Are Compression Boots the Real Deal?

Compression boots are the latest fad among certain well-heeled elite athletes, not to mention aspiring weekend warriors. You may not have heard of these boots, but they’re gaining traction. So what are they, and do they really deliver significant exercise-recovery benefits? 

Also known as air compression boots, or compression recovery boots, these devices consist of a pair of spacesuit-looking (Antarctic expedition-appropriate?) thigh-high boots that you wear like mini sleeping bags for the legs. Lying prone, you hook them up to air hoses, plug the device in, and an associated pump/control unit causes them to inflate and deflate rhythmically.

Somewhat like static compression hose, which exert greater pressure at the ankles, and less pressure at the thighs, these devices begin squeezing you initially at the ankles. The areas of inflation rise up the legs towards the thighs, before deflating and beginning the sequence all over again. This presumably helps massage the legs and coax fluids upwards, from the ankles towards the trunk. Used in hospitals for decades to help prevent deep vein thrombosis, these devices are catching on with the public.

Compression Boots By Any Other Name

It’s perhaps a sign of their relative newness that these boots answer to any number of names, including leg circulation boots, Peristaltic Pulse Dynamic System, Dynamic Compression System, and Intermittent Pneumatic Compression System, among others. Serious scientific inquiry regarding the proposed benefits provided by these boots is relatively hard to come by. A handful of studies have come down in favor of certain recovery benefits, while a smaller handful has failed to note any such exercise-recovery-related improvements.

That evidently hasn’t prevented the U.S. Olympic team from investing in multiple units of these devices. They’re viewed as providing some of the exercise recovery benefits typically realized by using deep tissue massage. Athletes ranging from powerlifters to downhill skiers have attempted to boost recovery using these trendy devices.

What’s the Evidence?

A 2015 study published in the Journal of Strength and Conditioning Research concluded that “external pneumatic compression” did not significantly improve peak power, average power, or subjects’ fatigue index.⁶ But, at 25 and 35 minutes into recovery, there was a significant drop in the blood lactate concentration, compared to subjects who did not use the compression boots. 

Although the study sample was small, at just seven men and seven young women, this finding is intriguing. Lactic acid buildup in the bloodstream after intense exercise is linked to burning sensations in the muscles, plus possible cramps, nausea, and weakness.

These effects are separate from the muscle soreness that may be experienced for up to several days after an intense bout of exercise. That familiar sensation is linked to muscle tissues undergoing repair and remodeling and may be welcomed as a sign of strengthening muscle.

Rather, lactate buildup elicits an unpleasant feeling in the immediate aftermath of intensive exercise. It should be noted that we’ve known since the 1930s that most exercise-induced lactic acid clears from the bloodstream anyway, within about one hour after stopping the exercise that provoked it, when followed by rest or “walking it off”.

More recently, a study published in Research in Sports Medicine concluded that both manual therapy (massage) and compression boots “reduced muscular fatigue scores acutely after treatment following the race and post-race day 1…”² 

Some research has examined the effects of peristaltic pulse external pneumatic compression (PEPC) on gene expression in muscle tissue. This research appears to show that even a single bout of this compression therapy affects genes involved in muscle function.⁶ In general, these findings appear to demonstrate a trend towards reduced post-exercise stiffness and inflammation, and thus, faster, more effective recovery.¹ 

Possible Benefits for the Treatment of Leg Lymphedema

There is some evidence that intermittent pneumatic compression systems are beneficial for the treatment of lymphedema of the leg(s).⁷ The consensus appears to be that external pneumatic compression is an effective method, similar to complete manual decongestive massage, which helps minimize fluid buildup and reduce swelling in affected areas.¹⁰ There is also mounting evidence that devices operating at higher pressures deliver greater increases in lymph flow out of affected tissues.

Conclusion

Although it is still early days, there is mounting evidence that “compression boots” may be of some benefit for both post-intensive-exercise recovery among athletes and lymphedema patients seeking relief through decongestive therapy. For athletes, the use of these devices may help prevent some measure of inflammation and post-workout stiffness.

For lymphedema patients, these devices have even more obvious potential benefits. Like manual decongestive therapy, which must be administered by a trained professional, these automated systems appear to help fluid return to working lymphatic vessels for drainage. This helps alleviate some of the characteristic lymph buildups that occur in affected limbs or other areas of the body. Thus, these devices may be of some benefit to patients who can afford to invest in them.  

References

1. Haun CT, Roberts MD, et al. Does external pneumatic compression treatment between bouts of overreaching resistance training sessions exert differential effects on molecular signaling and performance-related variables compared to passive recovery? An exploratory study. PLoS One. 2017 Jun 29;12(6):e0180429. doi: 10.1371/journal.pone.0180429. eCollection 2017.
2. Heapy AM, Hoffman MD, et al. A randomized controlled trial of manual therapy and pneumatic compression for recovery from prolonged running – an extended study. Res Sports Med. 2018 Jul-Sep;26(3):354-364. doi: 10.1080/15438627.2018.1447469. Epub 2018 Mar 7.
3. Hoffman MD, Badowski N, Chin J, Stuempfle KJ. A Randomized Controlled Trial of Massage and Pneumatic Compression for Ultramarathon Recovery. J Orthop Sports Phys Ther. 2016 May;46(5):320-6. doi: 10.2519/jospt.2016.6455. Epub 2016 Mar 23.
4. Kephart WC, Mobley CB, et al. A single bout of whole-leg, peristaltic pulse external pneumatic compression upregulates PGC-1α mRNA and endothelial nitric oxide sythase protein in human skeletal muscle tissue. Exp Physiol. 2015 Jul 1;100(7):852-64. doi: 10.1113/EP085160. Epub 2015 Jun 17.
5. Kitayama S, Maegawa J, et al. Real-Time Direct Evidence of the Superficial Lymphatic Drainage Effect of Intermittent Pneumatic Compression Treatment for Lower Limb Lymphedema. Lymphat Res Biol. 2017 Mar;15(1):77-86. doi: 10.1089/lrb.2016.0031.
6. Martin JS, Friedenreich ZD, Borges AR, Roberts MD. Acute Effects of Peristaltic Pneumatic Compression on Repeated Anaerobic Exercise Performance and Blood Lactate Clearance. J Strength Cond Res. 2015 Oct;29(10):2900-6. doi: 10.1519/JSC.0000000000000928.
7. Martin JS, Kephart WC, et al. Impact of external pneumatic compression target inflation pressure on transcriptome-wide RNA expression in skeletal muscle. Physiol Rep. 2016 Nov;4(22). pii: e13029. 
8. Morris RJ. Intermittent pneumatic compression – systems and applications. J Med Eng Technol. 2008 May-Jun;32(3):179-88. doi: 10.1080/03091900601015147.
9. Overmayer RG, Driller MW. Pneumatic Compression Fails to Improve Performance Recovery in Trained Cyclists. Int J Sports Physiol Perform. 2018 Apr 1;13(4):490-495. doi: 10.1123/ijspp.2017-0207. Epub 2018 May 16.
10. Zaleska M, Olszewski WL, Durlik M. The effectiveness of intermittent pneumatic compression in long-term therapy of lymphedema of lower limbs. Lymphat Res Biol. 2014 Jun;12(2):103-9. doi: 10.1089/lrb.2013.0033.
11. Zelikovski A, Kaye CL, Fink G, Spitzer SA, 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 Dec;27(4):255-9.