Working
in the complimentary fields of medicine and exercise physiology can provide
insight in to new ideas and products.
It can also aid in teasing out how the theories behind various practices
are developed. An example of this is the
use of compression garments to aid recovery and increase performance. While increased recovery or enhance
performance, regardless of the mechanism of action, is beneficial, a review of
literature reveals little data supporting the benefit of compression garments
in athletes. Over the next several
postings, the efficacy of compression stocking use in athletes will be
evaluated.
Compression
garments are not new devices. Their use
in medicine has been wide spread for a number of years. Forms vary from tight stockings covering from
the calf and thigh to pneumatic devices that contract and release at programmed
intervals. The most common use is to
prevent clots from forming in individuals with circulation issues. Essentially, a pooling of blood can occur in
the limbs called venostasis. This
pooling is a prime environment for small clots to form as the blood sits in
place. When an event occurs that allows
the pooled blood to be pushed back to the heart, these clots can then cause
strokes, pulmonary embolisms, and heart attacks. This is the same mechanism that prompted
walking and moving around in an airplane on long flights. By compressing the limbs with appropriate
garments, venous return can then be improved and therefore significantly reduce
stroke and heart attack risk non-invasively.
A key
factor in this, however, is the role of an individual’s mobility. The mechanism by which blood returns to the
heart is called the skeletal muscle pump.
As a muscle contracts, the veins are compressed causing blood to be
pushed under pressure. It then moves
towards the heart due to a series of valves in the vasculature. These essentially make the veins one-way as
they shut if blood tries to go the wrong way.
The valves are similar to airport security-- once you pass it, you can’t
go backwards, but instead, have to circulate all the bay back around.
Compression
garments are not a standard issue item when a patient enters a hospital or
other health care facility. Rather, they
are used in patients with severely impaired mobility. This can include degenerative diseases,
stroke, or simply being too weak to move.
Essentially, these individuals no longer have an effective skeletal muscle
pump. But, if or when mobility returns,
the use of the garments is discontinued.
This can include a patient simply being able to walk to the bathroom or
self-propel using their legs in a wheelchair.
I’ve even seen cases where physicians made a deal with patients that if
they walked to the nursing station once every two hours they are awake, the
order for the garments would be removed.
The key factor in this is the small amount of mobility required to
negate the need for the garments.
Contrast
this with the athlete population. The
skeletal muscle pump is used throughout exercise. Then, after a workout, these individuals are
able to move around normally, typically without any form of venous
insufficiency. With these facts, it
appears that the method of action used in ill patients would not be applicable
in healthy athletes. However, since
strenuous exercise may alter some bodily functions as well as the fact that a
secondary mechanism of action may exist, it is still important to assess the data
to see if benefits are seen as we will do in future postings.
