Minor Dissertation prepared in partial fulfilment of the Master of Science in Exercise and Sports
Physiotherapy Degree

Investigation of the impact of compression garments on endurance running performance and exercise induced muscle damage in the lower leg

Department of Human Biology
Division of Exercise Science and Sports Medicine
University of Cape Town
Student Investigator: Grethe Geldenhuys
Supervisor: A/Prof Andrew Bosch Co-supervisor: Dr Jeroen Swart
2017

The copyright of this thesis vests in the author. No quotation from it or information derived from it is to be published without full acknowledgement of the source. The thesis is to be used for private study or noncommercial research purposes only.

Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author.

Declarations

DECLARATION

I, Alda Grethe Geldenhuys, hereby declare that the work on which this dissertation is based is my original work (except where acknowledgements indicate otherwise) and that neither the whole work nor any part of it has been, is being, or is to be submitted for another degree in this or any other university.

No part of this dissertation may be reproduced, stored in a retrieval system, or transmitted in any form or means without prior permission in writing from the author or the University of Cape Town.

Signature

Signature Removed

__________________________ Date ____________15 August 2017_

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Acknowledgements

“It always seems impossible until it is done.”

(Nelson Rolihlahla Mandela)

My praise to God through whom all things are possible.
I would also like to take this opportunity to extend a heartfelt thank you to everyone without whom this study would not have been possible.

To my supervisors, A/Prof Andrew Bosch and Dr Jeroen Swart for sharing their expertise and invaluable knowledge and for providing guidance and assistance with the dissertation.

To the study participants, for their enthusiasm, and for dedicating their invaluable time to be involved in this research project.

To my course convenor, Dr Theresa Burgess, and co-convenor, Ms Kim Buchholtz for the advice, encouragement and support during the degree.

To University of Cape Town’s Postgraduate Funding office for kindly granting an academic merit

scholarship to enable my studies.
To Mr Brett Phillips for sharing his expertise and dedicating his time to training the researcher in the execution of ultrasound scans.

To Mr Thor Langley for his expertise and execution of the countermovement jump data collection while in South Africa on exchange from the University of Jyväskylä, Finland.

To Mr Trevino Larry for his assistance with logistical and practical arrangement surrounding the data collection period.

To A/Prof Brenda Morrow and Prof Mike Lambert for their valuable guidance with the statistical analysis component of the dissertation.

To the masters class of 2016-2018 for making this challenging journey considerably better with a great mix of comedy, intellectual discussions and kindness along the way.

To my amazing extended family, fantastic friends and all my loved ones who are the best part of my world. A special thanks to my wonderful parents Maretha and Albert, lovely siblings Marli and Norval
Geldenhuys and brilliant significant other Byron Mawer, for their irreplaceable support, unconditional love and guidance in all my endeavours. I would be nothing and nowhere without all of you in my life.

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Table of Contents

Declarations ............................................................................................................................................2 Acknowledgements.................................................................................................................................3 List of figures...........................................................................................................................................7 List of tables............................................................................................................................................8 List of abbreviations................................................................................................................................9 Glossary of terms ..................................................................................................................................10 Abstract.................................................................................................................................................12 CHAPTER 1: Introduction and scope of dissertation.............................................................................13

• 1.1
• Introduction ..........................................................................................................................13

1.2 Aim & Objectives.........................................................................................................................13
1.2.1 Aim.......................................................................................................................................13 1.2.2 Objectives.............................................................................................................................14
1.3 Plan of Development ..................................................................................................................14
Chapter 2: A review of the literature....................................................................................................15
2.1 Introduction ................................................................................................................................15
2.1.1 Overview ..............................................................................................................................15 2.1.2 Methods...............................................................................................................................15 2.1.3 Background ..........................................................................................................................15
Findings in the literature:..................................................................................................................17 2.2 Endurance running......................................................................................................................17
2.2.1 Endurance running and the Old Mutual Two Oceans Ultramarathon.................................17 2.2.2 Exercise-induced muscle damage (EIMD)............................................................................17 2.2.3 Gender and age related differences in EIMD and running performance ............................18 2.2.4 Methods to reduce EIMD.....................................................................................................19 2.2.5 Methods to maximise performance ....................................................................................19 2.2.6 Summary of the literature: Endurance running...................................................................20
2.3 Compression Garments in Runners ............................................................................................21
2.3.1 Compression garments worn during running......................................................................21 2.3.2 Compression garments worn during recovery from running ..............................................23 2.3.3 Problematic trends...............................................................................................................24 2.3.4 Summary of Literature: Compression Garments in Runners...............................................25
2.4 Compression garments in other sports.......................................................................................36
2.4.1 Compression garments worn during exercise .....................................................................36 2.4.2 Compression garments worn during recovery from sport ..................................................36 2.4.3 Problematic trends...............................................................................................................37

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2.4.4 Summary of the literature: Compression garments in sport...............................................37
2.5.1 Review Studies of Compression Garments..............................................................................41
2.5.2 Summary of review studies of compression garments........................................................42
2.6 Instrumentation..........................................................................................................................43 2.6.1 Instrumentation for exercise induced muscle damage ...........................................................43
2.6.1.1 Circumference measurements..........................................................................................43 2.6.1.2 Ultrasound and other radiographic imaging.....................................................................43 2.6.1.3 Subjective ratings..............................................................................................................45 2.6.1.4 Blood/Serum testing .........................................................................................................45 2.6.1.5 Summary of instrumentation for exercise induced muscle damage................................45
2.6.2 Instrumentation for running performance..............................................................................46
2.6.2.1 Time trials and time-to-exhaustion tests..........................................................................46 2.6.2.2 Other running performance tests.....................................................................................46 2.6.2.3 Countermovement Jump testing ......................................................................................47 2.6.2.4 Summary of Literature: Instrumentation..........................................................................47
2.7 Summary of the literature review...............................................................................................48
CHAPTER 3: Investigation of the impact of below knee compression garments on exercise induced muscle damage and performance in endurance runners.....................................................................49

Study Procedure....................................................................................................................................49
3.1 Introduction ................................................................................................................................49 3.2 Methodology...............................................................................................................................50
3.2.1 Research design and recruitment........................................................................................50 3.2.2 Sampling...............................................................................................................................51 3.2.3 Completion of study.............................................................................................................51

• 3.3
• Measurement instruments ...................................................................................................52

3.3.1 Screening tools and consent................................................................................................52 3.3.2 Study instrumentation .........................................................................................................52 3.3.3 Training with instrumentation.............................................................................................55 3.3.4. Compression Garments.......................................................................................................55
3.4 Procedure....................................................................................................................................55
3.4.1 Data collection .....................................................................................................................55 3.4.2 Data management ...............................................................................................................56 3.4.3 Statistical Analysis................................................................................................................56 3.4.5 Ethical considerations..........................................................................................................57
Results...................................................................................................................................................59
3.6 Participant flow.......................................................................................................................59 3.7 Baseline Data ..........................................................................................................................61

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3.8 Follow up data.........................................................................................................................63 3.9 Changes over time of main outcomes ....................................................................................81 3.10 Summary of significant main outcomes................................................................................89
Discussion..............................................................................................................................................91
3.11.1 Introduction .......................................................................................................................91 3.11.2 Research Participants.........................................................................................................91 3.11.3 Main outcome measures related to exercise-induced muscle damage............................93 3.11.4 Performance measures......................................................................................................97 3.11.5 Further possible contributing factors ................................................................................97 3.11.6 External Conditions............................................................................................................98 3.11.7 Training period...................................................................................................................98 3.11.8 Study limitations and future directions .............................................................................99
CHAPTER 4 ..........................................................................................................................................101
Summary & Conclusion...................................................................................................................101
REFERENCES........................................................................................................................................103 APPENDICES ........................................................................................................................................114
Appendix A: HREC approval ............................................................................................................114 Appendix B: Example of recruitment advertisement .....................................................................116 Appendix C: Nordic Musculoskeletal Questionnaire ......................................................................117 Appendix D: Physical Activity Readiness-Questionnaire+ ..............................................................118 Appendix E: Screening tool.............................................................................................................122 Appendix F: Informed consent........................................................................................................124 Appendix G: Operational Definitions and protocol ........................................................................128 Appendix H: Visit 3 - Adapted Visual Analogue Scale and Self-developed Questionnaire.............129 Appendix I: Visit 4 - Adapted Visual Analogue Scale and Self-developed Questionnaire ..............134 Appendix J: Training history questionnaire ....................................................................................137 Appendix K: Summary of Data Collection.......................................................................................139 Appendix L: Individual Results Template........................................................................................141 Appendix M: Data Capturing...........................................................................................................142 Appendix M: Timing of Data Collection ..........................................................................................143 Appendix N: Example of follow up email correspondence during recruitment.............................144
Follow up email following initial interest....................................................................................144 Example of email correspondence regarding for Visit 1.............................................................145 Example of email correspondence prior to visit 2-4...................................................................147