It has been almost three years now since I last looked at the scientific literature surrounding compression/recovery boots (I will refer to them from here on out as compression boots). A few years ago, there was still very limited published research on this topic, and that research was very mixed at best and primarily consisted of relatively small studies with few participants. Essentially, I concluded that compression boots simply didn’t have the evidence to back them up as a worthwhile investment into one’s recovery. Besides, adequate sleep quantity and quality as well as good overall nutrition are really the key drivers to 99.9% of one’s recovery from training. So, even though there really weren’t any drawbacks or negatives to wearing compression boots as a recovery tool, I figured time and energy was better spent on good sleep and good nutrition. This is still true today and will always be true. Good sleep and good nutrition should always be the focus before introducing any sort of additional recovery tool or modality. Nothing makes up for a lack of good quality and quantity sleep and proper nutrition practices when it comes to recovery.
However, I am aware that there are many athletes out there, and coaches too, that are looking for that extra 0.01% to help accelerate their recovery and further improve their performance (assuming they are sleeping well and eating well). So, I will continue to keep up to date with various technologies and methods claiming to improve recovery in athletes as there is indeed an established market for them, and people do buy into that market. I figure, if at the very least I can help an athlete or coach decipher which evidence-based products to invest their limited time, energy, and money into, then I can feel better about the overall work I do as a Coach.
The concept of an intermittent compression-based boot or sleeve is not novel. These sorts of devices have been around for decades, and a few devices have FDA approval as a medical device to help some patients with cardiovascular disease (9). There is emerging evidence that these sorts of medical grade devices can also be useful in other clinical populations as well. However, it was more recently that these types of intermittent compression devices were being investigated for their potential benefits on recovery in athletes. It was in the early 1990’s that researchers first published on the potential utility of compression boots for recovery, and then about two decades later, more and more researchers began investigating this area and consumer-based compression boots started to flood the market.
Modern-day compression boots, however, are not cheap, with some of the top brands selling their boots anywhere between $500-$1000 depending on the company and the accessories you purchase with it. So, I think it is important to understand before making a purchase like that, do compression boots do what they claim to do, and do they help enhance recovery? Let’s look at the most current scientific literature on this topic and find out.
What does the updated science tell us?
As I mentioned previously, there has been a small body of research that has examined the effects of compression boots on recovery from strenuous exercise in both healthy adults and athletes. This research is very mixed, with some studies showing that there may be some small benefit to be had from wearing compression boots after strenuous exercise related to improved recovery of electrical activity of acutely fatigued muscles, quicker recovery of exercise capacity after a fatiguing exercise bout, accelerated recovery of hormonal indicators of stress, and accelerated reduction in inflammatory biomarkers post-exercise (3,7,8,10,11). However, on the other hand, there are a handful of studies as well demonstrating the opposite and that there is no net benefit of wearing compression boots post-exercise on indicators of recovery (2,4,5,6).
This past year in 2022, Blumkaitis and colleagues (1) published a study in which they had thirty healthy male adults perform a fatiguing exercise bout and then immediately either undergo a 30-min compression boot session, wear a compression garment on their legs for 30-min, or receive no treatment. Researchers were looking to see if there was any effect of the single compression boot treatment or compression garment treatment on muscle soreness, fatigue, blood markers of stress/fatigue, and plyometric jumping performance at 24- and 48-hours post-exercise. All study participants experienced muscle soreness and fatigue after the fatiguing exercise bout as expected, however the compression boot treatment and compression garment treatment groups experienced a lesser drop on plyometric jump performance at 24 and 48 hours when compared to the control group, indicating that these treatments had an impact on healthy adults’ recovery of elastic and neuromuscular qualities post-exercise. There were no other benefits seen for the treatment group. As with most of these studies around recovery boots, this study had an extremely small sample size not powered to detect true effectiveness.
Another recent study published in 2022 by Tally and colleagues (9) found somewhat similar results in that a compression treatment for three consecutive days following a fatiguing exercise bout has a positive impact on study participants’ ability to recover exercise capacity when compared to the control group. However, this study implemented a specific form of compression called ‘external counter pulsation’ in which three different compression cuffs are sequentially and rapidly inflated during diastole (i.e., relaxation of the heart muscle) and then rapidly deflated during systole (i.e., contraction of the heart muscle). This is a specific compression sequence that differs substantially from the typical compression pattern found in consumer-based recovery boots, so the findings of this study should not be translated directly over to more mainstream athletic recovery boots.
Altogether, despite more research slowly emerging in this area, the research still seems to be mixed at best and is still limited by very small sample size studies, which limits our ability to draw more firm conclusions as to compression boots’ true effectiveness. The placebo effect is something that also confounds research around recovery modalities post-exercise. Very often, individuals that believe a treatment is helping them recover will experience some measurable recovery benefit even if the modality or device is not eliciting a physiological response that would benefit recovery. In other words, if someone believes compression boots are going to help them recover better, they may experience some recovery benefit, not from the device itself, but from the belief in the device.
This is an important distinction to be made when it comes to any sort of intervention or treatment in the space of exercise training, recovery, and performance, as often the belief in something itself is more powerful than the device, modality, treatment, or intervention.
So what does this all mean?
I still believe that I am much of the same mindset that I was in about three years ago last time I looked at the existing research around compression boots: There is the potential for compression boots to have some physiological benefit on recovery from hard exercise or training, however, this is still very much theoretical at this point as it is becoming increasingly more difficult to tease out if the benefits seen in some studies are due to the placebo effect or not. Small sample sizes in the studies done to date do not help in determining true effectiveness of these devices either. It is important to note that wearing compression boots as a recovery modality do not seem to carry any sort of negative impact. So, those that decide to wear these devices can rest assured that there is no detriment to wearing them, but there may or may not be any real value in the device itself for recovery purposes.
If you have 1) established good sleeping and nutrition habits, 2) are looking to incorporate some additional forms of recovery into your routine to seek out that extra 0.01%, and 3) have the extra cash and time to invest in utilizing compression boots, then these devices certainly cannot hurt to try. In fact, if having compression boots forces you to slow down, kick your feet up, and relax, then these might be a worthwhile investment for you. Some athletes have a hard time just sitting down and doing nothing. However, if having compression boots is the thing that sparks you to sit down and relax each day, then this sort of device can be a great thing to add into your routine.
On a personal note, I have worn compression boots myself, and I can vouch for them feeling good once they are on. When it comes to recovery, there is something to be said about doing things that just feel good and help you relax. I am unconvinced by the research literature available to date in the true effectiveness of compression boots, however, and so I do not think I will invest my money into purchasing a pair. I will continue to invest my time and money into optimizing my sleep and nutrition habits before I spend a big chunk of money on any sort of recovery device like compression boots. But if the research literature becomes more convincing that a device like compression boots can in fact have a true impact on recovery, then who knows, maybe I’ll pull the trigger and buy a pair.
Blumkaitis JC, Moon JM, Ratliff KM, Stecker RA, Richmond SR, Sunderland KL, Kerksick CM, Martin JS, Mumford PW. Effects of an external pneumatic compression device vs static compression garment on peripheral circulation and markers of sports performance and recovery. European Journal of Applied Physiology. 2022 Apr 27:1-4.
Cochrane DJ, Booker HR, Mundel T, Barnes MJ. Does intermittent pneumatic leg compression enhance muscle recovery after strenuous eccentric exercise?. International journal of sports medicine. 2013 Nov;34(11):969-74.
Collins R, McGrath D, Horner K, Eusebi S, Ditroilo M. Effect of external counterpulsation on exercise recovery in team sport athletes. International Journal of Sports Medicine. 2019 Aug;40(08):511-8.
Northey JM, Rattray B, Argus CK, Etxebarria N, Driller MW. Vascular occlusion and sequential compression for recovery after resistance exercise. J Strength Cond Res. 2016;30(2):533–539.
O’Donnell S, Driller MW. The effect of intermittent sequential pneumatic compression on recovery between exercise bouts in well-trained triathletes. J Sci Cycl. 2015;4(3):19.
Overmayer RG, Driller MW. Pneumatic compression fails to improve performance recovery in trained cyclists. International journal of sports physiology and performance. 2017;13(4):490-5.
Roberts LA, Caia J, James LP, Scott TJ, Kelly VG. Effects of external counterpulsation on postexercise recovery in elite rugby league players. International journal of sports physiology and performance. 2019 Nov 1;14(10):1350-6.
Russell S, Evans AG, Jenkins DG, Kelly VG. Effect of external counterpulsation on running performance and perceived recovery. International Journal of Sports Physiology and Performance. 2020 Feb 27;15(7):920-6.
Tally S, Kado-Walton M, Hillery N, Wing D, Higgins M, Groessl E, Nichols J. Effects of External Counterpulsation on Performance and Recovery After Exertion. American Journal of Sports Science. 2022;10(4):84-91.
Wiener A, Mizrahi J, Verbitsky O. Enhancement of tibialis anterior recovery by intermittent sequential pneumatic compression of the legs. Basic Appl Myol. 2001;11(2):87–90.
Zelikovski A, Kaye C, Fink G, Spitzer S, Shapiro Y. The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. Br J Sports Med. 1993;27(4):255–259.
Happy training and racing!
-Ryan Eckert, MS, CSCS
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