Compression Socks, just a trend?

Paula Radcliffe was one of the first well known people to make use of compression socks. Now days they have become very popular in most sport although I have not yet seen them used by cyclist in the pro peloton? Although cyclist tend to wear them for recovery. Compressions are also popular with pole vaulters, long and high jumpers.

Compression garments and socks have a place in the medical world for patients who suffer with deep vein thrombosis, bed ridden patients that can not move or people that have to sit for long periods of time such as traveling in aircraft.

The theory behind compression socks are that the compression helps to improve blood circulation. The graduated compression from the ankle to the calf helps blood that tends to pool in the lower limbs fight gravity and thus improve circulation. This then could move dexoygenated blood quicker away from the limbs with oxygenated blood flow back.

Another theory is and this will explain why long jumpers and pole vaulters use the socks where blood circulation is perhaps not a major issue is muscle vibration. Every time the foot strikes the ground the force of the impact send vibrations through the lower leg. These vibrations caused by impact are thought to be a contribution to muscle fatigue and delayed muscle soreness. There is research which has shown compression socks to increase leg power (Kraemer et al., 1996, 1998).

Research on compression socks whether they work has had mixed results. Knowing whether the socks improve blood flow during activity has been hard to research compared to using the socks for recovery which is probably why cyclist are not using them yet for racing. Although a portable NIRS could be a future option for testing something like this during exercise.

There have been research that show improvement in performance and economy while other research has shown no improvement in performance but a reduction in muscle soreness. (Kremmier et al. 2009 and Ali et al. 2007). Some research has looked at how compression socks influence lactate (blood lactate is measured not muscle lactate) and has found the socks seem to help lower blood lactate . Why this occurs is open for discussion as there are different theories what happens to the lactate. But perhaps with the increased blood circulation the blood helps transport the lactate to other muscles that need the lactate so improves the lactate shuttle?

Studies from (Byrne & Easton, 2010, Ali 2007), found decreases in muscle soreness from plyometrics and running. It is thought that the compression helps to alleviate inflammation and swelling. Once again why compression socks help with this is not known and there are several theory's.

Overall most research found decreases in muscle soreness but there is mixed results on the improvement in blood flow more so during intense exercise which is hard to study. The variations in research could be because of the wide variety of socks used from different manufacturers. The use of graduated compression to constant pressure compression socks. There is a certain amount of correct compression needed at different parts of the lower leg for a compression sock to work. It seems that a graduated compression sock running tighter at the ankles and less up to the calf would improve blood flow better than the same pressure in the case of constant compression sock. But also there is a individual element as different people could have a different reaction. People with circulation problems will likely see bigger results.

I own three different brands of compression socks and pants. It is impossible to say if they actually work without having some form of tests done. If someone feels like they work it may be psychological. But wearing the socks does feel very comfortable, and most of the research although perhaps it can not explain why the socks work indicate some form of benefit most of which shows reduced muscle soreness and improved blood flow at least during recovery use. Compression socks are just another small thing that makes a small improvement in recovery which could add up with all the other small tools that we add to our training. For now I will continue to wear my socks during hard session, or where there is high impact. And when the fashion catches on in cycling I might wear it during a Sunday coffee ride.

Altitude training, IHT, Hypercapnia recovery and the benefits.

Many athletes now days have some sort of altitude camp or Intermittent Hypoxic Training (IHT). There are various combinations of Living high training high or living high training low etc. With living high and training low (which could be done using a altitude tent) a athlete can avoid reduced muscle recruitment found when training high so have a better training session at lower altitude with the benefit of increased red blood cells.  A more common practice now days is IHT which has shown to be more effective than altitude tents. Depending on the protocol the body will adapt to the hypoxia effect and increase red blood cell production so there is more oxygen carrying blood going to the working muscles.

If you have read the post FaCT way of looking at the body you might understand why there could be altitude responders and non-responders. Example: If your muscles are the limitation before the altitude camp, then after e.g. three weeks at altitude  they may not have changed at all but in fact the muscle "may" be worse from the camp due to a reduced muscle recruitment at altitude. If that is so and we have better oxygen transportation with more Oxygenated blood (higher red blood cell count) it is much easier for the heart to keep the vital organs happy. Pumping more blood to the muscle will make no sense, as the limitation of muscle can't take more oxygen in anyway (muscle recruitment/utilization). This would be a non-responder and the same holds true when athletes use EPO and in some cases there are also non-responders. So once again knowing what each individual athletes limitation is through testing and not guessing will help one to understand the effects of training at altitude.

What I would like to give more in depth information on is the lesser known benefits of Hypoxia or Hypercapnia.  Many of the ideas come from the Russian school and one of the "leading" researchers is, Dr. Buteyko. Here is a abstract which might make you see the bigger picture.

• Oxygenation: Carbon dioxide (CO2) plays a large role in oxygen transport from the blood to the cells of the brain and body. A reduction in CO2 levels brings with it reduced oxygenation of tissue and vital organs (Verigo-Bohr Effect).
• Acid/Alkaline Balance and the Immune System: CO2, through its conversion to carbonic acid, is a primary regulator of the acid/alkaline balance of the body. 
• Vessels: CO2 helps to dilate smooth muscle tissue.
• The Cardiovascular System: CO2 helps regulate the cardiovascular system.
• The Digestive System: A direct relationship exists between the level of CO2 in the body and the functioning of the digestive glands.

Tatiana V. Serbrovskaya (High Altitude Medicine & Biology ( Department of hypoxic States, Bogomoletz Institute of physiology (Kiev Ukraine ) Volume 3, number 2 2002 @ Mary Ann Liebert Inc.

"Intermittent hypoxia research in the former Soviet Union and the Commonwealth of Independent States : History and review of the concept and selected applications. High Alt Med Biol 3:205-221,2002.- This review aims to summarize the basic research in the field of intermittent hypoxia in the Soviet Union and the Commonwealth of Independent States (cis) that scientists in other Western countries may not be familiar with, since Soviet scientists were essentially cut off from the global scientific community for about 60 years. In the 1930s the concept of repeated hypoxic training was developed and the following induction methods were utilized: repeat stays at high-mountain camps for several weeks, regular high altitude flights by plane, training in altitude chambers, and training by inhalation of low-oxygen-gas mixture. To the present day, intermittent hypoxic training (IHT) has been used extensively for altitude pre acclimatization; for the treatment of a variety of clinical disorders, including chronic lung diseases, bronchial asthma, hypertension, diabetes mellitus, Parkinson's disease, emotional disorders, and radiation toxicity, in prophylaxis of certain occupational diseases; and in sports. The basic mechanisms underlying the beneficial effects of IHT are mainly in three areas: regulation of respiration, free-radical production, and mitochondrial respiration. It was found that IHT induces increased ventilatory sensitivity to hypoxia, as well as other hypoxia-related physiological changes, such as increased hematopoiesis, alveolar ventilation and lung diffusion capacity, and alterations in the autonomic nervous system. Due to IHT, antioxidant defence mechanisms are stimulated, cellular membranes become more stable, Ca2+ elimination from the cytoplasm is increased, and O2 transport in tissue is improved. IHT induces changes within mitochondria , involving NAD-dependent metabolism, that increase the efficiency of oxygen utilization in ATP production. These effects are mediated partly by NO-dependent reactions. The marked individual variability both in animals and humans in the response to, and tolerance of, hypoxia is described. Studies from Soviet Union and the CIS significantly contributed to the understanding of intermittent hypoxia and its possible beneficial effects and should stimulate further research in this direction in other countries."

If you are still awake and have followed up to now well done!  So from these benefits one can summarise that IHT has many health benefits also.  Athletes are known to use Hypercapnia for recovery from day after day hard sessions or stage races but the protocol for this is hard to find and one would unlikely complete a full IHT course.  It is a matter of research and thinking how  and when to best apply it after ie a hard race.    

Here is another article to read. The lung and carbon dioxide:

There are many manufacturers of equipment that can be used for IHT and hypercapnia ie  AltiPower, the main disadvantage is maintenance cost of the CO2 filters, but also it can be hard to control SpO2 levels, the SpiroTiger  can be "abused" and allot more precisely control SpO2 levels through breathing alone. Disclaimer: SpiroTiger is NOT build to be used as IHT equipment but only as a diaphragmatic endurance training equipment. It is essential that with any IHT equipment a pCO2 and at the minimum a  Pulse Oximeter is used during IHT.  Dropping the blood saturation (SpO2)  to low, could lead to hospitalization or even death.

Latest in fancy kit vs testing. Part 2

(This follows from Latest in fancy kit vs testing. Part 1) Testing is seen as a way to assess how good a athlete has become. If any improvements have been made, to see how long and hard a athlete can push themselves.  We are told we pushed a bigger wattage, we have a better power to weight ratio, we have reached a higher max heart rate, we need to improve on lactate threshold. Would it not be better to look at fitness testing to find a athletes weakest link in the trainable system (Physiology from a different angle) and if the weakest link has become stronger? Thus looking at the individual systems in the body.  To do this we have to change the philosophy, that power and speed and time are objective tools to see a result towards the physiology, that individual physiological reactions are the tool for success.

This idea and the tools used with it will be in another 10 - 15 years time when it is hopefully better accepted by Sport Science in general. We now have great physiological testing tools, NIRS, PhisioFlow, Polar Heart Rate Monitors, Suunto Heart Rate Monitors that give information on EPOC and BioHarness which measures through a heart rate strap body temperature, breathing rate, ECG and pulse. But due to the development of flashy and high tech gadgets like SRM (which undeniably has had its successes) we are taking a step backwards from physiological information. We have rowing machines and spinning bikes that have wattage information and everybody is pushing for a target wattage and forgets to listen to the bodies response. We have new training devices like the SpiroTiger which is a brilliant training tool when used correctly but due to our own competitiveness we will try to push the biggest bag size and breathing frequency with only short term if little improvement.

We have to wait until people can see and understand physiology from a different angle and that absolute values and graphs are great tools but give limited information for the deeper assessment to the working body.

Latest in fancy kit vs testing. Part 1

This article and much of this blog is inspired by the forward thinking of FaCT Canada. 


Look at any one of the recent Olympics or World Championships for most sports, and one will see the amount of money spent on sport equipment rather than the athlete centered ideas.  Agreeably some equipment is essential but I am talking more about the latest in aerodynamic helmets, swimsuits, clothing design because image is everything.  Or we see professional cycling teams with bigger budgets than some low key Olympic sports that spends huge sums of money on doctors and drugs (this is a generalisation) i.e. the Festina afair 1998.

But then one sees these same things in general public sport where we see riders rather buy the latest deep section aero wheels to be faster (modern bicycles and cycling speeds, any relation? ), rather than get properly assessed and tested so that they can have real performance improvements by searching for the weakest link and looking for bio-markers.

Swimming is a example that has not changed a lot in the way we coach and train athletes. Despite the fact that we have Heart Rate monitors now for water use (Hosand) and even intramuscular Oxygenation testing (NIRS), we still plan programs on amounts of fingers on your hand and length of the pool and turns on a clock. 

Have a think about it.


Latest in fancy kit vs testing part 2

SpiroTiger

SpiroTiger:  Spiro what? sounds like a fuzzy little animal that lives in the woods!  Rather it is currently the only training device that can train your lungs effectively.  Sure there are other low cost devices such as Powerbreathe and PowerLung out there, but they will only allow one to train the respiratory muscles for about 30 seconds before one goes blue in the face and keels over panting.

The PowerLung is more like gym training for the lung where as the SpiroTiger was designed to train the endurance muscle of the lungs which will train the diaphragm, breathing co-ordination and the inter and intra muscles involved during breathing.

If used correctly will a athlete develop a larger VO2? Will you run/bike/ski/swim faster? Will you have more power? It all depends on what is limiting your performance... if you have a respiratory limitation and then strengthen this limiter then the answer to the previous questions is a possible yes. So for the same given heart rate, power output and effort your lungs could be more efficient.  Depending on how much you use and abuse the SpiroTiger (abuse because there is some unofficial protocols for hypoxia (IHT) training, disclaimer: The Spiro Tiger is not ( NOT ) build to be used as a IHT equipment but only as a diaphragmatic endurance training equipment the reason is the O2 and pCO2 reactions) you could improve the gas exchange in the lungs, improve muscle coordination of the muscles involved.  Example: If a athlete was tested to have a limitation of the respiratory system and strengthened the lungs he will likely be able to race or train longer before his diaphragm muscles starts to tire out, where upon his vT or TV (Tidal Volume) might likely drop (smaller TV), his breathing rate will increase and the body will have one of several reactions, one could be metaboreflex (here is another explanation, metaboreflex) or the ECGM (Extended Central Governor Model).   The better we can train our weakest system (which can be found through various tests) the better we can train the system before the ECGM or CGM "kicks in".

You may ask don't we train our lungs when doing normal exercise?  Yes and no!  How often can you stress your respiratory system to get the training effect you want for the lungs? If your lungs is not your weakest link and example your muscle utilisation is the limiter and you train just up to the point where the muscle is stressed (assume the other two systems do not compensating for it) then it is unlikely you will be able to efficiently and regularly train the respiratory system through normal exercise.

With the SpiroTiger a athlete can effectively train his lungs every day, but within reason, I wouldn't use it the day before a race or hard session in case the breathing muscles involved has not recovered in time.

Abit more on the device and my own findings using the SpiroTiger: The device works with a hand held unit that can be programmed for breathing frequency and bag size.  The unit will also give information if you continue to breath incorrectly at the current breathing rate (inhaling more air than is being exhaled and vice versa) that you will start to hyperventilate or go hypercapnia in which case the machine will shut down as a safety precaution.  Apart from washing the device there is zero maintenance cost to it.  A Pulse Oximeter is used as part of my Spiro training to monitor blood oxygen saturation which is also vital when doing Hypercapnia workouts. 

Using it one will unlikely see any difference for some weeks. The main problem with the device is boredom, working out session which is interesting and fits in with my normal training programme.

Is it a training session?  Damn right, a average session is about 25 - 45 minutes. Sometimes after a session I am totally knackered, out of breath and my stomach muscles hurt!   Why my stomach muscles are hurting is probably because  I am using my diaphragm more than normal. The Diaphragm plays a big part in core stabilization.  So strengthening of the diaphragm with breathing training could prevent or slow the process of a athlete falling apart at the core. 

I have noticed huge differences in breathing using the SpiroTiger as part of a warm up before a race or hard training session. Yup breathing into a bag that resembles a over sized condom in front of your team mates does make one look like a plonker! But while they are lying on the floor from the last sprint session and I am already walking down the hill for the next rep who's laughing then!  Some differences I have notice both from daily use and as part of a warm up is, not gulping or gasping for air, I seem to recover (respiratory) quicker between intervals.  I don't have erratic breathing patterns in the early parts of a session and my lungs don't hurt as much anymore. A warm up may vary depending on what kind of race warm up a athlete needs respiratory wise.  One theory is a warm up of the diaphragm to give a metaboreflex reaction before the start of a race so you have pushed the respiratory rate into over drive so that when the race starts the body doesn't panic and the metaboreflex is delayed. Or you simply need to control the CO2 level, so you could go either hypercapnia or hypocapnia all dependent on your race start type. There is no specific protocol and it is very individual, I myself am still trying different variations to see what works. 

Another area that I have noticed differences compared to the past has been when training at altitude (IHT and Hypercapnia is not suported by the manufacturer, a athlete should work with a physiologist or doctor when planning to use the SpiroTiger for other than what the manufacturer recommends). With all of this there could be other factors also involved but I believe a lot has to do with how I have trained my lungs which was previously not possible. Another area I will summarise in a later blog is the use of hypercapnia for recovery which comes mainly from Russian studies.

SpiroTiger is not the solution to winning a race that will make you go from zero to hero, but it will add another tool to your training box. Keep in mind when training the respiratory system with this device that you are only training a part of the whole working system and the results are very individual. For further reading on SpiroTiger training visit the SpiroTiger FaCT, SpiroTiger Time to try harder.

Core exercises, are we sure we are activating the core?

Nearly every personal trainer, fitness advisor, coach advocates core work.  But once again do we understand what we are doing by following the trend!  We would like to think that what we are training with core exercises is the best way to activate the core muscle, and that it would improve posture, stability, balance etc. Do we understand the muscle involved when doing a core exercise?  I'm not goin to rewrite the following article as I don't think I can do it justice.  The summary is that traditional core exercises has its place for developing certain areas but a athlete can activates his core muscles more positively and directly with a simple squat, or dead lift exercise.  Here to read: rethinking-core-training-is-it-fad.

Also on FaCT Canada is a very long discussion that shifts away a bit from the above topic but from 9 post down the subject becomes of interest to the core topic and looks at it from a different angle, discussing the involvement of the diaphragm  as a major core stabilizer and follows to a interesting subject on its own on muscle activation during weight training.   (There is mention on a device called a SpiroTiger which I will discuss in a upcoming blog with my own experiences on the device which also has a effect on the core).

Lactate fuel or foe?

Myth:  Lactate causes fatigue. Fact:  It corresponds with fatigue but does not cause it. In fact it is a mechanism to help delay fatigue. I will try to explain what lactate is and let you navigate to the links to understand how lactate is formed. Lactate has had a bad wrap over the years and even though it is proved that it is not the cause of fatigue people still believe that the burn is associated to lactate!  Or on TV a commentator might comment "look at that cyclist he's unclipped his foot from the pedal and shaking the lactate out of his legs" Wow! there must be a stream of lactate on the asphalt to sweep up!

Lactate is part of the Cori Cyle.  Lactate is hugely affected by the amount of glucose in the body.  A carbo low diet will have a lower lactate level than for the same intensity when the body is carbo loaded.  So lactate is rather a indication of fuel in the body. 

• Lactate gets produced to help to retard acidosis.  (Acidosis is thought to be the cause of the burn).  
• Lactate goes through the Cori Cyle and is converted back to pyruvate and then glucose  where it is used as a fuel again.
• The heart and brain prefers lactate as a fuel!!!

So based on the current research lactate is essential to fuel the body. Still doubting if it is so bad?

Traditionally athletes cool down after a hard session to get rid of lactate.  If lactate is such a important fuel in the body is it wise to cool down after or between hard session when the heart and brain needs this fuel and you are using more glucose to go for the cool down which could be used for recovery? Perhaps what the body is rather doing during a cool down is to get rid of excess CO2, pumps oxygenated blood back to the muscle and simply metabolises lactate back in to fuel! I don't know the full answer to not cooling down, its a question that was discussed by FaCT  see the discussion here! but once you understand the inter functions of the body one can start challenging traditional ideas.

Here is a easy to read article on lactic acid.

Here is a in depth look at the Biochemistry of Lactate Metabolism

It will help to have a chemistry back ground to fully understand and appreciate the article but reading past the formulas one will still understand the article.

You can find many more on this and other topics in the FaCT Canada discussion.

The fallacy of static stretching

Perhaps it's time to re look what happens when we stretch.  You can read the full article Science of Running.  A brief summary. We are bombarded with the words stretch, every thing from stretching helps to remove lactate (more on lactate in a coming post), stretching make you run faster, makes you less prone to injury's bla bla bla.  Dont get me wrong stretching has a place at the right time, and then it is a question of static or dynamic.  But there is research that suggests stretching reduces running economy and would likly hold true for other sports also.  The main idea and research is that the bodys tendons act like a spring, each time when the foot hits the ground the spring is loaded and absorbs the energy from impact, and then a moment later the energy is released to let you jump, run or sprint further.

In a similar way the muscle could be looked at as a elastic band, a new elastic band is fairly springy and has lots of energy stored within which will spring back, as where a stretched out band won't have the same elasticity.  So what this means is the athlete that stretched before he started his plyometric session or run is less economical when you apply the elastic ban principle to muscle.

Here is a short article from FaCT Canada on stretching.  And here are the links to the research if you havnt already read the full article at Science of Running,  Research 1  Research 2 Research 3.

The FaCT way of looking at the body!

I have a keen interest in the FACT - Feldmann and Chlebek Testing System, mainly their way of looking at the athletes body from a alternative angle to the usual University text book answer.  Instead of only looking at lactate as a marker of performance/fatigue one should look at the process that is going to lead to the "lactate threshold point" or as FaCT test it LBP (lactate balance point).

The body has three trainable systems: The heart, the lungs, the muscle. Did I just say lungs? yes the lungs are trainable in the same way the heart and muscle is.  More on that topic in another post.  Each person has a weak link in their body. Some have strong lungs but weak muscle system, others strong heart weak lung system etc.   FaCT calls this weak link the limitation or limiter.

Your body will only go as fast as the weakest link, at some point your body is going to have one of the other two main systems that is going to compensate for this limiter.  So if your respiratory system is weak then there could be a poor gas exchange, the diaphragm is weak then you could for e.g. start having a lower TV (tidal volume) and a increased breathing rate.  The heart might compensate by increasing the cardiac output which will increase heart rate to compensate for the loss in incoming oxygen or not getting rid of the CO2 in the gas exchange.  At the LBP your CGM (Central Governor Model, Noake's) is going to "kick in" to save the body's vital organs.  Similar will happen if you have a muscular limitation.  Either there isn't enough capillarization, mitochondria etc which could affect muscle utilization of the oxygenated blood to the muscle. once again there will/should be a compensator such as lungs or heart.

The body can only go as hard and fast as it's weakest link before the CGM or ECGM, metaboreflex etc "kicks in".

Each athlete will have a different limiter, and the same workout for two athletes will have a different training effect based on the above.  This is why some training programs will work for some athletes and not for others, as the coach hopes that he's workout is training VO2 meanwhile athlete 'A' has a muscle utilisation problem so will never stress his VO2 while athlete 'B' has great utilisation but a VO2 weak link so will benefit from the VO2 session.  Are you starting to see the picture?  The coach has 5 athletes but only 2 improve and he wonders why!

The FaCT solution to this problem is to test the body for the three trainable systems the FaCT way  and then to train the weak link without guessing and hoping hopelessly that a programme that has worked for 60% of athletes over the past 20 years will work again.  Here is a short article on the limitation subject from another athlete Rethinking current exercise physiology.

Why do we do x amount of reps and intervals?

Ever wondered why we do 10 x 4 min? Probably because there are 10 fingers so its easy to count, 4min the clock goes round 4 times. 400m, 800m the coach doesn't have to move and can always be in the same place! Swim 50m once again the coach doesn't have to move (lazy coach?). 8x3min, its the coaches favourite interval!!! and God help you if you cant finish the intervals and your time and heart rate starts dropping!!

We are hoping we are training the cardiac or VO2 etc. We are thinking that a workout has a certain effect but really we do not have a clue and just blindly hope because it has worked on other athletes. Its the world of objective training values. How about training on physiological parameter? That will be the discussion in the next topic. Here for further reading understanding intervals and quantifying intervals.