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Compression Socks Real or Just a Big Squeeze?

Go to any road race this weekend or athletic event and you will see people wearing fancy new socks that the manufactures claim to decrease the negative effects of blood lactic acid build up in the legs and increase performance. But do these knee high socks (gradual compression stocking or GCS) actually do what the manufactures claim? The logic of their claims seems valid so does it hold water?

Gradual Compression Stockings or GCS are nothing new. They have been around for a very long time in the medical field to help patients that suffer from venous insufficiency conditions or VI. VI is when the veins of the lower extremities do not exert enough force on their walls to overcome the forces of gravity and help with the return of blood to the heart. The GCS provide the added external pressure needed to assist in the return of blood back to the heart. It has been speculated that if GCS’s can work with patients with increasing the efficiency of the venous return of blood that it may help athletes such as endurance runners increase their efficiency of venous return of blood and decrease the workload on the heart. It has also been speculated that if they do increase the efficiency of venous return then the body will be able to clear lactate levels faster and thus increase athletes performance.

According to much of the research that I could find it is not that simple when one is trying to increase the performance in running. The most common studied GCS that I found were GCS that ranged from 15 mmHg to 35 mmHg. Note that 35 mmHg GCS are very tight stockings and rank up there with the pressure of skinny jeans on a football linebacker. It would take sometime to get use to the pressure of GCS that high and still be able to comfortably run.

The majority of research I found shows that there is no performance enhancements associated with the use of GCS when it comes to measured results such as total time to fatigue when put on a maximal treadmill run test, peak heart rate, VO2 Max, rates of perceived exertion, lactate threshold. In fact in one study that I came across the researchers found that the total time to fatigue on a treadmill with elite distance runners actually decreased with the GCS. Though the study did also show that the lactate levels in the runners blood were lower in the GCS after the treadmill test, they attributed that to the decrease amount of time running time on the treadmill¹. But what was also interesting was that though there were wasn’t much research to show that GCS increase running performance there was some research to show that leg power was maintained better with the athletes that wore the GCS.

Athletes that wore the GCS and performed 10K time trials and then were asked to perform a countermovement jump test were found to have much higher rebound jumps as opposed to a group that did not wear the GCS and also ran the 10K time trial². This was attributed to the increased proprioceptive feedback from the GCS and the fact that the stockings do not allow the calf to “jiggle” as much during the landing phase of the jump.

This is not to say that GCS were not found to have any positive effects in any of the studies that I found. Most of the studies that I found that reported to have a positive result on runners were those that did not focus on running performance but more on recovery. Several studies did show that the use of GCS did help with the decrease in fluid volume in the calfs after a treadmill endurance tests³ and helped return the athlete to a level of homeostasis faster during active recovery⁴. Though it is not clear whether or not if an athlete has to wear the GCS during the workout or they can receive the same effect by putting the GCS on right after the workout.

The use of GCS as a tool to increase performance during a race is still up for debate and personally I don’t see how a trained individual with calfs that are well developed would receive much benefit from such devices. But, as a tool to help with recovery there is much more evidence for the use of GCS’s and I think a much better reason to purchase anything. Because if recovery is better and faster the results of your training will be that much better and you won’t be relying on some ‘super socks’ to get you the results you are looking for.



  1. Ali, A., Creasy, R., & Edge, J. (n.d.). The Effect of Graduated Compression Stockings on Running Performance. Journal of Strength and Conditioning Research, 1385-1392.

  2. Rider, B., Coughlin, A., Hew-Butler, T., & Goslin, B. (n.d.). Effect Of Compression Stockings On Physiological Responses And Running Performance In Division Iii Collegiate Cross Country Runners During A Maximal Treadmill Test. Journal of Strength and Conditioning Research, 1-1.

  3. Bovenschen, H., Booij, M., & Carine J. M. Van Der Vleuten. (n.d.). Graduated Compression Stockings for Runners: Friend, Foe, or Fake? Journal of Athletic Training, 226-232.

  4. Bovenschen, H., Booij, M., & Carine J. M. Van Der Vleuten. (n.d.). Graduated Compression Stockings for Runners: Friend, Foe, or Fake? Journal of Athletic Training, 226-232.



Running is a real pain in the knee!

There is a very high percentage of people that experience some sort of knee pain or discomfort when they run. General the pain is along the kneecap (patella) and it becomes worse when running, going up and down stairs, and with lunging. This pain is many times what is referred to as patellofemoral pain syndrome or ‘PFPS’. It can be very frustrating to anyone that wants to become more active or start training for a road race. I have had many clients and patients complain of this issue and I can tell you that tackling it takes patience, time, and consistency. But what causes PFPS in the first place, why does it seem that females tend to have a greater incidence of this, and how is it treated?


Well, true PFPS which is the most common complaint of active people when it comes to knee pain, is when a runner is in the stance phase of running and the patella does not glide evenly in its groove on the bottom of the femur and causes discomfort. This is generally caused by muscle and connective tissue force imbalances in the hips, thighs, knees, and even down to the ankles. This imbalance causes the knee to “crash in” and limit full extension of the knee during the stance phase of running.


It has to be remembered that running is a very dynamic activity when the motion is broken down into its individual pieces. When the foot strikes the ground the gravitational forces want to collapse all the joints inwardly. This pressure to collapse has to be fought by every muscle from the lower back to the foot over and over again. The issue becomes even more of a challenge when a person has a wider hip resulting in the knee being less directly under the hip increasing the forces of the knee to collapse inwardly. Females tend to have a larger hip to knee angle, also known as a Q-angle, resulting in an increased risk of developing PFPS. But this is not to say that people that have PFPS or those who are at higher risk for developing PFPS should not run. This can be treated and all it takes is some simple exercises that are easy to do.


As one can image PFPS has been studied at great lengths and when treated correctly and consistently it is very fixable. In an 2011 article in the Journal of Athletic Training entitled: ‘Changes in knee biomechanics after a hip-abduction strengthening protocol for runners with patellofemoral pain syndrome.’ outlined a simple two exercise program that had a 43.1% reduction in pain, 32.69% increase in hip strength, and significant increase in running biomechanics in 3 weeks. It has been shown time and time again that following this program and ones like it regularly will go a long way to correct the dynamic biomechanical issues causing PFPS. Remember to do this daily and not to stop just because the pain stopped. If you have any questions feel free to contact me at


Start and Finish with Hamstring, Quad, and calf stretches along with foam rolling of the legs.


A Strong Breath is a Strong Spine

I wanted to continue on the topic of last week about the important role that the diaphragm (the main muscle responsible for active breathing) plays on not just pulling and pushing air in and out of the lungs but also providing stability to the spine. As I wrote in last weeks blog about the importance the diaphragm plays in increasing running economy it also plays a large role in stabilizing the spine during loading activities such as walking, running, or lifting.

After reviewing last weeks article from the Journal of Strength and Conditioning entitled: ‘Functional’ inspiratory and core muscle training enhances running performance and economy I reached out to the lead author. I wanted to see in his research if any of the subjects had reports of lower back pain and if his subjects reported a decrease in the lower back pain or discomfort. He wrote back saying that if subjects did have complaints of lower back pain in the past six months they were excluded from the study but he did forward me some great articles on that topic.

According to two articles he sent me, one from the Spine Journal titled: The effect of inspiratory muscle fatigue on postural control in people with and without recurrent low back pain and the other from The Journal of Respiratory Physiology and Neurobiology titled: Greater diaphragmatic fatigability in individuals with recurrent back pain, the authors were able to show a strong association of lower back pain and weak or deconditioned diaphragms. These findings sheds a lot of light on the very important and multifunctional role the diaphragm play with respect to breathing and spine stability.

The article from The Spine Journal titled: The effect of inspiratory muscle fatigue on postural control in people with and without recurrent low back pain took individuals with a history of lower back pain and those without a history of lower back pain and studied their spinal control while on an unsteady moving surface. The researchers found that when the individuals with no history of back pain perform exercise to fatigue their diaphragm, that they used similar rigid and poor mechanics to control their back in much the same way the individuals did with a history of lower back pain and did not fatigue their diaphragm. This study showed that the body relies a lot on portions of the diaphragm to stabilize the back effectively and when it cannot it reverts to a rigid and locked technique that is less effective in dynamic motion.  

In the article from the Journal of Respiratory Physiology and Neurobiology titled: Greater diaphragmatic fatigability in individuals with recurrent back pain the researchers showed that the diaphragm fatigued in individual with a chronic history of lower back pain when placed under a load. This result is interesting when combined with the first article, the article from my last post and in many other articles. It shows the important role that the diaphragm plays in dynamically stabilizing the spine. It also shows the importance of taking the time to strengthen the diaphragm and not just assume that because you are breathing hard in your workout that you are strengthening your diaphragm.

There are several techniques that have been shown to increase the strength of the diaphragm as well as devices sold on the internet. The technique that I know works well is called diaphragmatic breathing exercises or crocodile breathing. These are simple exercises that you can do lying down on your stomach or back or sitting in your chair. To perform the basic exercise lay down or sit straight up in your chair and think to yourself, “pull the air in through the noise and to the bottom of my belly and squeeze it out with my belly through pursed lips”. Make sure to count to at least 5 seconds in and 7 seconds out and for about 15 reps for 3 sets in the beginning. I do warn you that you may fall asleep while doing this exercise so please don’t do it while driving.


Breathe Right, Breathe Strong

In the past I wrote about how core strength is important and that everyone should work on it but how there is a point of diminishing return with time spent on training the core. Much of the focus of many articles that I have found have specifically looked only at the muscles that support the back, pelvis, and hips which are also known as the lumbopelvic region. Studies showed that after a certain point those muscles will only help so much when it comes to increasing power and more interestingly, to me atleast, running economy.

But what happens if you train not just your traditional core muscles but what about also training your deep inspiration breathing muscles to be stronger? Will that improve your running economy and overall running performance?

The answer can be found in a recent article published this August in the Journal of Strength and Conditioning entitled: ‘Functional’ inspiratory and core muscle training enhances running performance and economy. This study was very interesting in that is focused on how strengthening the muscles responsible for deep breathing also affect the stability of the lumbopelvic region as well as increasing the efficiency of energy production during running. The authors had a group of 16 seasoned distant runners participate in a 6 week interval training program and split them up into two equal groups of traditional interval training and core training and the same program plus simultaneous inspiratory muscle training.

Simultaneous inspiratory muscle training is a type of training that incorporates regular exercises (squats, presses, crunches, etc) while at the same time using an inspiratory muscle training device (i.e. POWERbreather®). This device requires the person using it to focus on recruiting his/her muscles responsible for drawing air into the lungs. The authors had the experimental group use the device during the core training.

The results were very telling on how important the muscles that control breathing are not challenged nearly enough with traditional training methods whether it be core training or endurance training. The authors were able to show a significantly greater improvement with the experimental group compared to the control group in endurance, distance covered in a 1 hour treadmill test, lactic acid threshold, and sport specific endurance plank test. The improvements claimed do warrant everyone to look at how much time in your training regimen is spent on focusing on your breathing.

I think it is no jump to suggest that more time focused on an activity that keeps us alive and working on improving the muscles that are responsible for it, will go a long way in improving your overall fitness. For more information on exercises that could help checkout ‘crocodile breathing’ or e-mail to find out some good strategies that could help.  


Thoracic Mobility is Agility 

This week I wanted to focus on the topic of thoracic mobility that is very important when trying to develop strength and athletic performance. Thoracic mobility refers to the thoracic spine or mid-back that runs from about that big bump on the base of the neck (more noticeable on males) to about the bottom of the scapulae (shoulder blades). This portion of the spine curves out in best case scenarios 30 degrees and serves as an attachment point for the ribs. It provides the backbone to your thoracic cavity which houses your lungs, heart, and other organs.

The thoracic spine is a very stable structure and designed to have a moderate amount of motion. Now over time the thoracic spine starts to curve more because of the stresses and functions that we perform daily like sitting at a desk and typing, driving, or walking with our head down. Over time the T-spine (thoracic spine) becomes rigid in this position, the ligaments and muscles in the front of the T-spine shorten pulling it into more of a flexed position while the muscle and ligaments in the back of the T-spine become stretched and weak. This forward flexion of the spine is called kyphosis and tends to wreak havoc on functional mobility of the shoulders, neck, lower back, hips, knees, ankles, and breathing.

How and why does poor posture in the T-spine cause so many problems on everything? Well first off no one part of the body can truly work independent of other parts of the body and all that support originates in one place - the back. Well to be completely true the brain is where everything originates but thats a discussion for another day. A common way of demonstrating this is to hunch your back forward, really forward and try and lift your arms above our head. You will find that it is very awkward and you are limited in how far you can actually lift your arms. Now hold that position in standing and look up so your eyesight is parallel with the floor. You will again notice that to do this you have to overcompensate by arching your neck and your lower back to equal degrees in total to achieve this. Now try and lift, run, take a deep breathe, or rotate. Owww! Now your posture may not be that extreme but it may be still off.

To perform athletic events well and without injury or to train to become more fit the body must perform thousands of different movement patterns. If the T-spine is ridged, flexed forward, or both and subsequently not allowing for the full range of motion that is needed to perform certain activities freely the body will find an alternative way to achieve the goal. The problem is that these alternative ways of moving or compensatory movement patterns result in increase stresses on structures that are not designed to take those stresses. These new stress begin to wearout those structures that are taking the excessive loads. This results in a chain of events that lead to the programing of poor movement patterns, decreased performance, and ultimately injury.

How do you fix this? It can be pretty easy. Start with lying your mid back on a physio-ball for 3 minutes and allow your body to conform to the shape of the ball. Do this several times a day and then follow it by laying on your stomach and arch your back up so your chest comes off the ground and hold for 5 - 10 seconds without using your hands for 3 sets of 10 reps. Make sure not to arch your lower back when you do this because that will only take away from the goal your are attempting to achieve.

For more information feel free to contact me and I will do my best to help you out.