When to Wear Compression Socks

Everyone can benefit from good circulation. 

A strong vascular system helps your blood deliver oxygen and nutrients to your cells and help your heart stay healthy. One easy way to improve your circulation is through compression therapy. Compression socks—an inexpensive form of compression therapy—work by gently squeezing your foot, ankle, and calf to push blood from your extremities back towards your heart. 

Compression stockings and socks can be ankle length, knee-high, or thigh-high. The level of compression is measured in millimetres of mercury (mmHg), and a high-quality compression sock should be labeled accordingly. The most effective knee-high socks offer graduated compression, delivering more pressure at the ankles and less on the calf. 

With graduated compression socks, you should expect to see a label with a two-number range of mmHG (with the higher compression at the ankle and the lower compression at the calf). For example, with a 15-25 mmHg compression sock, you'll experience 25 mmHg (medium compression) at the ankle and 15 mmHg (mild compression) at the calf. 

So, let's say you’ve purchased a pair of knee-length graduated compression socks. When should you wear them, and how do you get the most out of your purchase?

We've made a list of the top seven times that you should reach for your compression socks. We've also identified times when you should leave the socks in the drawer. Lastly, we've provided instructions for caring for your socks, so that you get the most possible wear out of every pair. 

#1 | When You Take a Long Flight

Reach for your compression socks when you're about to board a flight. Compression socks help to relieve swelling. According to Deepak L. Bhatt, MD, MPH, Editor in Chief of Harvard Heart Letter, "They can help prevent swelling in the foot, ankle, and lower leg that often occurs during any period of prolonged sitting—not just in planes but also in buses, trains, and cars." By promoting blood flow and good circulation, compression stockings or socks can make you more comfortable during air travel. 

In addition, compression socks prevent the formation of small blood clots, which can plug a vein and cause deep vein thrombosis (DVT). Sometimes, blood clots even break loose and lodge in the lungs, causing a pulmonary embolism, which can be fatal. According to a 2016 study, "high‐quality evidence shows that airline passengers similar to those in the trials in this review can expect a substantial reduction in their risk of a symptomless DVT if they wear compression stockings." (Clarke et al.) Compression socks reduce your risk of developing problematic blood clots deep inside your veins, and that can be a good thing since DVT and long-distance travel have been linked. 

The Center for Disease Control (CDC) explains the dangers: 

Blood clots can form in the deep veins (veins below the surface that are not visible through the skin) of your legs during travel because you are sitting still in a confined space for long periods of time. The longer you are immobile, the greater is your risk of developing a blood clot. (“Blood”)

When you know that you'll be sitting on a plane for many hours, you can reduce circulation problems and decrease your likelihood of developing blood clots by opting to wear graduated compression socks.

2 | When You're on Your Feet or Sitting for Hours

As with long periods of travel, sitting still or standing for long periods of time can be detrimental to your health. We've already explained why long periods of sitting can be dangerous. To recap—DVT and swelling can result from prolonged sitting, especially when you're stuck in the same position. 

Unfortunately, standing can be dangerous, too. When you stand for a long shift at work, the blood can pool in your legs and cause edema (swelling). Alex Hutchinson, writing for Runner's World, explains, "So the elevated risk of heart disease for standing jobs like sales clerk, cook, and machine operator is real, and something that people should be aware of. It’s likely a result of blood pooling in the legs, and the increased stress of pumping it back up to the heart." By reaching for compression socks, you can give your circulatory system a boost and stop your blood from pooling in your feet and lower legs.

#3 | When You're Recovering From Surgery

Most doctors recommend follow-up care after a surgery. Sometimes, compression therapy involving socks or stockings can be part of that protocol. According to the U.K. National Health Service, "[Compression socks are] often recommended if it's likely you'll be unable to move around much after surgery, either due to the after-effects of surgery or having another medical condition that affects your mobility." 

Your risk of developing DVT increases after surgery on the hip, knee, legs or abdomen, especially if you've been under general anesthetic for more than 90 minutes. In addition to decreasing the likelihood of DVT, compression socks may help with other complaints, such as leg swelling and discomfort. We recommend deferring to your surgeon or doctor, especially when it comes to your post-surgical care.

#4 | When You're Pregnant

Pregnancy, especially multiple births, can put women at risk for developing DVT, edema, and chronic venous insufficiency (CVI). CVI can lead to spider and varicose veins, which can be painful and unsightly. The website for the National Heart, Lung, and Blood Institute explains, "Veins have one-way valves inside them that open and close to keep blood flowing toward the heart. However, weakened or damaged valves or walls in the veins can cause blood to pool and even flow backwards.” This pooling blood causes a number of symptoms, including itchiness, aching, and skin discoloration. 

Unfortunately, once varicose or spider veins develop, they are permanent. For that reason, compression therapy is recommended for pregnant women. Compression socks work to help prevent the failure of the valves within your veins. In addition—for those women who have already developed DVT, edema, or chronic venous insufficiency—doctors often recommend compression socks as a way to reduce discomfort and keep symptoms from worsening.

#5 | When You Exercise

As most athletes know, strenuous exercise causes lactic acid buildup. When the muscles in our bodies receive limited oxygen, we turn pyruvate into a substance called lactate to continue producing energy. 

Stephen M. Roth, professor of kinesiology, explains:

. . . The production of lactate and other metabolites during extreme exertion results in the burning sensation often felt in active muscles...This often painful sensation also gets us to stop overworking the body, thus forcing a recovery period in which the body clears the lactate and other metabolites. 

Of course, sometimes you want to keep exercising, even when you feel the painful sensation of lactic acid buildup. 

Imagine you're a professional athlete, and you're in the final twenty seconds of a career-defining game. You’re experiencing a painful sensation, as lactic acid builds up in your legs, but you want to keep pushing yourself in spite of the pain. Compression socks help reduce the buildup of lactic acid in your legs, allowing you to continue at full force. 

Even if you're not a professional athlete, wearing compression socks may help you to reduce discomfort while exercising and reduce muscle fatigue after your workout. According to a 2016 study, “...By wearing compression clothing, runners may improve variables related to endurance performance (i.e., time to exhaustion) slightly...They should also benefit from reduced muscle pain, damage, and inflammation.” (Engel et al.)

So, when you're looking to physically push yourself to the limit, reach for compression socks. If you experience muscle fatigue, inflammation, or cramping during cardio exercise, we recommend you wear compression socks during exercise to prevent or reduce those issues. If you experience muscle soreness after cardio exercise, we recommend you wear them directly after your workout for at least 3-4 hours to improve recovery and increase circulation.

#6 | When You're Dealing with Vascular Issues

As we've already explained, compression socks can help reduce your risk of developing DVT, CVI, and a number of other vascular problems. 

But what if you've already experienced vascular issues? 

Turn to compression socks to help reduce your symptoms and risk factors.

Venous Leg Ulcers

One side effect from chronic venous insufficiency is leg ulcers, open skin sores on your legs or feet. As the National Heart, Lung, and Blood Institute website explains, "Compression stockings may also help heal leg ulcers or sores that are a complication of varicose veins. Because vein problems are chronic, your doctor may suggest that you continue to wear compression stockings.” So, even after your ulcers heal, compression therapy can help to keep them at bay. 

This is confirmed by a 2019 study by Health Quality Ontario, which concludes, “The available evidence shows that, compared with usual care, compression stockings are effective in preventing venous leg ulcer recurrence and likely to be cost-effective.” So, if you've experienced venous leg ulcers as a result of chronic venous insufficiency, you'll benefit from wearing compression socks, both when you have active ulcers and when you're working to prevent recurrence.

Venous Insufficiency—Varicose Veins and Spider Veins

If you've already developed varicose and spider veins as a result of chronic venous insufficiency, you may see bulbous or discolored veins and capillaries on your legs. These develop when the one-way valves inside your veins fail. While the valves cannot be repaired, one of the main therapies recommended to help combat the pain and discomfort of varicose and spider veins is compression therapy. 

If you have graduated compression socks, you can wear them to help reduce the swelling, pain, discoloration, and discomfort caused by venous insufficiency.

Deep Vein Thrombosis

DVT occurs when you develop a blood clot deep in your vein. This can lead to life-threatening problems, including thrombophlebitis (swelling of the vein), postphlebitic syndrome, and pulmonary embolism. While you should seek immediate medical treatment for DVT, it's likely that compression therapy may be one of the treatments recommended by your doctor.

One study that compared compression therapy and bed rest for patients suffering from deep vein thrombosis (DVT) concluded that, "Leg compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT." (Blättler) By boosting your circulation and reducing the pooling of blood in your legs, compression socks stop additional clots from forming. Medium compression (20-30 mmHG) is usually recommended for the treatment of DVT.

Pulmonary Embolism

Many doctors recommend compression therapy for patients recovering from pulmonary embolism. For example, according to their website, “NYU Langone doctors almost always recommend that people with pulmonary embolism wear graduated compression stockings during daily activities.” 

Medication and surgery are common treatments for pulmonary embolism. In the aftermath of a pulmonary embolism, not only can compression socks reduce the risk of developing new blood clots, but they can also ease the symptoms associated with post-thrombotic syndrome, which include edema, heaviness, and discoloration.

#7 | When You Want to Prevent Edema

By forcing the blood back up the leg, graduated compression socks can reduce swelling caused by pregnancy, medication, underlying disease, or DVT. Swelling can often go hand-in-hand with discoloration, discomfort, and pain, and compression socks can help with those symptoms. 

Be sure to consult your doctor about the underlying cause for your edema. In some cases, compression socks may reduce the symptoms of your edema without addressing the root cause.

When NOT to Wear Compression Socks

• We do not recommend wearing compression socks overnight.
• Do not wear compression socks over other socks, stockings, or pantyhose. 
• Don’t wear compression socks that are the wrong size.
• Don’t wear compression socks if you have fragile skin or a condition that limits skin sensation in the legs and feet .
• If you suffer from ischaemia, peripheral neuropathy, congestive heart failure, diabetes, or cellulitis, you should consult your doctor before wearing compression socks or stockings.

Compression Socks: When to Use Them

Whether you’re traveling, sitting, standing, running, jumping, or recovering, compression socks can help you feel your best.

How to Care for Your Compression Socks

• Wash on a cold cycle with like colors. 
• Do not use bleach or fabric softener. 
• Air dry or hang try to maintain the elasticity of the compression.

 

Sources:

Bhatt, Deepak L. “Ask the Doctor: Compression Stockings for Long-Distance Travel?” Harvard Heart Letter, Harvard Health Publishing, Aug. 2014, www.health.harvard.edu/heart-health/ask-the-doctor-compression-stockings-for-long-distance-travel-.

Blättler, W., and H. Partsch. “Leg Compression and Ambulation Is Better than Bed Rest for the Treatment of Acute Deep Venous Thrombosis.” Int Angiol, Vol. 4, 22 Dec. 2003, pp. 393–400. PubMed, https://www.ncbi.nlm.nih.gov/pubmed.

“Blood Clots and Travel: What You Need to Know.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Feb. 2020, www.cdc.gov/ncbddd/dvt/travel.html.

Clarke, M. J., Broderick, C., Hopewell, S., Juszczak, E.,Eisinga, A. “Compression stockings for preventing deep vein thrombosis in airline passengers” Cochrane Database Syst Rev, December 19, 2016.

Engel FA, Holmberg HC, Sperlich B. "Is There Evidence that Runners can Benefit from Wearing Compression Clothing?" Sports Med. Vol. 46, Iss. 12. Dec 2016(12):, pp. 1939-1952. PubMed, https://www.ncbi.nlm.nih.gov/pubmed/27106555.

Health Quality Ontario. “Compression Stockings for the Prevention of Venous Leg Ulcer Recurrence: A Health Technology Assessment.” Ontario Health Technology Assessment Series Vol. 19, Iss. 2, pp. 1-86. 19 Feb. 2019.

“How Long Should I Wear Compression Stockings after Surgery?” NHS Choices, NHS, 18 Dec. 2018, www.nhs.uk/common-health-questions/operations-tests-and-procedures/how-long-should-i-wear-compression-stockings-after-surgery/.

Hutchinson, Alex. “Standing All Day Is Twice as Bad as Sitting for Your Heart.” Runner's World, Hearst Magazine Media, 21 Oct. 2019, www.runnersworld.com/health-injuries/a20860422/standing-all-day-is-twice-as-bad-as-sitting-for-your-heart/.

“Recovery & Support for Pulmonary Embolism.” Patient Care at NYU Langone Health, NYU Langone Health, nyulangone.org/conditions/pulmonary-embolism-in-adults/support.

Roth, Stephen M. “Why Does Lactic Acid Build Up in Muscles? And Why Does It Cause Soreness?” Scientific American, Springer Nature America, Inc., 23 Jan. 2006, www.scientificamerican.com/article/why-does-lactic-acid-buil/.

Sachdeva, Ashwin. “Graduated compression stockings for prevention of deep vein thrombosis during a hospital stay,” Cochrane Vascular Group, Nov 3, 2018.

“Varicose Veins.” National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services, www.nhlbi.nih.gov/health-topics/varicose-veins.