Initially a medical grade device, compression boots are now mainstream—and some athletes consider them an absolute necessity. These days, you can find air-filled boots like NormaTec, Rapid Reboot, and AIR RELAX at gyms, studios, and physical therapy offices. Heck, depending on how much disposable cash you have laying around, you can even buy your own. But are they worth the time or financial investment?
First things first. We need to know how and why they work.
“Your body is constantly generating metabolic waste as it produces and uses energy, and that waste gets circulated throughout your blood,” explains Kathleen Leninger, DPT, a physical therapist at Custom Performance in New York, NY. “Because your legs are below your heart, it’s harder for the heart to pump that waste from your legs to your lymph system, which helps get rid of it.”
The idea behind compression is pretty simple: It helps your system increase blood flow to certain areas, which helps circulate that waste to get rid of it faster. But not all compression is created equal. Below, check out some of the most popular compression boot systems and learn about the benefits and downsides of these high-tech recovery tools.
How Are Compression Boots Different from Compression Socks?
Who Was Top American at the 2022 Boston Marathon compression athletes use: compression and intermittent pneumatic compression.
Compression socks fall into the regular compression category. They squeeze the legs, which improves blood flow from the feet upwards, reducing swelling and discomfort. As such, compression socks are generally tighter at the bottom and get progressively looser.
Intermittent pneumatic compression devices mechanically inflate and deflate segments of a sleeve at different times to do the same thing. Compression boots actually go all the way up to the top of your thighs, so your entire leg reaps the benefits.
Picture it this way: “If you have a tube of toothpaste and the only toothpaste left is all the way at the bottom, you have to squeeze the top stuff out first, then you move to the next chamber until you work your way to the bottom,” says Leninger. That’s similar to how intermittent pneumatic compression devices work.
That’s not to say there’s anything wrong with using compression socks. Intermittent pneumatic compression devices might just work quicker.
“The sheer amount of compression you’ll receive from a mechanical device will work exponentially faster than socks,” says Eric Madia, head of sports science at the Sports Performance Lab. Think about it as an active stretch versus a passive stretch: The socks are a passive way of providing compression, while pneumatic compression devices are more active.
What Are the Benefits of Compression Boots?
If you’ve ever worn a pair of these puffy sleeves, you know it just feels good—kind of like a massage. And “if the only benefit you get is sitting down and relaxing for 20 minutes while you use them, that’s still worth it,” says Leninger. Luckily, there are Sports Performance Lab.
For starters, the boots enhance blood flow and circulation. According to a 2018 study in the Journal of Applied Physiology, intermittent compression applied during recovery from exercise resulted in increased limb blood flow, potentially contributing to changes in exercise performance and recovery.
Compression boots can also reduce swelling. No matter what kind of run you do, whether it’s a 5K or a 50K, your muscles experience microtears from repetitive stress. “You may not even notice it, but edema, or swelling, occurs when your body starts to repair those microtears,” says Leninger. That swelling will go away naturally if you’re recovering appropriately (think: staying off your feet, elevating your legs, resting), but compression can help shorten the amount of rest you may need by preventing swelling from pooling in a certain area when you have to go straight from a run into life.
“When that metabolic waste from a workout is sitting there in your cells taking up space, that’s space that your blood could be bringing new nutrients to in the muscle,” says Leninger. The more nutrients your muscles are getting, the faster they can repair and rebuild.
One 2016 study on ultramarathon runners published in the Journal of Orthopaedic & Sports Physical Therapy found that post-exercise pneumatic compression therapy offered the same benefits as post-exercise massage, specifically lowering overall muscular fatigue. And daily treatments using a pneumatic compression device reduced recovery time from DOMS when compared to a continuously-worn compression sleeve, according to research Winter Running Hats International Journal of Exercise Science.
The Downsides of Compression Boots
The only real negative to compression boots? They can get kinda pricey. Some of the most popular systems cost around $1,000. That's not an insignificant amount of money for the average runner.
On a scientific front, “there are very few studies, if any, that show a negative effect for athletes,” says Leninger, which can make you feel better about the splurge.
Another downside is that the systems are not always intuitive for the average user. Whereas you physical therapist may know exactly what setting to put you on depending on your current training and feedback, it’s not always so obvious for the layperson who is using boots at home.
When you’re using the compression boots, Madia recommends staying below level seven on the pressure dial. “Higher pressures can cause discomfort and numbness,” he says. If you feel a tingling sensation in your feet, that’s a sign the pressure is too high. And if after a session, you can see a depression from the seams of the boots marked on your legs, that’s also a sign the pressure is too high.
How to Use Compression Boots
This should be a no-brainer, but the more work you do, the more recovery you need. “In general, the harder your effort, the more metabolites, build, and waste you’re going to need to clear from your cells,” says Madia. Reserve them for after speed work, post-long run, marathon training, or after whatever workout is most taxing, and you’re more likely to see the benefits. They can also be especially helpful when you know you have two hard efforts back to back, says Leninger.
Madia recommends using the boots at least three to four times a week for recovery. “That’s usually one to two workouts, and then you flush your system,” he explains. “That ratio has really shown the best amount of recovery in our athletes.”
In most cases, you’ll want to use the boots post-workout. “That goes back to your nervous system—before a workout, you want to to get neurologically excited; afterward, you want the opposite effect, you want your nervous system to switch to that rest and digest response, which is what the boots induce,” says Madia.
That said, not all stress is athletic stress. "If you’re someone who’s on your legs a lot—like a waitress on a later shift—then using them before a workout can be helpful in flushing out your legs,” says Leninger. In that case, 10 to 15 minutes before a workout could be helpful.
After a workout, Madia recommends spending 30 to 35 minutes in the boots. “That tends to be the sweet spot in terms of clearing out what you need to clear out,” he says. So throw on your favorite TV show and relax.
Of course, everyone’s training is different and your recovery is going to depend on your mileage, volume, and intensity. “My guideline for people is always to do the max amount of time the system allows (usually 20 minutes), then get up, go to the bathroom, walk around,” says Leninger. “If an hour later, you still feel like your workout was enough to warrant more compression, you can always do another 20 minutes.”