Promoting healthy blood circulation is one of the most important steps we can take to feel our best every day. Strong, healthy veins help us to move, heal, breathe, digest food, and think clearly. One of the easiest ways to improve blood circulation is by trading regular socks for compression socks. Why wear ordinary socks when you can wear socks with benefits?
What are compression socks?
Unlike casual or dress socks, compression socks are designed to gently squeeze your legs to promote blood flow from your legs and feet back towards your heart. There are two main types of compression socks, graduated and uniform. Graduated compression provides more pressure around your ankle and gradually gets looser as the sock moves up your leg. Uniform compression provides constant pressure throughout the length of the sock. However, graduated compression is more effective at improving circulation and well-being, whether you’re working at a desk from 9-to-5, traveling on long flights, recovering from a workout, or hiking through the Dolomites.
Most adults can benefit from more efficient circulation. Whether you’re an athlete looking to improve your recovery after a workout or a person who stands for long periods at work, compression socks can help you feel your best. When you assist your veins in circulating blood, you decrease the likelihood of painful swelling, blood clots, and varicose and spider veins.
Compression therapy has been used by doctors, nurses, clinicians, and physical therapists for over 50 years to improve common circulatory issues. But you don’t need to have existing health problems to benefit from compression therapy. The gentle pressure from compression socks promotes faster muscle recovery, so compression therapy works for everyone, everyday.
What are graduated compression socks?
Graduated compression socks are the most effective type of compression sock used to boost circulation. Graduated compression socks fit the tightest around the ankle and provide a high-to-low gradient of pressure that travels up the length of the calf. They also help the blood in your leg travel back up to your heart against the force of gravity by applying pressure to vein walls from the outside. More blood pumping means more energized legs and less pain and swelling of the feet.
What are uniform compression socks?
Athletes often wear uniform compression socks to support blood flow to muscles during workouts, although they are not as effective in promoting healthy blood circulation. Uniform compression socks distribute equal pressure from the ankle and up toward the knee.
What do compression socks do?
Compression socks apply moderate pressure to your legs and ankles, promoting blood circulation back to your heart. This increase in blood flow provides a variety of benefits including:
- Providing relief from aches, pains, and fatigue
- Reducing swelling in the legs, feet, and calves
- Preventing soreness after exercise
- Assisting in the prevention of deep vein thrombosis (DVT) and varicose veins
- Improving performance during strenuous cardiovascular exercise
- Speeding up recovery times from injury or surgery
- Reducing lactic acid build-up
How do compression socks work?
Compression socks and stockings are made from elastic fabrics that are designed to stretch and fit tightly around your legs and feet. The pressure applied to the legs can help your blood vessels work more efficiently. Therefore, the arteries that take oxygen-rich blood to your muscles and legs can relax, so blood circulates more freely. The leg veins receive a boost, pushing blood back to your heart. This circulation boost has a variety of health benefits backed by numerous studies and medical research (see footnotes).
Why do compression socks have to be tight or apply pressure to work? Well, the pressure from the sock reduces the diameter of major vein walls and, as a result, increases the volume and velocity of blood flow. As a helpful visual, we often tell our customers about the “garden hose effect.” If you were to turn on a garden hose and place your thumb on top of the nozzle, you would get a tight, concentrated spray of water. This is effectively what a compression sock is doing to your veins—decreasing the vein wall to improve the velocity of blood flow.
With graduated compression socks, the pressure of the sock—measured as mmHg—is highest at the ankle and gradually loosens as the sock reaches the knee. The degree of compression or pressure is described by a range (e.g. 15-25mmHg). The higher number indicates the amount of pressure at the ankle and the lower number indicates the pressure at the top of the sock right below the knee. Graduated compression socks are the most effective way to boost circulation, compared to uniform compression socks (which don’t provide a stated mmHg level).
When to wear compression socks
If you’re already aware of compression socks, you probably associate their use with treating health ailments caused by poor circulation. But compression socks are helpful for anyone who's looking to improve their everyday well-being and especially for those who travel frequently, sit at a desk, or work on their feet all day.
Traveling Long Distances
If you’re about to embark on a long flight, chances are you’ll be inactive and sitting in a confined space for a prolonged period of time. Long periods of sitting can cause swelling in the foot, ankle, and lower leg. This increases your risk of blood clots and discomfort.
Why do your feet and legs swell while sitting on an airplane? It’s not due to the altitude or the pressurized cabin—common misconceptions—but it’s a result of sitting for too long. During periods of prolonged sitting—not just in planes but also in cars, trains, and buses—your leg muscles don’t contract, which prevents blood from efficiently traveling back to your heart. As a consequence, blood and fluid pool in the lower legs and feet, leading to swelling. The lethargic blood flow can even cause small blood clots to form. Occasionally, a clot will plug a vein and impede blood flow, causing a painful condition called deep vein thrombosis (DVT).
DVT is a life-threatening condition that involves blood clot formation in the deep veins of your body after a long period of immobility or poor blood circulation. If the clot moves to the lungs, the condition can be fatal. Even if you’ve never had vascular problems before, you could be at risk for DVT. Multiple studies have shown and suggest that wearing compression socks can help prevent DVT on long airplane flights. For that reason, wearing compression socks on a long flight is a smart precaution that everyone can take to ensure good health.
Prolonged standing and sitting
Whether you’re a nurse, teacher, analyst, or a restaurant employee, the majority of working adults are on their feet or at a desk for long periods of time. If you’re experiencing leg swelling, achiness, or discomfort in your feet and legs, studies have shown that compression socks can improve blood flow when you’re unable to move around throughout the day. Improving your blood circulation may also help you perform better overall, since an increase in blood flow means more oxygen to your brain, and increased awareness and energy.
Treating symptoms of medical conditions
Another common reason people wear compression socks is to treat pre-existing medical conditions associated with poor blood circulation. Doctors often recommend that patients use compression socks to alleviate symptoms associated with:
- Varicose veins and spider veins
- Deep-vein thrombosis (DVT)
- Edema (swelling)
- Chronic venous insufficiency (CVI)
- Post-thrombotic syndrome (PTS)
- Postural Orthostatic Tachycardia Syndrome (POTS)
- Shin splints
- Plantar Fasciitis
- Lymphedema
Varicose veins are enlarged, twisted veins, which can show prominently near the skin’s surface. They’re caused by an increase in blood pressure inside the vein valves and walls. Varicose veins can lead to serious circulatory issues and cause severe pain and discomfort.
Spider veins are a mild version of varicose veins that tend to be a cosmetic concern. These damaged veins are small and usually not harmful or painful. They can be red or blue and appear as webs or branches.
Vascular issues like varicose and spider veins can occur due to pregnancy, sitting or standing for long periods, inactivity, high blood pressure, obesity, or a family history of varicose veins or deep vein thrombosis. By assisting your veins in circulating blood with graduated compression socks, you’re decreasing the likelihood of painful swelling, blood clots, and varicose and spider veins.
Pregnancy
Pregnant women can benefit in several ways from wearing compression socks. During pregnancy, women are likely to experience mild to severe edema (swelling) in their feet and legs, placing them at an increased risk for developing both varicose veins and blood clots. Foot and ankle swelling during pregnancy is common and usually goes away after delivery.
A variety of factors contribute to swelling during pregnancy. For starters, your body retains more fluid during pregnancy. In addition, the growing uterus puts pressure on your veins, which impairs the return of blood to your heart. Hormonal changes may also play a role.
Compression knee or thigh high socks have shown to be effective at preventing painful swelling and varicose veins. The use of medical compression therapy is recommended throughout the duration of the pregnancy and for 6 weeks after birth to prevent discomfort, edema, and blood clots.
Recovering from surgery
Recovering from surgery of the hip, leg, or knee often requires a lot of rest, which can lead to lower mobility. The resulting immobility during recovery can increase the risk of developing deep-vein thrombosis (DVT). To reduce the possibility of developing DVT, post-operative care may include wearing compression socks, keeping up adequate fluid consumption, and maintaining mobility as required by your doctor.
Recovering from physical activity
Athletes wear compression clothing to boost blood circulation and prevent the build-up of excess lactic acid. As we work out, our muscle cells use more oxygen than our blood can deliver, and the absence of oxygen causes muscle cells to generate an excess of lactic acid.
Producing lactic acid is entirely natural and necessary to avoid muscle exertion, but it also triggers the body to produce other metabolites that are responsible for muscle soreness and premature muscle fatigue.
Compression clothing is also beneficial for athletes with existing circulation issues. For example, tennis athlete Serena Williams wore compression clothing during the women’s French Open in 2018 after experiencing a pulmonary embolism the year before. A pulmonary embolism occurs from a blockage in the pulmonary arteries, which are located in the lungs. Blood clots are typical culprits of pulmonary embolisms; they often travel up from the deep veins in your legs.
People with a history of pulmonary embolism often use anti-embolism stockings, compression socks, and pneumatic compression (calf or thigh-high cuffs) in conjunction with blood thinners, leg elevation, and continuation of physical activity to prevent future blood clots.
How long to wear compression socks?
There is no single answer. If you’re in good health, you can safely wear them all day. You should take them off before bedtime, as they are not recommended overnight. Also, when you elevate your legs, it’s not necessary to wear compression socks. While it’s safe to wear compression socks all the time, they’re especially recommended for long periods of sitting or standing.
On average, compression socks should be replaced every 3 to 6 months to ensure compression efficacy for treating or aiding in the prevention of circulatory issues. The elastic inside most compression socks breaks down over time, especially if the socks are washed often. The more worn-down the elastic, the less compression benefit your socks provide. Luckily, Comrad’s Companion compression socks are made with flexible synthetic fibers (nylon and spandex), which help prevent shrinking as much as possible.
Most compression socks last longer if they are hand-washed with cold water with a mild detergent or soap. To maintain elasticity, avoid using bleach, fabric softeners, or dryer sheets. Comrad’s compression socks can be worn 3-5 times before needing to be washed because they feature SmartSilver technology. Comrad socks are treated with a silver ion antimicrobial that binds to the fabric, killing bacteria and preventing odor. Hang-to-dry is the optimal way to preserve the shape and compression of compression socks. However, if you prefer to dry your socks inside a dryer, be sure to dry them on the lowest heat setting available.
How to measure for compression socks?
Finding the right fit for compression socks is important, especially when you use them to treat certain medical conditions. Socks that are too loose and roll-down can place extra pressure on some areas of your legs, which may further restrict blood circulation. In contrast, socks that are too tight can restrict circulation everywhere, causing more pain and depleting the oxygen level in your legs. If you’re using medical grade compression socks, please see your health care provider to assist with measurement and fitting.
Most over-the-counter compression products are "ready-made," which means they are already sized, based on your shoe size, height, and weight. Medical-grade compression socks and pantyhose are custom-ordered using a tape measure to determine the circumferences of specific points of your feet and legs. To avoid buying compression products that are too tight, it may be a good idea to have your measurements recorded during a time when your body experiences the most swelling, like after a long period of standing.
The two most important areas to measure for compression socks are the left and right calves. The circumference measurements should be taken with your feet planted firmly on the ground and your body in a resting position. Thigh-high socks require an additional circumference measurement around the widest area of your thighs, which is normally the upper-mid region of the hamstrings and quadriceps below the buttocks.
Thigh-high compression socks or stockings shouldn’t reach the very top of your legs or meet the pubic or hip-bone area. Adding pressure to smaller circumference areas in this way can cut off circulation to your legs and cause blood to pool in the lower extremities.
How tight should compression socks be?
All compression socks should fit tightly, but more importantly, the tightness or level of compression is dependent on the symptoms you’re treating (e.g. varicose veins, edema, DVT) or use case (e.g. preventing swelling while traveling, improving muscle recovery after exercising, or having more energy while on your feet).
In general, when wearing compression socks, it’s common to feel warmth in your feet and legs. The socks should fit firmly, and you may even feel a slight tingling or itchy sensation.
When looking for particular sizes of compression socks, you may notice that sock compression is measured in "mmHg," which stands for millimeters of mercury. This is a standard unit of pressure that is used for compression products, and it's the most critical sizing measurement to look for when deciding which compression socks are right for you.
After you’ve determined the size and style of your compression socks, it’s easy to try different pressure ranges to find out which one works best for your needs. There are several compression levels available for compression socks, but the four standard levels include:
- Light: 8-15 mmHg
- Mild: 15-20 mmHg
- Medium: 20-30mmHg
- Firm: 30-40 mmHg
Comrad compression socks feature compression near the middle of the range at 15-25 mmHg and are best for everyday wear. Comrad features True Graduated Compression, meaning that the sock fits tightest around the ankle and provides a high-to-low gradient of pressure that travels up the length of the calf. Each compression range represents the minimum and maximum amount of compression provided by a sock.
Light Compression (8-15 mmHg)
Light compression socks provide 8-15mmHg and are commonly used for tired, heavy, and achy legs. They are commonly used by healthy wearers that sit or stand for extended periods. They’re commonly available in national pharmacies as over-the-counter purchases.
Mild (15-20mmHg) & Medium Compression (20-30 mmHg)
Mild 15-20 mmHg compression socks provide relief for mild leg and foot swelling, minor varicose veins, and tired or achy legs. 15-20mmHg is most commonly used compression for travel, pregnancy, swelling, aches, and pains.
Medium 20-30 mmHg compression socks provide support for moderate leg and foot swelling, moderate discomfort, moderate spider and varicose veins, support and recovery for athletic performance and endurance. 20-30mmhg is most commonly used for long-haul travel, moderate edema, lymphedema, Deep Vein Thrombosis (DVT), post-operative recovery, injury recovery, pregnancy, and moderate varicose veins.
Comrad provides 15-25 mmHg, which means the amount of compression does not fall below 15 mmHg or go above 25 mmHg. We refer to this range as “the compression sweet spot,” since it provides the full benefits of mild and medium compression compression.
Typical users of mild and medium compression socks might include:
- Food servers, bartenders, baristas, and chefs
- Medical personnel (e.g., nurses, doctors, nursing aids, and support staff)
- Teachers
- Runners and Cyclists
- Salesfloor employees
- Flight attendants and pilots
- Executives/Consultants
- Financial Analysts
Firm (30-40 mmHg) Compression
Medical grade compression socks are available in three different class levels, although the first class is the most widely used. A 30-40 mmHg compression level is considered “firm,” but not too strong. This level of compression provides just enough pressure to manage painful swelling, vein disorders, post-operative discomfort, and muscle soreness. Firm compression socks also help prevent recurring venous ulcerations, varicose veins, and DVT.
Compression levels offered within the second and third medical classes (40 mmHg and above) are stronger and often prescribed for treating medical conditions. Firm compression socks provide 30-40 mmHg and are helpful for moderate to severe swelling. The 30-40 mmHg range of compression is used to treat conditions such as chronic venous insufficiency (CVI), DVT, lymphedema, severe edema, venous ulcers, and symptoms caused by vein procedures (e.g., vein stripping). The strongest level of compression is 40-50 mmHgand that’s commonly used for treating advanced lymphedema, DVT, and CVI.
How to put on compression socks
Compression socks are notoriously difficult to put on because they are tighter than regular socks. Before wearing compression socks, make sure your feet and legs are completely dry.
Step-by-step instructions for putting on compression socks
For a visual breakdown, check out our video on “How To Put On Compression Socks.”
- Find a comfortable place to sit where you can maintain your balance.
- Stick your hand inside the sock and grab the heel pocket (for open-toe socks, grab the end of the sock instead).
- Turn 75% of the sock inside out, leaving an opening or pocket area to place your foot inside.
- Now that the sock is inside out, place your foot inside the foot pocket, and begin pulling the sock up around your feet. Make sure the sock fits comfortably around your foot before continuing.
- With your foot now inside the sock, grab the sock cuff with both hands and begin pulling the sock up the sides of your leg.
- Once you have the sock rolled up to its maximum length, smooth out any loose sections or wrinkles. The sock should fit securely over your leg and stay in place without any assistance.
- Repeat for the other foot.
Stocking donners and donner gloves
If you struggle with bending over to pull up your socks, you may want to use a stocking donner and donner gloves. Each device is inexpensive and helpful for pulling up compression stockings. Unlike socks, compression stockings are made from thin and fragile fabrics, so people with softer hands may have a difficult time gripping the slippery fabrics. Stocking donner gloves feature a silicone surface over the outside palms, which allows users to pull hosiery over their legs in a secure fashion.
Where to buy compression socks?
Low to moderate compression socks are available over-the-counter at most pharmacies, although the most fashionable compression socks are available here, through Comrad. Our compression socks feature True Graduated Compression between 15-25 mmHg for the Companions and 15-20mmHg for the Guides. We call the 15-25mmHg range the “sweet spot of compression,” as they provide many of the benefits of 20-30mmHg socks, such as treating mild swelling and discomfort, while still being comfortable enough for everyday wear.
High compression socks (40 mmHg or higher) are typically found at medical supply stores. Certain medical conditions require custom-fit compression socks and a prescription from a health care provider. The upside of this is that prescription-strength compression socks are sometimes covered by health insurance–– so it’s always a good idea to talk to your doctor about the best compression socks for your body!
Sources
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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.
Clarke, Mike J. “Compression stockings for preventing deep vein thrombosis (DVT) in airline passengers” Cochrane Vascular Group, Sept 14, 2016.
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“How Long Should I Wear Compression Stockings after Surgery?” NHS Choices, NHS, 18 Dec. 2018, www.nhs.uk/common-health-