Evidence Based Recovery: Compression Garments, Heat, & Cold
Compression garments (CG) have been used by athletes for decades although their use is increasing as the technology and and breadth of options increase. It is postulated that CG improves both athletic performance and recovery. CG have been reported to reduce blood lactate accumulation following exercise, reduce muscle oscillation and vibration, maintain repeated vertical jump power, and improve post-exercise clearance of muscle damage markers (Duffield, 2010). Many styles of CGs exist, including stockings (knee length, thigh length), sleeves, upper-body garments (covering the torso and the upper limbs in full or part) and lower-body garments (from the waist, covering the lower limbs in full or part) (MacRae, 2011).
Heat therapy, sometimes referred to as thermotherapy, is the application of heat to a body part resulting in increased temperature. Heat therapy is popular among athletes and lay people alike for the treatment of a variety of soft tissue ailments. Heat can come in the form of reusable or disposable hot packs, water bottles, heat pads, electrical heat pads, stones, baths, sauna, paraffin wax, medications, heat lamps and more. Physiological effects of heat therapy include pain relief, increased blood flow, metabolism and elasticity of connective tissue (Nadler, 2004). Adverse events from heat therapy are low. According to a 2006 Cochrane review, adverse events related to use of superficial heat were minor, mainly consisting of “pink skin” (French, 2006).
The use of cold therapy to recover from physical activity is popular among athletes. Various modalities are utilized including cold water immersion (CWI), cold water application, ice packs, cooling vests, cooling rooms or chambers, ice massage and cold drinks. Cold water immersion (CWI) is a popular recovery strategy. It is generally aimed at alleviating post-exercise pain and DOMS.
Heat vs Cold
One of the most commonly asked questions among patients is: heat, cold or both? Which is superior? There is controversy regarding the effectiveness of cold and heat after exercise. This common clinical conundrum is clouded by personal experience and bias, patient experience, the opinion of athletic trainers, and the lack of clear evidence in the medical literature. This is further complicated by the lack of clarity in the literature evaluating individual heat and cold therapies. There is also lack of consensus which modality of application is best, duration of application, temperature treatment goals, which forms of exercise benefit and which areas of the body have the greatest benefit. Cold is better tolerated at extreme temperatures, allowing for more rapid cooling than heating pads, which require more time for warming the muscles to avoid warming too quickly and burning the skin.
A few studies have tried to compare heat and cold. A 2006 Cochrane review evaluating heat or cold for low back pain generally concluded that the quality of evidence was low for both. They did state that heat wrap therapy provides short-term reduction in acute and subacute back pain and that no conclusions could be drawn about the use of cold for low back pain (French, 2006). More recently, Malanga concluded that there was some clinical evidence that cold therapy is effective for pain relief of acute musculoskeletal injuries, but more high powered, high quality studies are required. They also concluded that heat therapy has better demonstrated therapeutic benefit for both analgesic and promoting healing (Malanga, 2015). They concluded that heat was the modality of choice for acute low back pain and muscle soreness.
In conclusion, we can safely say compression garments help with DOMS and sensation of fatigue and may also help as a recovery tool for performance. The challenge with compression garments will be clarifying the best types of compression garments and parts of the body where they are most efficacious. Heat therapy is a safe recovery modality that helps with muscle related pain and soreness, range of motion and may help with performance. Cold therapy helps with DOMS and post-exercise fatigue; the evidence is mixed on performance recovery.