International Journal of Sports Physiology and Performance, 2014, 9, 256  -264

http://dx.doi.org/10.1123/IJSPP.2013-0126
© 2014 Human Kinetics, Inc.
www.IJSPP-Journal.com
ORIGINAL INVESTIGATION

Effect of Wearing Compression Stockings on Recovery

After Mild Exercise-Induced Muscle Damage
François Bieuzen, Jeanick Brisswalter, Christopher Easthope,
Fabrice Vercruyssen, Thierry Bernard, and Christophe Hausswirth

Background: Compression garments are increasingly popular in long-distance running events where they are
used to limit cumulative fatigue and symptoms associated with mild exercise-induced muscle damage (EIMD).
However, the effective benefits remain unclear. Objective: This study examined the effect of wearing com-
pression stockings (CS) on EIMD indicators. Compression was applied during or after simulated trail races
performed at competition pace in experienced off-road runners. Methods: Eleven highly trained male runners
participated in 3 simulated trail races (15.6 km: uphill section 6.6 km, average gradient 13%, and downhill
section 9.0 km, average gradient –9%) in a randomized crossover trial. The effect of wearing CS while running
or during recovery was tested and compared with a control condition (ie, run and recovery without CS; non-
CS). Indicators of muscle function, muscle damage (creatine kinase; CK), inflammation (interleukin-6; IL-6),
and perceived muscle soreness were recorded at baseline (1 h before warm-up) and 1, 24, and 48 h after the
run. Results: Perceived muscle soreness was likely to be lower when participants wore CS during trail running
compared with the control condition (1 h postrun, 82% chance; 24 h postrun, 80% chance). A likely or pos-
sibly beneficial effect of wearing CS during running was also found for isometric peak torque at 1 h postrun
(70% chance) and 24 h postrun (60% chance) and throughout the recovery period on countermovement jump,
compared with non-CS. Possible, trivial, or unclear differences were observed for CK and IL-6 between all
conditions. Conclusion: Wearing CS during simulated trail races mainly affects perceived leg soreness and
muscle function. These benefits are visible very shortly after the start of the recovery period.

Keywords: muscle soreness, perceived recovery, fatigue, performance

Trail-running events have become increasingly popu-
lar over the past 5 years.1 Trail runs are commonly defined
as long-duration events in mountainous terrain, alternat-
ing uphill and downhill sections. The physiological and
mechanical stresses experienced by runners are similar
to those experienced with other running events such as
flat marathon running, but some effects may be increased.
Indeed, trail running leads to greater exercise-induced
muscle damage (EIMD) because of the repeated eccentric
contractions performed during the downhill portions of
the race.2–5 EIMD is characterized by an increased release
of muscle enzymes into the plasma6 and a substantially
Bieuzen and Hausswirth are with the Laboratory of Sport,
Expertise and Performance, National Inst of Sport (INSEP),
Paris, France. Brisswalter and Easthope are with the Laboratory
of Human Motricity, Sport, Education and Health, University of
Nice Sophia Antipolis, Nice, France. Vercruyssen and Bernard
are with the Laboratory of Human Motricity, Sport, Education
and Health, University of South France Toulon-Var, Toulon,
France.
impaired maximal-force-generation capacity.2,3,6 These
mechanical and physiological changes occur from the
start of the exercise and persist for a few days after.6 The
popularity of this activity has led to increasing numbers
of athletes participating in trail events, during which they
must complete a race per day for 2 or more consecu-
tive days.7–10 Thus, it appears essential to use recovery
strategies that allow athletes to train or compete at their
maximal performance capacity.
Among the most commonly used recovery modali-
ties, many are used after the effort, including massage,11
water immersion,12 or compression garments.13 In recent
years, an increasing number of athletes have chosen to
wear compression garments both during and after trail
running as part of recovery.14,15 Athletes and coaches
expect this to provide benefits, but to date few data have
demonstrated a true positive effect of compression gar-
ments on physiological and performance variables.15
Wearing compression garments during exercise is thought
to decrease EIMD, mainly by reducing tissue vibrations
during exercise.16 Wearing compression garments during
recovery, on the other hand, could help clear myocellular
proteins and inflammatory mediators from the injured

256

area17 and/or reduce perceived pain.18,19 However, in a
recent review of over 20 studies on this topic, MacRae et
al15 indicated that fewer than 20% of those studies13,20,21
measured the effect of this recovery modality in field
conditions. Thus, in most studies EIMD was induced by
a laboratory protocol not accurately reflecting the reality
of sporting events.
Therefore, we devised the current study to examine
the effect of wearing compression stockings (CS) on
indices of EIMD in a trail-running context. CS were worn
either during or after a trail run performed at competi-
tion pace by experienced off-road runners. Considering
the specificity of our running task, we hypothesized that
wearing CS during running or during recovery could limit
the increase in indicators of mild EIMD (ie, perceived
pain, muscle damage, inflammation, and reduced muscle
strength and power).
Methods
Eleven highly trained male runners (age 34.7 ± 9.8 y, body
mass 72.3 ± 6.8 kg, maximal oxygen uptake 60.1 ± 6.5
mL · min–1 · kg–1; mean ± SD) participated in this study.
Participants were recruited through classified advertise-
ments on Web sites specialized in trail running. Inclusion
criteria included a minimum of 2 years of trail-racing
experience and a training volume of 40 to 100 km/wk
(mean 60 ± 20 km/wk) in the 3 months preceding initial
testing. The participants were all familiarized with the
laboratory testing procedures to be used. The experi-
mental protocol was conducted according to the Hel-
sinki statement and had been approved by a local ethics
committee (CCP XI, France—Ref 10 028). All subjects
signed informed-consent forms before participation in
this study. From 2 days before to 2 days after each trial,
all participants adhered to a predefined dietary protocol
and refrained from strenuous exercise.
Overview
Each athlete completed 5 testing sessions separated by
rest periods of 1 week. During the first session, sub-
jects performed a leg-dominance test22 followed by an
incremental test to determine maximal oxygen uptake
(VO2max). In their second session, they performed knee-
extension 1-repetition maximum and maximal coun-
termovement jump (CMJ) tests. In their third to fifth
sessions, subjects performed 3 simulated trail races in
a randomized crossover trial and were monitored over a
48-hour recovery period. During each of these 3 sessions,
the effect of wearing CS during the run or during the
recovery period was tested as follows: run and recovery
without CS (control condition; non-CS), run with CS and
recovery without compression (CS run), and run without
CS and recovery with compression (CS recovery). Before
and 1, 24, and 48 hours after each simulated trail race,
isometric maximal voluntary contraction (MVC) of the
knee extensors and a CMJ were measured without CS.
Compression Stockings and Recovery   257
Blood samples were obtained, and perceived muscle pain
was measured at the same times.
Determining VO2max
Participants performed an incremental exercise test to
exhaustion on a motorized treadmill. Pulmonary gas-
exchange samples were collected breath by breath and
averaged for every 10-second period using a metabolic
measurement system (Oxycon Alpha, Jaeger, Wuerzberg,
Germany). Heart-rate (HR) data were recorded using an
RS800CX (Polar, Kempele, Finland). After a 6-minute
warm-up at 10 km/h, the treadmill speed was increased
by 1 km/h every 2 minutes (with a 4% grade). Maximal
HR (HRmax) and VO2max were determined as the high-
est 30-second mean, fulfilling the classical criteria of a
respiratory equivalent greater than 1.1, HR greater than
90% of the age-predicted maximum, and a VO2 plateau,
despite an increase in mechanical intensity.23
Simulated Trail Races
To familiarize the participants with the experimental
outdoor sessions, 2 practice runs at race pace in condi-
tions close to the race context were completed 2 to 4
weeks before the experimental sessions. The simulated
trail race consisted of 3 laps of 5.2 km (total distance:
15.6 km) in mountainous terrain. Each lap was composed
of a climbing segment (2200 m, average gradient 13%)
followed by a downhill segment (3000 m, average gradi-
ent –9%). Athletes were equipped with an RS800CX G3
to monitor their HR. The weather was also monitored
during each session. At the end of the race, rating of
perceived exertion was assessed using the Borg 6- to
20-point scale.24 Immediately after the end of the run,
athletes engaged in the CS recovery condition donned
CS. During the first run, subjects consumed carbohydrates
(CHO) in the form of a gel (Maxim Sports Nutrition, 2
per runner) and energy drinks (Maxim Sports Nutrition;
6% CHO, 600 mL water). A CHO intake of 25 g per gel
pouch was assumed, while fluid intake was measured
by weighing the bottle after the first simulated trail race
on an electronic scale. The CHO and fluid intake were
replicated for each participant during the second and third
simulated trail races.
Elastic Compression
For the CS run condition, the gastrocnemius muscle was
compressed using an elastic compression sleeve during
running (constant pressure of 25 mmHg, 94% polyamide
and 6% elasthane; Pulse Road, Sigvaris, Saint-Just-Saint-
Rambert, France). The compression sleeve extended
from below the knee to the lateral malleolus. For the
CS recovery condition, an elastic CS was used during
recovery (constant pressure of 20 mmHg, elasthane,
polyamide, cotton, and wool; Sigvaris Recovery, Sigvaris,
Saint-Just-Saint-Rambert, France). Compression was
applied to both calves. CS were individually fitted for
258  Bieuzen et al
standardized compression, based on the manufacturer’s
recommendations.
Outcome Measures
All outcome measures were recorded at baseline (1 h
before warm-up before running) and 1, 24, and 48 hours
after each simulated trail race in the following order:
postexercise pain, blood collection, vertical-jump testing,
and knee-extension MVC.
Postexercise Pain
Immediate- and delayed-onset perceived soreness were
assessed using a visual analog scale during the perfor-
mance of a standardized half-squat to ensure a standard
reference. The scale we used in this investigation con-
sisted of a 10-cm line with written descriptors placed at
both the extremes. Beginning at the extreme left and fin-
ishing at the extreme right, the descriptors read 0 normal
to 10 extremely sore.25 We gave the subjects standard
instructions on how to complete the scale before each
measurement. The subjects placed an X at the point on
the line that best described their pain. We measured the
intersecting center point of the X to the nearest 0.1 cm.
Blood Sampling and Processing
Biological markers were measured in plasma prepared
from blood samples collected in 2 lithium heparin tubes
and centrifuged for 10 minutes (10,000 rpm). Plasma
samples were aliquotted and frozen at –80°C before
analysis. Plasma creatine kinase (CK) concentrations
were determined using a Hitachi 911 automated clinical
chemistry analyzer (Roche Diagnostics Corp, India-
napolis, IN, USA) and commercially available reagents
(Roche Diagnostics Corp). Interleukin-6 (IL-6) levels
were determined using enzyme-linked immunoassay
kits (ELISA kit Quantikine HS600, R&D System, Min-
neapolis, MN, USA). The sensitivity limit for the method
was 0.039 pg/mL.
Vertical-Jump Testing
Jumping performance was evaluated using a contact
map26 (Ergojump Bosco System, Junghans GMBH,
Schramberg, Germany). For the CMJ, subjects were posi-
tioned on the Bosco apparatus in a standing position and,
before jumping, countermoved until the knee was flexed
to approximately 90°. Three jumps were performed, with
2-minute resting periods between jumps to avoid fatigue.
The best result was retained for analysis in each case.
MVC
For MVC testing, subjects were securely strapped to the
seat of an isokinetic dynamometer (Biodex System 3,
Shirley, NY, USA), with the knee-joint angle of the right
leg set at 90° (full leg extension = 0°). The axis of the
knee joint was carefully aligned with the rotational axis
of the dynamometer, and all settings were recorded and
maintained constant over all testing sessions. Subjects
warmed up on the isokinetic dynamometer by repeating
22 submaximal (50% MVC) isometric contractions. They
were then instructed to “attempt to extend the knee as
hard and fast as possible” for the three 5-second MVC
measurements (55-s rest between attempts) while stan-
dardized verbal encouragement was given. The highest
MVC value measured from the 3 attempts was used for
analysis.
Statistical Analysis
For statistical analysis, physiological data were log-
transformed to reduce bias arising from nonuniformity
errors. Data were analyzed for practical significance
using magnitude-based inferences.27 All qualitative
analyses were conducted using a modified statistical
spreadsheet.28 We used this qualitative approach because
traditional statistical approaches often miss the magni-
tude of an effect, which is typically more relevant to
therapeutic prescription than a statistically significant
effect. Between-trials standardized differences or effect
sizes (ES, 90% confidence interval [CI]) were calculated
using the pooled standard deviation.29 Threshold values
for Cohen ES statistics were >.2 (small), >.5 (moderate),
and >.8 (large). For between-trials comparisons, prob-
abilities were calculated to establish whether the true
(unknown) differences were lower than, similar to, or
higher than the smallest worthwhile difference or change
(0.2 multiplied by the between-subjects SD, based on the
Cohen ES principle).29 Quantitative chances of higher or
lower differences were qualitatively ranked as follows:
<1%, almost certainly not; 1% to 5%, very unlikely; 5%
to 25%, unlikely; 25% to 75%, possible; 75% to 95%,
likely; 95% to 99%, very likely; >99%, almost certain. If
the chance of higher or lower differences was <5%, the
true difference was assessed as unclear. Otherwise, we
interpreted that change as the observed chance.27 Data
are presented as mean ± SD, unless otherwise stated.
Results
There were no clear differences in the average finishing
time (non-CS, 5590 ± 393 s; CS run, 5704 ± 560 s; CS
recovery, 5684 ± 437 s), final rating of perceived exer-
tion (non-CS, 17 ± 2; CS run, 16 ± 3; CS recovery, 19 ±
1), or mean running intensity as a percentage of HRmax
(non-CS, 92% ± 6%; CS run, 95% ± 2%; CS recovery,
94% ± 2%) between conditions. Weather conditions
were stable throughout tests, with ambient temperatures
ranging from 20°C to 24°C (south of France) during the
running sessions.
Immediate- and Delayed-Onset Muscle
Soreness
The mean changes between trials in terms of perceived
leg soreness are displayed in Figure 1. Perceived immedi-

Figure 1 — Between-trials changes (Cohen d or effect size) in perceived muscle soreness at 1 hour, 24 hours, and 48 hours post-
run. Gray circles around the plot highlight likely (75–95%) differences in changes in delayed-onset muscle soreness in the given
between-trials comparison. Abbreviations: CS, compression stockings.
ate- (ie, 1 h postrun) and delayed- (ie, 24 h postrun) onset
muscle soreness were likely to be lower with the CS run
trial (1 h postrun, 3.6 ± 2.1 [1/17/82%]; 24 h postrun,
3.3± 2.3 [2/18/80%]), while the standardized difference
was considered small and unclear with CS recovery (1 h
postrun, 5.0 ± 1.9 [55/30/15%]; 24 h postrun, 4.2 ± 1.9
[46/41/13%]) compared with the non-CS trial (1 h post-
run, 4.8 ± 2.6; 24 h postrun, 4.1 ± 1.9). The difference
between CS run and CS recovery at 1 hour and 24 hours
postrun was likely to be beneficial in favor of CS run;
the standardized difference was considered moderate (1
h postrun, 85/12/3%; 24 h postrun, 82/14/4%). No clear
differences between the 3 conditions were found at 48
hours postrun.
Muscle Function: MVC and CMJ
MVC was likely to be lower than prerun at 1 hour postrun
and was possibly lower at 24 hours postrun in the CS
run compared with non-CS. The standardized difference
was considered small in this case (Table 1). In contrast,
no clear differences were observed in CMJ relative to
baseline values between these 2 conditions at 1 hour and
24 hours postrun. At 48 hours postrun, on the other hand,
a very likely beneficial effect of CS run, compared with
non-CS, was observed with a large standardized differ-
ence. When CS recovery was compared with non-CS,
the change in MVC was likely to be lower at 24 hours
postrun, while the change in CMJ was likely, possibly,
and very likely beneficial with CS recovery at 1 hour, 24
hours, and 48 hours postrun, respectively (ES consid-
ered small to moderate). At 48 hours postrun, a possible
Compression Stockings and Recovery   259
beneficial effect of CS run compared with CS recovery
was observed on MVC and CMJ changes, with a small
standardized difference.
Indicators of Muscle Damage
and Inflammation
Except for CK at 24 hours postrun—which showed a
likely harmful effect with CS recovery compared with
non-CS and a moderate standardized difference—only
possible, trivial, or unclear differences were observed for
the plasma biomarkers of muscle damage and inflamma-
tion CK and IL-6 (Table 2).
Discussion
The results presented here provide new evidence that
wearing CS during running can immediately benefit
muscle recovery, as inferred from MVC and CMJ. How-
ever, no effect on CK and IL-6 levels was observed.
Runners may also derive minor benefits from wearing
CS during the recovery period.
Perceived Muscle Soreness
Immediately and up to 48 hours after running, subjects
reported significant muscle soreness, suggesting the pres-
ence of delayed-onset muscle soreness as a result of mild
EIMD. The results presented here suggest that wearing
CS during exercise has a small to moderate standardized
effect on perceived pain, with reduced soreness­of the leg
260
Table 1 Between-Trials Comparisons of Changes in Maximal Voluntary Contraction and Countermovement Jump Compared With Pretrial
Measurements, Mean ± SD
Time Postrun, Maximal Voluntary Contraction (N/m) Time Postrun, Countermovement Jump (cm)
1h 24 h 48 h 1h 24 h 48 h
Non-CS –22.2 ± 16.7 –16.7 ± 20.1 –3.4 ± 22.3 –2.2 ± 5.0 –6.5 ± 5.1 –8.5 ± 5.3
CS run –8.2 ± 22.2 –3.3 ± 23.7 3.7 ± 27.8 –1.4 ± 3.3 –3.7 ± 3.6 –2.9 ± 3.7
CS recovery –18.3 ± 32.3 0.3 ± 19.5 –9.1 ± 29.5 0.6 ± 4.4 –4.4 ± 2.6 –4.7 ± 2.6
CS run vs non-CS
difference in means (90% CL) 14.0 (–1.6; 29.6) 13.4 (–6.4; 33.2) 7.1 (–13.2; 27.4) 0.8 (–1.7; 3.3) 2.8 (–0.9; 6.4) 5.6 (1.8; 9.4)
effect size (rating) 0.29 (small) 0.26 (small) 0.14 (trivial) 0.09 (trivial) 0.31 (small) 0.86 (large)
% chances for CS run values to be 70/29/1 60/37/3 39/53/8 27/66/7 64/30/7 97/3/0
higher/trivial/lower than non-CS
rating CS run vs non-CS Likely beneficial Possibly beneficial Unclear Unclear Unclear Very likely beneficial
CS recovery vs non-CS
difference in means (90% CL) 3.9 (–10.4; 18.2) 17.0 (1.0; 33.0) –5.7 (–28.5; 17.1) 2.9 (–0.2; 5.9) 2.0 (–0.3; 4.4) 3.8 (1.4; 6.2)
effect size (rating) 0.12 (trivial) 0.35 (small) –0.08 (trivial) 0.43 (small) 0.25 (small) 0.62 (moderate)
% chances for CS recovery values to be 33/66/6 77/22/1 11/58/31 80/18/2 58/39/3 96/4/0
higher/trivial/lower than non-CS
Rating CS recovery vs non-CS Unclear Likely beneficial Unclear Likely beneficial Possibly beneficial Very likely beneficial
CS run vs CS recovery
difference in means (90% CL) 10.1 (–10.8; 31.0) –3.6 (–19.9; 12.7) 12.8 (–3.9; 29.5) –2.1 (–3.5; –0.6) 0.7 (–1.8; 3.2) 1.8 (–0.7; 4.2)
effect size (rating) 0.16 (trivial) –0.11 (trivial) 0.22 (small) –0.35 (small) 0.11 (trivial) 0.35 (small)
% chances for CS run values to be 42/51/7 6/62/32 54/44/2 0/17/83 38/46/16 70/26/4
higher/trivial/lower than CS recovery
Rating CS run vs CS recovery Unclear Unclear Possibly beneficial Likely harmful Unclear Possibly beneficial
Abbreviations: CS, compression stockings.
 Table 2 Between-Trials Comparisons of Creatine Kinase and Interleukin-6 Levels, Difference From Pretrial Levels, Mean ± SD
Time Postrun, Creatine Kinase (U/L) Time Postrun, Interleukin-6 (μg/L)
1h 24 h 48 h 1h 24 h 48 h
Non-CS 81 ± 29 157 ± 86 79 ± 45 5.56 ± 2.54 –0.10 ± 0.33 –0.03 ± 0.38
CS run 99 ± 61 275 ± 305 72 ± 57 5.56 ± 2.81 –0.01 ± 0.23 –0.09 ± 0.48
CS recovery 91 ± 42 203 ± 122 94 ± 62 5.76 ± 1.85 –0.08 ± 0.13 –0.04 ± 0.18
CS run vs non-CS
difference in means (90% CL) 18.8 (–8.7; 46.4) 118.9 (–29.6; 267.4) –6.5 (–44.3; 31.2) 0.00 (–1.90; 1.90) 0.09 (–0.04; 0.22) –0.06 (–0.42; 0.30)
effect size (rating) –0.03 (trivial) 0.21 (small) –0.18 (trivial) –0.31 (small) 0.21 (small) –0.09 (trivial)
% chances for CS run values to be 1/96/3 51/40/9 7/46/47 20/23/57 52/45/3 26/34/40
higher/trivial/lower than non-CS
rating CS run vs non-CS Trivial Unclear Unclear Unclear Possibly harmful Unclear
CS recovery vs non-CS
difference in means (90% CL) 10.4 (–6.9; 27.6) 46.0 (–9.8; 101.8) 14.6 (–19.7; 49.0) 0.20 (–1.33; 1.74) 0.01 (–0.20; 0.23) –0.01 (–0.23; 0.21)
effect size (rating) 0.24 (small) 0.56 (moderate) 0.33 (small) 0.22 (small) 0.01 (trivial) –0.22 (small)
% chances for CS recovery values to be 58/39/2 85/13/2 66/28/6 52/30/18 29/44/27 14/34/52
higher/trivial/lower than non-CS
Rating CS recovery vs non-CS Possibly harmful Likely harmful Unclear Unclear Unclear Unclear
CS run vs CS recovery
difference in means (90% CL) 8.5 (–9.9; 26.8) 72.9 (–52.5; 198.3) –21.2 (–62.1; 19.8) –0.20 (–1.94; 1.53) 0.08 (–0.10; 0.26) –0.05 (–0.38; 0.28)
effect size (rating) –0.18 (trivial) –0.15 (trivial) –0.38 (small) –0.56 (moderate) 0.22 (small) 0.12 (trivial)
% chances for CS run values to be 2/54/44 12/45/43 3/23/74 7/16/77 53/39/8 43/32/25
higher/trivial/lower than CS recovery
Rating CS run vs CS recovery Trivial Unclear Possibly harmful Unclear Unclear Unclear
Abbreviations: CS, compression stockings.

261
262  Bieuzen et al
muscles from the end of exercise. This result contrasts
with those reported in other field studies involving flat
running. For example, immediately after a flat road run
(10-km road running or 40-min running at 80% VO2max),
Ali et al20 showed no beneficial effect of wearing gradu-
ated compression garments. This difference could be
related to the specificity of muscle soreness induced
by trail running. During trail running, specific muscle
contractions are induced due to the need for strong con-
centric contractions during uphill portions and dominant
eccentric movements during downhill portions of the
course. This might result in more extensive muscle oscil-
lations and greater variations in physiological responses,
particularly with repeated downhill portions.4 In another
study, Friesenbichler et al16 showed that with fatigue,
the soft tissue of the triceps surae oscillated from an
extended duration at an increased vibrational magnitude
in trail conditions. Thus, CS could have a greater impact
in trail running than in flat running due to reduced tissue
oscillations.
The advantage of wearing CS during recovery
remains unclear in the literature. Some studies have indi-
cated a positive effect,19–21,30,31 whereas others failed to
show any effect.32,33 Our results are consistent with this
lack of effect, indicating no benefits on muscle soreness
from lower-limb compression during recovery, even
though the compressive properties of the garment could
reduce edema after EIMD.32,33
Muscle Function
Our results show a decrease in muscle function after a
simulated trail race, suggesting the appearance of fatigue,
but that this can be partially counteracted by wearing CS.
This is the first time a likely beneficial effect has been
reported for wearing CS in an outdoor running context.
The effect is observed on isometric peak torque and MVC
at 1 hour postrun (effect size considered small) and 24
hours postrun, and for all recovery periods on CMJ (very
likely beneficial effect, ES considered large). Mixed
findings have been reported in the literature, but mostly
no demonstrable difference from control conditions was
reported with short-duration exercises (ie, resistance or
repeated-sprint exercises) performed in laboratory condi-
tions.30–32 As with leg soreness, we believe that athletes
may have experienced reduced muscle oscillation34 and/
or reduced mechanical stress35 when wearing CS during
trials. This could also explain the CMJ result observed
for the CS run group at 48 hours postrun. Jakeman et al19
reported similar results in laboratory conditions after 10 ×
10 plyometric drop jumps. Those authors suggested that
using compression garments immediately after exercise
could limit the detrimental consequences of moderate
EIMD by stabilizing muscle-fiber alignment. Indeed, it
has been suggested that membrane damage after EIMD
leads to a failure to contract as a result of damage to
contractile components of the sarcomere and disruption
of the excitation–contraction coupling relationship.36
Jakeman et al19 therefore hypothesized that improved
recovery of the membrane structure could speed the
recovery of contractile force and the excitation–contrac-
tion coupling processes, which would be seen through a
reduced decrease in muscle performance. Their results
and the results presented here support this hypothesis.
Indicators of Muscle Damage
and Inflammation
In line with 2 previously published studies,13,21 we
observed no benefits of wearing CS on indirect indices of
muscle damage (CK) or inflammation (IL-6). Although
these markers are widely used to identify EIMD,6 they
show a high interindividual and intraindividual variabil-
ity, which reduces the accuracy with which they gauge
the magnitude of muscle damage.6,37 Therefore, in this
article we used CK and IL-6 as indicators of damage to
categorize the level of EIMD; in this case it was mild (ie,
small reduction in force-generating capacity [<20%], CK
activity lower than 1000 IU/L, and recovery completed
within 48 h after exercise).6 However, this protocol may
not have been sufficiently damaging to be affected by
the different experimental conditions. Future work with
exercise protocols inducing moderate or severe EIMD
will be necessary to determine how this treatment affects
longer-term recovery.
Conclusion
Experienced off-road runners can benefit from wear-
ing CS during a simulated trail race, due to improved
postexercise recovery. However, a placebo effect cannot
be excluded, as the current study did not include a pla-
cebo condition.
The benefits observed are mainly on perceived leg
soreness and muscle function and are visible rapidly, from
the start of the recovery period. No benefits were observed
on indirect blood markers of muscle damage or inflam-
mation. Finally, runners slightly improve their muscle
function by wearing CS during the recovery period.
Practical Implications
• Wearing CS during running accelerates recovery of
muscle function recovery as soon as the end of the
exercise.
• Wearing CS during exercise leads to benefits in terms
of perceived muscle soreness.
• The use of CS should be recommended during run-
ning sessions potentially inducing muscle damage,
as they can improve recovery.
Acknowledgments
This study was funded by Sigvaris Sports (Saint-Just-Saint-
Rambert, France), who provided the compression stockings

used in the experiment. The funders had no role in study design,
data collection and analysis, decision to publish, or preparation
of the manuscript.
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