<p><em>Minor Dissertation prepared in partial fulfilment of the Master of Science in Exercise and Sports </em><br><em>Physiotherapy Degree </em></p><p><strong>Investigation of the impact of compression garments on endurance running performance and exercise induced muscle damage in the lower leg </strong></p><p><em>Department of Human Biology </em><br><em>Division of Exercise Science and Sports Medicine </em><br><em>University of Cape Town </em><br>Student Investigator: <em>Grethe Geldenhuys </em><br>Supervisor: <em>A/Prof Andrew Bosch </em>Co-supervisor<em>: Dr Jeroen Swart </em><br><em>2017 </em></p><p>The copyright of this thesis&nbsp;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. </p><p>Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author. </p><p>Declarations </p><p><strong>DECLARATION </strong></p><p>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. </p><p>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. </p><p>Signature </p><p>Signature Removed </p><p>__________________________ Date ____________15 August 2017_ </p><p><strong>2 | </strong>P a g e </p><p>Acknowledgements </p><p><em>“It always seems impossible until it is done.” </em></p><p><em>(Nelson Rolihlahla Mandela) </em></p><p>My praise to God through whom all things are possible. <br>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. </p><p>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. </p><p>To the study participants, for their enthusiasm, and for dedicating their invaluable time to be involved in this research project. </p><p>To my course convenor, Dr Theresa Burgess, and co-convenor, Ms Kim Buchholtz for the advice, encouragement and support during the degree. </p><p>To University of Cape Town’s Postgraduate Funding office for kindly granting an academic merit </p><p>scholarship to enable my studies. <br>To Mr Brett Phillips for sharing his expertise and dedicating his time to training the researcher in the execution of ultrasound scans. </p><p>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. </p><p>To Mr Trevino Larry for his assistance with logistical and practical arrangement surrounding the data collection period. </p><p>To A/Prof Brenda Morrow and Prof Mike Lambert for their valuable guidance with the statistical analysis component of the dissertation. </p><p>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. </p><p>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 <br>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. </p><p><strong>3 | </strong>P a g e </p><p>Table of Contents </p><p><a href="#3_0">Declarations ...........................................................................................................................................</a><a href="#3_0">.</a><a href="#3_0">2 </a><a href="#4_0">Acknowledgements................................................................................................................................</a><a href="#4_0">.</a><a href="#4_0">3 </a><a href="#8_0">List of figures..........................................................................................................................................</a><a href="#8_0">.</a><a href="#8_0">7 </a><a href="#9_0">List of table</a><a href="#9_0">s</a><a href="#9_0">.</a><a href="#9_0">..........................................................................................................................................</a><a href="#9_0">.</a><a href="#9_0">8 </a><a href="#10_0">List of abbreviations...............................................................................................................................</a><a href="#10_0">.</a><a href="#10_0">9 </a><a href="#11_0">Glossary of terms .................................................................................................................................</a><a href="#11_0">.</a><a href="#11_0">1</a><a href="#11_0">0 </a><a href="#13_0">Abstract................................................................................................................................................</a><a href="#13_0">.</a><a href="#13_0">1</a><a href="#13_0">2 </a><a href="#14_0">CHAPTER 1: Introduction and scope of dissertation............................................................................</a><a href="#14_0">.</a><a href="#14_0">1</a><a href="#14_0">3 </a></p><ul style="display: flex;"><li style="flex:1"><a href="#14_1">1.1 </a></li><li style="flex:1"><a href="#14_1">Introduction .........................................................................................................................</a><a href="#14_1">.</a><a href="#14_1">1</a><a href="#14_1">3 </a></li></ul><p><a href="#14_2">1.2 Aim &amp; Objectives........................................................................................................................</a><a href="#14_2">.</a><a href="#14_2">1</a><a href="#14_2">3 </a><br><a href="#14_3">1.2.1 Ai</a><a href="#14_3">m</a><a href="#14_3">.</a><a href="#14_3">.....................................................................................................................................</a><a href="#14_3">.</a><a href="#14_3">1</a><a href="#14_3">3 </a><a href="#15_0">1.2.2 Objectives............................................................................................................................</a><a href="#15_0">.</a><a href="#15_0">1</a><a href="#15_0">4 </a><br><a href="#15_1">1.3 Plan of Development .................................................................................................................</a><a href="#15_1">.</a><a href="#15_1">1</a><a href="#15_1">4 </a><br><a href="#16_0">Chapter 2: A review of the literature...................................................................................................</a><a href="#16_0">.</a><a href="#16_0">1</a><a href="#16_0">5 </a><br><a href="#16_1">2.1 Introduction ...............................................................................................................................</a><a href="#16_1">.</a><a href="#16_1">1</a><a href="#16_1">5 </a><br><a href="#16_2">2.1.1 Overview .............................................................................................................................</a><a href="#16_2">.</a><a href="#16_2">1</a><a href="#16_2">5 </a><a href="#16_3">2.1.2 Methods..............................................................................................................................</a><a href="#16_3">.</a><a href="#16_3">1</a><a href="#16_3">5 </a><a href="#16_4">2.1.3 Background .........................................................................................................................</a><a href="#16_4">.</a><a href="#16_4">1</a><a href="#16_4">5 </a><br><a href="#18_0">Findings in the literature:.................................................................................................................</a><a href="#18_0">.</a><a href="#18_0">1</a><a href="#18_0">7 </a><a href="#18_1">2.2 Endurance running.....................................................................................................................</a><a href="#18_1">.</a><a href="#18_1">1</a><a href="#18_1">7 </a><br><a href="#18_2">2.2.1 Endurance running and the Old Mutual Two Oceans Ultramarathon................................</a><a href="#18_2">.</a><a href="#18_2">1</a><a href="#18_2">7 </a><a href="#18_3">2.2.2 Exercise-induced muscle damage (EIMD)...........................................................................</a><a href="#18_3">.</a><a href="#18_3">1</a><a href="#18_3">7 </a><a href="#19_0">2.2.3 Gender and age related differences in EIMD and running performance ...........................</a><a href="#19_0">.</a><a href="#19_0">1</a><a href="#19_0">8 </a><a href="#20_0">2.2.4 Methods to reduce EIMD....................................................................................................</a><a href="#20_0">.</a><a href="#20_0">1</a><a href="#20_0">9 </a><a href="#20_1">2.2.5 Methods to maximise performance ...................................................................................</a><a href="#20_1">.</a><a href="#20_1">1</a><a href="#20_1">9 </a><a href="#21_0">2.2.6 Summary of the literature: Endurance running..................................................................</a><a href="#21_0">.</a><a href="#21_0">2</a><a href="#21_0">0 </a><br><a href="#22_0">2.3 Compression Garments in Runners ...........................................................................................</a><a href="#22_0">.</a><a href="#22_0">2</a><a href="#22_0">1 </a><br><a href="#22_1">2.3.1 Compression garments worn during runnin</a><a href="#22_1">g</a><a href="#22_1">.</a><a href="#22_1">....................................................................</a><a href="#22_1">.</a><a href="#22_1">2</a><a href="#22_1">1 </a><a href="#24_0">2.3.2 Compression garments worn during recovery from running .............................................</a><a href="#24_0">.</a><a href="#24_0">2</a><a href="#24_0">3 </a><a href="#25_0">2.3.3 Problematic trends..............................................................................................................</a><a href="#25_0">.</a><a href="#25_0">2</a><a href="#25_0">4 </a><a href="#26_0">2.3.4 Summary of Literature: Compression Garments in Runners..............................................</a><a href="#26_0">.</a><a href="#26_0">2</a><a href="#26_0">5 </a><br><a href="#0_0">2.4 Compression garments in other sports......................................................................................</a><a href="#0_0">.</a><a href="#0_0">3</a><a href="#0_0">6 </a><br><a href="#0_1">2.4.1 Compression garments worn during exercise ....................................................................</a><a href="#0_1">.</a><a href="#0_1">3</a><a href="#0_1">6 </a><a href="#0_2">2.4.2 Compression garments worn during recovery from sport .................................................</a><a href="#0_2">.</a><a href="#0_2">3</a><a href="#0_2">6 </a><a href="#0_3">2.4.3 Problematic trends..............................................................................................................</a><a href="#0_3">.</a><a href="#0_3">3</a><a href="#0_3">7 </a></p><p><strong>4 | </strong>P a g e </p><p><a href="#0_4">2.4.4 Summary of the literature: Compression garments in sport..............................................</a><a href="#0_4">.</a><a href="#0_4">3</a><a href="#0_4">7 </a><br><a href="#0_5">2.5.1 Review Studies of Compression Garment</a><a href="#0_5">s</a><a href="#0_5">.</a><a href="#0_5">............................................................................</a><a href="#0_5">.</a><a href="#0_5">4</a><a href="#0_5">1 </a><br><a href="#0_6">2.5.2 Summary of review studies of compression garments.......................................................</a><a href="#0_6">.</a><a href="#0_6">4</a><a href="#0_6">2 </a><br><a href="#0_5">2.6 Instrumentatio</a><a href="#0_5">n</a><a href="#0_5">.</a><a href="#0_5">........................................................................................................................</a><a href="#0_5">.</a><a href="#0_5">4</a><a href="#0_5">3 </a><a href="#0_7">2.6.1 Instrumentation for exercise induced muscle damage ..........................................................</a><a href="#0_7">.</a><a href="#0_7">4</a><a href="#0_7">3 </a><br><a href="#0_8">2.6.1.1 Circumference measurements.........................................................................................</a><a href="#0_8">.</a><a href="#0_8">4</a><a href="#0_8">3 </a><a href="#0_9">2.6.1.2 Ultrasound and other radiographic imaging....................................................................</a><a href="#0_9">.</a><a href="#0_9">4</a><a href="#0_9">3 </a><a href="#0_3">2.6.1.3 Subjective ratings.............................................................................................................</a><a href="#0_3">.</a><a href="#0_3">4</a><a href="#0_3">5 </a><a href="#0_10">2.6.1.4 Blood/Serum testing ........................................................................................................</a><a href="#0_10">.</a><a href="#0_10">4</a><a href="#0_10">5 </a><a href="#0_11">2.6.1.5 Summary of instrumentation for exercise induced muscle damage...............................</a><a href="#0_11">.</a><a href="#0_11">4</a><a href="#0_11">5 </a><br><a href="#0_12">2.6.2 Instrumentation for running performanc</a><a href="#0_12">e</a><a href="#0_12">.</a><a href="#0_12">............................................................................</a><a href="#0_12">.</a><a href="#0_12">4</a><a href="#0_12">6 </a><br><a href="#0_13">2.6.2.1 Time trials and time-to-exhaustion tests.........................................................................</a><a href="#0_13">.</a><a href="#0_13">4</a><a href="#0_13">6 </a><a href="#0_14">2.6.2.2 Other running performance test</a><a href="#0_14">s</a><a href="#0_14">.</a><a href="#0_14">...................................................................................</a><a href="#0_14">.</a><a href="#0_14">4</a><a href="#0_14">6 </a><a href="#0_3">2.6.2.3 Countermovement Jump testing .....................................................................................</a><a href="#0_3">.</a><a href="#0_3">4</a><a href="#0_3">7 </a><a href="#0_15">2.6.2.4 Summary of Literature: Instrumentation.........................................................................</a><a href="#0_15">.</a><a href="#0_15">4</a><a href="#0_15">7 </a><br><a href="#0_5">2.7 Summary of the literature review..............................................................................................</a><a href="#0_5">.</a><a href="#0_5">4</a><a href="#0_5">8 </a><br><a href="#0_5">CHAPTER 3: Investigation of the impact of below knee compression garments on exercise induced </a><a href="#0_5">muscle damage and performance in endurance runners....................................................................</a><a href="#0_5">.</a><a href="#0_5">4</a><a href="#0_5">9 </a></p><p><a href="#0_16">Study Procedure...................................................................................................................................</a><a href="#0_16">.</a><a href="#0_16">4</a><a href="#0_16">9 </a><br><a href="#0_17">3.1 Introduction ...............................................................................................................................</a><a href="#0_17">.</a><a href="#0_17">4</a><a href="#0_17">9 </a><a href="#0_18">3.2 Methodology..............................................................................................................................</a><a href="#0_18">.</a><a href="#0_18">5</a><a href="#0_18">0 </a><br><a href="#0_19">3.2.1 Research design and recruitmen</a><a href="#0_19">t</a><a href="#0_19">.</a><a href="#0_19">......................................................................................</a><a href="#0_19">.</a><a href="#0_19">5</a><a href="#0_19">0 </a><a href="#0_5">3.2.2 Sampling..............................................................................................................................</a><a href="#0_5">.</a><a href="#0_5">5</a><a href="#0_5">1 </a><a href="#0_20">3.2.3 Completion of study............................................................................................................</a><a href="#0_20">.</a><a href="#0_20">5</a><a href="#0_20">1 </a></p><ul style="display: flex;"><li style="flex:1"><a href="#0_21">3.3 </a></li><li style="flex:1"><a href="#0_21">Measurement instruments ..................................................................................................</a><a href="#0_21">.</a><a href="#0_21">5</a><a href="#0_21">2 </a></li></ul><p><a href="#0_22">3.3.1 Screening tools and consen</a><a href="#0_22">t</a><a href="#0_22">.</a><a href="#0_22">..............................................................................................</a><a href="#0_22">.</a><a href="#0_22">5</a><a href="#0_22">2 </a><a href="#0_23">3.3.2 Study instrumentation ........................................................................................................</a><a href="#0_23">.</a><a href="#0_23">5</a><a href="#0_23">2 </a><a href="#0_13">3.3.3 Training with instrumentatio</a><a href="#0_13">n</a><a href="#0_13">.</a><a href="#0_13">...........................................................................................</a><a href="#0_13">.</a><a href="#0_13">5</a><a href="#0_13">5 </a><a href="#0_24">3.3.4. Compression Garments......................................................................................................</a><a href="#0_24">.</a><a href="#0_24">5</a><a href="#0_24">5 </a><br><a href="#0_25">3.4 Procedure...................................................................................................................................</a><a href="#0_25">.</a><a href="#0_25">5</a><a href="#0_25">5 </a><br><a href="#0_26">3.4.1 Data collection ....................................................................................................................</a><a href="#0_26">.</a><a href="#0_26">5</a><a href="#0_26">5 </a><a href="#0_27">3.4.2 Data management ..............................................................................................................</a><a href="#0_27">.</a><a href="#0_27">5</a><a href="#0_27">6 </a><a href="#0_28">3.4.3 Statistical Analysis...............................................................................................................</a><a href="#0_28">.</a><a href="#0_28">5</a><a href="#0_28">6 </a><a href="#0_29">3.4.5 Ethical consideration</a><a href="#0_29">s</a><a href="#0_29">.</a><a href="#0_29">........................................................................................................</a><a href="#0_29">.</a><a href="#0_29">5</a><a href="#0_29">7 </a><br><a href="#0_5">Results..................................................................................................................................................</a><a href="#0_5">.</a><a href="#0_5">5</a><a href="#0_5">9 </a><br><a href="#0_30">3.6 Participant flo</a><a href="#0_30">w</a><a href="#0_30">.</a><a href="#0_30">.....................................................................................................................</a><a href="#0_30">.</a><a href="#0_30">5</a><a href="#0_30">9 </a><a href="#0_31">3.7 Baseline Data .........................................................................................................................</a><a href="#0_31">.</a><a href="#0_31">6</a><a href="#0_31">1 </a></p><p><strong>5 | </strong>P a g e </p><p><a href="#0_32">3.8 Follow up data........................................................................................................................</a><a href="#0_32">.</a><a href="#0_32">6</a><a href="#0_32">3 </a><a href="#0_5">3.9 Changes over time of main outcomes ...................................................................................</a><a href="#0_5">.</a><a href="#0_5">8</a><a href="#0_5">1 </a><a href="#0_0">3.10 Summary of significant main outcomes...............................................................................</a><a href="#0_0">.</a><a href="#0_0">8</a><a href="#0_0">9 </a><br><a href="#0_0">Discussion.............................................................................................................................................</a><a href="#0_0">.</a><a href="#0_0">9</a><a href="#0_0">1 </a><br><a href="#0_33">3.11.1 Introduction ......................................................................................................................</a><a href="#0_33">.</a><a href="#0_33">9</a><a href="#0_33">1 </a><a href="#0_34">3.11.2 Research Participants........................................................................................................</a><a href="#0_34">.</a><a href="#0_34">9</a><a href="#0_34">1 </a><a href="#0_35">3.11.3 Main outcome measures related to exercise-induced muscle damage...........................</a><a href="#0_35">.</a><a href="#0_35">9</a><a href="#0_35">3 </a><a href="#0_36">3.11.4 Performance measure</a><a href="#0_36">s</a><a href="#0_36">.</a><a href="#0_36">....................................................................................................</a><a href="#0_36">.</a><a href="#0_36">9</a><a href="#0_36">7 </a><a href="#0_37">3.11.5 Further possible contributing factors ...............................................................................</a><a href="#0_37">.</a><a href="#0_37">9</a><a href="#0_37">7 </a><a href="#0_29">3.11.6 External Condition</a><a href="#0_29">s</a><a href="#0_29">.</a><a href="#0_29">..........................................................................................................</a><a href="#0_29">.</a><a href="#0_29">9</a><a href="#0_29">8 </a><a href="#0_38">3.11.7 Training period..................................................................................................................</a><a href="#0_38">.</a><a href="#0_38">9</a><a href="#0_38">8 </a><a href="#0_39">3.11.8 Study limitations and future directions ............................................................................</a><a href="#0_39">.</a><a href="#0_39">9</a><a href="#0_39">9 </a><br><a href="#0_0">CHAPTER 4 .........................................................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">01 </a><br><a href="#0_33">Summary &amp; Conclusion..................................................................................................................</a><a href="#0_33">.</a><a href="#0_33">1</a><a href="#0_33">01 </a><br><a href="#0_0">REFERENCE</a><a href="#0_0">S</a><a href="#0_0">.</a><a href="#0_0">......................................................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">03 </a><a href="#0_0">APPENDICES .......................................................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">14 </a><br><a href="#0_33">Appendix A: HREC approval ...........................................................................................................</a><a href="#0_33">.</a><a href="#0_33">1</a><a href="#0_33">14 </a><a href="#0_0">Appendix B: Example of recruitment advertisement ....................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">16 </a><a href="#0_0">Appendix C: Nordic Musculoskeletal Questionnaire .....................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">17 </a><a href="#0_0">Appendix D: Physical Activity Readiness-Questionnaire+ .............................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">18 </a><a href="#0_0">Appendix E: Screening too</a><a href="#0_0">l</a><a href="#0_0">.</a><a href="#0_0">...........................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">22 </a><a href="#0_0">Appendix F: Informed consent.......................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">24 </a><a href="#0_0">Appendix G: Operational Definitions and protocol .......................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">28 </a><a href="#0_0">Appendix H: Visit 3 - Adapted Visual Analogue Scale and Self-developed Questionnair</a><a href="#0_0">e</a><a href="#0_0">.</a><a href="#0_0">...........</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">29 </a><a href="#0_0">Appendix I: Visit 4 - Adapted Visual Analogue Scale and Self-developed Questionnaire .............</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">34 </a><a href="#0_0">Appendix J: Training history questionnaire ...................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">37 </a><a href="#0_0">Appendix K: Summary of Data Collectio</a><a href="#0_0">n</a><a href="#0_0">.</a><a href="#0_0">.....................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">39 </a><a href="#0_0">Appendix L: Individual Results Templat</a><a href="#0_0">e</a><a href="#0_0">.</a><a href="#0_0">......................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">41 </a><a href="#0_0">Appendix M: Data Capturing..........................................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">42 </a><a href="#0_0">Appendix M: Timing of Data Collection .........................................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">43 </a><a href="#0_0">Appendix N: Example of follow up email correspondence during recruitmen</a><a href="#0_0">t</a><a href="#0_0">.</a><a href="#0_0">...........................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">44 </a><br><a href="#0_40">Follow up email following initial interest...................................................................................</a><a href="#0_40">.</a><a href="#0_40">1</a><a href="#0_40">44 </a><a href="#0_0">Example of email correspondence regarding for Visit 1............................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">45 </a><a href="#0_0">Example of email correspondence prior to visit 2-4..................................................................</a><a href="#0_0">.</a><a href="#0_0">1</a><a href="#0_0">47 </a></p>