Compression therapy works. Decades of research show it can improve recovery, reduce swelling, support joints, improve venous return, ease post-exercise muscle soreness, and lower the risk of DVT during long-haul travel. Clinicians prescribe it and pharmacies stock it.
So why does the published evidence on compression garments look so inconsistent? Why do meta-analyses keep reporting non-significant performance effects, mixed clinical outcomes, and wide variation in client response?
The answer, increasingly, is fit.
The compression most people are wearing isn’t the compression that was prescribed
Off-the-shelf compression garments are sized using two body measurements — typically height and weight — and offered in generic ranges (S, M, L, XL). A single “medium” might cover clients from 150 cm / 65 kg to 180 cm / 85 kg. That works for a t-shirt. It doesn’t work for a medical device whose efficacy depends on applying a specific pressure to a specific anatomical point.
The problem has been documented for over a decade. Hill et al. (2015), in a study of three commercially available compression brands, found that when subjects were fitted to the garments according to the manufacturers’ instructions, the actual pressure delivered varied dramatically between individuals. For one brand, pressure at the quadriceps ranged from 4 to 16.7 mmHg, and at the calf from 10.3 to 25 mmHg. The off-the-shelf garments failed to meet the intended pressure target in 34% of male subjects and 47% of female subjects. The authors concluded that the majority of people wearing off-the-shelf compression may not be receiving therapeutic levels of compression at all.
Some brands correlate size from a few height and circumference measurements. These measurements are used to try and help guide you to their closest standard size. If your leg is perfectly standard, that’s fine (and rare), but limbs vary in size AND shape – a standard size might be ideal for part of your limb, but the rest of the compression will be too high or too low.
Standard sizing is not a small fitting issue. It is a fundamental problem with how effective compression is delivered.
Why this matters clinically
Pressure that’s too low does nothing. Pressure that’s too high is worse than nothing — it can restrict blood flow, cause discomfort, reduce adherence, and in some cases impair the very recovery the garment is meant to support (Wannop et al. 2016).
The effect on client response is striking. Stickford et al. (2015) measured oxygen consumption in athletes wearing off-the-shelf compression and found that individual responses ranged from a 4.8% decrease to a 5.1% increase — using the same garment, on similar people, doing the same task. Some subjects benefited. Others were actively disadvantaged. The average effect was close to zero, which is exactly what you’d expect when a population is randomly distributed across a too-low / about-right / too-high pressure range.
This is the most likely explanation for the long-standing puzzle in the compression literature: meta-analyses (da Silva et al. 2018) reporting non-significant pooled effects, while individual well-controlled studies show meaningful benefit. When most participants in a trial aren’t receiving the prescribed dose, the trial measures the noise of the fitting process, not the effect of the therapy.
What changes when fit is right
When compression is delivered at the intended pressure, the picture looks very different.
Brown et al. (2022), comparing custom-fit compression against off-the-shelf compression and a sham treatment in rugby players recovering from muscle-damaging exercise, found that:
- Custom-fit garments produced ~10% faster recovery of lower body strength than off-the-shelf garments.
- Custom-fit was the only condition where strength returned to baseline within 48 hours.
- Off-the-shelf compression performed no better than the sham — i.e. than wearing no compression at all.
- Creatine kinase (a marker of muscle damage) returned to baseline within 48 hours in the custom-fit group, but remained elevated in the off-the-shelf group.
Lewis et al. (2025) found that CAPE tights were the only garment (compared with premium off-the-shelf competitors) with a positive credible interval for stroke volume and therefore provided a clear advantage in inducing higher bloodflow. CAPE tights were able to increase central haemodynamic flow by 3.5 mL/beat, which extrapolates to ~378 L of additional cardiac output per day.
The clinical literature shows the same pattern across other indications. Custom-fit compression is associated with better adherence, fewer fitting complications, longer garment lifespan, and improved outcomes in venous insufficiency, oedema, post-operative support, lymphoedema management, and DVT prevention.
The therapy works. It just has to actually reach the client at the correct pressure.
The fitting bottleneck
Until recently, “custom fit” meant a clinician with a tape measure, taking up to 30 individual circumferences along a limb, sending that to a producer to transcribe those measurements into a pattern, and manufacturing the garment. The process took up to an hour with the client, was prone to transcription error, was costly, and required specialist training — which in practice meant only a small number of clients ever received truly custom-fit compression. For most clinics, the choice was between off-the-shelf (fast, cheap, often ineffective) and bespoke (effective, slow, expensive).
This is the bottleneck the compression industry has been stuck behind for forty years.
A faster path to accurate fit
CAPE produces medical-grade, custom-fit compression garments generated from a 3D body scan rather than a tape measure. The CAPE Health app turns any iOS device into a clinical scanner; the scan takes around 90 seconds, and our patented AutoTailor platform automatically generates the garment pattern based on the client’s anatomy and the prescribed compression regime. Left and right limbs are sized independently, which matters more than it sounds — most clients are not symmetrical, and post-operative or post-injury clients rarely are.
The point isn’t that this is a different compression product. It’s that the fitting bottleneck is no longer a reason to default to off-the-shelf garments and accept the variability in outcomes that comes with them.
Takeaway
Compression therapy is well-evidenced and clinically valuable. The reason it often appears to underperform — in trials and in clinics — is that most clients aren’t receiving the pressure that was prescribed. Off-the-shelf sizing cannot deliver consistent therapeutic compression across a real-world patient population. Custom fit, generated from individual anatomy, can.
For clinicians, the practical implication is straightforward: when a client’s outcome on compression has been disappointing, the first variable to question is fit — not the therapy itself.
Next step: We’re real, we’re local, and we’re here for you. Call 1300 BIONICS to learn how easy, effective and lucrative CAPE custom-fit compression can be for your clinic.
CAPE produces medical-grade compression garments, individually sized from a 3D scan, for rehabilitation, post-operative recovery, oedema and lymphoedema management, venous insufficiency, and MSK injury recovery. The CAPE Health app turns any iOS device into a clinic-ready scanner, with garments produced in Australia and delivered in a week.
References
Brown F, Jeffries O, Gissane C, et al. Custom-fitted compression garments enhance recovery from muscle damage in rugby players. J Strength Cond Res 2022;36(1):212–219.
da Silva CA, Helal L, da Silva RP, et al. Association of lower limb compression garments during high-intensity exercise with performance and physiological responses: a systematic review and meta-analysis. Sports Med 2018;48:1859–1873.
Hill J, Howatson G, van Someren K, Davidson S, Pedlar C. The variation in pressures exerted by commercially available compression garments. Sports Engineering 2015;18:115–121.
Lewis S, Kelly V, Peake J, Effects of custom-fit compression garments on stroke volume and blood flow regulation. The 30th European College of Sport Science (ECSS) Annual Congress, Rimini, Italy, July 1–4.
Stickford ASL, Chapman RF, Johnston JD, Stager JM. Lower-leg compression, running mechanics, and economy in trained distance runners. Int J Sports Physiol Perform 2015;10(1):76–83.
Wannop JW, Worobets JT, Madden R, Stefanyshyn DJ. Influence of compression and stiffness apparel on vertical jump performance. J Strength Cond Res 2016;30(4):1093–1101.
Weakley J, Broatch J, O’Riordan S, et al. Putting the squeeze on compression garments: current evidence and recommendations for future research — a systematic scoping review. Sports Med 2022;52(5):1141–1160.