The Circulatory System and Venous Insufficiency
The circulatory system comprises of the heart, arteries, veins and capillaries. Arteries carry blood away from the heart to body tissue (organs, skin, muscles etc.). Oxygen passes from the circulatory system to body tissue via capillaries.
Waste products from body tissue (such as lactic acid) simultaneously passes back into capillaries and then back to the heart via the venous (vein) system.
While both are classified as blood vessels, arteries and veins have a very different composition. Arteries are tough muscular tubes which contract (pulsate) and can push blood along the circulatory system. Veins, on the other hand, are thin and do not pulsate. They rely on muscle contraction, an internal one-way valvular system and gravity to get blood back to the heart.
Veins that return blood from the peripheries (e.g., calf, arm) therefore have to work extra hard against gravity, putting pressure on the valves.
If our muscle groups (particularly in the calves) are unable to support the venous system, back flow occurs with increased pressure damaging the one-way valve system. This can ultimately make the valves incompetent leading to varicose veins and venous insufficiency.
Long standing venous insufficiency often leads to swelling in the limbs and skin breakdown.
High back flow pressure is not the only reason why veins fail. There are a host of other medical conditions that can produce the same negative outcome as venous insufficiency.
Compression garments, aim to aid and mimic muscular contraction, assisting veins in the return of blood back to the heart from our extremities. They can be useful adjuncts to enhance our athletic performance and recovery, whether that be a morning walk or when playing sport. They can also be used in the treatment of various medical conditions under the supervision of your doctor. With lots of options available, finding the correct garment to suit your needs can be a challenge. It is, however, important if maximal benefits are to be obtained.
This LBSM Compression Garment Guide has been designed to make it easy for you to select the correct garment to suit your medical, fitness or performance needs. We have selected some of the best, tried and tested products that have been backed by scientific and medical research. All of our garments are prescribed by our doctors and have been used by our patients. Some of these products are also used at elite level in sport and are highly recommended.
Why do I need a compression garment?
There are 5 main reasons to wear a compression garment:
Performance benefit. Users are looking to enhance their speed and endurance whilst keeping fit or playing sport.
Recovery benefit. Users are looking to enhance their recovery after exercise to get back to sport quicker and even reduce the risk of injury.
Medical use and prescription. Users have been advised to wear a compression garment (usually prescribed to them) for certain medical conditions such as poor circulation, thrombosis, varicose veins and lymphoedema. They may also be used in the post-operative period to help recovery and/or prevent complications.
General support. Users wanting to have more support for their muscles, tendons and joints and reduce swelling.
Travel and Flight socks. Patients travelling wish to reduce swelling in their limbs whilst travelling and particularly when flying. Patients may also want to reduce the risk of developing deep vein thrombosis (DVT).
Compression garments, aim to aid and mimic muscular contraction, assisting veins in the return of blood back to the heart from our extremities.
What is science behind compression garments in sport performance?
There is a growing body of research that describes how compression garments are beneficial after exercise. There is also emerging evidence that describes how using compression garments during exercise can help improve individual performance. We have summarised the science behind compression garments in sport and performance. If you want to read more, feel free to click on the reference links to reach the original papers.
Benefits of wearing compression garments whilst exercising:
- Effects on the cardiovascular system
Compression garments improve blood flow back to the heart, otherwise known as “venous return”. This has potential to improve heart function and allow the heart to pump more efficiently.
- Boosts Strength and Power
Compression garments may increase muscular strength and power outputs due to an increased speed of recovery between bouts of effort and an increase in the overall time to muscle exhaustion. (Engal et al, 2016)
- Improving muscle endurance
Improvements in running economy, biomechanical variables, perception, and muscle temperature can improve endurance and reduce fatigability by optimising aerobic capacity (Brophy Williams et al, 2018, Engel et al., 2016)
- Improved support and Breathability
Compression shirts, leggings or socks provide you with more support, tactile sensation and comfort for when you train. This may help keep muscles warm and primed. Compression garments may feel tight but they are also breathable, which helps you to stay cool. (Mason et al, 2011)
- Improving running economy
There is evidence to suggest that compression garments may improve running economy by increasing proprioception, muscle coordination and propulsive force during running.
- Improved sensorimotor function and reaction times
Compression garments have been shown to improve the sensorimotor function of muscles, meaning that muscles have better feedback and responsiveness to various stimuli. This may enhance the reactivity of muscles and therefore reaction time.
Benefits of wearing compression garments after exercise:
- Aids recovery and reduces limb swelling
A study looking at elite athletes found that garment use can reduce swelling, which can be a cause of discomfort after exercise. Recovery may also be enhanced by the flushing of waste products, such as lactic acid and lymphatic waste (Lee DC et al, 2020).
- Muscle oscillation reduction
Impact exercise such as running creates force that transmits and oscillates in our body, including through tendon, muscles, bones and joints. Compression garments dampen down this vibration, preventing microdamage/tears in your soft and hard tissues. Reducing force transmission and vibration in muscle through compression garments have been shown to reduced fatigue and recovery time (Brophy Williams et al, 2018).
- Delays DOMS (Delayed onset of muscle soreness) and reduced inflammation.
Garments have been shown to improve delayed onset of muscle soreness after heavy work outs. Inflammatory markers associated with muscular damage (CRP, Creatine Kinase, Interlukin 6) can be raised after an intense work out. Studies have suggested that some of this inflammation can be reduced with use of compression therapy (Dupuy et al. 2018).
Are there any negative affects to using garments?
Even though there growing evidence promoting the use of compression garments, it is acknowledge that there may be an element of placebo or perceived benefit (Brownlee, 2022). Improvements in perceived fatigue may improve wellbeing, mental attitude and ultimately performance (Weakley, J, 2022). What is clear is that there hardly any risk with using grade 1 compression stockings for performance and recovery. Please note, that use of grade 2 stockings and above does require a medical consultation prior to prescription.
Feel free to discuss the risk and benefits of compression garments for your sporting and exercise needs with our team.
MEDICAL ALERT! IF YOU HAVE DIABETES AND/OR PERIPHERAL VASCULAR DISEASE, WE RECOMMEND SPEAKING TO A DOCTOR BEFORE WEARING A COMPRESSION GARMENT.
What medical conditions can be treated with compression garments?
Compression stockings are useful for treating conditions associated with poor vein drainage. These conditions include;
- Varicose veins
- Venous ulcers
- Venous eczema
- Deep or superficial vein thrombosis
- Post-thrombotic syndrome
- Lymphoedema (primary or secondary)
- Vascular malformations
Compression garments can also be used to help prevent some of the conditions listed above, particularly those patients with risk factors. If you are concerned about any of the conditions listed above, please get in contact with our team to discuss further.
What are the different types of compression garments?
Depending on your requirements, compression garments can vary hugely. Some of the main considerations when choosing a garment are;
- Graded vs Non-Graded Garments
Most sports compression garments and flight socks apply the same level of compression throughout the length of the garment and provide ‘light’ compression. This can often be enough for most people, particularly if they are quite active. However, some garments have a graded compression, meaning that compression is higher at the ankle/wrist, and decreases as you go up the leg/arm. A graded compression garment may be required to improve drainage of blood from the limb and improve muscle activity. This can be useful when non-graded garments are providing sub-optimal compression or there is a specific medical requirement.
We would strongly recommend speaking to a medical professional before purchasing and wearing any graded compression garments.
- Upper vs lower limb
Improving blood flow back from your arms and legs can help with performance and recovery. Arm compression garments have become more popular in recent years and have been shown to have benefits in sports that are both upper and/or lower body dominant e.g., tennis and running. Much of this decision may come down to user preference and choice. However, certain medical conditions may require a compression garment for a dedicated limb. Examples include in the treatment of lymphoedema or with varicose veins.
- One side vs both sides
Generally speaking it is better to wear a garment on both sides. This keeps compression symmetrical across the body. Exceptions may include arm garments which may only be relevant on one side (e.g., in a right-handed tennis player). On the other hand, graded compression garments need not always be worn on both sides and often can be just prescribed for one side only, depending on the medical requirement. Speak to your medical practitioner if you are unsure whether you should be wearing a garment on both sides.
- Above or below knee stockings
For lower limb stockings users have a choice of above or below knee stockings. For most uses in sport and exercise, thigh-length garments are acceptable and come in the form of ‘skins’. With tighter garments, below-knee compression garments are usually preferred as they allow more freedom at the knee joint. Thigh-length stockings should be considered if there is a specific medical requirement such as severe varicose veins above the knee, swelling which extends above the knee or following an operation.
- Open or closed toe
Open toe stockings provide the same medical compression that closed toe stockings do. Closed toe garments in the form of stockings are more user friendly and act as socks as well as garments. Open toe stockings may be necessary if the user:
- Has issues with their toes such as arthritis, clawing or fungal infection.
- Prefers to wear a separate sock over the compression stocking.
- Has a long foot size compared with their calf size.
- Has regular podiatry/chiropody appointments.
- Want more ventilation than closed toe compression socks, making them easier to wear in warmer and humid conditions.
What colour should I get?
Choosing the correct colour for your compression garment can be important. Some compression garments may need to be discreetly hidden and blend into everyday use e.g., under business attire and casual wear. On other occasions you may benefit from the garment standing out e.g., running at night-time.
We recommend keeping it simple and sticking your garment choice to white, black or one that matches your skin colour.
How much compression do I need in my garment?
This is one of the most frequent questions that garment users will ask. Put simply, the amount compression or support required by a garment will be determined by what the user is trying to achieve from wearing it. There may also be medical indications for high or lower graded compression stockings. To complicate matters, garment manufacturers also have varying compression standards and levels between their products.
Most non-graded garments will be light (Class 1 and below) and may provide enough compression for general use and in most sporting contexts. Graded garments (Class 2 and above) are usually prescribed when additional compression is required, after a medical consultation. This prescription could be for sporting and performance benefit and/or a treatment for a diagnosed medical condition.
How do we grade compression?
For leg compression garments we recommend using the British Standard for Class of Compression.
This is a manufacturing standard that companies need to conform to regarding yarns, labelling, product durability (wash / wear) and compression profile. The specification standardises and regulates the category as a medical compression garment. British Standard BS 6612:1985 and conforms to Drug Tariff Technical Specification No. 40 for the provision of Class I, II and III graduated compression.
The British standard measures the amount of compression at the ankle and translates into;
- Class I – Light (mild) support – 14–17mmHg compression at the ankle
- Class II – Medium (Moderate) support – 18–24mmHg compression at the ankle
- Class III – Strong support 25–35mmHg compression at the ankle
To find out type of garment you need what level of compression you need, please use our LBSM Compression Garment Flow Chart.
Are there any risks to wearing compression garments?
The main risk of any compression garment is that too much compression is applied and blood flow to limb is compromised. We recommend removing your stocking and talking to your doctor if you experience any pain or problems with your stocking as this may indicate an underlying condition.
Other risks of wearing compression garments include rashes, skin infections and skin breakdown (ulcers). We advise regular skin cream to be applied both morning and night before and after wearing your garments.
Although most of the shelf, non-graded compression garments will be safe to wear, we would always recommend speaking to a medical professional to discuss your requirements and choice of garment.
Are there any investigations I need to have before wearing a compression garment?
To help mitigate the risks described above, your doctor may do some investigation prior to advising/prescribing a compression garment. These investigations check your circulatory health and include;
- History and Examination. Your doctor will ask you about any potential risk factors you may have for poor circulation including family history, smoking and exercise patterns. They will also examine your pulses (arm and leg) to make sure they are strong and steady. A special blood pressure test may be required (ABPI) to better understand the numerical values of the pressures in your circulatory system. Your doctor will also check the condition of your skin to make sure they are suitable for compression stockings.
- Blood tests. Certain biomarkers may be checked to see if they indicate potential conditions that may lead to poor circulation, such as high cholesterol and diabetes.
- Scans. It may be necessary to order further investigation to assess your circulatory system. This is often done using an ultrasound machine but in rarer cases a dye test may be required.
How often do I need to wear compression garments?
This again largely depends on what the user is trying to achieve. General rules of thumb include;
- Garments worn to enhance performance and recovery can be used during warm up and exercise. They can also be worn for periods after exercise to enhance recovery.
- Travel and flight socks can be donned for at least 4 hours before and after a flight or travel episode.
- Compression stockings should be removed at bedtime. If this is not possible, they can be worn continuously for up to a maximum of 7 days.
- Having two pairs of stockings can be helpful when continuous use is needed to allow for washing and cleaning of the garment.
- Graded compression stockings should be replaced every 3–6 months as they use their effectiveness as they begin to loosen. Each time a stocking is replaced, the leg should be re-measured (if required). Our products have been specifically chosen for their durability.
Please feel free to contact our team if you have any questions around compression garments or your requirements.