By now, you’ve probably seen compression boots at sporting events, in a physical therapy office, or somewhere on social media. These recovery tools have gone mainstream and though they’re pricey, even the recreational cyclist may turn to them after a tough workout or long ride.
Compression boots offer tired legs an “air massage,” and manufacturers claim they can stimulate blood flow and flush lactic acid from your limbs. In theory, this should hasten recovery. But what are the proven benefits of compression boots?
Here’s everything you need to know about these boots before you make a purchase.
The Benefits of Compression Boots
Compression boots use intermittent pneumatic compression, which basically means they inflate and deflate to create pressure at different points on the leg, helping to improve blood flow.
“Your body is constantly generating metabolic waste as it produces and uses energy, and that waste gets circulated throughout your blood,” says Kathleen Leninger, D.P.T., a physical therapist at Custom Performance in New York City. “Because your legs are below your heart, it’s harder for the heart to pump that waste from your legs to your lymph system, which helps get rid of it.”
The idea behind compression boots is pretty simple when you think about it that way: The compression helps your system increase blood flow to your legs, which helps circulate the waste, so your body can get rid of it faster.
Research attempts to back up the benefits of compression boots on blood flow. For example, a study published in the Journal of Applied Physiology in 2018, suggests that intermittent compression applied during recovery from exercise resulted in increased limb blood flow. This can potentially contribute to changes in exercise performance and recovery, according to the authors. Keep in mind, this study only involved 12 healthy participants.
No matter what kind of cycling you do, whether it’s a tough HIIT session on your trainer or a long ride on your favorite trail, your muscles experience microtears from repetitive stress. “You may not even notice it, but edema, or swelling, occurs when your body starts to repair those microtears,” says Leninger. That swelling will go away naturally if you’re recovering appropriately (think: staying off your feet, elevating your legs, resting), but compression can also help shorten the amount of rest you may need by preventing swelling from pooling in a certain area when you have to go straight from your bike to the office, for example.
“When that metabolic waste from a workout is sitting there in your cells taking up space, that’s space that your blood could be bringing new nutrients to in the muscle,” says Leninger. The more nutrients your muscles are getting, the faster they can repair and rebuild.
Some research also supports the idea of compression boots helping to speed up the recovery process. For example, a clinical trial published in 2016 in the Journal of Orthopaedic & Sports Physical Therapy, involving 72 ultramarathon runners, found that post-exercise pneumatic compression therapy offered the same benefits as post-exercise massage. Daily treatments using a pneumatic compression device also reduced recovery time from delayed onset muscle soreness when compared to a continuously-worn compression sleeve, according to research published in 2018 in the International Journal of Exercise Science, which involved eight participants.
A 2015 study on 24 highly trained Olympic athletes (half women, half men) reported that those who received a 15-minute session of pneumatic compression therapy after their morning training session, enjoyed a reduction in their pain pressure threshold (a scientific way of saying their muscles were less sensitive when you pressed on them) immediately after the session and for the remainder of the day after the afternoon practice. Their peers who recovered without the compression therapy did not experience any such pain relief.
It’s worth noting that though the physiological research is largely promising, research on performance metrics is lacking. In other words, studies show that you will likely feel better, but it’s harder to find research to confirm that you’ll perform better...though the two may go hand in hand for some riders.
“I bought the Normatec boots because after trying them, I loved the compression on my tired legs,” says Kaysee Fulbright (formerly Armstrong), a pro mountain bike racer. “After a long day of travel or training, it helps me to recover, and on the days where I’m lazy [and not feeling like a recovery ride], it helps me to be lazy and incentivizes me to sit down and put my legs up and recover.”
The research aside, if you’ve ever worn a pair of these puffy sleeves, you know it simply feels good to site in them—kind of like a massage. “If the only benefit you get is sitting down and relaxing for 20 minutes while you use them, that’s still worth it,” says Leninger.
Compression Boots vs Compression Socks
While you might think compression boots are similar to compression socks, they are actually quite different and work in different ways (hence why the former is a lot more expensive than the latter).
There are two types of compression athletes use: consistent compression and intermittent pneumatic compression. Compression boosts use intermittent pneumatic compression, meaning they mechanically inflate and deflate segments of a sleeve at different times. Compression boots actually go all the way up to the top of your thighs, so your entire leg reaps the benefits.
Compression socks, on the other hand, squeeze the legs without movement or changes in pressure. Typically, compression socks are tighter at the bottom and get progressively looser to improve blood flow from the feet upwards, reducing swelling and discomfort in the legs. (Keep in mind, if you just started noticing swelling in the legs, especially after a workout, and it doesn’t get better in two to three weeks, talk to your doctor. It could be something more serious.)
Many compression boots allow you to control the amount of pressure and all of them offer more active compression than socks. It’s somewhat similar to the difference between an active stretch and a passive stretch. “The sheer amount of compression you’ll receive from a mechanical device will work exponentially faster than socks,” says Eric Madia, a New Jersey-based strength and conditioning coach.
The Downsides of Compression Boots
The biggest downside to compression boots is the damage they might do to your wallet. Some of the most popular systems cost around $1,000—a significant amount of money for many cyclists.
Another downside is that the systems are not always intuitive for the average user. Whereas your physical therapist may know exactly what setting to use, depending on your current training and feedback, it’s not always so obvious for the layperson using boots at home.
Also, while there is research on the benefits of compression boots (as explained above), most of the studies involve only a few participants. There are also studies out there, still small but newer, that say compression boots do not have a significant benefit.
For example, one review published in the Journal of Sport Rehabilitation in 2021, which only included three studies on intermittent pneumatic compression in total, stated that this method was not an effective means of reducing exercise-induced muscle damage in endurance athletes. However, it did point out there is short-term relief, just not continued relief. Another study published in the International Journal of Exercise Science in 2020, involving just 10 distance runners, said this form of compression yielded no substantial benefits.
The bottom line: We need larger and more long-term research to say the science 100 percent backs up the benefits of compression boots. And just because you use the boots doesn’t mean you should skimp on other recovery practices like sleep and nutrition.
How to Use Compression Boots for Recovery
This should be a no-brainer, but the more work you do, the more recovery you need. “In general, the harder your effort, the more metabolites, build, and waste you’re going to need to clear from your cells,” says Madia.
So slip the boots on after intervals, long rides, century training, or after whatever workout is most taxing. They can also be especially helpful when you know you have two strenuous efforts back to back, says Leninger.
Madia recommends using the boots at least three to four times a week for recovery. “That’s usually one to two workouts, and then you flush your system,” he explains. “That ratio has really shown the best amount of recovery in our athletes.”
When you’re using the compression boots, Madia recommends staying below level seven on the pressure dial. “Higher pressures can cause discomfort and numbness,” he says. If you feel a tingling sensation in your feet, that’s a sign the pressure is too high. And if after a session, you can see a depression from the seams of the boots marked on your legs, that’s also a sign the pressure is too high.
In most cases, you’ll want to use the boots after a workout, rather than before. “That goes back to your nervous system—before a workout, you want to to get neurologically excited; afterward, you want the opposite effect, you want your nervous system to switch to that rest and digest response, which is what the boots induce,” says Madia.
After a workout, Madia recommends spending 30 to 35 minutes in the boots. “That tends to be the sweet spot in terms of clearing out what you need to clear out,” he says. So throw on your favorite TV show and relax.
Finally, remember that not all stress is athletic stress. “If you’re someone who’s on your legs a lot—like a waitress on a later shift—then using them before a workout can be helpful in flushing out your legs,” says Leninger. In that case, 10 to 15 minutes before a workout could be helpful.
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John Vasudevan, M.D. is an associate professor at the University of Pennsylvania. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He is a Team Physician for UPenn Athletics and medical director of the Broad Street Run and Philadelphia Distance Run, and previously for the Rock 'n' Roll Half-Marathon and Tri-Rock Triathlon in Philadelphia. He is a director of the running and endurance Sports Medicine Program at Penn Medicine. Dr. Vasudevan provides non-operative management of musculoskeletal conditions affecting athletes and active individuals of all levels, and combines injury rehabilitation with injury prevention. He utilizes a variety of ultrasound-guided procedures and regenerative approaches such as platelet-rich plasma and percutaneous ultrasonic tenotomy. He sees patients at the Penn Medicine and the Philadelphia Veterans Administration hospital. Dr. Vasudevan attended medical school at the University of Wisconsin School of Medicine and Public Health in Madison. After his Transitional Year in Tucson, Arizona, he went to residency in PM&R at Thomas Jefferson University in Philadelphia and onwards to Stanford University for his fellowship in Sports Medicine. He has been in practice at the University of Pennsylvania since 2012.