An investigation of made-to-measure compression garments and their utility during running

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Ashby, J., 2021. An investigation of made-to-measure compression garments and their utility during running. PhD, Nottingham Trent University.

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Abstract

The effects of wearing made-to-measure compression garments on exercise performance and recovery has not been extensively examined. Most of the published research literature has opted to use ‘off the shelf’ standard sized compression garments (i.e., small, medium and large), which may not provide optimal fitting and consequently may not elicit the expected pressures. The research presented within this thesis was undertaken to examine the effect of wearing made-to-measure compression garments, developed using 3D scanning, on running biomechanics and thermal responses. The research within the thesis also presents novel methodologies for measuring compression garment pressures and examines the reliability and validity of 3D scanning.

The purpose of the first study was to develop a novel method to examine compression garment pressures and to determine the pressure profile (peak pressure and pressure gradient) on different aspects of the leg. Fifteen males volunteered to participate (age 24.6 ± 2.0 years, stature 178.9 ± 4.5 cm, body mass 77.4 ± 6.5 kg, mean ± standard deviation). Garment pressures were assessed from the malleolus to the gluteal fold using a Kikuhime pressure monitoring device which consists of a pressure transducer attached to a sensor that transmits pressure readings to the transducer with a typical error of measurement of ±1 mmHg. The sensor was pulled up the leg in 5 cm increments. Three-dimensional motion capture was used simultaneously with pressure measurements to quantify the measurement locations. Pressure assessment was performed on the anterior, posterior, lateral and medial aspects of the right leg. Pressure assessment was also performed at the anatomical locations used in previous research, defined as the established method (three medial lower leg, and three anterior upper leg locations; Brophy-Williams et al., 2014; Brophy-Williams et al., 2015). The main findings from the study were that peak pressure at the ankle was typically higher when measurements were made on the posterior (18.3 to 27.5 mmHg) and anterior (16.6 to 27.6 mmHg) compared to the lateral (12.4 to 21.2 mmHg) and medial (12.2 to 23.0 mmHg) aspects of the upper, lower and whole leg. The pressure gradient was steeper when measurements were made on the posterior (-21.7 to -26.9 mmHg) and anterior (-22.1 to -23.2 mmHg) compared to the lateral (-11.0 to -15.3 mmHg) and medial (-13.9 to - 19.3 mmHg) aspects of the upper, lower and whole leg. The root mean squared difference was smaller for pressure measurements made on the posterior (1.8 ± 0.4 mmHg) compared to the lateral (2.7 ± 0.5 mmHg), anterior (3.1 ± 1.1 mmHg) and medial (3.2 ± 1.1 mmHg) aspects of the whole leg, when pressure measurements were made using the novel method. When comparing the novel method to the established method, the peak pressure at the ankle was higher when using the novel method (27.5 ± 2.2 mmHg) compared to the established method (19.8 ± 3.0 mmHg), when pressures were measured over the whole leg. The pressure gradient was also steeper using the novel method (-21.7 ± 2.9 mmHg) compared with the established method (-11.2 ± 4.5 mmHg). The measured pressure profile (peak pressure and pressure gradient) of a compression garment is significantly influenced by the aspect of the leg, and the posterior aspect showed the smallest variation of pressure. Therefore, pressure III measurements should be made using the posterior aspect of the whole leg using the novel method which provides more pressure measurements compared to the established method which allows a more informative reflection of the elicited pressure across the whole leg.

The purpose of the second study was to make made-to-measure compression garments that elicit pressures within and below clinical standards and establish whether pressures and gradients could be replicated between participants in different garment conditions. Ten males volunteered to participate (age 24.3 ± 4.6 years, stature 181.5 ± 1.8 cm, body mass 75.7 ± 3.8 kg, mean ± standard deviation). Based on three-dimensional scans of the participants’ lower body, three different made-to-measure garments were manufactured: control, high gradient and asymmetrical. The control garment was designed to elicit pressure below clinical standards (< 14 mmHg) with no pressure gradient. The high gradient garment was designed to elicit pressure within clinical standards (14 – 35 mmHg) and to include a linear pressure gradient from distal to proximal (graduated compression). The asymmetrical garment was designed to elicit control conditions in the left leg and high gradient garment conditions in the right leg. Garment pressures were assessed using the method developed in study one (posterior). A root mean squared difference analysis was used to calculate the in-vivo linear graduation parameters. Linear regression showed that peak pressure at the ankle in the left and right leg were: control garment, 13.5 ± 2.3 and 12.9 ± 2.6; asymmetrical garment, 12.7 ± 2.5 and 26.3 ± 3.4; high gradient garment, 27.7 ± 2.2 and 27.5 ± 1.6 (all mmHg, mean ± standard deviation). The pressure reduction from the ankle to the gluteal fold in the left and right leg were: control garment, 8.9 ± 3.5 and 7.4 ± 3.0; asymmetrical garment, 7.8 ± 3.9 and 21.9 ± 3.2; high gradient garment, 25.0 ± 4.1 and 22.3 ± 3.6 (all mmHg, mean ± standard deviation). The results demonstrated that made-to-measure compression garments can be made to elicit pressures within and below clinical standards, and to elicit equivalent pressures and gradients in different participants and between participants’ legs.

The purpose of the third study was to examine the reliability (test-retest, intra- and inter-day) and validity of 3D scanning to measure leg volume. Fifteen males volunteered to participate (age 24.6 ± 2.0 years, stature 178.9 ± 4.5 cm, body mass 77.4 ± 6.5 kg, mean ± standard deviation). The volume of the lower and upper legs was examined using two consecutive 3D scans and water displacement (criterion) at baseline, 1 hour post baseline (intra-day) and 24 hours post baseline (inter-day). Reliability (test-retest, intra- and inter-day) and validity of the 3D scanner were compared to the water displacement criterion method, using Bland and Altman limits of agreement, Pearson’s product moment correlations, and paired samples t-tests. The 3D scanner method provided better test-retest reliability than the water displacement method as the 3D scanner had smaller systematic bias and limits of agreement (±1-1%, and 3-5% respectively) compared to the water displacement method (1-2% and 4- 7% respectively), for lower leg and upper leg volume measurements. The intra- and inter-day reliability was also better for the 3D scanner evidenced by narrower limits of agreement for intra-day reliability (3D scanner: 4-7%, and water displacement: 8-20%) and inter-day reliability (3D scanner: 5-6%, and IV water displacement: 9-16%). The 3D scanner was also found to be a valid method for measuring upper leg volume as the systematic bias and limits of agreement were within 10% of volume measurements made using the criterion water displacement method. The results suggest that the use of 3D scanning may be a reliable and valid method to measure leg volume.

The purpose of the fourth study was to examine the effect of border removal and region of interest size on skin temperature outputs of thermal images (thermograms) using a sensitivity analysis, before and after exercise. Ten males volunteered to participate (age 23.5 ± 2.8 years, stature 181.9 ± 4.8 cm, body mass 76.2 ± 5.3 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on a treadmill and thermograms were captured of the upper and lower, anterior and posterior legs, before and after exercise using an infrared thermal imaging camera. Temperature data was extracted from the thermograms using a custom MATLAB® program which performed 2% increments of border removal from the unadjusted border, and 5% reductions of the region of interest size (length reduction) from the unadjusted length. A sensitivity analysis was performed to examine the influence of border removal and region of interest size on skin temperature. The sensitivity analysis showed that overall, the mean and maximum skin temperature had no to small sensitivity to the removal of the border and region of interest size on the thermograms. However, it was found that the inclusion of the region of interest border reduced skin temperature outputs between 0.14-0.24°C, at baseline and post exercise. The results suggest that the border of a thermogram should be removed when selecting a region of interest for analysis. Furthermore, regions of interest should be carefully selected over the specific area under investigation to reduce the influence of hot and cold areas within the thermogram caused by underlying tissues (muscle and bone).

The purpose of the fifth study was to examine the effect of wearing made-to-measure compression garments, with different pressure profiles, on thermal responses and comfort perception before and after exercise. Ten males volunteered to participate (age 23.5 ± 2.8 years, stature 181.9 ± 4.8 cm, body mass 76.2 ± 5.3 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on a treadmill whilst wearing four made-to-measure compression garments that differed in pressure and pressure gradient. The garment conditions were: 1) control garment which was designed to elicit pressure below clinical standards (< 14 mmHg) with no pressure gradient; 2) high gradient garment which was designed to elicit pressure within clinical standards (14–35 mmHg) and to include a steep pressure gradient from distal to proximal (graduated compression), 3) medium gradient garment which was designed to elicit pressure within clinical standards (14–35 mmHg) and to include a shallower pressure gradient from distal to proximal than the high gradient garment, and 4) asymmetrical garment which was designed to elicit control conditions in the left leg and high gradient in the right. Thermograms were captured of the upper and lower, anterior and posterior legs, at baseline, after a warm-up and after exercise, using an infrared thermal imaging camera. Participants completed a comfort questionnaire, comprised of multiple visual analogue scales, before and after exercise. V Temperature data was extracted from the thermograms using a custom MATLAB® program which standardised the regions of interest which were determined using the results from study four. The results revealed no differences of mean skin temperature between garment conditions at any time point (P > 0.05) and mean skin temperature change from baseline to post run ranged between 1.4 – 2.0°C, 1.1 – 1.5°C, 1.6 – 1.8°C and 1.2 – 1.7°C for the lower anterior and posterior, and the upper anterior and posterior leg segments respectively, in all four compression garment conditions. General comfort was lower for the left leg and right leg in the medium gradient garment (left: 7.9 ± 2.7, and right: 8.0 ± 2.7) compared to the control (left: 12.7 ± 1.8, and right: 12.8 ± 1.6), and asymmetrical (left: 12.1 ± 1.9, and right: 11.6 ± 2.2) garment conditions (P < 0.05). The pressure profile elicited by made-to-measure compression garments had no effect on thermal responses, and skin temperatures were not elevated to levels which would be associated with reductions in exercise performance (i.e., > 35°C). However, compression garments with higher pressures may provide greater discomfort, thus, there must be an optimal balance between wearer comfort and elicited pressures.

The purpose of the sixth study was to examine the effect of wearing made-to-measure compression garments, with different pressure profiles, on running biomechanics. Nine males volunteered to participate (age 22.9 ± 2.1 years, stature 182.0 ± 5.1 cm, body mass 76.4 ± 5.6 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on an instrumented treadmill whilst wearing made-to-measure compression garments that differed in pressure and pressure gradient. The garment conditions were identical to those of study five which were: control, high gradient, medium gradient and asymmetrical garments. Kinematics, kinetics and heart rate were measured during the run. Principal component analysis (PCA) was conducted to compare running kinematic and the kinetic variables of ground reaction force, joint powers, joint moments, joint angles and joint angular velocities, between compression garment conditions. The PCA results showed no differences between compression garment conditions for kinematic and kinetic variables, evidenced by a lack of data clustering. Heart rate was lower in the high gradient (128 ± 32 bpm) and medium gradient (127 ± 32 bpm) garments compared to the control (133 ± 33 bpm) garment condition (P = 0.039 and P = 0.011 respectively). The lower heart rate suggests that made-to-measure compression garments do not effect running kinematics and kinetics but may provide a cardiovascular benefit during submaximal running.

Overall, made-to-measure compression garments can be developed to elicit the same prescribed pressure profiles between participants. Moreover, the application of 3D scanning used to support the manufacture of the made-to-measure garments may also be used to reliably measure leg volume. Furthermore, when worn during submaximal running at 20.5 ± 0.8°C, made-to-measure compression garments with different pressure profiles do not elevate skin temperature to temperatures associated with performance decrements (i.e., > 35°C), and do not influence running biomechanics but may provide cardiovascular benefits as evidenced by reduced heart rate.

Item Type:	Thesis
Creators:	Ashby, J.
Date:	October 2021
Rights:	The copyright in this work is held by the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the author.
Divisions:	Schools > School of Science and Technology
Record created by:	Laura Ward
Date Added:	17 May 2022 08:09
Last Modified:	17 May 2022 08:09
URI:	https://irep.ntu.ac.uk/id/eprint/46328