#872 Do I keep using compression socks until healed? - DOC

#872 Do I keep using compression socks until healed?

Do I need to keep using compression socks until my injury is really healed? Well, that is what we’re talking about today on the Doc On The Run Podcast.



This morning, I had a conversation with a runner who had an injury. He has been getting a lot better and one of the things he did that seemed to really help improve things was compression socks.

Compression helps because when you have inflammation, everything swells. If you put pressure on the outside of the tissue to keep it from swelling, it feels better. Getting that compression that gets you through the inflammatory phase and gets you into the proliferative phase where things are healing and repair is happening as opposed to getting ready to repair the tissue by cleaning up and getting cells in there that are just starting the process, that compression can kind of help you get from one phase to another.

His question was a really good one. He said, “I had so much improvement with that but with the injury I have, every time I take the socks off and on it feels like I am moving the injured tissue now, and I not really sure if I need it. So, do I need to continue to use compression or not?” And he is a couple of weeks out from his injury. He’s doing way better. He has very little discomfort now. He has virtually no swelling at all. And so, I said, Look, this is the way I would think about it, if you are out of that initial trouble phase where the foot’s really actively swelling, you do not really need compression socks unless one of two things is happening.

The reason that you use compression socks initially is to get your real pain numbers. So, part of the strategy I want to work with athletes like if you were to call me for a consultation, the first thing I would do if you call me and said, “Hey I want to schedule a consultation.” I say, “Okay, fine. Let’s pick a time. Here is what you need to do. In the meantime, track your numbers, your pain numbers, you need to know how much it hurts while you are sitting still, when you are walking around, when you are barefoot versus wearing shoes going upstairs, downstairs.”

All the things that you do normally in your home every day, you want to figure out what your pain numbers are. Then you figure out how much discomfort you have because of the swelling. There are lots of ways to reduce the swelling but one of those is wearing compression socks. So, if you wear compression socks for a couple of days and your pain goes way down,  stress fracture didn’t miraculously heal in two days but what did happen is you remove the fluid.

The portion of the pain that is the difference between the numbers you have before you to use compression to get the inflammation out and then after, well that is just attributable to the swelling in the tissue. So, you get the fluid out, now you know your real pain numbers and you can pick a strategy and some tactics to get it to heal. But you shouldn’t have to use compression while you are healing.

Scenario number two is when you should use compression when you think you are going to have a lot of inflammation and you want to prevent it from happening. For example, I did Ironman triathlons for almost 10 years. I did 15 of them and when I would do an Ironman race, I would sleep in compression socks for three days after an Ironman. I wear them around the clock for three days. After a marathon, I wear them for two days around the clock, sleep in them and that really prevented a lot of the inflammation that happened in my feet, my ankle, my legs, my calves, all of that, right after one of those races because when you do an Ironman, you are going to have inflammation, you are going to have tissue damage, and if you can prevent it from really getting out of control, you can often get back to activity faster.

If you are resuming activity after you have had an injury, what I would do is not just use compression all the time, I think it’s an unnecessary hassle and it comes with a risk. A risk of moving tissue that you do not want to move while you are jerking those socks on and off your feet trying to get them on and try to get them back off to take a shower and stuff like that. So, if you do not need that additional wrestling with the compression socks, do not use them unless you’ve had an episode where you thought you did too much.

Maybe you went out for a run, it felt so good to run, it was sunny and all that. You ran a little bit further or a little bit faster than you were supposed to given where you are in your recovery, then you can sleep in compression socks at night to prevent any rebound inflammation. If you start working out at the gym and then you do some exercises that you think maybe were a little too stressful for that piece of tissue, then you can wear compression socks to prevent that rebound inflammation and help move you in the right direction a little faster. But those are two different scenarios when you might want to use compression but no, most people do not just need to continue wearing compression socks until they’re completely healed because that could take a long time.

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