Compression Garments Failed to Reduce Lower Extremity Injury Risk in Marathon Training
Among runners preparing for a half or full marathon, compression garments did not reduce the odds of a lower extremity running-related injury. The estimate landed close to null, with an odds ratio of 1.07 and a 95% confidence interval from 0.48 to 2.40, leaving no signal of either protection or harm in this cohort of 329 runners who were free of injury at baseline.
The result cuts against a common training-room belief that lower-leg compression can shield tissue from the repetitive load of marathon preparation. In this study, the biological plausibility was never the issue; the question was whether any putative reduction in muscle oscillation, venous pooling, or post-exercise soreness would translate into fewer clinically meaningful injuries over time. It did not.
A Target Trial Emulation in Real-World Marathon Trainees
The analysis used data from the prospective SUMMUM-2017 cohort and framed it as a hypothetical randomized trial. Runners entered one of four cohorts during their build-up to the Utrecht Marathon and were followed for 16 weeks, with questionnaires distributed every two weeks. At baseline, each runner reported whether compression garments were being used, and the analysis included only those without a running-related injury at entry.
That design matters because randomized trials on this question have not been available. Rather than waiting for a conventional trial that may be difficult to organize in a volunteer endurance population, the investigators reconstructed the key features of an ideal experiment: a clear eligibility window, a defined start point, repeated follow-up, and an outcome that could be tracked longitudinally. The approach cannot erase confounding entirely, but it does force the comparison closer to a causal question than a simple cross-sectional survey would.
The endpoint was also pragmatic. A runner was considered injured when the Oslo Sports Trauma Research Center questionnaire yielded a score above zero and the complaint met the study definition of a running-related injury: a self-reported problem involving muscles, joints, tendons, or bones, present for at least one running session and severe enough to reduce distance, speed, duration, or frequency. Blisters and delayed-onset muscle soreness were excluded, keeping the focus on injuries that actually interfere with training.
Null Effect Despite a Common Preventive Strategy
The absence of a measurable benefit is clinically important because compression garments are widely used with an injury-prevention intent. Endurance runners often wear compression socks or tubes hoping to stabilize the lower limb, reduce impact stress, and preserve training continuity through high-mileage blocks. Yet the study found no evidence that self-selected garment use lowered injury odds at any point during the training period.
The confidence interval was wide, which means a modest protective effect cannot be ruled out, but neither can a modest increase in risk. In practical terms, the data do not support telling marathon trainees that compression garments will prevent lower extremity injury. They may still prefer them for comfort, perceived support, or recovery, but those reasons are separate from prevention.
Why the Mechanism May Not Translate Into Injury Prevention
Compression garments have shown more consistent effects in recovery-focused research than in injury prevention research. Prior work has suggested reductions in muscle soreness, lower creatine kinase activity, and faster recovery after training or competition, possibly through improved venous return and altered metabolite clearance. Those outcomes reflect physiology after exertion; injury prevention is a different problem.
Running-related injuries usually emerge from the accumulation of load, tissue tolerance, biomechanics, prior injury history, and training errors. A sock or sleeve may slightly change surface-level mechanics or symptoms, but it is unlikely to neutralize the repetitive strain that drives most overuse injuries across a marathon block. If a garment reduces perceived fatigue or soreness without materially changing tendon or bone loading, the preventive effect would be expected to be small or absent, which fits this result.
A single 2-week window can reveal a painful injury. It does not necessarily reveal a preventive intervention.
What the Cohort Design Can and Cannot Tell Clinicians
The study’s strength lies in its attempt to answer a real-world question in a population that actually uses compression garments. Runners entered training at different points before race day, completed serial follow-up, and self-reported both exposure and injury status. The design also acknowledged an important limitation of observational data: the runners chose whether to use compression garments, so the exposure was not randomized.
Several details were not captured, and those absences matter when interpreting the result. The study did not register the type of compression garment or how consistently it was worn. Without compliance data, pressure gradient, or garment specification, any biologic effect could have been diluted by heterogeneous use. A runner who wears a loosely fitted sock intermittently is not meaningfully comparable to one who uses a high-compression sleeve on every training run.
Even with those caveats, the main message remains steady. Within this 16-week marathon preparation period, compression garment use did not shift the injury curve in either direction in a statistically meaningful way. The data do not justify a preventive claim.
Bedside Meaning for Runners and Sports Clinicians
For clinicians counseling marathon trainees, the finding supports a narrower conversation. Compression garments can be discussed as a comfort or recovery aid, but not as a proven strategy to prevent lower extremity running-related injuries. Prevention still depends on training load management, attention to prior injury, gradual progression, sleep, nutrition, and early response to pain that threatens running mechanics.
Runners often want a simple external fix for a problem rooted in cumulative stress. This study suggests compression garments are not that fix. If a patient uses them and likes them, there is no evidence here that they worsen injury risk, but there is also no evidence that they reduce it.
The unanswered practical issue is whether a more tightly controlled trial, with standardized compression level, compliance tracking, and weekly outcome assessment, would detect a small effect that self-selected use obscured. Until then, the current evidence from this target trial emulation leaves the preventive promise of compression garments unfulfilled for half and full marathon runners.