Why are so many triathletes suddenly wearing compression stockings? Only a medical condition could account for this fashion faux pas.
It was quite a sight watching the elite triathletes running down Ali'i Drive in Kona, Hawaii, wearing their knee-high stockings in the eighty-degree heat, at the 2007 Ironman World Championships. Compression stockings are the latest trend in sports performance. With tight compression at the ankle and less compression near the knee, these stockings promote circulation of blood back up to the heart, easing the work for the veins in the lower leg. Wearing stockings can delay leg fatigue and enhance the muscles, veins, and mechanics of the legs to function better. Compression stockings have been prescribed by the medical community for decades for various circulatory conditions, including deep vein thrombosis.
Deep vein thrombosis (DVT) is a condition where the deep veins of the legs develop blood clots.
The triathlon community prides itself on being physically fit, knowledgeable about the human body and its response to training principles, and confident in proper nutrition practices. The sport of triathlon and the demands on the body, however, may increase the athlete’s risk for developing DVT.
Cycling is often spent in the crouch, or “aero,” position. During training sessions and long rides, time on the bike often exceeds two hours. Because the hips are in flexion (forward bend at the hip), circulation in the veins of the groin is limited. As the heart pumps to meet the energy demands of the body there is increased pressure on the major veins in the pelvis. This constant pressure on these veins puts them at risk of injury, and the process of hemostasis, defined in human physiology as “preventing blood loss,” is higher to avoid further damage.
A balance between intense workouts and lighter ones combined with rest, hydration, and nutrition is crucial to performance. Any overtrained athlete can attest to the strain on the muscles, bones, sleep patterns, and immune system, with no exception to the circulatory system. Veins are very elastic and respond to the demands of the body. In a physically fit individual, the veins are exceptionally strong, responsive, and efficient at supplying the body with blood. However, under stress, as in the case of overtraining, veins are less elastic, and the body works harder to rid the organs and circulation of infection. It is the combination of a harder working immune system and weakened blood vessels that increases the risk for DVT.
Dehydration is often the make or break factor on race day. Too much water too soon can lead to cramping and electrolyte imbalance later in the race, too little water and fatigue may lead to electrolyte issues, and overheating can often lead to a “did not finish” on one’s race calendar. Without proper hydration, blood thickens and blood flow is compromised. Dehydration is a major factor in both the cause and progression of DVT.
DVT is preventable, but because symptoms are often unrecognized, education and awareness is crucial. The following strategies may help triathletes prevent DVT and athletes who are prone to blood clots.
* Consume more omega-3 fatty acids. Found in flax, salmon, and walnuts, omega-3 fatty acids improve the elasticity of blood vessels. They also make blood less viscous, improving its ability to flow through blood vessels. For circulatory health, the American Journal of Clinical Nutrition recommends consuming one gram of omega-3 fatty acids per day, which is the equivalent of two fish meals per week.
* Stay hydrated. According to the Cleveland Clinic Foundation, the body is fifty-five to seventy-five per cent water, and although the kidneys are primarily responsible for human water balance, the venous system also plays a major role in ensuring that electrolytes and fluids throughout the body are in check. Sports nutritionist Nancy Clark recommends drinking eight to ten glasses of water per day—more on training and race days—and if workouts extend over one hour, a source of carbohydrates should be added for energy.
* Consider compression stockings. With graduated compression as they go up the legs, compression stockings support the lower leg’s ability to pump blood back up to the heart. When sitting for long periods in addition to frequent movement, compression stockings prevent blood pooling in the legs, which is an attribute for DVT.
* Incorporate rest and recovery into a training program. Just as it will benefit on race day and maximize training sessions, the balance of intense workouts with recovery days will ensure optimal immune function and repair organ systems, muscles, and the often neglected circulatory system. As well, after long runs or bike sessions, it is important to take extra time to stretch the hip flexors and groin to accommodate extensive forward flexion at the hip. The multisport nature of triathlon is a benefit to the athlete in the prevention of DVT for the cross-training advantages of swimming, running, and other flexibility training such as yoga.
Triathlete’s have an advantage in the prevention of DVT. They are knowledgeable about human physiology and their own body’s response to training principles and have a sincere interest in the “why” behind a particular workout or training gear purchase. DVT is preventable and manageable for those prone to clots, providing one is informed and able to recognize the warning signs. Any triathlete knows that feeling off the bike when his legs are so heavy they feel like bricks, that feeling after running so many hills he doesn’t think his legs can go any more, and the post-race reminder of a race well run when he is washing the body marking off his calf for days. “Killer legs” should refer to the strong, defined legs the triathlete has built from hard training. Don’t allow it to be anything else.
About the Author
"Killer Legs" was originally published in the Cycling and Multisport issue of IMPACT Magazine, May/June 2008.