Journal

How Tight Should Compression Socks Be?

Medically reviewed by Dr. Michael Darder OBGYN — Written by Kari Johnson

Published April 20th, 2020

The answer to this question depends on your goals. Are you looking to prevent spider veins during pregnancy, improve your athletic performance, or avoid the formation of blood clots in deep veins? Dozens of studies have shown that compression socks and stockings improve blood flow, promote circulatory health, and provide relief from uncomfortable health conditions. In this article, we'll talk about how to choose the right pressure measurement for your body, so that you can ensure the best possible health outcomes.

You might assume that tighter is always better when it comes to compression therapy. That's not the case. In reality, many studies have shown that firm and extra firm medical grade compression cause discomfort. As an example, one research paper determined, “In a trial of high versus low compression stockings (40 mmHg vs 15 mmHg at ankle) after varicose vein surgery, both were equally effective in controlling bruising and thrombophlebitis, but low compression stockings proved to be more comfortable.” (Schouler et al. 402) Since patients must wear compression socks consistently to experience positive health impacts, it's important to find a compression level that addresses your health goals while minimizing discomfort.

What Is Graduated Compression?

Before we address the different compression strengths available, you should know that not all compression socks work the same way. Uniform compression socks exert an equal amount of pressure throughout the length of the sock, from cuff to toe. On the other hand, graduated compression socks provide gradient pressure, fitting tightest at the ankle, then gradually becoming looser at the calf.

To understand why graduated compression is more effective, think of how your vascular system works. Arteries carry blood away from the heart; whereas, veins carry oxygen-poor blood and waste materials back towards the heart. If you're standing or sitting all day—or you have certain venous conditions—swollen legs may result from blood and fluid pooling in the lower legs and feet. Graduated compression socks assist your veins by exerting upward pressure, pushing blood and lymphatic fluids from your ankle toward your calf to improve circulation back toward your heart

Graduated compression therapy, which can be used in socks, thigh-high stockings, hosiery, and other garments, has been studied extensively. Research shows that graduated compression impacts athletic recovery (Ali et al.), increases the velocity of venous blood flow and improves valve function (Agu et al.), and reduces the risk of deep vein thrombosis (DVT) for airline passengers (Clarke et al.). Graduated compression socks are also easy-to-wear and inexpensive compared to other forms of compression. 

You'll be able to recognize graduated compression socks, as opposed to uniform compression socks, because their labels include a pressure range marked in millimeters of mercury (mmHg). The higher number corresponds to the pressure measurement at the ankle, and the lower number corresponds to the pressure measurement at the calf.

Measurements in Millimeters of Mercury

Compression socks come in a variety of standard pressure measurements. Before you select a compression range, consult your doctor. Be sure that you don't have any health conditions that contraindicate compression therapy. If you're looking to wear compression socks to receive overall health benefits, rather than to prevent or treat a particular condition, we recommend purchasing compression socks under 30 mmHg.

Light: 8-15 mmHg

Light compression is recommended for mild symptoms, including mild leg swelling and discomfort that comes from prolonged periods of sitting or standing. Light compression is also recommended for pregnant women hoping to avoid spider and varicose veins during pregnancy.

Mild: 15-20 mmHg

This is the most commonly available over-the-counter compression strength. Doctors often recommend mild compression for first-time wearers. It’s a great option for anyone hoping to prevent swelling and DVT, especially during long flights. Mild compression can be worn everyday by people whose jobs require long periods of sitting or standing.

Medium: 20-30 mmHg (Medical Grade Class I)

Class I compression socks help to relieve severe edema or lymphatic edema. Medium compression is also used to treat active ulcers, symptoms of post-thrombotic syndrome (PTS), orthostatic hypotension, and superficial thrombophlebitis. This is an optimal compression level for athletic recovery and endurance, as well.

Firm: 30-40 mmHg (Medical Grade Class II) 

Class II compression socks treat more severe cases of edema, PTS, orthostatic hypotension, superficial thrombophlebitis. They’re also recommended for patients at extreme risk of developing DVT.

Extra Firm: 50-60 mmHg (Medical Grade Class III)

Class III compression socks treat acute lower body swelling, severe varicose veins, and DVT. They can only be purchased through a medical supply store or pharmacy with a prescription.

The Compression Sweet Spot: 15-25 mmHg

At Comrad, we make knee-high, graduated compression socks in two different pressure ranges. Guides, measuring 15-20 mmHg, fit into the mild compression category. Companions, measuring 15-25 mmHg, provide the benefits of both mild and medium pressure compression socks. For that reason, we say that our 15-25 mmHg socks occupy “the compression sweet spot”—in between the mild products you'd find at the drug store and medium-strength, medical-grade socks. 

How Tight Should Compression Socks Feel?

No matter what level of compression you wear, you'll probably notice that compression socks feel tighter than regular socks. You may even feel a slight tingling sensation as your blood circulation improves. Any warmth or tingling comes from the flow of blood returning from your feet to your heart. 

When you wear compression socks, they should not cause pain or numbness. If you do experience adverse symptoms or circulation problems, take off the compression socks immediately and consult a doctor. Compression socks are not recommended for people with certain medical conditions—peripheral neuropathy, peripheral artery disease (PAD), skin infections, or dermatitis.

For the best results, put on your compression socks during the early morning, before you experience swelling in your legs and feet. Be sure that your socks lie smoothly against your skin without any bunching fabric.  

Be certain to purchase a pair of compression socks in the correct size for your body. Comrad offers S-XL sizing options, along with extra large calf sizes up to 20 inches. Check out our sizing chart to ensure that your compression socks fit perfectly—tight enough that you experience all the benefits of compression and loose enough that you can feel comfortable wearing them all day long. 

How Soon Will I See Results?

Again, it depends on your reason for wearing compression socks. For those who hope to improve athletic performance and recovery, you should experience a difference right away. For someone who wants to prevent varicose and spider veins from forming during pregnancy, success might be measured by the absence of symptoms. 

Ask your doctor how soon you should expect to see results, based on your health goals. For anyone who experiences tired, achey, or swollen legs, compression therapy can be a game-changer. In a recent interview about compression socks, vascular surgeon Dr. Claire Griffin explains that many patients notice, “an immediate symptomatic improvement in how their legs feel at the end of the day.” (“Compression Socks”)

Whether you’re a frequent traveler, an athlete, or a person who sits at a desk all day at work, think about upgrading your sock drawer to include fashionable options with real medical benefits. If the scientific literature is any indication, you might experience a reduction in symptoms—along with improved performance and recovery—right away. 

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