The mechanism by which CG provide benefits to athletic performance and/or aid in recovery is unclear. They may stabilize the soft tissue or joint. Another theory is the compression reduces ‘available space’ for swelling and blood by creating a pressure gradient. Another is enhanced blood flow improving clearance of exercise metabolites. Finally, the decrease in space may decrease cytokine chemotaxis, blunt the the inflammatory response, or some combination of the above.
Compression garments do not appear to help mitigate inflammatory markers after exercise. In one study, blood tests were similar between groups (Blood lactate, insulin like growth factor-1, free testosterone, myoglobin, creatine kinase, interleukin 6, and interleukin 1) (Goto, 2014). In athletes exercising with and without CG on the lower extremities during and 24 hours following exercise, researchers found an improvement in perceived muscle soreness but no difference on heart rate, rate of perceived exertion, lactate, pH, CK or c-reactive protein (CRP) (Duffeld, 2010).
One of the challenges in evaluating the efficacy of compression garments is the heterogeneity of products, which body parts they are applied to, variations between brands and which ones are studied. This makes research evaluating them challenging as well as extrapolating data from say a compression garment for the wrist to one for the knee. Keeping that in mind, the majority of studies conclude that compression garments help with DOMS and a sensation of fatigue. There is also a fair number of studies that suggest the use of CG as a recovery tool improves subsequent strength recovery, force production, sprint and jump performance. The majority of evidence does not support the utility of CG in clearing post-exercise blood markers (i.e. lactate, CK, etc). Taken in totality, CG appear to have utility as a recovery aid. The heterogeneous nature of the products and research makes generalization difficult, but there are no known side effects and their likely benefit makes them an easy recommendation to use as a recovery modality. More research is needed to better delineate the best types of compression garments and parts of the body where they are most efficacious.
In summary, heat therapy appears to be a safe recovery modality with some evidence supporting benefits. The mechanism of benefits remains unclear at this point. Thermotherapy appears to help with muscle related pain and sensation of muscle soreness following exercise. Heat appears to help with range of motion, especially in combination with stretching. In recovering athletes, heat may also facilitate maintenance of power output and strength following exercise. It is important to note not all studies find benefit. There is a lack of clarity about how much heat is required and for how long, although most studies recommend 20-30 minutes at a time.
In summary, the research on cold therapy as a recovery modality for athletes is challenging to interpret. Most studies, but not all, suggest that cold therapy helps with DOMS, post-exercise fatigue and pain. The effects on performance are mixed, with some suggesting benefits and others not. Although intuitively cold therapy should lower post-exercise inflammatory markers and markers of muscle damage, not all studies resulted in this conclusion. The superiority of one cold modality over another remains unclear, although most research uses cold water immersion. The temperature and duration of benefit are not well established, but the best study recommends 11-15 ℃ with an immersion time of 11 – 15 minutes. Cold therapy should be recommended to help with post-exercise muscle soreness and fatigue but approached with caution when discussing the effects on performance.
It is difficult to provide evidence based recommendations regarding the superiority of heat vs cold as a recovery modality following exercise. Based on the petrofsky study, which provides the best data available, cold is a superior analgesic to heat. For attenuating muscle damage and strength loss, heat was superior for the first 24 hours, after which cold was superior. Ultimately, there remains an ongoing need for more sufficiently powered high-quality RCTs on the effects of cold and heat therapy on recovery after exercise. One of the challenges is creating blinded studies of cold and heat. The majority of studies are non-blinded which subjects them to bias. Additionally, when recommending heat or cold therapies, there is a lack of clarity of “how much and for how long”. Researchers also need to delineate which modalities of heat and cold application are superior.
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