Recently I sat down with Todd Ellenbecker, Chairman of the USTA Sports Science Committee, Director of Sports Medicine for the ATP tour, and clinic director of Physiotherapy Associates, in Scottsdale, Arizona. We spoke about research that’s been done on compression garments, whether they enhance athletic performance and/or muscle recovery, and what applications they may have for professional and recreational tennis players.
Justin diFeliciantonio: More and more, it seems, we’re starting to hear about the benefits of compression garments. Companies like Skins and Under Armour claim that wearing the garments can help expedite recovery, and even increase athletic performance during competition. What do you make of these claims?
Todd Ellenbecker: There’s obviously a lot of interest in this topic, and a lot of products out there. Fortunately, more and more research is being done trying to understand the mechanisms by which these compression garments work, and if they improve performance. A few studies have shown that they do actually increase endurance performance and anaerobic threshold while wearing the garments during exercise.
But the real question is: Is it the garment that does it? Or something that the garment causes? [Researchers] haven’t been able to work out exactly how the garments function. I think the majority of data that’s out there, in a handful of studies, shows that they alter blood flow, improving the removal of lactic acid and some of the waste products of exercise. Which would indicate that wearing them may be beneficial in recovery, perhaps more so than during competition. Although, again, there are studies that looked at runners wearing such garments, and they actually had improved endurance times and anaerobic thresholds in laboratory environments.
JD: There are so many studies out there. And of course, they’re not all equally rigorous. Which studies on compression would you say are most respected by others in your field and by the scientific community?
TD: Probably one of the most qualified, respected guys in our field is William Kraemer, of the University of Connecticut. Dr. Kraemer has been the President of the National Strength and Conditioning Association, and is basically a legend from the standpoint of strength and conditioning. He’s published a number of studies that have looked at this topic. One was in 2000, in a journal called Medicine and Science in Sports and Exercise: “The influence of compression hosiery on physiological responses to standing fatigue in women.” Dr. Kraemer also did another that studied the “Influence of Compression Garments on Vertical Jump Performance in NCAA Division I Volleyball Players.” That was in 1996. Unfortunately, you’re probably not going to find one on tennis, per se.
We all know that different manufacturers have come out with compression garments through the years. Remember Martina Hingis? She wore an Adidas shirt, which had a long sleeve on one side and a short sleeve on the other. Otherwise, these garments are particularly common in cycling and other endurance sports. Cyclists in the Tour de France, after finishing their stages, will go directly into a recovery area, where they almost immediately put on long, lower-extremity tights that extend from the ankles all the way up to the groin, again, to assist with blood flow and recovery. So they’re being used in a lot of sports. And while I can’t speak definitely on the garments related to tennis, if you look at what benefits have been indicated for athletes in other sports, having something that increases blood flow and recovery certainly would benefit a tennis player.
JD: I understand that, in addition to advising the USTA, you also work with the ATP tour. Are you aware of any ATP players who put on recovery tights after matches? In the amateur tennis world, I certainly don’t see this happening.
TE: Yeah, I don’t think it’s hit tennis yet. I don’t know of any professional players that are presently using the garments for recovery purposes. What I do know is being used now by players are ice baths and massage. Certainly, compression is something we’re looking into with the USTA and ATP; we’re continuing to consult the latest data and studies to see if it does apply to our players.
JD: To your knowledge, how effective would you say compression garments are, compared with ice baths and massage treatment? Do the different modalities reduce, say, lactic acid at a comparable rate?
|For our product profile archive, which includes Zensah's Compression Leg Sleeves, click here.|
TE: I think these recovery modalities use a similar mechanism; ice baths, massage, and compression garments, I think they all try to provide some type of compression or changes to local blood to facilitate the clearing of metabolic waste products. So based on the research, I think the mechanisms involved are similar. But I can’t cite for you a study that compares, you know, one type versus another type versus another. The compression studies that I’ve looked at are usually just using compression, and not comparing it to other modalities.
JD: I’m a bit surprised by some of the dates of the studies you mentioned earlier—Dr. Kraemer’s volleyball study in the 1990s, for example. These garments don’t appear to be a new phenomenon.
TE: Oh, absolutely not. Actually, it goes back even earlier than that. [For years] compression has been used for people with lower extremity histories and circulatory compromise. There’s a company called Jobst, which has been around for a hundred years in orthopedics that manufactures garments for men and women who have these problems. And now it’s bleeding into, no pun intended, the athletic arena.
JD: You work with a lot of people with joint and soft tissue injuries, correct? At your physiotherapy practice, do you prescribe compression to your patients?
TE: We use it more for swelling reduction. [We work with] these Jobst garments and compression hoses—not so much products, like Skins, that are designed to enhance the performance of athletes. But we do use them and prescribe them for swelling after ankle injuries, knee injuries, and various contusions. And you’ve probably heard of the Game Ready device, which is a type of cold therapy that has a compression component. It’s more like a sleeve you wear for a short period of time, rather than something the patient leaves with.
JD: No, I’m not familiar with that.
TE: Game Ready: It’s a wonderful device that’s used in a lot of athletic training rooms and physical therapy clinics for acute injuries. It combines ice with a compression-type effect. What most people don’t know is that, when you look at studies on icing: Yes, applying ice constricts the [blood] vessels. But ice isn’t the only part of treating swelling in the extremities; there also needs to be compression and elevation. The injured area has to be lifted to facilitate draining. That’s why many of the devices now combine ice with compression and elevation. It’s the old saying, RICE or PRICE: Protect Rest Ice Compress Elevate. We combine all of these elements to help with blood flow and reduction of swelling.
JD: We’ve talked a lot about the effects of compression on the lower extremities. What about the upper body? Say I sustained a shoulder injury, and I was trying to rehabilitate it. Would using some kind of compression shirt be beneficial?
TE: For the shoulder, probably not. Actually, I just finished a study. I worked with a researcher from Japan at the University of Osaka, and we looked at the effects of wearing a compression shirt. The Japanese company Yonex makes such a shirt, which they tout for improving performance. We wanted to know the effects of the garment on shoulder strength. And we found that there was really no benefit on strength. There were some minor motor control benefits. Meaning, we think there was some benefit in feedback and proprioception. So the idea is that, wearing the garment gives feedback to the skin receptors, much like a knee brace or ankle brace. So there may be some benefit in that sense.
|For our Question of the Day Archive, which includes more thoughts on muscle recuperation from Todd Ellenbecker, click here.|
But back to your question, Justin. If you had a shoulder injury, I wouldn’t necessarily recommend a compression garment. If you had a lot of scapular dysfunction, meaning weakness of the shoulder blade area, there are posture shirts that are very, very popular now among baseball players and other athletes. These garments help you assume a better posture; they support the back of the body by helping to better align the scapular. So it’s also good for people who work in offices.
JD: Oh really. How do these posture shirts work? Are they built up in certain areas?
TE: Exactly. Basically, it’s like an Under Armour shirt, tight fitting. And then imagine: Going on a diagonal from your shoulder back along to the middle of your spine, right over the top of the shoulder blade, there are these re-enforced, thicker fabrics. They’re relatively tight. So when you put the shirt on, they actually pull you back. If you’re sitting on a computer right now, chances are that you’re sitting in a slumped posture. Imagine putting on a tight shirt that makes you sit up straight and squeeze your shoulder blades together. That’s what a posture shirt does. Dr. James Andrews, in Birmingham, Alabama, actually did a research study that found that Little League throwing athletes who wore posture shirts increased their velocity by 1 m.p.h. That’s obviously not that much. But it’s better than decreasing your performance. That’s the only study I know of in the upper body; and I don’t know of one in tennis. But again, that’s not necessarily a compression shirt as what’s called a posture shirt.
JD: It’s striking to me that much of this compression technology hasn’t completely transferred over to the tennis world. I’ve been a serious tennis player for years, and all this is new to me.
TE: Yeah, I think if you look at Runner’s World or Triathlon World, you’ll see that endurance sports are ahead of tennis in the compression arena. Now more and more, if you live in New York City and run through Central Park, you’ll see people running in knee-high stocking garments, and they’re actually running in them in an attempt to attenuate shock and increase blood flow. But as I said, we don’t see that so much in tennis at the present time. But I wouldn’t rule it out. As more research becomes available, I believe more and more players may consider [using] it at the highest levels of the game.