Why I Will Not Sell Calf Compression Sleeves; the Risk of DVT in Runners

At Orthopedic Rehabilitation Specialists I sell and use medical quality compression socks to control swelling that causes pain and limits activities. I sell athletic compression socks at The Runners High for the same reason. To control swelling, the socks have to have enough pressure gradients to cover the whole foot and calf with more pressure at the bottom and less pressure towards the top. The medical quality compression socks are manufactured to specific FDA guidelines for fit and pressure. Some other athletic compression socks are not. I very carefully test the compression socks we sell. If it does not give enough pressure it will not control swelling. However, if the fit and pressure are not correct it can cause blood to be backed up in the calves and feet, and that can lead to a type of blood clot known as deep vein thrombosis (DVT).

75% of the public does not know what DVT is. If left untreated, DVT can lead to pulmonary embolism (PE) which has a high death rate. Runners need to be aware that strenuous leg exercise such as running is a risk factor for DVT. For a period of time, maybe up to a day after a long, hard workout, runners are at greater risk of DVT than the general population – maybe as high as the elderly population.  When combined with other DVT risk factors such flying in a plane, dehydration, using birth control pills, or an injury that causes swelling or internal bleeding, the risk for DVT multiplies. Runners can get this potentially deadly condition if they don’t know the risks of DVT and don’t know what to look out for before it happens. Most runners don’t know that calf pain can be DVT. Most of my patients never knew to check for swelling until I taught them.  

I do use compression socks at work because I mostly stand and often work 10 hour shifts. In recent years, my ankles and feet tend to swell by the end of a shift without compression.  While vendors claim that compression socks improve recovery from exercise, I find no difference when using compression socks to control swelling except when standing all day or during air travel. I do not use them for running because I have no swelling even on my longest runs and I prefer running in regular socks.

However, I do not use or sell calf compression sleeves. I often wear test the products we sell in my store, and whenever I wear test compressive calf sleeves that have enough pressure to give support, I have increased swelling in my feet and ankles. My shoes feel tight by the end of my shift and my regular socks create lines that dig into my skin.  Compressive calf sleeves make my symptoms much worse than if I wore no compression to work at all. In my PT practice, I also see this swelling in injured runners that use calf compression sleeves. This backup of fluid in the legs creates a risk factor for DVT.

Here’s another reason why I will not sell compressive calf sleeves: Imagine a female runner who has just raced the marathon of her life, who is taking birth control pills, and who is flying right home after her run while wearing calf sleeves because she has a calf injury. All those factors multiply her risk of triggering DVT and PE.  But the calf sleeve vendors do not inform their customers of this risk in their marketing or packaging. I would hate to have a customer buy these products from my store and have it contribute to such a life-altering condition.

 

Compression sleeve and regular sock at end of work day. Notice swelling building up between sleeve and sock.

Compression sleeve and regular sock at end of work day. Notice swelling building up between sleeve and sock.

Notice swelling when sleeve and sock removed that built up during the day.

Compression sock worked all day. The sock and calf sleeve are the same exact pressure , size and from the same vendor.

 

No swelling from wearing compression socks till end of shift.
No swelling from wearing compression socks till end of shift.

Bruce R. Wilk, P.T., O.C.S. is author of the “The Post Injury Running Recovery Program” and Director of Orthopedic Rehabilitation Specialists

 

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46 Responses to Why I Will Not Sell Calf Compression Sleeves; the Risk of DVT in Runners

  1. Bruce Wilk says:

    Sean T. Kendrick Thank you for your article. I’ve run with Zensah compression sleeves and also with their full compression socks in the past. I never felt any performance benefit from them, and often I would feel they hampered performance.
    about an hour ago via mobile ·

  2. Bruce Wilk says:

    Kt Lafferty This is interesting!! Since several people in this group suggested the sleeves, I now swear by them for recovery! But… I am the girl on the birth control pills… who will be flying home after my first half… and probably wearing the sleeves. This gives me something to think about now!

  3. Good point. I had never thought about possibilities of DVT in sleeves vs socks. I have had success with socks with shin splints and calf issues. I had usually recommended socks since the foot often has soreness and/or swelling along with the lower leg after prolonged standing and running.

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  5. Chris Hobson says:

    Interesting article. I was diagnosed with P.E. a few days after completing a half marathon. Yep, it scared the hell out of me. I fly on a regular basis, was on b.c., the on HRT. Perhaps we should chat, for I wear the calf sleeves whenever I fly. But i never wear them to bed nor when I run.

  6. Griff Randle says:

    This is an interesting post. From a face-validity stand point, Mr. Wilk’s argument is sound that increased compression on an athlete and backing up the superficial venous system may result in increased venous stasis and resultant coagulation in the peripheral tissues. Imagine a novel idea when the superficial vasculature is cut off distal to the pump, it is more likely to pool in the uncompressed tissues. Unfortunately, the incidence of DVT in long distance runners is exceedingly low and has yet to be documented in a highly regarded, peer-reviewed journal when due to compression sleeves in exclusion. Athletes and non-athletes alike are at an elevated risk for developing blood clots when known factors such as oral contraceptives, prolonged posturing as during long air travel, and inherited clotting abnormalities are present, and the addition of the variable of fixed calf compression has yet to be assessed on a wide scale. The highest risks for DVT are observed immediately post large surgeries, as well as when taking medications that put individuals into a pro-thrombic state. In fact, some levels of compression are recommended post DVT when returning to exercise.

    I do not nor have I ever worn compression socks or sleeves while running, but I have had a number of running patients recovering from medial tibial stress syndrome/ periostitis report anecdotal success in return to running with use of these devices. Every day when I take off my dress shoes and dress socks I too look at my calf/ ankles (cankles) and notice a demarcation of where my socks started and where swelling sits, however this typically works itself out within a few hours. I’m not arguing for the use of compression sleeves as there is no data to support their efficacy in this patient population, nor is there any data to suggest the risk. I am merely stating that we get the facts straight that 1) DVT is exceedingly low in long distance runners 2) Highest risk for DVT is immediately post surgical and when taking medications which predispose one to be in a prothrombic state, and 3) there is no data to support efficacy for or risk of wearing compression stockings.

    And let’s be honest they look pretty cool too.

    Griff Randle, PT, DPT
    Orthopedic PT Resident
    University of Delaware

    • Bruce Wilk says:

      Emailed you got data that you must have missed.

    • brian h says:

      I dunno, I was a perfectly healthy marathoner and got DVT from a strain +dehydration + wrap&ice. I was on blood thinners for a year and I still get swelling, pain, varicose veins, etc. Is a compression sleeve safe for me? My doc recommended it. And it’s def possible to get DVT right after running/exercising. It feels just like a bruise (but you didn’t get hit there). Big red flag is swelling in a limb that isn’t injured, get that checked ASAP!! stay safe everyone.

  7. Bruce Wilk says:

    I don’t believe there’s enough merit in the author’s assertions regarding a link between calf sleeves and DVT. That picture to the left of my comment is me crossing a finish line in CEP calf compression sleeves under Nike Pro Combat tights and shorts. I’ve never experienced a swelling like the author describes and am perplexed by his first picture of his lower leg. Unless I’m viewing the picture wrong, he’s wearing a black CEP compression sleeve worn sideways. The taper in the stitching shown on the side of his leg is supposed to point down the back of the leg towards the heel. That’s the way a fit specialist told me they are worn and confirmed by CEP’s directions for wear. Heat of summer or dead of winter, they help me. I’ve even worn them to bed after a long day’s work on my feet or when I’ve overdone it doing some other exercise in excess, which is prone to happen when your mind tells you you’re younger than you really are. :) :)

    -Anonymous

  8. Bruce Wilk says:

    I believe swelling to be a problem that should be investigated and controlled. You pointed out something that I missed. I began the day with this sleeve straight and it got twisted during my wear test. This foot and ankle were more swollen then my other one.
    I did not notice the twisting when we took the picture, although the instructions that came with the sleeve do not discuss positioning or to check for twisting. When I provide compression socks and stockings I always tell my patients to check for positioning. The CEP socks I use never have twisted or resulted in swelling, and they are fit correctly. I used the same size sleeve and was pointing out the difference between the two with this post.

  9. I’d like to say “well done”! This is an excellent bit of material you have written. I am in agreement with you on many points. You have made me think.

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  14. sheila says:

    Yes the black calf compression sleeve is on backwards. The side stitching should
    meet on the proximal upper calf. It’s meant to point up .

  15. Emma says:

    I really appreciate you writing this article as you’re right, MOST sports and retail manufacturers don’t make the differentiation between socks and sleeves.

    We have added this warning to our packaging and will reference your article in an upcoming travel feature.

  16. Meg says:

    Interesting article!
    I’m an avid runner and I had a massive (as in, from the top of my thigh to mid-calf) DVT 2 years ago when I was 28. My biggest mistake was thinking, as a young, healthy runner that the soreness I felt in my leg for weeks was some persistent running injury and I just needed to rest. By the time I finally went to the emergency room, it was pretty serious and I was lucky to eventually regain full function of my leg with minimal permanent damage (and not have a PE!). It’s important for people, especially athletes, to know the symptoms of a DVT or PE since we’re the last people who expect to get one (especially young athletes!).

    Side note: although I was on birth control and have Factor 5 lieden (generic disorder that predisposes me to clotting), the cause of the clot actually turned out to be non-hodgkins lymphoma – in rare cases, a blood can be an indication of an underlying cancer.

    My thrombosis specialist (who is a marathon runner himself) recommended I use calf compression sleeves when running – not sure if they increase performance, but I find they do provide comfort/relief on my damaged leg (it is permanently a bit swollen and seems to swell more when working out/during warm weather). I’ll have to ask get his thoughts on this sock vs sleeve article!

  17. Cherie says:

    Recently ran a 5 mile race in compression sleeves and since that time I have had pain in my leg, similar to a high ankle sprain. Wondering now if the sleeves had anything to do with it. I do not remember any instructions on how to put them on either. 2 weeks later i still have pain in that area and top of foot.

  18. Paige says:

    My doctor recommended a golf ball muscle roller which i use before and after i run, wow what a difference!! Everyone runner needs one,night and day difference! http://zzathletics.com/Golf-Ball-Muscle-Roller-Massager-GBMR1.htm

  19. I’ve never seen an RCT saying that compression socks are going to increase your risk of DVT. If anything, there have been a few studies documenting lower risk of DVT with compression…http://0-www.ncbi.nlm.nih.gov.innopac.library.unr.edu/pubmed/12463616

  20. Sherry Venderley says:

    I bought a new pair of compression sleeves before my last half marathon in May and I wore them while training for a few weeks prior and had no adverse reactions. They were tighter and more supportive than my old ones so I thought that was good. I have had some swelling in my feet after long car rides or prolonged standing on my feet, and had some swelling after chemo for breast cancer, but each time it was an isolated event, dissipated quickly, and never became chronic. Had an Echo of the heart after chemo and checked out fine. I wore the sleeves while running this half as a preventative measure to encourage good circulation, and to help with recovery, but not for a swelling problem. When I finished the race and sat down to stretch my hamstrings my calves abruptly went into an instant spasm, bilaterally, which lasted about 15 minutes. Right side was worse and some right side pain persisted for a week or so after the race. When it was happening my feet involuntarily flexed upward (toes toward shin) and I could not release them. If I tried to move them or massage my calf the spasms increased. The pain was just awful, but once the spasms stopped I felt okay. I still had the compression socks on the whole time and had been in too much pain to remove them. As I look back at this and am also preparing for another half in September, I am wondering if it was the sleeves that caused my trouble. They are significantly tighter than any I have worn and I can’t think of another variable that was different. We trained with Hammer Gels and drank plenty of fluids, so hopefully hydration was not an issue. It was a chilly morning but warmed up throughout the race, but was by no means hot and sweating was not unusually bad. Wondering now if I should’ve seen my doc, but I tried to not be worried about it. In retrospect wondering now if I was to remiss in seeking help. I love running, train regularly, have run many races, and just want to be healthy.

  21. Jessie says:

    Bruce,

    The reason you are experiencing increased swelling while wearing compression calf sleeves is that they are not designed for everyday use. Compression calf sleeves do not offer the compression throughout the foot like compression socks do. You therefore risk blood pooling at the ankle if your blood is not being sufficiently circulated like it would be during more intense activity.

    Compression sleeves are great, but only while active!

  22. Lisa says:

    I run marathons and have used compression socks for recovery (never while running). As a woman with smaller feet these are a bit sloppy on the foot but since my swelling (no pain) is in lower calves I was reluctant to use sleeves for fear that they would act as they would cause swelling in the ankle and foot. I bought a pair and wore them after a 26 mile training run. I didn’t notice any swelling below the bottom of the sleeve and was thinking this might be the way to go. This article has given me pause. What about the options with stirrups? Have you tried these? they seem like they might be a good compromise.

    • Bruce Wilk says:

      I run in warm Miami year round and would never use sleeves to run in. I cold climates I use tights. The more compression the more material so I use to warm as needed while running out of town.

  23. Lisa says:

    As I mentioned, I am mot running in socks or sleeves and use them only for recovery. My question was whether the options with stirrups would get around the issue of swelling below the sleeve as the foot portion of my recovery socks is often too big and makes wearing many shoes difficult.

  24. Jonathan says:

    So are we saying that compression socks are fine. But compression sleeves should only be worn whilst running/exercising and not for long periods of time, but still are beneficial? I just bought a pair and was hoping that they might help me with recovering whilst I take a rest from exercise due to injury, I suppose that’s a bad idea? But would then plan to only wear them during exercise once recovered, in order to prevent future injury.

    • Bruce Wilk says:

      Jonathon there are NO clothes to treat injury.

      • Tim says:

        I actually disagree with this comment. I’m a podiatrist if that gives me any merit, but of course this being the internet I’ll expect some skepticism. Compression sleeves and socks, while not treating an injury, can improve healing times. They do this, as you know, by decreasing swelling and inflammation. A little inflammation is a certainly natural in any healing process, but when there is evidence of swelling it is usually a sign that the body has gone a bit overboard. This excess fluid slows down the healing process of the tissue and perpetuates the acute inflammatory response that can actually hurt the tissue more over time. This is why rest, ice, compression, and elevation are always recommended with acute injuries. I’ve used compression socks on myself and on patients for running injuries with great results. As far as DVTs go, there is no evidence that sleeves will cause them. These socks have pressure gradients to push fluid out of the ankle and up the calf. In order to cause the effect you mention, the sleeve would have to be so tight as to be extremely painful. No one would be able to wear a sleeve that tight when not exercising, and even if they could the pressure would cause a backup of fluid to the foot, where DVTs rarely if ever form.

  25. Pedro says:

    Great post! I think raising thowards the correct usage of each kind of sock/sleeve is important to prevent a fatal outcome.

    I’ve been prescribed by my orthopaedist to wear sleeves for shin splints… yet I was sold CEP Compression Sleeves which are probably great for running, but not to be seated all day at the office.

    Swelling startied on the ankle area so I now can’t trust either my orthopaedist or orthopaedic products lady.

    Bottom line: which products are available for Shin Splints recovery to be used for the 2 months I’m grounded from running?

    Thanks for your help!

  26. Gary says:

    I too am a podiatrist & Ironman triathlete who prescribes medical compression leg wear (MCL) for moderate to extreme amounts of oedema(swelling) for athletes & patients alike however, have never personally had the need to wear them. The 2 questions I have are: if you say you wear-test the garments you sell (which means you should know intimately how they should feel the whole time you’re wearing them) how did you not realize the compression sleeve had twisted-is this legs circumference smaller which begs the question do we buy 2 different sizes; when I prescribe MCL I always advise my patients to apply them when they start their day to prevent the gravitational back flow. I haven’t heard you mention if you put your compression sleeves on prior to an afternoon run which would certainly account for your noticeable swelling at the ankle. Thank you.

    • Bruce Wilk says:

      I did not run that day. I ran the day before. I used them on my regular PT shift all day. I regularly use the same vendor sock same pressure and sizing. I never get ankle and foot swelling in that product. I was using it as instructed and the twisting occurred on it’s own unnoticeable to me. This twisting has been reported to me now that I ask.

  27. John Wise says:

    where can i purchase these in Australia?

  28. Amanda head says:

    Reading all this with interest I’m a staff nurse, before we put compression on anyone we have to carry out a Doppler test to check people don’t have probs with circulation & that we are not going to be cutting of any remaining circulation with the compression.

  29. KP says:

    I have a question, I have a mild gastro tear I visited the ortho this past week. He to,d me to continue to use PRICE and add heat after day 5. The important factor is to monitor pain. I can walk now that it is day 5 with some tenderness but need to avoid sharp movements, the recovery period is 3 to 4 weeks. I have the stretches and pt all set to go. I was running 50 miles a week this winter, the injury occurred while accelerating during a basketball game as an official. I have a few more games in my schedule and my ortho suggested a compression sock/sleeve during the two hour game timeframe. What are your suggestions for socks?

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