Effects of Compression Garment Pressure on Recovery from Strenuous Exercise

Abstract

Purpose:
To identify the effects of 2 different grades of compression garment on recovery indices after strenuous exercise.

Methods:
Forty-five recreationally active participants (n = 26 male and n = 19 female) completed an eccentric-exercise protocol consisting of 100 drop jumps, after which they were matched for body mass and randomly but equally assigned to a high-compression pressure (HI) group, a low-compression pressure (LOW) group, or a sham ultrasound group (SHAM). Participants in the HI and LOW groups wore the garments for 72 h postexercise; participants in the SHAM group received a single treatment of 10-min sham ultrasound. Measures of perceived muscle soreness, maximal voluntary contraction (MVC), countermovement-jump height (CMJ), creatine kinase (CK), C-reactive protein (CRP), and myoglobin (Mb) were assessed before the exercise protocol and again at 1, 24, 48, and 72 h postexercise. Data were analyzed using a repeated-measures ANOVA.

Results:
Recovery of MVC and CMJ was significantly improved with the HI compression garment (P < .05). A significant time-by-treatment interaction was also observed for jump height at 24 h postexercise (P < .05). No significant differences were observed for parameters of soreness and plasma CK, CRP, and Mb.

Conclusions:
The pressures exerted by a compression garment affect recovery after exercise-induced muscle damage, with higher pressure improving recovery of muscle function.

Full text

The effects of compression garment pressure on recovery from strenuous exercise 1"
2"
Jessica Hill,1 Glyn Howatson,2,5 Ken van Someren,3 David Gaze4, Hayley Legg1, Jack 3"
Lineham1, and Charles Pedlar1
4"
5"
1 School of Sport, Health and Applied Science, St. Mary’s University, Twickenham, UK. 2 6"
Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life of Sciences, 7"
Northumbria University, Newcastle Upon Tyne, UK. 3 GSK Human Performance Lab, 8"
GlaxoSmithKline Consumer Healthcare, Brentford, UK. 4Chemical Pathology, Clinical 9"
Blood Sciences, St George’s Healthcare NHS Trust, London, UK. 5Water Research Group, 10"
School of Biological Sciences, North West University, Potchefstroom, South Africa. 11"
12"
13"
Corresponding author: Jessica Hill, School of Sport, Health and Applied Science, St. Mary’s 14"
University, Twickenham, TW1 4SX UK. Tel: +00 44 0 208 240 4000, Fax: +00 44 0 208 240 15"
4212, Email jessica.hill@stmarys.ac.uk. 16"
17"
Submission Type – Original Investigation 18"
19"
Running Head – Compression garment pressure and recovery 20"
21"
Word Count – 3494 22"
23"
Number of Tables – 3 24"
25"
Number of Figures - 3 26"
27"
28"
29"

ABSTRACT 30"
Compression garments are frequently used to facilitate recovery from strenuous exercise. 31"
Purpose: To identify the effects of two different grades of compression garment on recovery 32"
indices following strenuous exercise. Methods: Forty five recreationally active participants 33"
(n=26 males and n=19 females) completed an eccentric exercise protocol consisting of 100 34"
drop jumps. Following the exercise protocol participants were matched for body mass and 35"
randomly but equally assigned to either a high (HI) compression pressure group, a low 36"
(LOW) compression pressure group, or a sham ultrasound group (SHAM). Participants in 37"
the high (HI) and low (LOW) compression groups wore the garments for 72 h post-exercise; 38"
participants in the SHAM group received a single treatment of 10 minutes sham ultrasound. 39"
Measures of perceived muscle soreness, maximal voluntary contraction (MVC), counter 40"
movement jump height (CMJ), creatine kinase (CK), C-reactive protein (CRP) and 41"
myoglobin (Mb) were assessed before the exercise protocol and again at 1, 24, 48 and 72 h 42"
post exercise. Data were analysed using a repeated measures ANOVA. Results: Recovery of 43"
MVC and CMJ was significantly improved with the HI compression garment (p < 0.05). A 44"
significant time by treatment interaction was also observed for jump height at 24 h post 45"
exercise (p < 0.05). No significant differences were observed for parameters of soreness and 46"
plasma CK, CRP and Mb. Conclusions: The findings of this study indicate that the pressures 47"
exerted by a compression garment affect recovery following exercise-induced muscle damage 48"
(EIMD), with a higher pressure improving recovery of muscle function. 49"
50"
Key Words: Sport, external pressure, stockings, muscle function, muscle damage 51"
52"
53"
54"
55"
56"
57"
58"
59"
60"

INTRODUCTION 61"
Exercise that is unaccustomed or unfamiliar in nature can lead to the experience of exercise-62"
induced muscle damage (EIMD) (1,2). Symptoms associated with EIMD include decreased 63"
force production, decreased range of motion (ROM) and the experience of muscle soreness, 64"
all of which can negatively affect performance (3). Consequently, there is a growing interest 65"
in strategies that can minimise the experience of EIMD and accelerate recovery. 66"
67"
Compression garments are often used to aid recovery following strenuous exercise. The use 68"
of compression originates from clinical settings where limb compression is used to treat a 69"
range of inflammatory conditions including lymphedema (4), deep vein thrombosis (5) and 70"
chronic venous insufficiency (6). Research investigating the use of compression as a 71"
recovery modality in an athletic setting remains equivocal, with some research indicating 72"
favourable effects (7-10) and other research reporting no benefits (11-12). Whilst the exact 73"
mechanism for the benefit of compression garments remains unclear it is thought that 74"
application of compression can positively affect haemodynamics and attenuates swelling by 75"
facilitating lymphatic drainage and reducing the increase in osmotic pressure experienced as a 76"
result of tissue damage (13). In addition, compression is thought to provide mechanical 77"
support to the injured limb which may in turn prevent force decrements (13). 78"
79"
One methodological disparity between studies is the level of compression exerted by the 80"
garment. It is likely that the effects of a compression garment depend on the amount of 81"
compression applied (14), however if the degree of compression exerted by the garment is 82"
insufficient or too high, a beneficial effect is unlikely (15-16). Low levels of compression 83"
may be insufficient to modulate blood flow or osmotic pressure, and levels of compression 84"
that are too high may have a restrictive effect on blood flow. Optimal levels of compression 85"
beneficial to performance and recovery have yet to be determined, with current 86"
recommendations based upon clinical guidelines (17). However, pressures that are effective 87"
in a clinical population may not be effective in an athletic population. 88"
89"
Improved venous return has been observed at pressures of 20-25 mmHg at the calf and thigh 90"
respectively, with the authors of this study proposing pressures of 15.2-17.3 mmHg as the 91"
minimum required in order to achieve elevations in venous return (18). However it should be 92"
noted that these minimum pressures are estimations, calculated by assessing the cardiac 93"
output response to three different levels of compression garments (10-8, 15-12 and 20-16 94"
mmHg at the calf and thigh respectively). Sperlich et al. (19) investigated the effects of knee-95"
high socks that applied compression pressures of 0, 10, 20, 20 and 40 mmHg and observed no 96"
effect at any pressure on cardio-respiratory and metabolic parameters during submaximal 97"
running. In contrast to this, another study indicated that compression garments exerting 98"
pressures of 20 and 40 mmHg may improve alpine skiing performance by enabling a deeper 99"
tuck position with attenuated perceived exertion; however the authors indicated that the 100"
garment exerting 40 mmHg may reduce blood flow (20). 101"
102"
A variety of compression pressures have been used in current research ranging from 10-12 103"
mmHg (21) up to 40 mmHg (19). A major limitation with current research investigating the 104"
efficacy of compression is that a large number of studies have failed to measure exact 105"
interface pressures applied by the garments (4, 22-25). Previous research has highlighted 106"
large variations in the degree of pressure exerted by compression garments across a 107"
population, with a number of individuals receiving low levels of compression (26). This 108"
variation is likely due to differences in limb size and tissue structure within a particular size 109"
category of garment (22). Thus it is possible the degree of compression exerted was 110"

insufficient to enhance recovery in several studies that have observed no benefit (2). 111"
Knowledge of the pressures applied by compression garments is fundamental to developing 112"
understanding on how a garment affects parameters of performance and recovery. Without 113"
knowledge on the precise pressures applied in research studies we cannot accurately interpret 114"
or compare findings (15). Therefore the aim of this investigation was to assess whether 115"
garments exerting a higher degree of pressure are more effective in facilitating recovery 116"
compared to garments exerting a lower pressure. 117"
118"
119"
METHODOLOGY 120"
Participants 121"
Forty five recreationally active participants from any sport or training background (n=26 122"
male, n=19 female) volunteered to participate in this study. Following ethical approval all 123"
participants completed a health screening questionnaire and gave written informed consent. 124"
Individuals with a history of musculoskeletal injury and inflammatory disorders were 125"
excluded from participating in this study. All participants were asked to arrive at the 126"
laboratory in a rested state and refrain from heavy exercise in the 48 h preceding the study 127"
and for 72 h following the muscle damaging protocol; in addition, participants were required 128"
to refrain from using any recovery strategy for the duration of the investigation. Participant 129"
characteristics are presented in table 1. 130"
131"
Experimental overview 132"
Participants were matched for weight and randomly, but equally assigned, to either a low 133"
(LOW, n=15), or high (HI, n=15) compression treatment group, or a sham-ultrasound group 134"
(SHAM, n=15). Participants reported to the laboratory for familiarisation and baseline 135"
testing 1 h prior to the muscle damaging protocol. During the familiarisation participants 136"
were given a full verbal explanation of how each variable was to be measured and were 137"
required to undertake practice attempts of the muscle function tests until performance in each 138"
of the tests reached a plateau. Following the familiarisation participants sat with their feet up 139"
for 20minutes before the collection of baseline data commenced. Base line data was collected 140"
for the dependent variables creatine kinase (CK), high sensitivity C-reactive protein (CRP), 141"
myoglobin (Mb), global lower limb muscle soreness and quadriceps soreness, counter 142"
movement jump (CMJ), and maximum voluntary contraction (MVC) of the knee extensors. 143"
These variables were analysed again 1, 24, 48 and 72 h post muscle damaging protocol. 144"
Participants were required to attend the laboratory for post testing at the same time of day and 145"
variables were always collected in the same order. 146"
147"
Muscle damage procedure 148"
The muscle damaging protocol consisted of 100 drop jumps from a 0.6 m platform. 149"
Participants performed 5 sets of 20 drop jumps, with 10 seconds between each jump and a 2 150"
minute rest period between sets. Participants were instructed to jump maximally upon landing 151"
each jump. 152"
153"
Treatment groups 154"
Participants in the LOW compression group were fitted with a full length, lower limb, 155"
commercially available compression garment (MA1551b men’s compression tights, 2XU, or 156"
WA1552b women’s compression tights, 2XU, Melbourne, Australia) fitted according to 157"
manufacturer’s guidelines based upon participants’ height and weight. Pressure exerted by 158"
the compression garment was measured using a pressure-measuring device (Kikuhime, TT 159"
Medi Trade, Søleddet, Denmark), validated for use in this setting (6). Pressure was measured 160"

at the front thigh at the mid-point between the superior aspect of the patella and the inguinal 161"
crease and at the medial aspect of the calf at the site of maximal girth. Measurements were 162"
taken at each site whilst the subject was standing in the anatomical position. Measurements 163"
were repeated three times with the mean value recorded. Average pressures exerted by the 164"
garments were reported as 8.1 ± 1.3 mmHg at the thigh and 14.8 ± 2.1 mmHg at the calf. 165"
166"
Participants in the HI compression group wore a full length lower limb clinical medical grade 167"
II compression garment (Alleviant clinical class II medical stockings, Jobskin, Nottingham, 168"
UK) fitted according to manufacturer’s guidelines based upon leg circumference measured at 169"
7 locations on the leg. These garments exerted an average pressure of 14.8 ± 2.2 mmHg at 170"
the thigh and 24.3 ± 3.7 mmHg at the calf. All garments were worn for 72 h post exercise, 171"
participants were only allowed to remove them to shower. Participants were each given two 172"
pairs of the same garments to allow rotation when washing. 173"
174"
Participants in SHAM received 10 min of sham ultrasound comprised of 5 minutes each thigh 175"
(Combined therapy ultrasound/inferential, Shrewsbury Medical, Shropshire, UK). A water 176"
soluble ultrasound gel (Aquasonic 100 ultrasound transmission gel, Parker Laboratries, 177"
Fairfield, USA) was applied to the thigh, using the ultrasound head the gel was spread across 178"
the skin using circular movements. Throughout the duration of the ultrasound treatment the 179"
unit was turned off and obscured from view of the participants. All treatments were applied 180"
immediately following the muscle damaging protocol. 181"
182"
Dependent variables 183"
Muscle soreness: Global lower limb muscle soreness and localised soreness in the 184"
quadriceps muscle group was analysed using a 200 mm visual analogue scale (VAS) with ‘no 185"
pain’ at 0 mm and ‘unbearable pain’ at 200 mm. Participants stood with their feet shoulder 186"
width apart with hands on hips and were asked to perform a squat to 90°, return to standing 187"
and mark their subjective feelings of pain on the scale. 188"
189"
Muscle function: Maximal voluntary contraction was assessed using a strain gauge (MIE 190"
Medical Research Ltd., Leeds, UK). Participants were seated on a platform in a standardised 191"
position, with their hip and knee joints flexed at 90°. The strain gauge was attached 2 cm 192"
above the malleoli of the left ankle and participants were required to maximally extend the 193"
knee against the device for 3 s, verbal encouragement was given for the duration. Participants 194"
performed three repetitions, each separated by 1 min, with the greatest value recorded as 195"
MVC. Measurements were recorded in newtons. 196"
197"
Counter movement jump height was assessed using a force plate (Kistler 9287BA force 198"
platform, Kistler Instruments Ltd, Hamshire, UK). Participants were instructed to stand with 199"
their hands on their hips and perform a maximal jump on command. Participants performed 200"
three jumps the best of which was taken for analysis. Data from 5 participants (n=2 LOW, 201"
n=1 HI and N=2 SHAM) were not included in the jump data analysis due to technical issues 202"
with the equipment. 203"
204"
Blood measures: CK, high sensitivity CRP, and Mb were analysed from plasma blood 205"
samples. Approximately 8.5 mL of blood was collected from the antecubital vein into 206"
lithium heparin vacutainers. Following collection, the sample was immediately placed in a 207"
refrigerated centrifuge and spun at 3500 rpm, a relative centrifugal force of 3000 g, for 20 208"
minutes at 4°C to enable the separation of plasma. The plasma was immediately frozen at -209"
80°C for later analysis. Plasma CK and CRP Mb were measured using an automated 210"

analyser (Advia 2400, Chemistry System, Siemens Health Care Diagnostics, USA). 211"
Manufacturer’s report an intra-sample CV for the analyser of <3% at high and low 212"
concentrations and expected baseline sample ranges of 32-294 IU.L-1 and < 3 pg.mL-1 for CK 213"
and CRP, respectively. Plasma Mb was analysed using an electrochemiluminescence immuno 214"
assay (ECLIA) (Elecsys 2010, Roche Diagnostics GmbH, Germany). Manufacturer’s report 215"
an intra-sample CV for the analyser of <4% and expected values of 25-72ng.ml-1. 216"
217"
Statistical Analysis 218"
All data analyses was carried out using SPSS for Windows version 21, and values are 219"
reported as mean ± SD. Independent samples t-tests were used to identify any differences in 220"
group characteristics at baseline. All dependent variables were assessed using a treatment by 221"
time repeated measures analysis of variance (ANOVA). Where a significant effect was 222"
observed, interaction effects were further examined using a Bonferroni post hoc analysis. A 223"
significance level of p ≤ 0.05 was applied throughout. Effect sizes, using Cohen’s d, and 224"
90% confidence intervals (CI) were calculated to assess magnitude of effect on the change 225"
from baseline at 1, 24, 48 and 72 h post exercise. Threshold values were set at 0.2, small; 0.5, 226"
moderate; and 0.8, large. 227"
228"
229"
RESULTS 230"
Effect sizes and 90% CI comparing change from baseline with 1, 24, 48 and 72 h post 231"
exercise can be seen for each variable in table 2. A significant time effect was observed for 232"
global lower limb muscle soreness (F2.639,1=31.509, p < 0.001) and soreness of the quadriceps 233"
(F2.988,1=45.865, p < 0.001) indicating that there was a change in muscle soreness over time. 234"
Further post hoc Bonferroni tests indicated significant differences from baseline occurred at 235"
all time points in both global and quadriceps soreness (p < 0.05). No significant group (F2, 42 236"
=1.081, p = 0.325) or interaction effects (F5.278,2=0.861, p = 0.515) were observed for global 237"
lower limb soreness. This was consistent with the group (F2,42=0.972, p = 0.387) and 238"
interaction effects observed for quadriceps soreness (F5.976, 2 =0.855, p = 0.530) (Figures 1a 239"
and 1b). 240"
241"
Significant time effects were observed for MVC (F3.084, 1=49.760, p < 0.001), Bonferroni post 242"
hoc tests indicated that a significant difference from baseline occurred at all time points (p < 243"
0.05). Values reduced to 81.6 ± 9.0, 84.3 ± 6.3 and 81.4 ± 9.2 % of baseline 1 h after the 244"
damaging protocol and returning to 90.6 ± 11.6, 99.9 ± 9.9 and 91.2 ± 9.7% of baseline at 72 245"
h post in the LOW, HI and SHAM groups respectively. A significant treatment effect was 246"
observed for MVC (F2,42 = 3.832, p = 0.030), however there was no significant time by 247"
treatment interaction (F6.169,2 = 1.824, p = 0.097). Further post hoc analysis indicated the 248"
significant difference occurred between the HI and SHAM groups (p = 0.036) (figure 2). 249"
250"
Significant time effects were observed for Jump height (F4,1 = 11.202, p < 0.001), further post 251"
hoc analysis indicated that significant differences from baseline occurred at all time points (p 252"
< 0.05) figure 3. A significant time by treatment effect (F8,2 = 2.99, p = 0.004) and a 253"
significant treatment effect (F2,37 = 3.741, p = 0.33) was observed for jump height. Further, 254"
post hoc analysis indicated the significant treatment effect occurred between the HI and LOW 255"
compression groups (p = 0.032) and the time by treatment interaction occurred at 24 h post 256"
exercise between the HI and LOW compression groups (p = 0.002) (figure 3). 257"
258"

Whilst an overall significant time effect was observed for CK (F2.353,1 = 2.980, p = 0.021), 259"
further post hoc analysis failed to indicate a significant effect at any time point (p > 0.05). 260"
Post exercise plasma CK values were elevated 1 h post exercise in all experimental groups 261"
and remained raised for the duration of the study. No significant group (F2,42 = 0.174, p = 262"
0.841) or interaction effects were observed for CK (F4.706,2 = 1.383, p = 0.240), data is 263"
presented in table 3. 264"
265"
There was no significant time effect (F4,1 = 0.615, p = 0.570), group effect (F2,11 = 0.511, p = 266"
0.558) or time by group effect (F8,2 = 0.217, p = 0.858) for CRP. This was also consistent 267"
with Mb where there was also no significant time (F4,1 = 1.915, p = 0.110), group (F2,11 = 268"
0.387, p = 0.681) or time by group effect (F8,2 = 1.016, p = 0.462) (table 3). 269"
270"
271"
DISCUSSION 272"
The aim of this study was to investigate the effects of different compression pressures on 273"
indices of recovery following EIMD in a recreationally active population. The main finding 274"
was that a garment exerting higher levels of compression is more effective in modulating 275"
muscle function following exercise that induces muscle damage when compared to a garment 276"
exerting lower levels of compression and a sham treatment group. 277"
278"
In this study muscle function decreased following the damaging protocol, this was evidenced 279"
by a significant time effect for both MVC and jump height (p<0.05). Recovery of strength 280"
was greatest in the HI compression group with participants recovering to 99.9 ± 9.9% of 281"
baseline MVC values at 72 h post exercise compared to 90.6 ± 11.6 and 91.2 ± 9.7% in the 282"
LOW and SHAM group. A significant difference between treatment groups was observed for 283"
MVC with the difference occurring between the HI compression group and the SHAM group 284"
This observation is supported by the large effect sizes observed between the HI and SHAM 285"
group between 24 – 72 h post exercise and the moderate to large effect sizes observed 286"
between the LOW and HI group at the same time points. These observations suggest that 287"
strength recovered at an accelerated rate over 72 h in the HI compression group. 288"
289"
Additionally Jump height was significantly higher 24 h post exercise in the HI group 290"
compared to the LOW group, indicating that compression garments exerting higher levels of 291"
compression may be beneficial in improving recovery of muscle function. The failure to 292"
observe a significant treatment effect between the HI and SHAM group was unexpected, 293"
however a large effect size was seen at 24h post exercise. Although this study attempted to 294"
control for a placebo effect by using sham ultrasound, it is possible that the observation of 295"
improved recovery in the HI group may be linked to the participant’s belief that tighter 296"
compression garments have a positive response on recovery; this is a limitation of the study. 297"
298"
Improved recovery of muscle function has been observed in previous research (9,13,27), and 299"
has been attributed to an enhanced repair of the contractile elements of the muscle (13). 300"
Furthermore the application of compression may provide mechanical support to the limb 301"
resulting in reduced movement of the tissues and offering ‘dynamic immobilisation’, whilst 302"
still enabling use of the limb, this has been proposed to increase motor unit activation during 303"
tissue injury (13, 28). However, the exact mechanism responsible for this is unclear. Several 304"
studies have failed to observe improved muscle function with the use of a compression 305"
garment (11,21-22). However as the exact level of compression exerted by the garments was 306"
not measured in these studies it is possible the garments used did not exert enough pressure to 307"
be of benefit. 308"

309"
No significant between group differences were observed for global lower limb soreness and 310"
soreness in the quadriceps, this is similar to previous findings (11-12,21). However, moderate 311"
effect sizes were observed at 48 h post exercise between the HI and SHAM group for global 312"
muscle soreness and at 24 h post exercise between the LOW and HI group for quadriceps 313"
muscle soreness, indicating soreness was lower in the HI group. 314"
315"
The experience of DOMS arises as a result of damage to the soft tissue leading to an 316"
inflammatory response which causes localised oedema in the affected limb. The presence of 317"
oedema can stimulate pain afferents bringing about the experience of soreness (28). The 318"
application of compression may reduce the level of oedema by attenuating the magnitude of 319"
the inflammatory response thus reducing the severity of the soreness experienced (21,27). 320"
Whilst a large body of research has observed reductions in perceived muscle soreness with 321"
the use of compression garments (13,24,27), these studies failed to control for placebo effect, 322"
this needs to be considered when interpreting findings. 323"
324"
Creatine kinase and Mb are released from the muscle during the experience of muscle 325"
damage and as such are frequently used as markers of EIMD (21-22). Given the absence of a 326"
significant time effect for Mb and a non-significant post hoc results for the time effect in CK 327"
it is likely that the muscle damage protocol in this study did not cause sufficient enough 328"
muscle damage for a large CK and Mb response. Previous investigations have observed 329"
reductions in concentrations of CK with the application of compression (2,22). It is worth 330"
noting the peak concentrations of CK observed within the control group of this study (586 331"
IU.L-1), is much smaller than the values observed in other studies (2194 IU.L-1(7) and ~1750 332"
IU.L-1 (13)) all of whom found beneficial effects of compression. It is possible compression is 333"
not effective at modulating clearance of CK at lower concentrations. 334"
335"
A number of investigations have observed reduced inflammation with the use of a 336"
compression garment (9,13,21), however this study failed to observe any significant group 337"
differences for the inflammatory marker CRP. Furthermore no significant time effect was 338"
observed for this marker, it is possible that muscle damage was not severe enough to cause a 339"
large inflammatory response. Regardless of the magnitude of the inflammatory response it 340"
appears the exercise protocol was severe enough to cause pronounced performance 341"
decrements and elevations in muscle soreness. 342"
343"
344"
PRACTICAL APPLICATION 345"
Whether compression garments exert sufficient pressure to be effective has been raised by a 346"
number of investigators (21-22). This study provides evidence for the importance of 347"
compression pressure in modulating parameters of recovery. The majority of previous 348"
research has failed to measure exact pressures exerted by compression garments, until the 349"
reporting of interface pressure occurs in research on compression it is difficult to identify 350"
optimal levels of compression necessary for improving recovery. More knowledge is needed 351"
on the effects of different compression pressures in order to assist practitioners in the 352"
selection of a garment for a particular role. 353"
354"
355"
CONCLUSIONS 356"
In conclusion, a compression garment exerting higher compression pressures (14.8 ± 2.2 and 357"
24.3 ± 3.7 mmHg at the thigh and calf respectively) is more effective at improving muscle 358"

function than a compression garment exerting lower pressures (8.1 ± 1.3 mmHg at the thigh 359"
and 14.8 ± 2.1 mmHg at the calf) and a SHAM treatment group. Furthermore, no treatment 360"
group was superior in aiding the removal of plasma markers of muscle damage or 361"
inflammation. The degree of pressure exerted by the garment is an important factor in 362"
determining the efficacy of compression garments in recovery. These findings highlight the 363"
importance of wearing a correctly fitting garment when using compression as a recovery 364"
modality. 365"
366"
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different levels of compression during submaximal exercise. Phlebology 2011;26:102-414"
106. 415"
20. Sperlich B, Born D P, Swarén M, et al. Is leg compression beneficial for alpine 416"
skiers? Sports Sci Med Rehabil 2013;5(18): 1-12. 417"
21. French DN, Thompson KG, Garland, SW, et al. The effects of contrast bathing and 418"
compression therapy on muscular performance. Med Sci Sports Exerc 2008;40:1297–419"
1306. 420"
22. Davies V, Thompson KG, Cooper SM. The effects of compression garments on 421"
recovery. J Strength Cond Res 2009;23:1786–1794 422"
23. Bringard A, Perrey S, Belluye N. Aerobic energy cost and sensation responses during 423"
submaxmal running exercise – positive effects of wearing compression tights. Int J 424"
Sports Med 2006;27:373–378. 425"
24. Duffield R, Edge J, Merrells R, et al. The effects of compression garments on 426"
intermittent exercise performance and recovery on consecutive days. Int J Sports 427"
Physiol Perf 2008;3:454–468. 428"
25. Higgins T, Naughton GA, Burgess D. Effects of wearing compression garments on 429"
physiological and performance measures in a simulated game-specific circuit for 430"
netball. J Sci Med Sport 2009;12:223–226. 431"
26. Hill JA, Howatson G, van Someren K, et al. The variation in pressures exerted by 432"
commercially available compression garments. Sports Eng 2015;18:115–121. 433"
27. Jakeman JR, Byrne C, Eston RG. Lower limb compression garment improves recovery 434"
from exercise-induced muscle damage in young, active females. Eur J Appl Physiol 435"
2010;109:1137–1144. 436"
28. Kraemer WJ, French DN, Spiering BA. Compression in the treatment of acute muscle 437"
injuries in sport: review article. Int Sport Med J 2004;5:200–208. 438"
439"
440"
FIGURE LEGENDS 441"
Figure 1. Perceived ratings of global lower limb soreness (A) and quadriceps soreness (B) 442"
for the LOW, HI and SHAM treatment groups. Values are presented as mean ± SD. No 443"
significant differences were observed between treatment groups. ⱡ denotes significant time 444"
effect compared to baseline. 445"
446"
Figure 2. Percentage change in MVC for the LOW, HI and SHAM treatment groups. The HI 447"
compression group was significantly different from the SHAM treatment group. Values are 448"
presented as mean ± SD, data was recorded in newtons and converted to a percentage change. 449"
* denotes a significant difference from the HI group. ⱡ denotes significant time effect 450"
compared to baseline. 451"
452"
Figure 3. Percentage change in CMJ for the LOW, HI and SHAM treatment groups. The HI 453"
compression group was significantly different from the LOW compression group at 24 h post 454"
exercise. Values are presented as mean ± SD. * denotes a significant difference from HI 455"
group. ⱡ denotes significant time effect compared to baseline. α denotes significant 456"
interaction between HI and LOW compression groups. 457"

458"
Table 1. Participant characteristics for the low compression pressure group (LOW), high 459"
compression pressure group (HI) and sham ultrasound treatment group (SHAM). Values are 460"
presented as mean ± SD. 461"
462"
Table 2. Effect sizes ± 90% CI of the application of treatment on markers of exercise-induced 463"
muscle damage. 464"
465"
Table 3. Plasma markers of CK, MB and CRP for the LOW, HI and SHAM treatment 466"
groups. No significant differences were observed between treatment groups. Values are 467"
presented as mean ± SD. * denotes significant time effect was observed. 468"
469"

Table 1. Participant characteristics for the low compression pressure group (LOW), high compression pressure 470"
group (HI) and sham ultrasound treatment group (SHAM). Values are presented as mean ± SD. 471"
Age (yrs)
Height (cm)
Weight (kg)
LOW
29.2±4.7
173.6±11.7
73.3±17
HI
32.7±7.8
175±7.4
71.7±7.2
SHAM
28.3±4.1
174.1±9.4
71.7±10.2
"472"
" "473"

Table 2. Effect sizes ± 90% CI of the application of treatment on markers of exercise-induced 474"
muscle damage. 475"
476"
Post
24 h
48 h
72 h
Change from baseline
Global soreness
LOW v SHAM
HI v SHAM
LOW v HI
-0.12±15.7
0.41±10.9a
-0.47±13.6 a
-0.12±15.9
0.36±15.1a
-0.48±15.2a
0.35±18.8a
0.55±17.2b
-0.17±16.9
0.31±14.3a
0.45±12.8a
-0.11±11.9
Quadriceps soreness
LOW v SHAM
HI v SHAM
LOW v HI
0.14±15.2
0.32±13.0a
-0.18±11.5
-0.28±18.0a
0.39±16.7a
-0.74±15.6b
0.09±18.6
0.47±19.2a
-0.38±19.1a
0.03±16.3
0.26±15.6a
-0.27±14.9a
MVC
LOW v SHAM
HI v SHAM
LOW v HI
-0.02±3.8
-0.36±3.3a
0.35±3.2a
-0.33±3.7a
-0.80±3.7c
0.53±3.3b
-0.40±3.5a
-0.92±3.9c
0.61±3.6b
0.06±4.4
-0.88±4.0c
0.86±4.4c
CMJ
LOW v SHAM
HI v SHAM
LOW v HI
0.25±4.2a
0.10±3.5
-0.17±4.0
0.60±4.2b
-0.93±3.6c
-1.30±4.5c
0.86±4.0c
-0.01±4.2
-0.99±3.4c
0.62±3.3b
-0.38±3.2a
-1.09±3.0c
CK
LOW v SHAM
HI v SHAM
LOW v HI
-0.46±173.7a
-0.73±85.4b
-0.09±190.7
-0.51±99.0b
-0.27±119.2a
-0.13±145.8
-0.18±64.8
-0.14±125.4
0.05±122.6
-0.79±75.0b
0.12±153.6
0.50±155.1b
Mb
LOW v SHAM
HI v SHAM
LOW v HI
0.22±75.7a
-0.08±92.6
0.08±84.3
-0.47±96.0a
-0.26±111.2a
-0.15±101.1
-0.03±113.2
0.01±140.6
-0.03±111.8
-0.73±93.1b
-0.64±108.5b
0.01±113.0
CRP
LOW v SHAM
HI v SHAM
LOW v HI
0.06±0.5
-0.13±0.5
0.22±0.4
0.23±0.5
0.36±0.5
-0.09±0.5
0.14±0.5
0.11±0.4
0.04±0.5
0.10±0.5
0.02±0.5
0.07±0.5
477"
Mean effect refers to the first names group minus the second named group, a indicates a small effect 478"
size, b indicates a medium effect size, c indicates a large effect size. 479"
480"

Table 3. Plasma markers of CK, MB and CRP for the LOW, HI and SHAM treatment groups. Values are 481"
presented as mean ± SD. 482"
Pre
Post
24 h
48 h
72 h
CK (IU.L-1)
LOW
HI
SHAM
184.3±152.3
207.7±218.6
217±298.5
418.9±722.3
401.6±333.4
258.2±332.9
368±440.7
345.7±371.4
277.3±326.4
280±259.8
318.8±355.3
284.9±355.4
168.5±82.5
380.9±438.4
345.1±579.7
Mb (ng.ml-1)
LOW
HI
SHAM
434.3±107.0
458±182.2
490.4±88.5
489.8±186.1
571.5±155.7
585.8±180
534.1±204.8
519.7±145.7
480±170.2
439.5±155.3
454.8±261.9
487.7±158.8
504.1±194.7
566.7±159
429.7±128.3
CRP (pg.mL-1)
LOW
HI
SHAM
2.5±0.7
2.6±0.7
2.3±0.5
2.3±0.8
2.5±0.9
2.2±0.8
2.4±1.0
2.3±0.6
2.5±0.9
2.2±1.0
2.3±0.9
2.1±1.0
2.3±0.9
2.4±1.1
2.3±1.0
483"
484"

485"
486"

487"
488"
489"

490"
491"