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Anmarie Moreno is a collegiate-level Certified Athletic Trainer from Southern California. She completed her undergrad at Concordia University Irvine with a BS in Athletic Training and went on to get an MS in Exercise Science from CSULB. As a former collegiate athlete and now runner, she has always been passionate about understanding and researching the science of exercise, movement and physiology of the athletic population!

In this guest blog, Anmarie reviews the science out there on the relatively new piece of recovery technology, "compression boots." Read on to see what the science says and how these devices may or may not help you recover between your big efforts.

"I believe knowledge is our greatest tool in working toward peak performance and maintaining the longevity of our incredible bodies!"

The number of recovery resources are continuously growing. From cryotherapy, sauna, massage, electric stimulation, multiple myofascial release gadgets and many, many more, knowing what benefits us most is important in how we allocate our time in their use. Not to mention most come at a financial investment and we certainly want to get our bang for our buck. One modality in particular that has gained significant traction in both the running and fitness worlds is the application of pneumatic intermittent compression (PIC).

Pneumatic compression devices (PCD) are inflatable garments with individual compartments that are intermittently filled with air. The intention of this device is to mimic what our muscles naturally do for the body. Through movement, contracting skeletal muscle works as a pump to push deoxygenated blood upward through our venous system back to the heart, then the lungs for reoxygenation,  and back to the heart again to be redistributed through the body.  

Our lymphatic system also relies on our muscle for the movement of lymphatic fluid which is responsible for helping maintain our immune system. This is done by removing unwanted waste, debris, cells and pathogens from the bloodstream as well as regulating the fluid in our blood.

Pneumatic compression has been utilized in the medical field as a treatment for individuals suffering from Lymphodemia. Lymphodemia is caused by abnormalities in the lymphatic system that result in blockages and build-up of fluid and inflammation. While it has been proven to help those with this condition, the research on its benefit for healthy individuals has been inconsistent and lacking regarding athletes.

In one study conducted by Hoffman et al. , they looked into the effects that massage and pneumatic compression had on the recovery of subjects post ultramarathon. The ultramarathon was 161.3km with a 5500m cumulative climb. What they concluded was that in addition to the massage “pneumatic compression provided some immediate subjective benefits” but “There is no evidence, however, that such treatment provides extended subjective or functional benefits.” What is important to note about this study is that it specifically looked at athletes as a population, unlike other studies that have used healthy individuals who do not train endurance consistently.**

Looking more closely at the data in this study, it appeared that the massage group experienced the most improvement when compared to the control and IPC group and therefore may potentially be a superior form of recovery. More research is needed on the subject.

In another study done by Draper et al., they took 10 distant runners who performed two 20 miles runs at a VO2 max of 70% and measured post-run delayed onset muscle soreness (DOMS) and C-reactive proteins (CRP). Runners in the experimental group received 1 hour PIC post-run and daily for 5 days after. Between the two groups, there was no significant difference between the group that received no treatment and those who did. However, the CRP levels were less, though not significant, in the treatment group than those who did not receive treatment.  

C-reactive protein is a biomarker that is indicative of inflammation and muscle damage post-exercise. From their study, they found no significant difference between the decrease in those that received the treatment and those that did not.

Even though PIC seems to not have a significant effect on DOMS or CRP in a 20-mile run, it can still serve psychological benefits in perceived soreness as some found PIC and massage intervention to reduce their perceived soreness. These findings are in agreement with a study conducted by Bakar et al. who found that manual lymph drainage more rapidly reduced biomarkers released by muscle damage such as creatine kinase and lactate dehydrogenase.

What we can conclude from these two studies is that despite the lack of significant difference between both treatment and control groups, there still appeared to be some physiological benefits to PIC. However manual massages may still be a more efficient means of achieving those benefits. When training it is important to incorporate a variety of program methods for optimal conditioning and I believe the same can be said when approaching recovery.

While more research needs to be done on the effective benefits of PIC on endurance athletes, when combined with other forms of recovery, such as massage, self myofascial release, stretching, cryotherapy and sauna collectively it likely serves a purpose in our recovery toolbox. We are all unique and our bodies vary from person to person. What works for one may not always work for another so it is important you find facilities that allow you to test out the options available before investing in modalities for yourself.

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**Hoffman, M. D., Badowski, N., Chin, J., & Stuempfle, K. J. (2016). A randomized controlled trial of massage and pneumatic compression for ultramarathon recovery. journal of orthopaedic & sports physical therapy, 46(5), 320-326.