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Compression garments…do they help in recovery from exercise-induced muscle damage? ~ Jessica Hill

Athletes continuously push the boundaries of human performance; in essence, they manipulate training loads, which then promote adaptations within the body.  Following the application of training stress, recovery is essential. Athletes who undergo prolonged or intense training periods and fail to recover properly may experience progressive fatigue and a reduced ability to perform.1   As a result, a growing interest has emerged in strategies that counter the effects of training and facilitate recovery from the symptoms of exercise induced muscle damage (EIMD).

Photo by Tristan Honscheid. Used with permission. All rights reserved. Source: flickr

Photo by Tristan Honscheid. Used with permission. All rights reserved. Source: flickr

Compression garments are relatively new, characterised by their elastic properties, and are used to provide mechanical support to injured limbs.2 Due in large part to commercial promotion, the use of compression garments as a recovery strategy is becoming increasingly popular.  The literature investigating their efficacy appears mixed with studies supporting3,4 and refuting5 the use of such garments.

To clarify the role of compression garments in recovery from EIMD, we conducted a systematic review and meta-analysis on their efficacy in recovery from damaging exercise.6 The results indicate that compression garments had a moderate effect in reducing muscle soreness and plasma concentration of creatine kinase and in accelerating the recovery of muscle strength and power after exercise.

While the results of the meta-analysis demonstrate positive uses for compression garments in recovery, it is important to highlight that commercially available compression garments are usually fitted using a generalised sizing system. Individuals within a particular size classification will vary in body shape, which is likely to affect the degree of pressure exerted by the garment. This will have a direct impact on the ability of the garment to reduce symptoms associated with EIMD.7

In addition, the majority of published studies did not measure the degree of pressure exerted by the garments and simply report the estimated levels indicated by the manufacturer.  It is possible that a number of subjects wore garments that did not exert an adequate pressure. This could explain some of the variability of findings within the literature.

Not withstanding some of the limitations in garment fit, the results of our meta-analysis indicate that the use of compression garments appear to reduce some of the negative symptoms associated with EIMD.  These findings have implications for both elite athletes and recreational populations.

Jessica Hill is a Lecturer and BASES accredited physiologist working at St Mary’s University College.  She is currently undertaking a PhD investigating recovery from exercise induced muscle damage.


1.     Budgett R. Overtraining Syndrome.  Br J  Sports Med 1990;24:231-236.

2.     Kraemer WJ, French DN, Spiering BA. (2004). Compression in the treatment of acute muscle injuries in sport. Int Sport Med J 2004;5:200-208.

3.     Jakeman JR, Byrne C, Eston RG. Efficacy of lower limb compression and combined treatment of manual massage and lower limb compression on symptoms of exercise induced muscle damage in women. J Strength Cond Res 2010;24:3157-3165.

4.     Trenell MI, Rooney KB, Sue CM, et al. Compression garments and recovery from eccentric exercise: A P-MRS study. J Sports Sci Med 2006;5:106-114.

5.     Carling J, Francis K, Lorish C. The effects of continuous external compression on delayed-onset muscle soreness (DOMS). Int J Rehabil Health 1995;1:223-235

6.     Hill J, Howatson G, van Someren K, Leeder J, Pedlar C. Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med 2013;0:1-7.

7.     MacRae BA, Cotter JD, Laing RM. Compression garments and exercise: garment considerations, physiology and performance. Sports Med 2011;41:815-43.

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Foot orthoses – what do you need to know? Part II ~ Jason Agosta

To read Part I of “Foot orthoses – what do you need to know?” click here.

What to expect from a practitioner?

When you see a practitioner regarding your running injuries and/or efficiency expect that the practitioner has some understanding of running and activities themselves. Managing distance runners can be tricky. Your practitioner should understand running and that orthoses and footwear are only one small part of managing running injuries.

They should also understand that, above all, running efficiency and good postural form, along with appropriate training, are more important. Expect that there is an understanding of running and what it is like to be subject to significant stresses and that small differences have a large effect.

Observation of your running is useful and in some cases essential. This is preferably done over-ground, compared to treadmill running.

Photo by Peter Mooney. Used with permission. All rights reserved. Source: flickr

Photo by Peter Mooney. Used with permission. All rights reserved. Source: flickr

Types of orthoses

As in many industries over many years, materials used for orthoses have changed rapidly. There is no need for runners to have orthoses that are rigid, thick ,and heavy. Ideal orthoses for distance runners are flexible, lightweight and of minimal bulk.

Some ideal ‘running’ orthoses are even pre-formed and can be easily modified to suit individual needs. Preformed orthoses can be made from materials of different stiffness depending on what is required for the individual, ranging from extremely flexible to flexible/semi-rigid. More recent materials surpass older materials and are often lighter, more easily modified, and less bulky.

Although some flexible orthoses provide small ranges of control of excessive motions of the foot and usually have poor durability, they provide an excellent way to assess an individual’s suitability and tolerance to wearing orthoses.

‘Off-the-shelf’ orthoses are available commercially though they are often foam moulded devices, offering little support for the runner and are often bulkier than needed. Orthoses of this style are difficult to modify for the individual to achieve an ideal fit and level of support.

Casted rigid orthoses are manufactured from a plaster impression of the feet and enable large ranges of control to be achieved. Casted orthoses may be made from a variety of materials ranging from semi-rigid to rigid. In my opinion, there is no place for rigid orthoses to be used for distance runners.

There is a large variation among individuals to what type of device is most suitable and how much control is required. Runners adapt to their own individual running and are subject to significant forces so many times that the aim is to control only a percentage of excessive motion.

The initial wearing of orthoses. What to do and what to expect.

The first few days of wearing orthoses should involve only daily walking activities. There may be some pressure in the heel and/or arch area but this should only be temporary. To begin, orthoses should be worn for a short time only such for a few hours. If there is excessive pressure from the device, remove the orthoses for a short time. Wearing time should be gradually increased over the first five to seven days until you can wear the orthoses all day during daily activities and walking.

Running or participating in any activities should begin when the orthoses are comfortable and can be worn all day. Gradually introduce the wearing of the orthoses into running and other activities. This should take no longer than seven to ten days at most. If it takes more than this time or even several weeks to be comfortable the orthoses are more than likely too high.

Most people should be able to run in their orthoses after approximately one week, but there is variation between individuals. Orthoses should not impose any pressure to the feet and should be extremely comfortable with excellent fitting in footwear.

Modifying orthoses

If there are fitting problems, blisters, or excessive heel or arch pressures, orthoses should be easily adjusted. Feedback to the practitioner is most important! Approximately one-third of runners issued orthoses require adjustments. Orthoses should be worn with complete comfort! Modifying orthoses should be quick and easy when using excellent and appropriate materials.

Jason Agosta is a Podiatrist of 25 years and is also a former Australian representative at the World Cross Country Championships. His pb’s are 13.48 5000m, 29m for 10km. He still runs approximately 50-60kms per week. The above is very much his opinion in managing distance runners.

References and additional reading:

Cavanagh PR, La Fortune MA, (1980), Ground reaction forces in distance running. Journal of Biomechanics 13, 397-406

Clarke T E, Frederick EC, Cooper LB, (1983) Effects of shoe cushioning upon ground reaction forces in running. Int J Sports Medicine 4, 247-251

Feehery RV, (1986), The biomechanics of running on different surfaces. Clinics in Podiatric Medicine Surgery 3, 649-659

MacLean C, McClay Davis I, Hamill J, (2006), Influence of a custom foot orthotic intervention on lower extremity dynamics in healthy runners. Clinical Biomechanics 21, 623-630

McMillan A, Payne C, (2008), Effect of foot orthoses on lower extremity kinetics during running: a systematic literature review. Journal of Foot and Ankle Research 1:13

McMillan A, Payne C, (2011), Immediate effect of foot orthoses on plantar force timing during running: A repeated measures study. The Foot 21 26-30

Nigg BM, Bahlsen HA, (1988), Influence of heel flare and midsole construction on pronation, supination, and impact forces for heel toe running, Int J Sport Biomechanics 4, 205-219

Payne C, Chuter V, (2001), The clash between theory and science on the kinematic effectiveness of foot orthoses. Clinical Podiatric Medicine and Surgery 18 (4), 705-713

Robbins  SE, and Hanna AM, (1987) Running-related injury prevention through barefoot adaptations. Medicine Science in Sports and Exercise, 19, 2

Robbins SE, Gouw GJ, (1991) Athletic footwear: unsafe due to perceptual illusions. Medicine Science in Sports and Exercise, 23, 2

Shorten MR, Winslow DS, (1992), Spectral analysis of impact shock during running. Int J Sport Biomechanics

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Does your pronation matter when choosing a running shoe? ~ Rasmus Østergaard Nielsen

According to runners’ magazines, shoe stores, and practitioners, an understanding of your personal pronation type is crucial to choosing the proper running shoe. Indeed, this assumption has affected the runner´s choice of running shoes: in 2009, seventy-three percent of all cross-country runners identified foot posture compatibility with shoe design as the most important factor in choosing a running shoe.

But do runners really need to pay particular attention to their foot type when choosing a running shoe to reduce the risk of injury? The following is intended to provide readers with an evidence-based update on the most recent research in this field.

Nielsen-pronation-smallGoing from no evidence to little evidence…

In 2009, Richards et al published a review to determine whether the practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual’s foot type was evidence-based. They concluded it was not.

In 2011, Ryan et al concluded that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious. They based their findings on a randomized controlled trial, in which females running in motion control shoes sustained both a greater number of injuries and had a higher risk of missed training days than persons running in stability or neutral shoes.

Recently, colleagues and I published a paper in the British Journal of Sports Medicine. Almost 1,000 healthy novice runners were followed prospectively for a year while they ran in a neutral running shoe regardless of their foot type. No differences in injury survival existed between individuals with pronating feet or neutral feet. Based on the findings from our study and the study by Ryan et al, it seems clear that a neutral running shoe is a feasible choice regardless of the foot posture.

What about injured runners?

Many runners are injured and many seek advice on choice of running shoes in shoe stores and among clinicians. Unfortunately, very little is known about the choice of running shoe and injury risk among those having had an injury. It is highly important to stress that motion control shoes, neutral shoes, and minimalist shoes may be a feasible choice for injured runners with specific injuries. Personally, I think some injuries are well-treated in motion-control shoes, other injuries in neutral shoes, and others in minimalist shoes, or even no shoes at all.

What is pronation?

In the International Foot and Ankle Biomechanics community, up to forty different definitions of pronation have been presented. Therefore, pronation is a term which may cover various aspects of the foot such as rear-foot angle, navicular drop / height, bulge at the talo-navicular joint, or even several aspects of the foot merged into an index (i.e. foot posture index).

It is important to stress, that pronation may cover different aspects and it is, indeed, important to specify what is meant by pronation before using the term. In the most recent scientific articles, pronation is measured by the foot posture index (FPI). If pronation had been measured using a different approach, other results than those reported may have been presented.

For more information on foot pain, turn to Chapter 40 in Clinical Sports Medicine.

This CSM4ed blog is a forum for your opinions and questions. Feel free to comment on Twitter (@CSM4ed) or email us directly via david.adams at

Let us know how this site can help your clinical practice.

Rasmus Østergaard Nielsen received degrees in physiotherapy (2006) and Master of Health Science (2012) and has worked as as clinician from 2006. He is currently a Phd student at Aarhus University, Denmark. Nielsen also sold running shoes in a runner´s store from 2005 to 2009. Click here for full resume / CV.

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The risks of ionising radiation: three new studies and their impact on imaging in sports medicine ~ Jessica Orchard and John Orchard

In 2012, two major studies were published about the risks of ionising radiation from imaging. Pearce and colleagues’ study in The Lancet examined the excess risk of leukaemia and brain tumours for children and adolescents exposed to computed tomography (CT) scans. They found that children exposed to cumulative doses of 50mGy (3-5 CTs) may have triple the risk of leukaemia, and doses of 60mGy may have almost triple the risk of brain tumours.[1]

Photo by digital cat. Used with permission. All rights reserved. Source: flickr

Photo by digital cat. Used with permission. All rights reserved. Source: flickr

In addition, the Pijpe and colleagues’ GEN-RAD-RISK paper in the BMJ[2] study showed that women such as Angelina Jolie who carry a specific mutation associated with breast cancer (BRCA1/2), and who were exposed to diagnostic radiation before the age of thirty, had almost twice the risk of breast cancer (with a dose-response pattern). This study involved lower doses, which we have previously considered fairly ‘safe’ (e.g. 4mGy from a single mammogram or shoulder X-ray).

On the basis of these studies, we wrote a blog post and started writing an editorial for the British Journal of Sports Medicine. While we were in the final stages of preparing the editorial,[3] a third study was published. The Matthews et al Australian data linkage study,[4] with an enormous cohort (11 million) showed that the adjusted overall cancer incidence for young people exposed to a CT scan was twenty-four percent greater than for those who were not exposed.

That is, one in every 1800 scans resulted in an excess cancer case. As the mean follow up time was only 9.5 years (relatively short in relation to the time taken to develop cancer), this suggests the true lifetime risk may be much higher. We await with interest the relative risk in older people to see whether the risks for the young also apply to those in middle age.

We’ve known about the risks of radiation for some time, but these three studies quantify the risks. Essentially, they show that relatively low doses of ionising radiation, previously considered ‘safe’ can translate into excess cancer cases.

We believe that these findings call for a change in imaging practice. First, ionising radiation should be a consideration for the referring doctor when deciding whether a patient needs a scan (and if so, what type). Second, imaging techniques and machines that reduce ionising radiation doses should always be used. Finally, government funding models must be reviewed to ensure there are no inappropriate incentives towards a radiating scan.

For example, in Australia, if a young patient presents to a GP with low back pain and the GP orders a scan, Medicare would fund a CT scan but not a magnetic resonance imaging (MRI), even though this may be a safer alternative in terms of radiation.

The body of evidence is growing. We need to start translating evidence into practice, just as we did when it was discovered CT scans and X-rays should not be performed on pregnant women. Doctors can look back on scans that they ordered in the 1990s and 2000s and argue, justifiably, that they were following best practice at the time when they ordered a CT or SPECT bone scan.

From 2013, doctors who order a scan which involves ionising radiation in a young athlete would need to be able to argue that they understood the specific increased risk of cancer from these recent papers and felt that the need to get information from that specific scan outweighed that increased risk.

The days of ordering, say a CT scan to work out whether a teenage runner has a slight leg length discrepancy and might need a 3mm heel lift in one shoe, should be over as of the publication of these cancer linkage papers.

This CSM4ed blog is a forum for your opinions and questions. Feel free to comment on Twitter (@CSM4ed) or email us directly via david.adams at

Let us know how this site can help your clinical practice.

Jessica Orchard is a Project Officer in the Cardiovascular Division and an Adjunct Lecturer in the School of Public Health, University of Sydney, Australia. With tertiary qualifications in economics, law and public health, she also has extensive research experience in sports injury epidemiology and prevention.

John Orchard is a sports physician, injury researcher and team doctor. He is an Adjunct Associate Professor in the School of Public Health, University of Sydney, Australia.


1. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380(9840):499-505

2. Pijpe A, Andrieu N, Easton D, et al;. Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations:  retrospective cohort study (GENE-RAD-RISK). BMJ 2012;Sep 6(345):e5660

3. Orchard J, Orchard J, Grenfell T, et al. Ionising radiation: three game-changing studies for imaging in sports medicine (editorial). British Journal of Sports Medicine 2013;[online first: 10.1136/bjsports-2013-092499]

4. Mathews J, Forsythe A, Brady Z, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013;346:f2360

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The Power of Breath in Healing and Recovery ~ Tianne Allan, Registered Yoga Therapist

As a former national level swimmer I understand the importance of breath.  Those last ten meters when my lungs were burning and I ached for a good deep breath to get me to the wall first, it was all too clear.  These days, in my work as a yoga therapist, I understand a different side of the importance of breath. I witness daily the key role breath plays in supporting healing and recovery.

Photo by jayhem. Used with permission. All rights reserved. Source: flickr

Photo by jayhem. Used with permission. All rights reserved. Source: flickr

The first thing I do when working with a new client is a breath assessment. Breath rate, quality, balance, placement, and capacity are a few of the factors I examine.  In my experience, 100 percent of new clients breathe sub-optimally, inhibiting rather than supporting recovery. In fact, most clients are not even aware of their breathing. Nor are they aware of how easily they can positively affect their healing and recovery –by improving their breathing.

Optimal breathing, (also known as diaphragmatic breathing, belly breathing), stimulates the parasympathetic nervous system (PNS), that part of the autonomic nervous system that works to heal, rebuild through the anabolic process, and regenerate the body.  The parasympathetic nerves also stimulate the immune system, digestive, and eliminative organs such as the liver, pancreas, stomach, and intestines.

When the parasympathetic nervous system is activated, the body is a self-healing mechanism.  “This skill, (diaphragmatic breathing) is inborn but often lies dormant (think of how a baby breathes). Reawakening it allows you to tap one of your body’s strongest self-healing mechanisms.”[i]

By contrast, sub-optimal breathing (chest breathing) increases stress, anxiety, muscular tension and is catabolic in nature. “Short, shallow breathing causes a cascade of negative effects in the body, and the body associates that with the fight-or-flight response,” explains Al Lee, co-author of Perfect Breathing. “It gins up the adrenaline, the cortisol, the stress chemicals.” In short, sub-optimal breathing steals health and vitality and inhibits healing and performance.

Optimal breathing is simple and effects are immediate. It can also be taught in under five minutes, though regularly practice is needed for on-going benefits.  Optimal breathing can be incorporated into any rehabilitation program and the rewards go well beyond healing and recovery.

“By learning to control your breathing, you will improve nearly every aspect of your life,” says Lee.  “These techniques are used by just about anybody in any discipline you can think of — fighter pilots to Olympic athletes, marksmen, special forces, you name it. They would say, ‘This is the most important thing I do.'”

Training clients to do optimal breathing can accelerate recovery time and get them back in their game with a new tool to greatly improve both their athletic performance and their life. And it’s right under their nose.

To learn more about optimal breathing, check out these great resources:

For more information on breath assessment and optimal breath training technique, contact Tianne Allan,

This CSM4ed blog is a forum for your opinions and questions. Feel free to comment on Twitter (@CSM4ed) or email us directly via david.adams at

Let us know how this site can help your clinical practice.

Tianne Allan is a yoga therapist, yoga teacher and  trainer in Vancouver, Canada.  She is a former national level swimmer and master swim coach of two world record holders.  She practices yoga, meditation, and breath work daily and still enjoys long, leisurely swims.  Her breathing stats are 8-3-2-10.


[i]Take a deep breath.” Harvard Health Publications, May 2009. Adapted from Stress Management: Approaches for preventing and reducing stress.


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