The market of pneumatic compression systems for sports recovery has grown and evolved over the last decade. While each system shares numerous design similarities, their pricing, claims, portability, muscle pressure, and compression patterns are all different. Nearly every professional team and top-tier college program uses compression in some form, whether wearable options, blood restriction bands, or pneumatic compression.Compressions systems may help athletes cope with heavy training or dense competition schedules. Click To Tweet
Recovery is of utmost importance to coaches and sports medicine professionals, and compression systems are one solution that may help athletes cope with heavy training or dense competition schedules. As of 2018, more than two dozen products have entered the market, but only about half of them have made enough traction to be included in our buyer’s guide. It features background on the medical history and theoretical benefits of pneumatic compression recovery systems, and a full explanation of how they function.
What Is Pneumatic Compression?
When air pressure is used to treat or support fluid circulation in the extremities, it’s considered to be pneumatic compression. Typically, the systems appear as a cuff, full-length inflated pants, or sleeves. An external air pump that is strong enough to inflate auxiliary sleeves at desired levels of pressure usually provides the external compression.
Pneumatic compression is intermittent, meaning the pressure is purposely not continuous and tends to be much higher than with compression garments. Pneumatic compression is measured in millimeters of mercury, and research includes the type and strength of the pressure in order to make comparisons and conclusions on equipment and alternative modalities. Compression is similar to hydrostatic pressure and has both health benefits and a potential role in recovery. Intermittent pneumatic compression (IPC) is sometimes described as sequential, since most systems provide a practical pulse up to the torso starting at the foot or wrist. Lastly, IPC is recovery, not a training modality, and is not to be confused with occlusion training.
Medical History of Pneumatic Compression
Like many recovery products in sport, most compression systems originated as medical devices. The most notable crossover was NormaTec, a solution that stemmed from an invention by Dr. Jacobs. In early 2007, it provided teams with their first sports recovery system. Later, other companies followed suit with similar systems, all employing air pumps and sleeves to facilitate recovery of the lower extremities. Today, dozens of systems exist internationally, with only a handful actually used consistently by professional and recreational athletes. To understand the pneumatic compression systems, readers should note a product’s medical past to invest smarter in not only compression solutions, but all recovery devices.
The three areas where intermittent pneumatic compression has strong carryover and success are lymphedema, deep vein thrombosis (DVT), and general medical needs that are complementary, such as diabetes and pulmonary embolism risks. Most of the interest lies in the circulatory benefits that can improve venous return and the mechanical support of the lymphatic system. Perhaps the most common question with sequential compression devices that are used in the medical arena is how they affect sports recovery, and that is discussed later in the theoretical recovery benefits section. Medically, the evidence for using compression for injury is not strong, but mechanical compression with external devices is supportive based on the pathology. Currently, the scientific literature defends the use of sequential devices for lymphedema and DVT, and other special cases with narrow parameters and limited outcomes.
Sequential pneumatic compression systems cease to be medical devices and become sport recovery devices mostly as a result of market positioning, as the designs and features are nearly identical. Manual therapy with athletes is as old as sport itself, so it’s no surprise that sports have gravitated to the device market along with self-therapy treatments.
Theoretical Recovery Benefits
Research on the recovery benefits of pneumatic compression tends to focus on performance enhancements before and after treatment, with little changes outside range of motion. Therefore, it’s likely that the benefits to athletes are more rooted in assisting the prophylactic needs of heavy sports training. Over the last decade, about 20 studies have investigated pneumatic compression devices and most saw responses in the following areas. Improvements in anaerobic and endurance performance have not been found, but it’s likely the systems supported by compression are not related to neuromuscular power.It’s likely the systems supported by compression are not related to neuromuscular power. Click To Tweet
Perceptual experiences in soreness and pain are theoretically possible, due to the temporary pressure around the working muscles. While measures in lactate and circulating creatine kinase do decrease, the actual research on pain levels are only reported. Therefore, it should be noted that compression devices may provide a transient change in comfort that is sensory; meaning they don’t reduce or block pain, just reshape the experience briefly.
Positive improvements in the ANS (autonomic nervous system) are commonly referred to, but it is unknown how lasting the effect is. A confounding challenge is determining whether it is the elevated legs or the placebo effect elevating heart rate variability measures, but the scientific literature does support positive improvements to the ANS for increased circulatory changes from compression systems. How much an enhancement DOES improve athlete recovery remains a mystery at this point.
Reductions in muscle tone are also theorized to be a part of compression, as range of motion improvements documented in the scientific research are evidence that short-term changes are likely to occur. It is not known how much enhancement there is to the neuromuscular system and how valuable those enhancements are, as very few longitudinal studies on muscle function and performance are available. Possible decreases in edema are likely to help relief of osmotic pressure, but so far, the research is scant on cellular adaptations.
Lymphatic Movement and Kinetics
Sequential pneumatic compression directly influences the movement of circulative lymph, as the lymphatic system is predominantly a passive system relying on human locomotion and movement. Several invasive studies have evaluated lymphatic support devices and found that, through tracing, lymph flow increases using the equipment. It’s not currently known if the athlete benefits from additional lymphatic circulation from external compression devices.
A proposed theory that circulatory engagement can improve recovery is slightly misleading, as the temporary reduction in passive lactate clearance is not actually recovery but an accelerated state of readiness. The research on blood flow using instrumentation has yet to see a lasting effect or improvement in muscle readiness, and not enough research on sports-related injuries is currently available.
Other theoretical adaptations and recovery theories are emerging, such as cellular responses similar to occlusion training, but it’s too early to include them at this time. Again, it seems that the athlete response is mainly a prophylactic experience that removes sensory discomfort from the area, and it’s perceptual. Most of the research that discredits the use of compression targets hard performance changes (that are unlikely to occur), but they are also important to show the limitations of the product. In short, the physiological changes during the compression treatment create an experience that athletes value, and new research shows its potential with healing, such as Achilles injuries and other ailments.New research shows compression’s potential with healing, such as Achilles injuries & other ailments. Click To Tweet
Key Features and Product Design Factors
Nearly every product on the market shares the same general design, meaning each system has an air pump and garment that applies a repeated pressure to the limb(s). Each system has air tubes, a controller, and heavy-duty inflatable cuffs or full pants and/or arm sleeves. Warranties and claims are all rather similar, but each company has its own customer agreement and limitations to its product use.
You should carefully weigh all design benefits when investing in a device, as one feature alone isn’t sufficient to make a difference unless it’s indispensable. For example, some systems don’t provide upper body options, so those features are likely to be of importance. Listed below are the primary features most buyers look for when purchasing pneumatic compression devices.
Levels of Pressure
Every system has its own level of pressure, but most ranges are far above 50 millimeters of mercury and the end range of pneumatic compression is about 130 millimeters. Most systems can be adjusted up and down based on comfort, and they can deliver higher ranges if they are higher performance models.
Each pneumatic compression system has either a unique pattern of pressure application or a similar pattern of graded restriction. As mentioned earlier, the purpose of the term “intermittent” is to convey that the interplay of pressure and release creates the desired response, and the pattern of sequential compression that is ideal is yet unknown.
The sleeves are often designed to have multiple chambers to create a more effective milking action, as most systems act like a tourniquet and move pressure, for example, up from the foot to the thigh. The optimal number and shape of chambers is unknown, but having five of them for the leg and arms is standard with most products.
Air Pump Size and Noise
A common complaint in the past was that air pumps were loud and created an unpleasant experience, but now they are nearly silent, small, and easier to control. Most of the noise comes from the initiation of gathering pressure from air compressors in the pump, but the release of air is also part of the sound. Most systems are currently not distracting or loud, but some are definitely quieter than others.
Obviously, the final factor for those on a limited budget is price. The cost of an entry-level product that is incomplete and limited can start around US$500, and most systems are more than twice that price. Durability and consistency for the application is expected, but each company offers unique warranties, as mentioned earlier. Some products are more portable than others, but almost all include a travel bag and can be brought as carry-on for air travel.
The Leading Recovery Compression Systems
If the list below was composed a few years ago, most of the products would still be viable, but there has recently been a lot of change in the market. The list doesn’t include general medical devices for edema or deep vein thrombosis, and only sport-specific brands are on it. Some systems employ cryotherapy features, but those add-ons are not necessary to benefit from compression. Here are seven systems that are popular in team and elite sport.
This Massachusetts company was one of the first sports recovery companies to get into the pneumatic compression market, and it’s a leader in both design and adoption. Not only does it provide multiple models for both regular and professional use, it also offers the most extensive auxiliary products, such as hip and arm sleeves. The NormaTec is internally cold and the system has been revised multiple times over the last 10 years. In addition to its patent pulse technology, it has setting options that allow the user to add more pressure to specific zones during the treatment. While the cost of the NormaTec is on the high end, its value lies in its durability and the design features that elite sport demands.
This new company in the sports recovery market specializes in both portability and additional cold treatment for sports injury and recovery. Squid Compression’s products are single limb or small area only, and are more medical than recovery. They are ultra portable, as the air pump can fit in a user’s hand, and the sleeves can fit in an athlete’s backpack. The Squid wraps can provide local treatment to the elbow, wrist, thigh, knee, shoulder, and ankle. Included in the system is a cold pack, battery and controller, hose, and compression attachment. There are only four levels of pressure, but the product is more for sports medicine than recovery. For a price point, the products are in the under-$800 range, but they can only treat partial singular limb areas. The Squid is a U.S. product and distributed domestically.
This Korean company has FDA clearance like the rest of the listed companies, and distributes both in the U.S. and internationally. RevitaPump has a 20-year history of supporting the medical community, and offers a complete line of sleeve accessories, such as waist, hip, arm, and, obviously, leg support. The product is considered a professional version and it is priced near the cost of other elite compression systems but is notably less expensive than the marquee products. RevitaPump claims their price is lower because they don’t do marketing events—it is around the $800 point. They provide a warranty for the product line.
Most of the attention Game Ready receives is in the post-surgical space, and their product’s strength is the cooling system it provides to athletes. The system features compression, heat therapy, and even contrast therapy. Game Ready is the most extensive system on the market, and has an appropriate cost associated with the vast range of modalities included. It is used in both the clinical setting and general recovery area, so it’s seen as a bridge from medical to performance. Game Ready is a California-based company, but its wraps and accessories are available in other countries outside North America. Their product is FDA-approved and considered a medical device, but it can be used to facilitate both injury and recovery.
The Rapid Reboot is a prosumer product, as it’s priced to satisfy the higher-end weekend warrior and emerging elite athlete. Its standard leg system includes pants and a travel bag, and costs just under $1,000. Rapid Reboot provides a two-year warranty, and their pants have four specific targeted locations. In addition to leg recovery, the system also has options for upper body and hip recovery. Rapid Reboot is a new company, and is based in the U.S. (Utah). Currently, it has a product ambassador program, and sponsors athletes.
A lower-entry product, Air Relax provides a solution more geared to the recreational athlete and weekend warrior. With a price of $400 for a medium-sized pant, it’s likely that Air Relax is appealing to the general fitness space rather than elite sport. Air Relax is similar to other brands with chambers, pulse settings, and general design. Currently, there isn’t a lot of research on the system itself, as the science the company promotes on its website refers mainly to other products. The warranty is for one year, and the product can be used in other countries.
This product from RP Sports is considered professional-grade, as the features, design, and price are in line with NormaTec. The company also provides tubs and occlusion products, and it sells attachments and multiple product offerings such as an elite line of recovery compression. The RecoveryPump (lite version) is portable and has a controller that provides up to 100mm of mercury (pressure). The product has sleeves for arm recovery and even includes a jacket for more-demanding recovery sessions for the upper body. The U.S.-based company provides a partner program, and a money-back guarantee. JoHan Wang, a former NBA performance specialist, is RP Sports’ scientific advisor.
The list above is likely to change slightly in the coming years, but many of the products do have a great track record of solid sales and customer loyalty. So far, most of the interested markets are elite endurance sport such as triathlons and marathons, professional team sports, and CrossFit. The price point of more consumer-friendly products has grown the market to what it is now, and the new players will have to innovate to both meet the standards of compression recovery and do it at a price point the market will tolerate.
Final Recommendations for Compression Systems
Pneumatic compression is popular with athletes and the user experience is straightforward. Nearly every system is portable, with a price point that is affordable for recreational-level athletes. The consumer market is now sizable where cost-effective options exist, but most of them are not suitable for athletes or elite performers in other areas such as dance.Expect future compression devices to be more ergonomic, with more supportive athlete rehab research. Click To Tweet
In the future, expect more players to enter the market with refinements such as smart device control and more ergonomic designs to match to the anatomical needs of the body. In addition to the predicted design advancements, an increase in research on recovery and rehabilitation with athletes is also expected.
Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF