Guidelines for Sport Compressive Garments Design: Finite Element Simulations Approach

doi:10.21203/rs.3.rs-4205261/v1

Purpose

Despite compression garments (CG) having acquired significant attention in the sports field, there remains ongoing debate regarding their actual effectiveness in enhancing athletic performance and expediting post-exercise recovery. This article delves into various aspects, with a focus on CG design and the materials they are made of, aiming to analyze the importance of personalized compression strategies based on individual anthropometric measurements and non-linear compression designs.

Methods

Through anthropometric analysis of 40 healthy participants, this study examined the morphological characteristics of the lower limb and their implications for CG design.

Results

Measurements of limb length and circumferences revealed complex interactions among anatomical variables, emphasizing the need for customized and adaptable device design. Finite element simulations further clarified the challenges in achieving uniform pressure gradients along the lower limb, highlighting the limitations of one-piece devices and suggesting tailored segmented designs for individual limb segments.

Conclusion

The results demonstrated that while one-piece devices may offer simplicity, they often fail to provide optimal compression due to non-linear variations in limb dimensions. Conversely, segmented devices, particularly those with bilinear progression, exhibited superior performance in applying targeted compression across different limb segments. This more detailed approach to customization could significantly contribute to optimizing outcomes and user comfort.

Compressive Garments

Finite element simulation

Customized garment design

Graduated compression

Compression garments (CG) have emerged as a focal point in the world of sports, finding widespread use across various disciplines, be them individual or team oriented. Their significance lies in the diverse range of potential effects they offer, primarily centered around two key aspects: performance enhancement and expedited recovery for athletes[1, 2]. These specialized garments, mostly used on the lower limbs, are supposed to be purposefully crafted to apply targeted pressure to specific areas with the overarching goal of optimizing blood circulation, bolstering muscle support, and elevating overall athletic prowess. In the realm of sports science, CG has garnered considerable attention as a promising tool for athletes seeking a competitive edge[2, 3]. By promoting heightened blood flow[4] and mitigating muscle vibration[5] during physical activities, CG holds the potential to augment muscle performance and endurance, culminating in elevated athletic output. Moreover, the post-exercise application of CG has been linked to reduced muscle soreness[1, 6] and swifter recovery times[2], making them an enticing asset for athletes committed to refining their training regimens and maximizing their potential[1].

During physical activity, the use of these garments could promote an increase in the production of nitric oxide (NO). When released, NO acts as a chemical signal that induces relaxation of the smooth muscle cells present in the walls of blood vessels, allowing them to dilate. It has been shown that intermittent pneumatic compression not only affects venous blood flow in the compressed area but also produces systemic effects on circulation. Variations in central venous pressure, pulmonary artery pressure, and pulse pressure have been identified, thanks to the increase in venous return induced by leg compression[7, 8]. Additionally, intermittent pneumatic compression of the foot has been found to have significant local effects on microcirculation, increasing blood flow measured with laser Doppler and transcutaneous oxygen tension[9]. Although evidence of local and systemic effects is associated with this compression, the exact mechanism is not yet fully understood, and whether intermittent pneumatic compression of the legs has an effect on the microcirculation of distant tissues is yet to be determined. Studies have demonstrated a notable increase in the diameter of arterial and venous vessels in distant skeletal muscles during intermittent pneumatic compression, suggesting a potential link between its effectiveness and increased NO release caused by hemodynamic changes during compression. This vasodilatory effect observed in distant skeletal muscle indicates that intermittent pneumatic compression may be a useful option for improving microcirculation, especially in ischemic and reperfused tissues[4].

Furthermore, the application of compression has been long-established in therapeutic medicine for the prevention and management of various conditions such as lymphedema, pulmonary embolism, deep vein thrombosis, wounds, scars, and venous leg ulcers[1]. Subsequently, the use of compression has been extended to the field of sports, with the introduction of CG marketed as a tool to improve various aspects of physical performance. While some evidence suggests that CG can reduce muscle oscillation, improve joint awareness, influence oxygen use during low-intensity exercise, modify local blood flow, reduce swelling, and alleviate muscle pain during post-exercise recovery, scientific consensus on their performance-enhancing effects in different forms of exercise remains limited[1]. Studies have analyzed the effects of compression on hemodynamic parameters, such as blood vessel diameter and blood flow, as well as on athletic performance and the reduction of muscle fatigue[1].

Determining the optimal compression level for different muscle groups is a complex process, with recommended pressures varying depending on the muscle group. For instance, the pressure on the leg should be 17 mmHg, while that on the thigh should be 15 mmHg[10]. However, the effectiveness of ready-to-use compression garments, commercially available, may be affected by the lack of individual body dimension information, leading to the use of generalized sizing systems that do not adequately account for the variability of body shapes and sizes.

While studies have shown promising results regarding the positive effects of CG on muscle recovery, the effectiveness may vary based on factors such as duration of usage, applied pressure, and the type of exercise performed[11]. It is essential to consider these variables and tailor the use of compression garments to individual needs and physiological responses.

CG have garnered considerable attention in the sports community for their potential to enhance athletic performance and expedite post-exercise recovery. By delving deeper into the literature and exploring the ideal materials and design elements, we aim to establish a gold standard for lower limb CG that maximizes their potential benefits. This collaborative effort between sport scientists and material engineers seeks to empower athletes, coaches, and sports practitioners with valuable insights to optimize the use of CG in their training and recovery strategies. Furthermore, the investigation into the effects of compression on NO release and its potential role in enhancing microcirculation and physical performance provides valuable directions for future research in this dynamic field.

2.1. Subjects

Forty healthy participants (20 males and 20 females) were enrolled in the study. Inclusion criteria required participants to be in good health and maintain at least a moderate level of physical activity. Furthermore, this research adhered to the ethical guidelines outlined in the Declaration of Helsinki. Prior to participation, all individuals read and provided their signature on an informed consent form that had been approved by the local Ethics Committee (protocol number 5108). The sample size was estimated with G*Power 3.1.9.7 for a correlation: bivariate normal model and input variables (tails = 2, correlation p H1 = 0.60, alpha = 0.05, power = 0.98) were estimated. The estimated minimum sample size was 36.

2.2. Leg Measurements

The leg chosen for measurement was the dominant leg of each subject. A measuring tape designed for nutritionists (RENPHO, California, USA) was used to measure the circumference and length of the lower limb. To be specific, measurements were recorded at the proximal, medial, and distal thirds of both the thigh and the leg. The lower limb's length was determined by measuring from the greater trochanter as the starting point to the malleolus as the endpoint.

2.3. Simulation

Finite element simulations have been conducted using a simplified model of the lower limb to investigate how the geometry and materials used in compression garments affect their performance. The lower limb has been modeled with axial-symmetric symmetry. While this representation may not be extremely accurate, it serves as a tool for understanding the key challenges that arise in achieving a gradual decrease in pressure from the base region to the upper region of the lower limb.

This assumption greatly simplifies the simulations by reducing the complexity from a full 3D problem to a more manageable 2D one. (Fig. 1).

Insert FIG. 1

The geometry of the lower limb is portrait in Fig. 1. The limb has been divided in leg and thigh, and both of them have been further divided in two sub-parts of equal size whose thickness is linearly varying along the length. This simplified geometry, while more streamlined, still accounts for the essential features. Both the leg and the thigh have been modeled as made up of muscles (see Singh et al., 2021[12] and Table 2 for the elastic parameters) since it is assumed that the contribution of the other tissues is negligible.

The geometry of the compression garments have been modeled in two different ways:

one lower limb garment with a linear progression (Fig.3);
two independent garments for the leg and the thigh with a linear progression (Fig.4);
two independent garments for the leg and the thigh with a bilinear progression (Fig.5 and Fig.6);

In Table 1, we provide measures for the proximal, central, and distal radii of the CG for the case (C), while for cases (A) and (B), also listed in Table 1, only the proximal and distal radii need to be included.

Table 1

Values of the radii at midpoint for the compressive garments.
			Radius at midpoint [cm]
Case	Material	Kind of garment	proximal	central	distal
(A)	Nylon	Single (lower limb)	9.0	-	3.8
(B)	Nylon	Linear (leg)	6.5	-	3.7
(B)	Nylon	Linear (thigh)	9.3	-	5.9
(C)	Nylon	Bilinear (leg)	5.3	5.1	3.7
	Nylon	Bilinear (thigh)	8.9	7.6	5.9
	Sparse fabric - Elastam25	Bilinear (leg)	4.5	4.2	3.1
	Sparse fabric - Elastam25	Bilinear (thigh)	7.2	6.1	4.9

Insert Table 1

The CG have been modeled with two materials, nylon and a sparse fabric made up of 75% Nylon and 25% Elastan (Elastam25).

The values of the elastic parameters for the Nylon have been taken directly from the COMSOL Multiphysics® software library (suite also used to perform the simulations), while the Young’s modulus of the sparse fabric from[13] Given the unavailability of a specific Poisson's ratio for the sparse fabric in the literature, we have made an assumption and assigned a value of 0.35. A sensitivity analysis has been conducted by introducing two additional Poisson's ratio values for the sparse fabric, specifically 0.25 and 0.45.

These values resulted in a constant variation in pressure along the limb section under consideration, with a maximum increase of + 1 mmHg for 0.45 and a maximum decrease of -1 mmHg for 0.25.

All the material parameters are summarized in Table 2.

Table 2

Values of the material parameters of the muscles and the fabric composing the compression bands.
	Young’s modulus [Pa]	Poisson’s ratio [-]
Muscle	0.03⨉10⁶	0.48
Nylon	2000⨉10⁶	0.4
Sparse fabric - Elastam25 (75% Nylon − 25% Elastane)	0.24⨉10⁶	0.35

Insert Table 2

All the simulations have been carried out with COMSOL Multiphysics® software (Structural Mechanics Module) and are comprised of two steps (Fig. 2):

the CG is initially simulated independently, and a load is applied along the positive r direction on the green boundary (Fig. 3) to stretch the garment beyond the size of the lower limb;
following that, the lower limb is introduced, the contact constraint on the black boundaries is enforced between the two bodies (Fig. 3), and gradually the load is reduced until it is completely removed.

Insert FIG. 2

The boundary conditions are represented in Fig. 3 and are the following:

the boundaries in blue have been fully clamped in the r and z directions (u_r=0 and u_z=0);
on the boundaries in red it is prescribed u_z=0;
on the boundaries in black a monolateral contact condition with the CG has been enforced (co-penetration is not permitted but detachment is allowed);
on the boundary in green a load is applied in order to stretch the CG (step 1) and it is then gradually decreased until it is completely removed (step 2).

Insert FIG. 3

2.4 Statistical analysis

Statistical analysis was performed using Jamovi for Windows, version 2.3.23. To determine statistical significance, a type I error rate of 0.05 was employed. Pearson's correlation coefficient was utilized to examine potential interactions among the lengths of the lower limb, leg, and thigh, as well as the circumferences of the proximal medial and distal portions of the leg and thigh.

As previously described in the methods section, measurements were recorded at the proximal, medial, and distal thirds of both the thigh and the leg, with the lower limb's length measurements. These results are presented in Table 3 for easy reference.

Table 3

Average values of the measurements of the dominant leg of each participant. Measurements were recorded at the proximal, medial, and distal thirds of both the thigh and the leg. The lower limb's length was determined by measuring from the greater trochanter as the starting point to the malleolus as the endpoint.
Length (cm)			Thigh Circumference (cm)			Leg Circumference (cm)
Thigh	Leg	Lower Limb	Proximal	Medial	Distal	Proximal	Medial	Distal
51.07± 4.12	33.7± 3.08	84.75± 4.36	55.67± 4.88	47.75± 4.11	37.35 ± 3.52	33.20± 2.61	32.35 ± 3.43	23.42± 2.57

Insert Table 3

In the Pearson correlation chart, the relationship between the total length of the lower limb and the lengths of the thigh and leg can be observed (Fig. 4). The data highlight a significant correlation between the lower limb length and both thigh length (r = 0.737, p < 0.001) and leg length (r = 0.426, p = 0.006), indicating a strong association between these variables. However, no statistical correlation was found between the leg and the thigh length (r= -0.296; p = 0.063).

Insert FIG. 4

3.1. Lower limbs girths

In this investigation, we observed notable distinctions in thigh circumferences when measured at various anatomical positions (Fig. 5). Specifically, the correlation analysis revealed significant relationships between these circumferences. The central high circumference exhibited a robust positive correlation with proximal thigh circumference (r = 0.852, p < 0.001), underscoring a strong association between these two measurements. Similarly, a significant positive correlation was observed between medial thigh circumference and distal thigh circumference (r = 0.766, p < 0.001), indicating a substantial connection between these variables. Furthermore, the distal thigh circumference displayed a significant positive correlation with proximal thigh circumference (r = 0.678, p < 0.001).

Insert FIG. 5

In this comprehensive analysis, significant variations in leg circumferences when measured at distinct anatomical positions were also uncovered (Fig. 6). Our correlation analysis revealed robust and statistically significant relationships among these circumference measurements. Specifically, the central leg circumference exhibited a noteworthy positive correlation with distal leg circumference (r = 0.622, p < 0.001), highlighting a substantial connection between these two variables. Additionally, a significant positive correlation was observed between central leg circumference and proximal leg circumference (r = 0.635, p < 0.001), indicating a strong association between these measurements. Furthermore, the distal leg circumference demonstrated a significant positive correlation with proximal leg circumference (r = 0.670, p < 0.001)

Insert FIG. 6

3.2. Lower limbs length and girths

The correlation analysis between thigh length and thigh circumferences yielded non-significant results (Fig. 7). Specifically, at the proximal level, the correlation coefficient was r = 0.109 (p = 0.502), at the medial level, it was r = 0.102 (p = 0.536), and at the distal level, it was r = -0.044 (p = 0.787).

Insert FIG. 7

Similarly, the correlation analysis between leg circumferences measured at corresponding points and leg length revealed non-significant findings (Fig. 8). Specifically, at the proximal level, the correlation coefficient was r = -0.078 (p = 0.631), at the medial level, it was r = -0.024 (p = 0.884), and at the distal level, it was r = 0.055 (p = 0.734).

Insert FIG. 8

3.3. Simulation

From Fig. 9 to Fig. 12 we report how the pressure on the surface of the lower limb changes along its length while changing the type of garment.

Insert FIG. 9

In Fig. 9 it is reported how the pressure changes on the surface of the lower limb for the case in which the garment is a single piece made up of nylon.

As it can be seen, achieving a consistently decreasing pressure gradient from the distal end of the leg to the proximal end of the thigh is not feasible. This is due to the fact that the radius of the leg does not change linearly along its length, which makes the outermost part the most compressed.

In order to overcome this limitation, two individual linear-garments are proposed.

Insert FIG. 10

In Fig. 10 it is possible to see how the pressure varies when two individual garments for the leg and the thigh made up of nylon are used. For this case, the radius of the garments changes linearly along their length and independently between the two.

As it can be seen, it is possible to fine-tune pressure levels in the distal regions of both the leg and thigh, maintaining a decrease in pressure. However, to maintain reasonable pressure in the distal areas, contact between the garment and the proximal part needs to be sacrificed, and this is not desirable, especially in the proximal part of the leg.

Insert FIG. 11

To overcome this drop of pressure close to the proximal areas, two individual bilinear-garments are here proposed.

In Fig. 11 it is possible to see the case in which the garments are made up of nylon, while in Fig. 12 the ones made up of Elastam25 (75% Nylon – 25% Elastane).

In both these cases, the radius of the garments changes bilinearly along their length and independently between the two.

As it can be seen, it is now possible to both tune the value of the pressure in the distal and in the proximal regions of both the leg and thigh, while maintaining a decrease in pressure.

Insert FIG. 12

In our study, the morphological characteristics of the lower limb underscore the complexity of designing CG. The existing and missing significant correlations between the limb measurements suggest that a one-size-fits-all approach may not be suitable. This finding aligns with previous research highlighting the importance of individualized garment designs tailored to athletes’ unique anatomies[1, 14–16]. Moreover, our simulation results shed light on the challenges in achieving a uniformly decreasing pressure gradient along the limb’s length. Comparing our findings with existing literature[17] it becomes evident that the key lies not only in the choice of materials but also in the garment’s design[18]. Unlike previous studies[18] our simulations considered both linear and bilinear progressions, revealing nuanced pressure variations across different garment types.

4.1. Optimal compression

The impacts of compression in the sports science world are widely acknowledged. Nonetheless, the effectiveness of compression is conditioned by its quantity and quality, as these factors determine the intended outcome. Incorrect application of compression can potentially negate its desired effects. Specifically, in the context of physical activity, a minimum compression of 15 mmHg[10, 19–21] is deemed necessary for an effective outcome. Moreover, the ideal compression entails a graduated increase in pressure distally, diminishing gradually in a proximal direction[21–23]. The variation in leg dimensions, including circumferences and lengths, highlights the crucial need to account for these individual morphological traits when applying compression. The insufficient or ineffective compression observed in certain cases, as noted from the previous paper from Hill et al. 2015[10], may stem from attempts to standardize garment sizes. This practice might inherently be deemed a mistake, as it overlooks the diverse anatomical features among individuals, potentially resulting in inadequate compression for some.

4.2. Length and circumference of the limb

Indeed, the results of this study unveiled a notable correlation between the total length of the lower limb and both thigh and leg lengths. Surprisingly, however, no significant correlation emerged between thigh length and leg length, a finding of particular relevance in CG design. This discrepancy underscores a critical factor in the garment’s efficiency. To ensure effective compression of the entire lower limb, the garment must encompass the entire limb[10, 19]. Given the absence of correlation between limb segments, it becomes imperative to adapt the garment’s length dynamically, accommodating various combinations to achieve optimal results. Additionally, significant correlations were observed among the proximal, central, and distal circumferences within both segments. This underscores that the width of the CG can be categorized uniformly. However, no correlations were identified between any circumference and its corresponding segment length, indicating that the design of CG must meticulously consider both these variables. This insight underscores the need for adaptable, custom-made designs in CG manufacturing. These designs should accommodate the distinct yet interconnected aspects, taking into account the need to design CG of varying lengths for different widths.

4.3. Simulation

Compression, based on anatomical observations, must be carefully calibrated to avoid a linear increase from the ankle to the thigh. This necessity arises from observed data indicating a non-linear pressure increase. This trend can be better interpreted as the intersection of two lines with different inclinations for each individual leg segment. A targeted compression approach is essential for proper support and optimal blood circulation in every leg region. This customization considers the specific anatomical needs of each individual[16, 24, 25], adapting to variations in leg conformation. Maintaining pressure that respects these anatomical characteristics significantly contributes to overall well-being, avoiding the inefficacy of uniform compression and allowing for better management of each individual's physiological peculiarities.

In order to assess how the design of different garments would affect the pressure distribution along the lower limb, three options have been simulated using finite element analysis.

4.3.1. Single linear garment

The results obtained from the simulation indicate that a single garment is unable to generate the sufficient and effective compression needed from the lower part of the leg to the upper part of the thigh, primarily due to non-linear variations in limb circumference. These variations, namely the non-uniform changes in limb dimensions along their length, impact the single garment's ability to apply adequate pressure uniformly. While single garments may offer greater comfort during use[21], they present significant limitations in delivering the expected benefits of graduated compression. To address this limitation, it is necessary to produce a range of garments with diverse ergonomic features that can accommodate the varying morphological characteristics of users. Consequently, the number of templates, which take into account the length and circumferences of the lower limb segments, may prove to be too extensive to be economically sustainable.

4.3.2. Separated linear garment

In second instance, the use of two separate linear garments is proposed: one dedicated to the thigh and the other to the lower leg. This configuration allows for a more customized application of compression, adjusting pressure levels differentially to accommodate the specific anatomical requirements of each leg part. We proceeded with a detailed analysis of the effects resulting from the use of these two separate garments, distinguishing between possible outcomes when using two distinct linear garments or two separate bilinear garments. Typically, the design of individual garments is linear as simpler techniques are required for production. The results regarding the individual linear CG indicate that desired pressure values can be achieved in the distal portion of both the thigh and the lower leg. However, it is important to note that, although the intensity of the average pressure on the skin may be considered sufficient, challenges arise related to the gradient and quality of the pressure, with a significant cost observed in the proximal part of the limb (~ 0.3–0.5 mmHg), resulting in a loss of pressure. This outcome uncovers two potential issues associated with the application of two distinct linear CG applied separately on the leg and thigh. Firstly, the reduced pressure in the proximal areas might not yield the anticipated physiological benefits due to an insufficient amount of pressure[10]. Secondly, the increased compression in the distal part of the thigh, compared to the proximal part of the leg, could result in a “funnel effect” that may counteract the intended facilitation of venous return[4, 19].

4.3.3. Separated bilinear garment

Finally, in addressing these challenges, the use of two separate and bilinear CG was examined, allowing for a more targeted application of compression with the ability to adjust pressure levels differentially for the thigh and lower leg, ensuring optimal compression and tangible benefits. The minimum pressure, obtained by the simulation on the upper part of the thigh, varies around 15–16 mmHg, depending on the material set, ensuring the minimal pressure to have a positive effect on the local hemodynamics[10]. However, the higher pressure, recorded on the distal part of the leg, does not exceed values that could be counterproductive[26]. Furthermore, the proximal gradual reduction of the pressure may efficiently aid venous return, reducing blood stagnation. This bilinear approach emerges as a more promising solution to achieve maximum benefits in terms of blood circulation and muscle support. In the case of two separate bilinear garments, regardless of the material they are made of (Nylon or Elastam25), optimal compression is achieved both distally and proximally while maintaining a gradual decrease in pressure from the lower limb's base to its upper region. This promotes the attainment of the anticipated benefits[2, 4, 11] from using these garments.

4.4. Material

Nylon is a commonly used synthetic material for creating durable, lightweight fabrics[27, 28]. It is renowned for its resistance to wear, abrasion, and moisture. Elastane, on the other hand, is a common material used in fabric production. It is a synthetic fiber known for its remarkable elasticity and ability to return to its original shape[29]. The presence of elastane in fabrics allows them to better conform to the body and maintain their original shape even after use and washing. When comparing these two materials, it is important to note their distinct qualities[26]. Each material serves specific purposes in the world of textiles, with nylon offering strength and longevity, while elastane provides comfort and adaptability to body contours. This is the reason why we have chosen to include both of these materials in the present study.

However, the comparison between the two materials used in the bilinear garments, nylon and Elastam25, suggests that those made of Elastam25 offer a more promising solution for achieving optimal pressure distribution along the lower limb. This leads to the hypothesis of better performance in terms of blood circulation, muscle function, and post-exercise recovery. An essential factor favoring Elastam25 garments is also the material they are composed of. Unlike nylon, Elastam25 is more elastic and flexible, significantly enhancing comfort during physical activities.

4.5. Limitations and Perspectives

The present study shows some limitations: 1) only two types of materials were considered. While the market offers a wide range of materials, we chose to focus on the most commonly used in the construction of compressive fabrics. However, it is important to acknowledge that we cannot generalize the conclusions drawn from our findings to all types of compressive fabrics, although we can do this for a wide range of commercial materials as long as they can be considered homogeneous.. Still, future research could explore a more diverse range of materials to provide a more comprehensive understanding of how different fabric compositions affect the performance of CG; 2) the simulation was conducted on a two-dimensional model, whereas considering the morphology of the leg in three dimensions would be more representative of real-world conditions. However, we know that the morphology of the leg is much more intricate, with curves, contours, and variations in volume that cannot be accurately captured in two dimensions. Future studies should aim to incorporate three-dimensional models to better account for the anatomical complexities and provide more realistic assessments of CG performance; 3) the present study is based on simulations and data analysis to identify the ideal characteristics of a compressive fabric. However, no tests have been conducted on human subjects to verify the effectiveness of the compression proposed in the simulation. Consequently, an important area of future development would be to translate the concept of compression into prototypes of real compressive fabrics and conduct tests to evaluate the effectiveness of such fabrics on human subjects.

Customizing compressions based on participants' anthropometric measurements, along with the use of non-linear compressions, can lead to superior outcomes in achieving highly effective and personalized compressions that cater to individual needs. This customization allows for a more even and comfortable distribution of compressions, thereby improving the overall effectiveness of CG. Specifically, segmenting the thigh and leg segments for individual compression applications represents a significant advancement in the design of personalized compression devices. This more detailed approach to customization could significantly contribute to optimizing outcomes and user comfort. The results of our study provide a solid foundation for the future development of more advanced compression devices and for designing further studies aimed at fully exploring the potential of this innovative approach in this field.

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

Acknowledgements:

Gianluca Rizzi acknowledges support from the European Commission through the funding of the ERC Consolidator Grant META-LEGO, N° 101001759 (fund holder Prof. Angela Madeo).

Conflict of interest statement:

The authors declare no competing financial interests.

Data Availability Statement:

The raw data supporting the conclusions of this article are available from the corresponding author upon reasonable request.

Author Contributions:

Conceptualization: AC, GR. Methodology: AC, MC, GR. Data collection: AC, MC, AB, MB. Data analysis: AC, MC, AB, MB, GR. Data interpretation: AC, MC, AB, MB, GR. Writing—original draft preparation: AC, MC, AB, MB, GR. Writing—review and editing: AC, MC, AB, MB, GR. All authors have read and agreed to the published version of the manuscript.

MacRae BA, Cotter JD, Laing RM (2011) Compression garments and exercise: garment considerations, physiology and performance. Sports Med 41:815–43. https://doi.org/10.2165/11591420-000000000-00000
Brown F, Gissane C, Howatson G, et al (2017) Compression Garments and Recovery from Exercise: A Meta-Analysis. Sports Med 47:2245–2267. https://doi.org/10.1007/s40279-017-0728-9
Pavin LN, Leicht AS, Gimenes SV, et al (2019) Can compression stockings reduce the degree of soccer match-induced fatigue in females? Res Sports Med 27:351–364. https://doi.org/10.1080/15438627.2018.1527335
O’Riordan SF, Bishop DJ, Halson SL, Broatch JR (2023) Do Sports Compression Garments Alter Measures of Peripheral Blood Flow? A Systematic Review with Meta-Analysis. Sports Med 53:481–501. https://doi.org/10.1007/s40279-022-01774-0
Kraemer WJ, Bush JA, Newton RU, et al (1998) Influence of a compression garment on repetitive power output production before and after different types of muscle fatigue. Sports Medicine, Training and Rehabilitation 8:163–184. https://doi.org/10.1080/15438629809512525
Kraemer WJ, Bush JA, Wickham RB, et al (2001) Influence of Compression Therapy on Symptoms Following Soft Tissue Injury from Maximal Eccentric Exercise. Journal of Orthopaedic & Sports Physical Therapy 31:282–290. https://doi.org/10.2519/jospt.2001.31.6.282
Tan X, Qi W-N, Gu X, et al (2006) Intermittent pneumatic compression regulates expression of nitric oxide synthases in skeletal muscles. J Biomech 39:2430–2437. https://doi.org/10.1016/j.jbiomech.2005.07.022
Unger RJ, Feiner JR (1987) Hemodynamic effects of intermittent pneumatic compression of the legs. Anesthesiology 67:266–8. https://doi.org/10.1097/00000542-198708000-00023
Abu-Own A, Scurr JH, Smith PDC (1993) Assessment of Intermittent Pneumatic Compression by Strain-Gauge Plethysmography. Phlebology: The Journal of Venous Disease 8:68–71. https://doi.org/10.1177/026835559300800206
Hill JA, Howatson G, van Someren KA, et al (2015) The variation in pressures exerted by commercially available compression garments. Sports Engineering 18:115–121. https://doi.org/10.1007/s12283-015-0170-x
Hill J, Howatson G, van Someren K, et al (2014) Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med 48:1340–1346. https://doi.org/10.1136/bjsports-2013-092456
Singh G, Chanda A (2021) Mechanical properties of whole-body soft human tissues: a review. Biomedical Materials 16:062004. https://doi.org/10.1088/1748-605X/ac2b7a
Mousavi G, Varsei M, Rashidi A, Ghazisaeidi R (2022) Experimental evaluation of the compression garment produced from elastic spacer fabrics through real human limb. Journal of Industrial Textiles 51:3593S-3612S. https://doi.org/10.1177/1528083720988089
Wang X, Wu Z, Xiong Y, et al (2023) Fast NURBS-based parametric modeling of human calves with high-accuracy for personalized design of graduated compression stockings. Comput Methods Programs Biomed 229:107292. https://doi.org/10.1016/j.cmpb.2022.107292
Gonzalez JC, Olaso J, Gil M, et al (2012) FASHION-ABLE: Needs and requirements for clothing, footwear and orthotics of consumers groups with highly individualised needs. In: 2012 18th International ICE Conference on Engineering, Technology and Innovation. IEEE, pp 1–10
Liu R, Xu B (2019) 3D Digital Modeling and Design of Custom-Fit Functional Compression Garment. pp 161–169
Baum JT, Carter RP, Neufeld E V, Dolezal BA (2020) Donning a Novel Lower-Limb Restrictive Compression Garment During Training Augments Muscle Power and Strength. Int J Exerc Sci 13:890–899
Weakley J, Broatch J, O’Riordan S, et al (2022) Putting the Squeeze on Compression Garments: Current Evidence and Recommendations for Future Research: A Systematic Scoping Review. Sports Med 52:1141–1160. https://doi.org/10.1007/s40279-021-01604-9
Watanuki S, Murata H (1994) Effects of wearing compression stockings on cardiovascular responses. Ann Physiol Anthropol 13:121–7. https://doi.org/10.2114/ahs1983.13.121
Montgomery PG, Pyne DB, Hopkins WG, et al (2008) The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball. J Sports Sci 26:1135–1145. https://doi.org/10.1080/02640410802104912
Davies V, Thompson KG, Cooper S-M (2009) The effects of compression garments on recovery. J Strength Cond Res 23:1786–94. https://doi.org/10.1519/JSC.0b013e3181b42589
Pruscino CL, Halson S, Hargreaves M (2013) Effects of compression garments on recovery following intermittent exercise. Eur J Appl Physiol 113:1585–1596. https://doi.org/10.1007/s00421-012-2576-5
Jakeman JR, Byrne C, Eston RG (2010) Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. Eur J Appl Physiol 109:1137–44. https://doi.org/10.1007/s00421-010-1464-0
Ye C, Liu R, Wu X, et al (2022) New analytical model and 3D finite element simulation for improved pressure prediction of elastic compression stockings. Mater Des 217:110634. https://doi.org/10.1016/j.matdes.2022.110634
Liu R, Liu J, Lao TT, et al (2019) Determination of leg cross-sectional curvatures and application in pressure prediction for lower body compression garments. Textile Research Journal 89:1835–1852. https://doi.org/10.1177/0040517518779246
Perrey S (2008) Compression Garments: Evidence for their Physiological Effects (P208). In: The Engineering of Sport 7. Springer Paris, Paris, pp 319–328
Sabir T (2018) Fibers used for high-performance apparel. In: High-Performance Apparel. Elsevier, pp 7–32
Kowalski K, Kłonowska M, Ilska A, et al (2018) Methods of Evaluating Knitted Fabrics with Elastomeric Threads in the Design Process of Compression Products. Fibres and Textiles in Eastern Europe 26:60–65. https://doi.org/10.5604/01.3001.0011.7303
Elsasser V (2010) Textiles: Concepts and Principles, 3rd ed. Fairchild Publications, Inc, New York, NY

No competing interests reported.

Guidelines for Sport Compressive Garments Design: Finite Element Simulations Approach

Status:

Version 1

Abstract