 N. The number of extension and re-
covery cycles was chosen to approximate an exercise session of ~80 min. Prior to the beginning of fab-
ric cycling, the period of fixed strain (pre-load extension depth) resulted in stress-relaxation of the
fabric: the mean minimum loads at the start of cycling had reduced by 50% from pre-load (Table 3).
Results indicated that both the minimum and maximum loads reduced from beginning to midway
through cycling (each P≤0.01), but not thereafter (P=0.503 and 0.173, respectively). These results sug-
gest that fabrics stabilise with acute use, although how this translates to pressure stabilisation is not
known.
Table 3. Multi-axial extension and recovery cycling of compression garment fabrics using a laboratory
tensile tester.
Cycle stage
Mean ± SD (N)
Pre-load (0.5 N) a
0.00
Minimum load b
Start
0.25 ± 0.01
Middle
0.32 ± 0.03
End
0.35 ± 0.05
Maximum load c
Start
-1.35 ± 0.05
Middle
-1.26 ± 0.06
End
-1.24 ± 0.08
SD, standard deviation
a Fabrics were pre-loaded with an extension that gave 0.5 N, then zeroed as the start point of extension and
recovery cycling (i.e. became 0 mm and 0 N)
b Minimum load is the extension load at a cycle depth of 0 mm (0 N indicates complete recovery, 0.5 N in-
dicates no recovery)
c Maximum load is the extension load at a cycle depth of 10 mm (negative indicates load direction)
An example of why it may be useful to know how applied pressures change with wear comes from
the work of Mayrovitz (1998), also reiterating potential arterial haemodynamic consequences of com-

pression. With ankle-to-knee compression bandaging of ~30 mmHg, below-knee pulsatile blood flow
was acutely higher by ~45% relative to the contralateral leg (with “noncompressive” control bandag-
ing) in resting healthy women in the supine position. Increased pulsatile blood flow (evaluated using
nuclear magnetic resonance flowmetry) was attributed to an overall increase in below-knee blood
flow. However, these increases were not present when re-evaluated after 7 h of normal activity. The
bandage-applied pressures had reduced by ~40–50% to 16–19 mmHg by the second measurement pe-
riod, so this may represent a causal relationship between the flow and applied pressures (Mayrovitz
1998). While compression bandages are considerably different to sports compression garments (such
dramatic changes in the applied pressures over this duration could only be expected using inelastic
bandaging), the point remains, if a particular beneficial outcome is present, this outcome may not re-
main if the applied pressures change beyond certain thresholds.
3 Compression garments and body coverage
3.1 Body coverage
Compression garments must cover particular body sites to be able to apply compression. The result is
either a higher proportion of body surface covered (the addition of coverage for sites that would oth-
erwise be uncovered), or an additional layer of clothing (for sites already covered). Like other cloth-
ing, compression garments will influence heat and moisture exchanges between the body and its envi-
ronment. The effects of coverage may be inconsequential or even useful in some situations, such as
during warm up or when the ambient temperature is cool, however, in other situations this coverage
must be balanced against comfort and thermoregulatory considerations. While a review of the ther-
mophysiological effects of compression garments is beyond the scope of this chapter, here we briefly
introduce some pertinent information about compression garments as a clothing layer per se.
3.2 Garment-body interactions
3.2.1 Comfort
Given the direct proximity of compression garments with the body covered, comfort is likely to influ-
ence an athlete’s tolerance to wearing these garments. Conceptually, wear comfort can be considered
to comprise four aspects: thermophysiological, skin sensorial, ergonomic, and psychological wear
comfort (Bartels 2005; Yoo and Barker 2005). Thermophysiological wear comfort relates to the way
clothing buffers, dissipates or transports metabolic or environmental heat and moisture through the
clothing. Skin sensorial wear comfort embodies the mechanical sensations caused by a textile in direct
contact with the skin. These sensations (and subsequent perceptions) include smoothness, softness,
roughness, stiffness, and the clinging feeling of wet clothing. Ergonomic wear comfort relates to the
fit of the clothing and the freedom of movement it allows, and is affected by factors such as the gar-

ment design, fabric structure, and extension properties of the materials. Psychological wear comfort is
how the individual feels in that clothing, and is influenced factors such as fashion, personal prefer-
ences and ideology (Bartels 2005; Yoo and Barker 2005). In speculation, perceived advantages of
wearing compression garments will contribute to psychological wear comfort, and under any given
conditions, will be balanced against potential disadvantages of thermophysiological, skin sensorial,
and ergonomic wear comfort, where such disadvantages exist.
3.2.2 Heat and moisture
When clothing is worn it establishes a microclimate next to the body. This microclimate is comprised
not only of the materials used to form the clothing (fibres, yarns and fabrics), but the air and (if pre-
sent) moisture within the fabric, between clothing layers (if other layers are worn), and adhered to the
surfaces as boundary layers. The exchange of heat between the body and environment occurs via
conduction, convection, and radiation. Evaporation also contributes to heat exchange via mass
transport (i.e. water vapour transfer). These processes of heat and mass transport depend on gradi-
ents (e.g. thermal or vapour pressure), and thus the ambient conditions are also important.
Air is a poor conductor of heat, and because fabrics act to stabilise air within its structure, fabrics are
generally good insulators (Wilson et al. 2002). With body movement or ambient air movement, con-
vection displaces warmed air within the fabric microclimate, leading to increased heat loss. Easily
displaced air may be advantageous when heat loss is required and disadvantageous when insulation
is required.
Sweating is crucial for heat balance during exercise. The interaction of sweat with clothing occurs in
both liquid and vapour forms. Clothing typically resists the transfer of water vapour away from the
body, thereby increasing the local vapour pressure and reducing the gradient for evaporation at the
skin surface. Water vapour transfer, like heat transfer, is augmented by forced convection. Further,
the water vapour permeability of a stretched fabric will likely be greater than that of that same fabric
in a relaxed state.
Compression garments are often claimed to ‘wick’ sweat to the garment surface where it can be evap-
orated easily, but the role of this liquid transportation in increasing heat loss from the body appears to
lack empirical support. Wicking, also known as capillary transport, is the spontaneous transport of a
liquid driven into a porous system by capillary forces (Kissa 1996; Patnaik et al. 2006). It is plausible
that capillary transport along the yarns in the spaces between fibres may act to disperse liquid mois-
ture from a wetted area (Saricam 2015), thus contributing to speedier evaporation. Further, with high-

er levels of liquid, the inter-yarn capillary spaces can saturate, making transverse capillary transport
possible (i.e. liquid movement from the skin surface to the outer fabric surface, perpendicular to the
plane of the fabric) (Rossi et al. 2011). However, if sweat is transported from the skin surface before it
evaporates, the contribution of the skin to the heat of vaporisation will decline. Indeed, the evapora-
tion of sweat from the fabric surface of a garment is less efficient (in terms of heat loss from the body)
than evaporation directly from the skin surface itself (Craig and Moffitt 1974; Nagata 1978). The site
of evaporation notwithstanding, liquid sweat displaces air and increases fabric thermal conductivity
(Chen et al. 2003) and so, in practice, an interaction of increases and decreases in heat and moisture
transfer likely occurs with wetted fabrics.
While heat loss is typically desirable during exercise, residual sweat in the garments following exer-
cise can lead to thermal discomfort via unwanted heat loss (‘post-exercise chill’). Garments that have
a short drying time mitigate such effects (Bartels 2005).
3.3 Some measurable fabric properties and why they are useful
Characterising the garments. Much like characterising participants and the applied pressures is use-
ful, so too is characterising a garment system and fabrics from which these are made. Garment prop-
erties are not static, but also respond to the conditions in which they are used: moisture from the am-
bient environment and from the body may be absorbed, adsorbed, or moved through a fabric by a
wicking process; an extended textile may exhibit non-elastic behaviour. What properties are relevant
to compression and compression products? How might products which superficially appear similar,
actually differ?
Table 4 lists two groups of fabric properties: those related to structure of the fabric and those related to
performance, and for each a list of test methods relevant to compression garments. Note that interna-
tional test methods dominate, as compliance with these is more likely to yield agreement among inter-
ested parties. Note too, that because many properties of textiles differ with ambient conditions, the
testing of fibres, yarns, fabrics, and garments is conducted under standard environmental conditions
following a period of conditioning in that same environment [typically 24 h at 20±2°C, 65±4% relative
humidity according to ISO 139 (International Organization for Standardization 2005) or 21±2°C, 65±5%
relative humidity according to ASTM D1776 (ASTM International 2016)]. However, there may be
good reason to test under different conditions, perhaps simulating conditions of use.

Table 4. Selected fabric test methods relevant to compression clothing
Property
Test method
Test determines
Title (reference)
Structure
thickness
ISO 5084: 1996
(reviewed 2013)
Thickness of textiles
and textile products
under specified pres-
sure
Textiles - Determination of thickness of textiles
and textile products (International Organization
for Standardization 1996)
mass
ISO 3801: 1977
(reviewed 2011)
Mass per unit length
and mass per unit area
of piece or sample
length of fabric and
mass per area of small
samples
Textiles - Woven fabrics - Determination of mass
per unit length and mass per unit area
(International Organization for Standardization
1977)
mass
BS EN 12127:
1998
(current)
Mass per unit area
based on measurement
of small samples of fab-
rics
Determination of mass per unit area using small
samples (British Standards Institution 1998)
mass
ASTM
D3776M - 09a
(reapproved
2013)
Mass per unit area of
full piece, bolt, cut, full
width specimens, small
swatch and narrow fab-
rics
Standard test methods for mass per unit area
(weight) of fabric (ASTM International 2013)
elongation
with force
ISO 13934-1:
2013
Maximum force, force
of rupture, elongation
at maximum force and
at rupture
Textiles - Tensile properties of fabrics - Part 1:
Determination of maximum force and elongation
at maximum force using the strip method
(International Organization for Standardization
2013b)
elongation
with force
ISO 13934-2:
2014
Maximum force, force
of rupture, elongation
at maximum force and
at rupture of fabrics
containing elastomeric
fibre
Textiles - Tensile properties of fabrics - Part 2:
Determination of maximum force using the grab
method (International Organization for
Standardization 2014a)
elasticity
BS EN 14704-1:
2005
(current)
Recovery from exten-
sion of fabrics
Determination of the elasticity of fabrics. Strip
tests (British Standards Institution 2005)
Performance
absorption
ISO 18696: 2006
(reviewed 2015)
Resistance of fabrics to
wetting (the absorption
of water into, but not
through, the fabric).
Suitable for measuring
the water-repellent effi-
cacy of applied finishes.
Textiles - Determination of resistance to water
absorption - Tumble-jar absorption test
(International Organization for Standardization
2006)
water
penetra-
tion (rain
resistance)
ISO 18695: 2007
(reviewed 2011)
Resistance of fabrics to
the penetration of water
by low impact - can
predict the probable
rain penetration re-
sistance
Textiles - Determination of resistance to water
penetration - Impact penetration test
(International Organization for Standardization
2007)

water
penetra-
tion (water
under
pressure)
ISO 811: 1981
(revision in
progress as
ISO/WD811)
Resistance to the pas-
sage of water through
the fabric
Textiles - Determination of resistance to water
penetration - Hydrostatic pressure test
(International Organization for Standardization
1981)
air perme-
ability
ISO 9237: 1995
(reviewed 2011)
Permeability of fabrics
to air
Textiles - Determination of the permeability of
fabrics to air (International Organization for
Standardization 1995)
thermal
resistance
ISO 5085-1:
1989
(reviewed 2015)
Thermal insulation pro-
vided by textiles /
transmission of heat
through a textile
Textiles - Determination of thermal resistance -
Part 1: Low thermal resistance (International
Organization for Standardization 1989)
thermal
and water-
vapour re-
sistance
ISO 11092: 2014
Thermal and water-
vapour resistance using
a variety of environ-
mental conditions, in-
volving combinations of
temperature, relative
humidity, air speed,
and in the liquid or gas-
eous phase, to simulate
different wear and envi-
ronmental situations
Textiles - Physiological effects - Measurement of
thermal and water-vapour resistance under
steady-state conditions (sweating guarded-
hotplate test) (International Organization for
Standardization 2014b)
exother-
mic and
endother-
mic prop-
erties
ISO 16533: 2014
Exothermic and endo-
thermic properties by
moisture absorption
and desorption
Textiles - Measurement of exothermic and endo-
thermic properties of textiles under humidity
change (International Organization for
Standardization 2014c)
force of
seam rup-
ture
ISO 13935-1:
2014
Maximum force of sewn
seams when the force is
applied perpendicular
to the seam
Textiles - Seam tensile properties of fabrics and
made-up textile articles - Part 1: Determination of
maximum force to seam rupture using the strip
method (International Organization for
Standardization 2014d)
force of
seam rup-
ture
ISO 13935-2:
2014
Maximum force of sewn
seams when the force is
applied perpendicular
to the seam for fabrics
containing elastomeric
fibre
Textiles - Seam tensile properties of fabrics and
made-up textile articles - Part 2: Determination of
maximum force to seam rupture using the grab
method (International Organization for
Standardization 2014e)
UV
AATCC
TM183- 2014
Ultraviolet radiation
blocked or transmitted
by textile fabrics
Transmittance or blocking of erythemally
weighted ultraviolet radiation through fabrics
(American Association of Textile Chemists and
Colorists 2014)
UV
AS/NZS 4399:
1996
(current)
Requirements for de-
termining the rated UV
protection factor of sun
protective textiles
Sun Protective Clothing – Evaluation and Classi-
fication (Standards Australia and Standards New
Zealand 1996)

Structural properties. Most fabrics are constructed of fibre and in compression products these are
typically synthetic fibres (e.g. polyester, polyamide) which may be blended (e.g. with some form of
elastane). Most are continuous filaments with various cross-sectional structures, typically with a
smooth surface, and may be single or plied. These yarns then are knitted either using weft or warp
technologies, yielding different fabric properties, particularly elasticity. Warp knits are typically more
resistance to extension than weft knits.
Consider the structural properties listed in Table 4 (and take the following remarks as ‘if all other fac-
tors are equal’). Thickness of a fabric has a major effect on thermal resistance: the thicker the fabric,
the more thermally resistant. Because most fabrics are themselves compressible, the test method for
fabric thickness specifies the pressure under which the thickness is measured. Mass of fabrics is ex-
pressed in grams per square metre (g/m2). The relevance here to compression garments is the effect
that fabric mass per unit area has on mass of the total garment. The trend in garments generally is for
apparel fabrics to be manufactured so the end products are lighter. Elongation is one of several ten-
sile-related properties. Note that while the test requires the strip of fabric to be extended to rupture,
investigators are often more interested in extending a fabric/garment an estimated percentage and
typically allowing recovery, and repeated extension/recovery cycles (elasticity). Changes evident with
this type of test (decay) are a better reflection of a compression garment or bandage, yet, surprisingly
few examples of fabric cycling experiments exist (see section 2.7 and Appendix 2). Elastic recovery is
more likely when the fabric contains an elastane filament (e.g. Lycra® or spandex, or a non-branded
elastane). So from the perspective of an end-user interested in compression, knowing that the elastici-
ty changes over time is highly relevant.
Performance properties. The second part of the table focuses on some examples of performance
properties. Together these deal with water, air, thermal, and UV properties. In relation to water, in-
terest may be in the extent to which the fabric absorbs moisture (from sweat or from an external
source). If a fabric absorbs and holds moisture, either in the fibre itself or in the fabric, this may have a
measureable effect on thermal resistance and on perceptions of discomfort of the wearer. Air permea-
bility is self-explanatory: to what extent does air pass through the fabric? The instrument settings for
this test depend on the fabric structure, so comparison of test results obtained on different fabrics
where the settings have differed is not appropriate. Thermal resistance too, is self-explanatory: to
what extent does a fabric resist transmission of heat? The physical set-up for the test attempts to simu-
late the skin/fabric interface. Fabrics differ in thickness and mass, as noted in the preceding section,
and both of these properties affect thermal transmission: a thicker fabric will typically exhibit greater
resistance. So for comparisons among fabrics, derived values can also be used (e.g. warmth: weight,

warmth: thickness). Resistance to water vapour transmission is measured using a similar set-up, with
a thin layer of water on the plate, and ratios are also derived for appropriate comparisons among fab-
rics. Compression garments are often worn outdoors, and in Australasia, protection against UV pene-
tration is a health-related consideration. Fabrics will be extended during wear so testing when ex-
tended will provide a more useful indicator of fabric performance in this regard.
To summarise, fabrics for compression items, while appearing similar, will differ in properties when
new and when worn. They are not static, but change during use, absorbing moisture (or not), chang-
ing in thickness when extended, which in turn reduces thermal resistance. Thus, simply reporting fi-
bre content and perhaps country of origin (manufacture) on a label or promotional information for a
compression item is unlikely to provide sufficient information for use in scientific investigations of ef-
fects of compression garments, or indeed, for the consumer's personal information. Further, while test
results on some fabrics may be provided by manufacturers/suppliers, these need to be scrutinised to
ensure an appropriate method has been used. Reporting fabric and garment properties also helps
identification of/changes in manufacturing trends over time and, in particular, assists in establishing
whether comparability of findings from different studies are warranted. For example, the compres-
sion shorts used in one highly cited study were 4.76 mm thick and made from 75% closed-cell neo-
prene and 25% butyl rubber (Doan et al. 2003); conventional sporting compression garment fabrics
have been reported as less than 0.7 mm thick (MacRae et al. 2012; Del Coso et al. 2014).
4 Comments and conclusions
Compression garments apply pressure to and cover body surfaces. In this chapter we have deliberate-
ly highlighted aspects of pressure and coverage that can be of importance yet often have been over-
looked. In particular, we argue that measuring, reporting, and understanding characteristics of the
applied pressures in vivo are essential for integrating the literature irrespective of whether or not
compression influences a particular outcome. That is, to support or rule out the influence of compres-
sion, the compression itself must be known. Further, it is not yet clear what applied pressures are re-
quired, particularly across different outcomes. We have also introduced aspects relevant for compres-
sion garments from the perspective of a layer of clothing that covers the body. Body coverage can
have consequences for heat and moisture interactions with the environment, and for wearer comfort.
We hope that the detail here helps the reader to contextualise and critically evaluate research on com-
pression garments in sport.
For further detail specifically about the physiological or performance effects of compression garments
in sport we refer the reader to the other chapters in this book and previously published reviews or

commentaries (e.g. Kraemer et al. 2004; Perrey 2008; MacRae et al. 2011; Born et al. 2013; Hill et al.
2014a; Surhoff 2014; Beliard et al. 2015; Marqués-Jiménez et al. 2016).
Acknowledgements
The authors would like to thank Dr Debra Carr for help with multi-axial extension and recovery test-
ing, Dr Linda Dunn for help with preparing Table 4, Liz Girvan and the Otago Centre for Electron Mi-
croscopy for SEM images, and Dr Simon Annaheim for helpful comments on the manuscript draft.
Appendix 1. Search details for Table 1.
For the purpose of summarising key characteristics (Table 1), a systematic search was performed to
identify relevant journal articles published over a ~5 y period (2011 to 15 Jan 2016). Inclusion criteria
were: 1) original research studies involving human participants and published in English, 2) studies in
which compression garments were worn for sport and exercise or recovery from sport and exercise,
and 3) that compression garments were worn for a period or periods during and/or after sport and ex-
ercise. There was no restriction on type of compression garment in terms of body area covered, alt-
hough the garment was to be similar to commercially available sporting garments (e.g. bandaging was
excluded). Exclusion criteria were: 1) studies in which compression garments were used for recovery
from injury, 2) use for disease prophylaxis, even if in association with exercise (e.g. exercise in patients
with lymphedema), and 3) abstracts and unpublished studies. The search was performed in Ovid®
MEDLINE using the search strategy (Table 5 below), identifying 166 articles.
One author (BM) screened the results first by title and abstract (101 excluded: 9 reviews or commen-
taries, 1 repetition, 91 topic medical, not compression garments, and/or not sport) then by full text (12
excluded: 3 injury related, 5 not sport or exercise, 4 due to garment); 5 further articles were located
from reference lists giving a total of 58 included (Ali et al. 2011; Dascombe et al. 2011a; Goh et al. 2011;
Lovell et al. 2011; Ménétrier et al. 2011; Miyamoto et al. 2011; Sperlich et al. 2011; Varela-Sanz et al.
2011; Dascombe et al. 2011b; Burden and Glaister 2012; Coza et al. 2012; de Glanville and Hamlin 2012;
Hamlin et al. 2012; MacRae et al. 2012; Rimaud et al. 2012; Wahl et al. 2012; Argus et al. 2013; Bahnert
et al. 2013; Barwood et al. 2013; Bovenschen et al. 2013; Driller and Halson 2013a; Faulkner et al. 2013;
Pruscino et al. 2013; Rugg and Sternlicht 2013; Sperlich et al. 2013a; Tsuruike and Ellenbecker 2013;
Valle et al. 2013; Driller and Halson 2013b; Bieuzen et al. 2014; Born et al. 2014a; Del Coso et al. 2014;
Duffield et al. 2014; Ferguson et al. 2014; Goto and Morishima 2014; Lien et al. 2014; Michael et al.
2014; Miyamoto and Kawakami 2014; Pereira et al. 2014a; Rider et al. 2014; Sperlich et al. 2014;
Venckunas et al. 2014; Vercruyssen et al. 2014; Born et al. 2014b; Hill et al. 2014b; Pereira et al. 2014b;

Areces et al. 2015; Armstrong et al. 2015; Gupta et al. 2015; Hooper et al. 2015; Lucas-Cuevas et al.
2015; Martorelli et al. 2015; Ménétrier et al. 2015; Mills et al. 2015; Miyamoto and Kawakami 2015;
Priego et al. 2015; Priego Quesada et al. 2015; Stickford et al. 2015; Zaleski et al. 2015).
Table 5. Search terms
Item #
Search term/search restriction
Number of results
1
compression.ti,ab.
82145
2
compressive.ti,ab.
15945
3
1 or 2
94566
4
clothing.mp.
16689
5
(garment or garments).mp.
1929
6
(stocking or stockings).mp.
4479
7
(sock or socks).mp.
811
8
(sleeve or sleeves).mp.
6599
9
tights.mp.
48
10
leggings.mp.
23
11
shorts.mp.
277
12
top.mp.
67366
13
upper-body.mp.
3442
14
lower-body.mp.
9254
15
4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14
108307
16
3 and 15
2951
17
exercise*.mp.
278507
18
sport*.mp.
71794
19
physical activity.mp.
66804
20
(run or running or ran).mp.
118260
21
(cycle or cycling or cycled).mp.
432976
22
endurance.mp.
28954
23
sprint*.mp.
4923
24
resistance.mp.
654350
25
17 or 18 or 19 or 20 or 21 or 22 or 23 or 24
1500610
26
16 and 25
429
27
limit 26 to yr="2011 -Current"
175
28
limit 27 to english language
166

Appendix 2. Multi-axial extension and recovery testing of a compression garment fabric
Garment pre-treatment and cutting of fabric samples. Unworn upper-body compression garments
to be used for fabric testing (for garment descriptions see MacRae et al. 2012) were subjected to six
consecutive gentle wash cycles as outlined in procedure 8A in ISO 6330 (International Organization
for Standardization 2000) and air dried in ambient laboratory conditions. This pre-treatment protocol
has been shown to achieve reasonable stability in properties of a range of fabrics (Gore et al. 2006). An
Electrolux Wascator FOM71MP-Lab (James Heal and Co Ltd., Halifax, England) automatic washing
machine was used with Heal’s ECE formulation non-phosphate reference detergent (B). Standard bal-
last (knitted 100% polyester fabric) was used to make up the total dry mass of 2 kg per load of test
garments. Fabric specimens were cut from garments according to BS EN 12751 (British Standards
Institution 1999). Fabrics were conditioned (for 24 h) and tested in a standardised environment 20.0 ±
2.0°C and 65.0 ± 4.0% relative humidity (International Organization for Standardization 2005).
Multi-axial extension and recovery. The behaviour of a compression garment fabric (n=3) during ex-
tension and recovery cycling was examined in accordance with a modified version of ISO 3379
(International Organization for Standardization 1976). An Instron Tensile Tester (Model 4464, Instron
Limited, England) with a 100 N load cell was fitted with a ball burst attachment (half sphere, diam e-
ter=50 mm) that cycled between fixed extension limits. Fabric specimens (diameter=100 mm within
clamping ring) were pre-loaded with the ball burst attachment to 0.5 N (i.e. moderate extension), and
cycled to a depth of 10 mm from the pre-load zero point for 7000 cycles, with a head speed of ~1000
mm/min (~50 cycles/min). The number of cycles was selected to approximately represent one exercise
session (e.g. bicycling with a cadence of 90 RPM, 7000 extension and recovery cycles is ~78 min of ex-
ercise). Load data were transferred to PC computer (PowerLab 16 SP; ADInstruments, Dunedin, New
Zealand) and collected at 1000 Hz using Chart software (Chart 4.2 for Windows; ADInstruments).
Means for cyclic minima and maxima were calculated at the beginning, middle, and end of cycling,
each over 15-min periods (minutes 0 to 15, 62 to 77, and 127 to 142). Note that the tensile tester re-
quired 142 min to complete the 7000 cycles (cf. the estimate of 78 min for exercise with a pedalling c a-
dence of 90) because it was not practicable to have a head speed equivalent to 90 cycles/min. Linear
mixed models with a compound symmetry covariance matrix was used for statistical analysis (SPSS
16.0, SPSS Inc). Bonferroni correction for multiple comparisons was used when required.

References
Ali A, Creasy RH, Edge JA (2010) Physiological effects of wearing graduated compression stockings
during running. Eur J Appl Physiol 109:1017–1025.
Ali A, Creasy RH, Edge JA (2011) The effect of graduated compression stockings on running
performance. J Strength Cond Res 25:1385–1392.
American Association of Textile Chemists and Colorists (2014) TM183-2014. Transmittance or blocking
of erythemally weighted ultraviolet radiation through fabrics. American Association of Textile
Chemists and Colorists, Research Triangle Park, North Carolina.
Areces F, Salinero JJ, Abian-Vicen J, et al (2015) The use of compression stockings during a marathon
competition to reduce exercise-induced muscle damage: Are they really useful? J Orthop Sports
Phys Ther 45:462–70.
Argus CK, Driller MW, Ebert TR, et al (2013) The effects of 4 different recovery strategies on repeat
sprint-cycling performance. Int J Sports Physiol Perform 8:542–548.
Armstrong SA, Till ES, Maloney SR, Harris GA (2015) Compression socks and functional recovery
following marathon running: A randomized controlled trial. J Strength Cond Res 29:528–533.
Ashdown SP (1998) An investigation of the structure of sizing systems. Int J Cloth Sci Technol 10:324–
341.
ASTM International (2016) ASTM D1776/D1776M - 16: Standard Practice for Conditioning and Testing
Textiles. ASTM International, West Conshohocken.
ASTM International (2013) ASTM D3776M - 09a. Standard test methods for mass per unit area
(weight) of fabric. ASTM International, West Conshohocken.
Bahnert A, Norton K, Lock P (2013) Association between post-game recovery protocols, physical and
perceived recovery, and performance in elite Australian Football League players. J Sci Med Sport
16:151–156.
Bartels VT (2005) Physiological comfort of sportswear. In: Textiles in Sport. Woodhead Publishing
Limited, Manchester, pp 177–203
Barwood MJ, Corbett J, Feeney J, et al (2013) Compression garments: No enhancement of high-
intensity exercise in hot radiant conditions. Int J Sports Physiol Perform 8:527–535.
Beliard S, Chauveau M, Moscatiello T, et al (2015) Compression garments and exercise: No influence
of pressure applied. J Sport Sci Med 14:75–83.
Berry MJ, McMurray RG (1987) Effects of graduated compression stockings on blood lactate following
an exhaustive bout of exercise. Am J Phys Med 61:121–132.
Bieuzen F, Brisswalter J, Easthope C, et al (2014) Effect of wearing compression stockings on recovery
after mild exercise-induced muscle damage. Int J Sports Physiol Perform 9:256–264.
Bochmann RP, Seibel W, Haase E, et al (2005) External compression increases forearm perfusion. J
Appl Physiol 99:2337–2344.
Born D-P, Holmberg H-C, Goernert F, Sperlich B (2014a) A novel compression garment with adhesive
silicone stripes improves repeated sprint performance - a multi-experimental approach on the
underlying mechanisms. BMC Sports Sci Med Rehabil 6:21.
Born DP, Sperlich B, Holmberg HC (2013) Bringing light into the dark: Effects of compression clothing
on performance and recovery. Int J Sports Physiol Perform 8:4–18.
Born D-P, Zinner C, Herlitz B, et al (2014b) Muscle oxygenation asymmetry in ice speed skaters: Not
compensated by compression. Int J Sports Physiol Perform 9:58–67.
Bovenschen HJ, te Booij M, van der Vleuten CJM (2013) Graduated compression stockings for runners:
Friend, foe, or fake? J Athl Train 48:226–232.
British Standards Institution (1999) BS EN 12751: Textiles – Sampling of fibres, yarns and fabrics for
testing. British Standards Institution, London.
British Standards Institution (1998) BS EN 12127: Determination of mass per unit area using small
samples. British Standards Institution, London.
British Standards Institution (2005) BS EN 14704-1: Determination of the elasticity of fabrics. Strip
tests. British Standards Institution, London.
Brophy-Williams N, Driller MW, Halson SL, et al (2013) Evaluating the Kikuhime pressure monitor

for use with sports compression clothing. Sport Eng 17:55–60.
Brophy-Williams N, Driller MW, Shing CM, et al (2014) Confounding compression: The effects of
posture, sizing and garment type on measured interface pressure in sports compression clothing.
J Sports Sci 33:1403–1410.
Burden RJ, Glaister M (2012) The effects of ionized and nonionized compression garments on sprint
and endurance cycling. J Strength Cond Res 26:2837–2843.
Carling J, Francis K, Lorish C (1995) The effects of continuous external compression on delayed-onset
muscle soreness (DOMS). Int J Rehabil Heal 1:223–235.
Chen YS, Fan J, Zhang W (2003) Clothing thermal insulation during sweating. Text Res J 73:152–157.
Chun-Yoon J, Jasper CR (1993) Garment-sizing systems : An international comparison. Int J Cloth Sci
Technol 5:28–37.
Comité Européen de Normalisation (2001) ENV 12718: Medical compression hosiery. Comité
Européen de Normalisation, Brussels.
Coza A, Dunn JF, Anderson B, Nigg BM (2012) Effects of compression on the muscle tissue
oxygenation at the onset of exercise. J Strength Cond Res 26:1631–1637.
Craig FN, Moffitt JT (1974) Efficiency of evaporative cooling from wet clothing. J Appl Physiol 36:313–
316.
Damstra RJ, Partsch H (2009) Compression therapy in breast cancer-related lymphedema: A
randomized, controlled comparative study of relation between volume and interface pressure
changes. J Vasc Surg 49:1256–1263.
Dascombe B, Laursen P, Nosaka K, Polglaze T (2011a) No effect of upper body compression garments
in elite flat-water kayakers. Eur J Sport Sci 13:341–349.
Dascombe BJ, Hoare TK, Sear JA, et al (2011b) The effects of wearing undersized lower-body
compression garments on endurance running performance. Int J Sports Physiol Perform 6:160–
173.
de Glanville KM, Hamlin MJ (2012) Positive effect of lower body compression garments on
subsequent 40-km cycling time trial performance. J Strength Cond Res 26:480–486.
Del Coso J, Areces F, Salinero JJ, et al (2014) Compression stockings do not improve muscular
performance during a half-ironman triathlon race. Eur J Appl Physiol 114:587–595.
Deutsches Institut für Gütesicherung und Kennzeichnung (2008) Medical Compression Hosiery.
Quality Assurance RAL-GZ 387/1. RAL Deutsches Institut für Gütesicherung und
Kennzeichnung e.V., Sankt Augustin.
Doan BK, Kwon Y-H, Newton RU, et al (2003) Evaluation of a lower-body compression garment. J
Sport Sci 21:601–610.
Driller MW, Halson SL (2013a) The effects of lower-body compression garments on recovery between
exercise bouts in highly-trained cyclists. J Sci Cycl 2:45–50.
Driller MW, Halson SL (2013b) The effects of wearing lower body compression garments during a
cycling performance test. Int J Sports Physiol Perform 8:300–306.
Dubuis L, Avril S, Debayle J, Badel P (2012) Identification of the material parameters of soft tissues in
the compressed leg. Comput Methods Biomech Biomed Engin 15:3–11.
Duffield R, Murphy A, Kellett A, Reid M (2014) Recovery from repeated on-court tennis sessions:
Combining cold-water immersion, compression, and sleep interventions. Int J Sports Physiol
Perform 9:273–282.
Faulkner JA, Gleadon D, McLaren J, Jakeman JR (2013) Effect of lower-limb compression clothing on
400-m sprint performance. J Strength Cond Res 27:669–676.
Ferguson RA, Dodd MJ, Paley VR (2014) Neuromuscular electrical stimulation via the peroneal nerve
is superior to graduated compression socks in reducing perceived muscle soreness following
intense intermittent endurance exercise. Eur J Appl Physiol 114:2223–2232.
Flaud P, Bassez S, Counord J-L (2010) Comparative in vitro study of three interface pressure sensors
used to evaluate medical compression hosiery. Dermatologic Surg 36:1930–1940.
Giele HP, Liddiard K, Currie K, Wood FM (1997) Direct measurement of cutaneous pressures
generated by pressure garments. Burns 23:137–141.

Goh SS, Laursen PB, Dascombe B, Nosaka K (2011) Effect of lower body compression garments on
submaximal and maximal running performance in cold (10°C) and hot (32°C) environments. Eur
J Appl Physiol 111:819–826.
Gore SE, Laing RM, Wilson CA, et al (2006) Standardizing a pre-treatment cleaning procedure and
effects of application on apparel fabrics. Text Res J 76:455–464.
Goto K, Morishima T (2014) Compression garment promotes muscular strength recovery after
resistance exercise. Med Sci Sports Exerc 46:2265–2270.
Gupta A, Bryers JJ, Clothier PJ (2015) The effect of leg compression garments on the mechanical
characteristics and performance of single-leg hopping in healthy male volunteers. BMC Sports
Sci Med Rehabil 7:10.
Hamlin MJ, Mitchell CJ, Ward FD, et al (2012) Effect of compression garments on short-term recovery
of repeated sprint and 3-km running performance in rugby union players. J Strength Cond Res
26:2975–2982.
Hegarty-Craver M, Kwon C, Oxenham W, et al (2015) Towards characterizing the pressure profiles of
medical compression hosiery: An investigation of current measurement devices and techniques.
J Text Inst 106:757–767.
Hill J, Howatson G, van Someren K, et al (2014a) Compression garments and recovery from exercise-
induced muscle damage: A meta-analysis. Br J Sports Med 48:1340–1346.
Hill JA, Howatson G, van Someren KA, et al (2015) The variation in pressures exerted by
commercially available compression garments. Sport Eng 18:115–121.
Hill JA, Howatson G, van Someren KA, et al (2014b) Influence of compression garments on recovery
after marathon running. J Strength Cond Res 28:2228–2235.
Hirai M, Niimi K, Iwata H, et al (2010) Comparison of stiffness and interface pressure during rest and
exercise among various arm sleeves. Phlebology 25:196–200.
Hooper DR, Dulkis LL, Secola PJ, et al (2015) Roles of an upper-body compression garment on athletic
performances. J Strength Cond Res 29:2655–2660.
International Organization for Standardization (2012) ISO 6938: Textiles - Natural fibres - Generic
names and definitions. International Organization for Standardization, Geneva.
International Organization for Standardization (2013a) ISO 2076: Textiles - Man-made fibres - Generic
names. International Organization for Standardization, Geneva.
International Organization for Standardization (2005) ISO 139: Textiles – Standard atmospheres for
conditioning and testing. International Organization for Standardization, Geneva.
International Organization for Standardization (2000) ISO 6330: Textiles – Domestic washing and
drying procedures for textile testing. International Organization for Standardization, Geneva.
International Organization for Standardization (1976) ISO 3379: Leather – Determination of distension
and strength of grain – Ball burst test. International Organization for Standardization, Geneva.
International Organization for Standardization (1996) ISO 5084: Textiles - Determination of thickness
of textiles and textile products. International Organization for Standardization, Geneva.
International Organization for Standardization (1977) ISO 3801: Textiles - Woven fabrics -
Determination of mass per unit length and mass per unit area. International Organization for
Standardization, Geneva.
International Organization for Standardization (2013b) ISO 13934-1: Textiles - Tensile properties of
fabrics - Part 1: Determination of maximum force and elongation at maximum force using the
strip method. International Organization for Standardization, Geneva.
International Organization for Standardization (2014a) ISO 13934-2: Textiles - Tensile properties of
fabrics - Part 2: Determination of maximum force using the grab method. International
Organization for Standardization, Geneva.
International Organization for Standardization (2006) ISO 18696: Textiles - Determination of resistance
to water absorption - Tumble-jar absorption test. International Organization for Standardization,
Geneva.
International Organization for Standardization (2007) ISO 18695: Textiles - Determination of resistance
to water penetration - Impact penetration test. International Organization for Standardization,

Geneva.
International Organization for Standardization (1981) ISO 811: Textiles - Determination of resistance to
water penetration - Hydrostatic pressure test. International Organization for Standardization,
Geneva.
International Organization for Standardization (1995) ISO 9237: Textiles - Determination of the
permeability of fabrics to air. International Organization for Standardization, Geneva.
International Organization for Standardization (1989) ISO 5085-1: Textiles - Determination of thermal
resistance - Part 1: Low thermal resistance. International Organization for Standardization,
Geneva.
International Organization for Standardization (2014b) ISO 11092: Textiles - Physiological effects -
Measurement of thermal and water-vapour resistance under steady-state conditions (sweating
guarded-hotplate test). International Organization for Standardization, Geneva.
International Organization for Standardization (2014c) ISO 16533: Textiles - Measurement of
exothermic and endothermic properties of textiles under humidity change. International
Organization for Standardization, Geneva.
International Organization for Standardization (2014d) ISO 13935-1: Textiles - Seam tensile properties
of fabrics and made-up textile articles - Part 1: Determination of maximum force to seam rupture
using the strip method. International Organization for Standardization, Geneva.
International Organization for Standardization (2014e) ISO 13935-2 Textiles - Seam tensile properties
of fabrics and made-up textile articles - Part 2: Determination of maximum force to seam rupture
using the grab method. International Organization for Standardization, Geneva.
Karimi HR, Jeddi AAA, Rastgoo A (2009) Theoretical analysis of load–extension behaviour of plain-
weft-knitted fabric. J Text Inst 100:18–27.
Kissa E (1996) Wetting and wicking. Text Res J 66:660–668.
Kraemer WJ, Bush JA, Bauer JA, et al (1996) Influence of compression garments on vertical jump
performance in NCAA Division I volleyball players. J Strength Cond Res 10:180–183.
Kraemer WJ, Bush JA, Newton RU, et al (1998a) Influence of a compression garment on repetitive
power output production before and after different types of muscle fatigue. Sport Med Train
Rehabil 8:163–184.
Kraemer WJ, Bush JA, Triplett-McBride NT, et al (1998b) Compression garments: Influence on muscle
fatigue. J Strength Cond Res 12:211–215.
Kraemer WJ, French DN, Spiering BA (2004) Compression in the treatment of acute muscle injuries in
sport. Int Sport J 5:200–208.
Kumar B, Das A, Alagirusamy R (2013) An approach to examine dynamic behavior of medical
compression bandage. J Text Inst 104:521–529.
Laing RM, Holland EJ, Wilson CA, Niven BE (1999) Development of sizing systems for protective
clothing for the adult male. Ergonomics 42:1249–1257.
Lien N, Steel KA, Graham K, et al (2014) What is the effect of compression garments on a novel kick
accuracy task? Int J Sport Sci Coach 9:357–365.
Liu R, Kwok YL, Li Y, et al (2005) Objective evaluation of skin pressure distribution of graduated
elastic compression stockings. Dermatologic Surg 31:615–24.
Liu R, Kwok YL, Li Y, et al (2007) Skin pressure profiles and variations with body postural changes
beneath medical elastic compression stockings. Int J Dermatol 46:514–523.
Liu R, Lao TTH, Li Y, et al (2008) Physiological response and comfort sensory perception towards
physical-mechanical performance of compression hosiery textiles. J Fiber Bioeng Informatics
1:55–64.
Lord RSA, Hamilton D (2004) Graduated compression stockings (20−30 mmHg) do not compress leg
veins in the standing position. ANZ J Surg 74:581–585.
Lovell DI, Mason DG, Delphinus EM, McLellan CP (2011) Do compression garments enhance the
active recovery process after high-intensity running? J Strength Cond Res 25:3264–3268.
Lucas-Cuevas A, Priego-Quesada J, Aparicio I, et al (2015) Effect of 3 weeks use of compression
garments on stride and impact shock during a fatiguing run. Int J Sports Med 36:826–831.

MacRae BA, Cotter JD, Laing RM (2011) Compression garments and exercise: Garment considerations,
physiology and performance. Sport Med 41:815–843.
MacRae BA, Laing RM, Niven BE, Cotter JD (2012) Pressure and coverage effects of sporting
compression garments on cardiovascular function, thermoregulatory function, and exercise
performance. Eur J Appl Physiol 112:1783–1795.
Manshahia M, Das A (2014) Effect of fiber and fabric constructional parameters on dynamic behavior
of compression athletic wear. Fibers Polym 15:414–421.
Marqués-Jiménez D, Calleja-González J, Arratibel I, et al (2016) Are compression garments effective
for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis.
Physiol Behav 153:133–148.
Martorelli SS, Martorelli AS, Pereira MC, et al (2015) Graduated compression sleeves: Effects on
metabolic removal and neuromuscular performance. J Strength Cond Res 29:1273–1278.
Mayrovitz HN (1998) Compression-induced pulsatile blood flow changes in human legs. Clin Physiol
18:117–124.
Mayrovitz HN, Larsen PB (1997) Effects of compression bandaging on leg pulsatile blood flow. Clin
Physiol 17:105–117.
McLaren J, Helmer RJN, Horne SL, Blanchonette I (2010) Preliminary development of a wearable
device for dynamic pressure measurement in garments. Procedia Eng 2:3041–3046.
Ménétrier A, Mourot L, Bouhaddi M, et al (2011) Compression sleeves increase tissue oxygen
saturation but not running performance. Int J Sports Med 32:864–868.
Ménétrier A, Mourot L, Degano B, et al (2015) Effects of three postexercice recovery treatments on
femoral artery blood flow kinetics. J Sports Med Phys Fitness 55:258–266.
Michael JS, Dogramaci SN, Steel KA, Graham KS (2014) What is the effect of compression garments on
a balance task in female athletes? Gait Posture 39:804–809.
Mills C, Knight J, Milligan G (2015) Do ergogenic aids alter lower extremity joint alignment during a
functional movement lunge prior to and following an exercise bout? J Hum Kinet 45:9–17.
Miyamoto N, Hirata K, Mitsukawa N, et al (2011) Effect of pressure intensity of graduated elastic
compression stocking on muscle fatigue following calf-raise exercise. J Electromyogr Kinesiol
21:249–254.
Miyamoto N, Kawakami Y (2014) Effect of pressure intensity of compression short-tight on fatigue of
thigh muscles. Med Sci Sports Exerc 46:2168–2174.
Miyamoto N, Kawakami Y (2015) No graduated pressure profile in compression stockings still
reduces muscle fatigue. Int J Sports Med 36:220–225.
Moffatt C (2008) Variability of pressure provided by sustained compression. Int Wound J 5:259–265.
Morton WE, Hearle JWS (2008) Physical Properties of Textile Fibres, 4th edn. Woodhead Publishing
Limited, Cambridge.
Mosti G, Mattaliano V, Partsch H (2008) Inelastic compression increases venous ejection fraction more
than elastic bandages in patients with superficial venous reflux. Phlebology 23:287–294.
Mosti G, Partsch H (2011) Compression stockings with a negative pressure gradient have a more
pronounced effect on venous pumping function than graduated elastic compression stockings.
Eur J Vasc Endovasc Surg 42:261–266.
Murthy G, Ballard RE, Breit GA, et al (1994) Intramuscular pressures beneath elastic and inelasic
leggings. Ann Vasc Surg 8:543–548.
Nagata H (1978) Evaporative heat loss and clothing. J Hum Ergol (Tokyo) 7:169–175.
Nikolic MD, Mihailovic T V (1996) Investigation of fabric deformations under different loading
conditions. Int J Cloth Sci Technol 8:9–16.
Partsch B, Partsch H (2005) Calf compression pressure required to achieve venous closure from supine
to standing positions. J Vasc Surg 42:734–738.
Partsch H (2005) The Static Stiffness Index: A Simple Method to Assess the Elastic Property of
Compression Material In Vivo. Dermatologic Surg 31:625–630.
Partsch H, Clark M, Bassez S, et al (2006a) Measurement of lower leg compression in vivo:
Recommendations for the performance of measurements of interface pressure and stiffness.

Dermatologic Surg 32:224–233.
Partsch H, Mosti G (2013) Sport socks do not enhance calf muscle pump function but inelastic wraps
do. Int Angiol 33:511–517.
Partsch H, Mosti G (2010) Comparison of three portable instruments to measure compression
pressure. Int Angiol 29:426–430.
Partsch H, Mosti G, Mosti F (2010) Narrowing of leg veins under compression demonstrated by
magnetic resonance imaging (MRI). Int Angiol 29:408–10.
Partsch H, Partsch B, Braun W (2006b) Interface pressure and stiffness of ready made compression
stockings: Comparison of in vivo and in vitro measurements. J Vasc Surg 44:809–814.
Partsch H, Winiger J, Lun B (2004) Compression stockings reduce occupational leg swelling.
Dermatologic Surg 30:737–743.
Patnaik A, Rengasamy RS, Kothari VK, Ghosh A (2006) Wetting and wicking in fibrous materials. Text
Prog 38:1–105.
Pereira MC, Bottaro M, Brown LE, et al (2014a) Do compression sleeves worn during exercise affect
muscle recovery? Isokinet Exerc Sci 22:265–271.
Pereira MC, Bottaro M, Brown LE, et al (2014b) The effects of graduated compression sleeves on
muscle performance: A randomised controlled trial. Int J Sports Sci Coach 9:985–992.
Perrey S (2008) Compression garments: Evidence for their physiological effects (P208). Eng Sport 7
(Vol 2) 319–338.
Priego JI, Lucas-Cuevas AG, Aparicio I, et al (2015) Long-term effects of graduated compression
stockings on cardiorespiratory performance. Biol Sport 32:219–23.
Priego Quesada JI, Lucas-Cuevas AG, Gil-Calvo M, et al (2015) Effects of graduated compression
stockings on skin temperature after running. J Therm Biol 52:130–136.
Pruscino CL, Halson S, Hargreaves M (2013) Effects of compression garments on recovery following
intermittent exercise. Eur J Appl Physiol 113:1585–1596.
Rider BC, Coughlin AM, Hew-Butler TD, Goslin BR (2014) Effect of compression stockings on
physiological responses and running performance in division III collegiate cross-country runners
during a maximal treadmill test. J Strength Cond Res 28:1732–1738.
Rimaud D, Calmels P, Pichot V, et al (2012) Effects of compression stockings on sympathetic activity
and heart rate variability in individuals with spinal cord injury. J Spinal Cord Med 35:81–88.
Rossi RM, Stampfli R, Psikuta A, et al (2011) Transplanar and in-plane wicking effects in sock
materials under pressure. Text Res J 81:1549–1558.
Rugg S, Sternlicht E (2013) The effect of graduated compression tights, compared with running shorts,
on counter movement jump performance before and after submaximal running. J Strength Cond
Res 27:1067–1073.
Saricam C (2015) Absorption, wicking and drying characteristics of compression garments. J Eng Fiber
Fabr 10:146–154.
Sperlich B, Born D-P, Kaskinoro K, et al (2013a) Squeezing the muscle: Compression clothing and
muscle metabolism during recovery from high intensity exercise. PLoS One 8:e60923.
Sperlich B, Born D-P, Swaren M, et al (2013b) Is leg compression beneficial for alpine skiers? BMC
Sport Sci Med Rehabil 5:18.
Sperlich B, Born D-P, Zinner C, et al (2014) Does upper-body compression improve 3 x 3-min double-
poling sprint performance? Int J Sports Physiol Perform 9:48–57.
Sperlich B, Haegele M, Krüger M, et al (2011) Cardio-respiratory and metabolic responses to different
levels of compression during submaximal exercise. Phlebology 26:102–106.
Standards Australia and Standards New Zealand (1996) AS/NZS 4399 Australia/New Zealand
Standard – Sun Protective Clothing – Evaluation and Classification. Standards Australia and
Standards New Zealand, Wellington.
Stickford ASL, Chapman RF, Johnston JD, Stager JM (2015) Lower-leg compression, running
mechanics, and economy in trained distance runners. Int J Sports Physiol Perform 10:76–83.
Surhoff S (2014) Compression therapy in sport. Phlebologie 43:137–139.
Thomas S (2003) The use of the Laplace equation in the calculation of sub-bandage pressure. EWMA J

3:21–23.
Troynikov O, Wardiningsih W, Koptug A, et al (2013) Influence of material properties and garment
composition on pressure generated by sport compression garments. Procedia Eng 60:157–162.
Tsuruike M, Ellenbecker TS (2013) Effects of a compression garment on shoulder external rotation
force outputs during isotonic contractions. J Strength Cond Res 27:519–525.
Uhl J-F, Benigni J-P, Cornu-Thenard A, et al (2014) Relationship between medical compression and
intramuscular pressure as an explanation of a compression paradox. Phlebology 30:331–338.
Valle X, Til L, Drobnic F, et al (2013) Compression garments to prevent delayed onset muscle soreness
in soccer players. Muscles Ligaments Tendons J 3:295–302.
Varela-Sanz A, Espana J, Carr N, et al (2011) Effects of gradual-elastic compression stockings on
running economy, kinematics, and performance in runners. J Strength Cond Res 25:2902–2910.
Venckunas T, Trinkunas E, Kamandulis S, et al (2014) Effect of lower body compression garments on
hemodynamics in response to running session.
Vercruyssen F, Easthope C, Bernard T, et al (2014) The influence of wearing compression stockings on
performance indicators and physiological responses following a prolonged trail running
exercise. Eur J Sport Sci 14:144–150.
Wahl P, Bloch W, Mester J, et al (2012) Effects of different levels of compression during sub-maximal
and high-intensity exercise on erythrocyte deformability. Eur J Appl Physiol 112:2163–2169.
Walker PMB (ed) (1993) Chambers Materials Science and Technology Dictionary. Chambers Harrap
Publishers Ltd, Edinburgh.
Watanuki S, Murata H (1994) Effects of wearing compression stockings on cardiovascular responses.
Ann Physiol Anthropol 13:121–127.
Wertheim D, Melhuish J, Williams R, et al (1999) Movement-related variation in forces under
compression stockings. Eur J Vasc Endovasc Surg 17:334–337.
Wildin CJ, Hui ACW, Esler CNA, Gregg PJ (1998) In vivo pressure profiles of thigh-length graduated
compression stockings. Br J Surg 85:1228–1231.
Williams AF, Williams AE (1999) “Putting the pressure on”: A study of compression sleeves used in
breast cancer-related lymphoedema. J Tissue Viability 9:89–94.
Wilson CA, Laing RM, Carr DJ (2002) Air and air spaces - the invisible addition to thermal resistance. J
Human-Environmental Syst 5:69–77.
Yoo S, Barker RL (2005) Comfort properties of heat-resistant protective workwear in varying
conditions of physical activity and environment. Part 1: Thermophysical and sensorial properties
of fabrics. Text Res J 75:523–530.
Zaleski AL, Ballard KD, Pescatello LS, et al (2015) The effect of compression socks worn during a
marathon on hemostatic balance. Phys Sportsmed 43:336–341.