What Are These Leggings?

Sunday night, to many people, is Game of Thrones night. I am not one of those people. I haven't watched any full episode and I honestly don't plan on doing so. Of the many that do, though, is USA Hockey player and Olympian Hilary Knight. Miss Knight took to social media prior to the start of the Game of Thrones episode last night to show her preparation for the show in the image to the left, and I immediately noticed something that I've never seen before. If you look closely, there appears to be a laptop to Miss Knight's right and she's wearing some rather thick leggings that almost look like hockey pants. I was a little shocked that Miss Knight would "armor up" for the show, so I began looking into these "NormaTec"-branded leggings that she is wearing in the photo.

The NormaTec website is flashy with photos of athletes and blocks of propaganda about the device being sold. But what is it? What is NormaTec, and what are these leggings? What do they do?

According to the website,

NormaTec is the leader in rapid recovery—our systems give a competitive edge to the world's elite athletes, coaches, and trainers. Our goal is to establish recovery as an integral part of every athlete's training, and we feel NormaTec systems are the best way to accomplish that. The NormaTec PULSE Recovery Systems are dynamic compression devices designed for recovery and rehab. All of our systems use NormaTec's patented PULSE technology to help athletes recover faster between trainings and after performance.

Our systems include a control unit and attachments which go on the legs, arms, or hips. They use compressed air to massage your limbs, mobilize fluid, and speed recovery with our patented NormaTec Pulse Massage Pattern. When you use our systems, you will first experience a pre-inflate cycle, during which the connected attachments are molded to your exact body shape. The session will then begin by compressing your feet, hands, or upper quad (depending on which attachment you are using). Similar to the kneading and stroking done during a massage, each segment of the attachment will first compress in a pulsing manner and then release. This will repeat for each segment of the attachment as the compression pattern works its way up your limb.

Interesting, to say the least. It appears as though Miss Knight is using the "PULSE Leg and Hip Recovery System" as seen to the right as she watches Game of Thrones. In looking through the NormaTec site, there's no mention of Miss Knight's name nor USA Hockey's involvement, so this may very well be her own system. It appears that there are a lot of endurance athletes - triathletes, cyclists, and marathoners - who are using this and have associated their names with the product. As I've stated in product examinations before, it doesn't matter whose name is associated to the product unless there's some benefit. The question must be asked: does the science behind the NormaTec product show benefits for the athlete?

There are four studies linked on the website via pubmed.gov that all point to peristaltic pulse dynamic compression (PPDC) being beneficial, but I wanted some third-party reviews just to corroborate the findings on the pubmed site. The first one that jumped out at me was on Lower Extremity Review that found "that peristaltic pulse compression of the lower extremities may provide a means of enhancing the rheological properties of the lower extremities without resorting to extreme temperatures, expensive body work, or stretching." It should be noted that the author, Dr. William A Sands, works for the US Olympic Committee and NormaTec had donated several devices of which he was free to use at his discretion as long as he upheld the standards set forth by the USOC and the IOC. He writes,

I was largely free to explore these devices and their use with athletes. However, my work with any technology or methodology was and is constrained by the fact that any device I investigated could do no harm, had to function within existing USOC and IOC rules, and had to result in large effects. Sport scientists are bound ethically and pragmatically by a high regard for the time and effort of their athletes. High-performance athletes have enormous demands on their time; they simply cannot, and usually will not, take part as a research volunteer unless there are direct benefits to them. In short, I could not simply study something that was of academic interest to me; the study had to exhibit a large probability of performance and recovery enhancements.

I'd say that getting a nod of approval from the United States Olympic Committee is a good sign, but it seems that Dr. Sands has been involved in most of the studies relating to the PPDC. In knowing that the medical evidence may be influenced by one man's opinion, I decided to go to the sources that have the names of the best athletes on the NormaTec site - namely, runners and cyclists.

Alex Hutchinson wrote an article on the Runner's World blog back in February 2014 about the NormaTec science. His article was prompted much in the same that mine was when he saw a tweet from Alex Hall that showed Hall using the NormaTec leggings. This sparked Hutchinson's curiosity about the claims made by NormaTec, so he went looking for answers. He writes,

Still, popularity aside, I'd never been able to figure out whether anyone had actually tested the device to see if it works -- until a friend recently forwarded me this study from the International Journal of Sports Medicine, published last November by researchers at Massey University in New Zealand. They took 10 volunteers and put them through a bout of "damaging" eccentric exercise (3 x 100 eccentric leg contractions) then monitored their recovery at 24, 48, and 72 hours using blood samples (to look for markers of muscle damage) and tests of strength and power. Each subject went through this process twice, one with the NormaTec immediately after plus again at 24 and 48 hours, and once without it.

And the results of that medical piece, also found on the pubmed site?

Nevertheless, it is important to note that IPC may have an impact on different types of exercise. Therefore, further research is necessary to investigate the potential role of IPC to expedite muscle recovery by focusing on finding an optimal pulse pressure, pulse time, duration and frequency of its application as well as investigating the effect IPC has on other modes of strenuous activity.

In other words, "We didn't find anything but maybe someone else will." That seems like a reasonable conclusion. Personally, I suspect that there's a pretty big placebo component going on here, but it's also clear that "proving" the benefits of recovery protocols is much trickier than people suspected when they first started trying to study things like ice baths and compression. It's very hard to quantify and measure the phenomenon of "feeling good." I will say this, though: if I was going to spend $1,750 on one of these suckers, it would be nice if it produced a measurable benefit.

Ouch. That's not the kind of review one wants from a running-centric blog when one's product is aimed at recovery for runners. In all fairness, though, that's just one medical publication. There are a number of studies out there that say it is beneficial. Are there other studies that cast doubt on the product?

Actually, yes. Shane Nicolas Draper's thesis at Cleveland State University entitled Effects of Intermittent Pneumatic Compression on Delayed Onset Muscle Soreness (DOMS) in Long Distance Runners concluded that, "Although the test subjects recovered one day earlier when using the NT device (Day 4) compared to the control (Day 5), this difference was not significant." Again, not good results for those that use these devices in endurance sports, and one could say that Miss Knight plays an endurance sport with the number of times she's on the ice.

If the only benefits seen are in flexibility, I'm not saying that isn't important for a high-level hockey player such as Hilary Knight. In fact, increased flexibility in the hips and legs would prevent more injuries that are commonly seen in hockey, and that's important as she'll be on the ice more often than off it with these treatments. As an example, Martin Brodeur was a yoga enthusiast, and he played relatively injury-free throughout his career.

However, the science seems to be unproven in NormaTec regarding recovery benefits. With prices ranging between $1495 and $2545 for the NormaTec, however, this seems like a hefty price tag to gain more flexibility when there are certainly more time-tested and inexpensive alternatives such as yoga and stretching.

Let me be clear: I'm not saying NormaTec doesn't work for athletes. Every athlete has his or her own preferences for rest and recovery. For Hilary Knight, that involves the NormaTec peristaltic pulse dynamic compression system that she can afford. For weekend warriors like you and I, that price tag may prove that it might be better just to find a yoga studio or daily stretching routine that works for you. Unfortunately for marathon runners, cyclists, and triathletes, the science just doesn't pan out for muscle recovery.

Until next time, keep your sticks on the ice!