Compression Garments for Hypermobility, EDS and POTS: What the Evidence Actually Says

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Adam Foster is an award-winning PT, author, and the driving force behind The Fibro Guy. Leveraging his extensive expertise in pain science and neuroscience, along with a profound understanding of the human body, Adam assists individuals suffering from chronic pain and hypermobility. His approach involves using tailored biopsychosocial rehabilitation strategies, aimed at reducing pain and stabilising joints for an improved quality of life.

What Are Compression Garments and How Do They Work?

Compression garments are exactly what they sound like: clothing that applies consistent mechanical pressure to your body. They come in various forms. Socks, stockings (knee-high, thigh-high, or waist-high), leggings, shorts, vests, gloves, and full-body suits. Some are off-the-shelf. Some are custom-made. And the amount of pressure they provide varies enormously, which is measured in millimetres of mercury (mmHg).

The pressure levels are typically graded like this:

15-20 mmHg (mild): what you’d find in most over-the-counter “support” stockings
20-30 mmHg (moderate): the starting point for medical compression, and what’s most commonly recommended for those with POTS or hypermobility
30-40 mmHg (firm): sometimes recommended for more significant blood pooling or orthostatic issues
40+ mmHg (very firm): typically prescription-only, used for severe venous insufficiency

But here’s where it gets interesting. The traditional explanation for why compression garments help is straightforward: they squeeze the veins in your legs, which pushes blood back towards the heart and reduces pooling. That’s the vascular story, and it’s true as far as it goes. However, for those with hypermobility and EDS, there’s a second mechanism that most resources completely overlook. And it might actually be the more important one.

The Proprioception Connection

If you’ve read any of our content on exercise and hypermobility, you’ll know that proprioception is a big deal for those with Ehlers Danlos syndrome. Proprioception is your body’s ability to sense where it is in space, how your joints are positioned, and how much force you’re using. And in EDS and Hypermobility Spectrum Disorders, this system doesn’t work as well as it should.

A 2015 study by Clayton and colleagues found that EDS patients were just as accurate as healthy controls when reaching towards a target, but significantly less precise [7]. Their error ellipses were approximately twice the size of controls. So the brain roughly knows where the hand is, but the signal is noisy, blurry, inconsistent. Think of it like trying to tune an old analogue TV. The picture is there, you can make it out, but it’s full of static. And here’s an important detail: chronic pain did not predict the proprioceptive imprecision [7]. It wasn’t just that pain was distracting them. Something about the connective tissue itself seems to affect how accurately the body can report its own position.

Why does this matter for compression garments? Because one of the leading theories is that compression works as a proprioceptive aid. The constant pressure provides additional sensory input through the skin and soft tissues, essentially giving the nervous system more data to work with. It’s like turning up the volume on a quiet signal. And several studies support this idea.

A small but interesting pilot study by Dupuy and colleagues tested somatosensory orthoses (compression garments combined with insoles) in six people with hypermobile EDS [4]. The postural control impairment was partially offset by wearing the compression garments, and the benefit was greatest when vision was removed, which is exactly what you’d expect if the garments were boosting proprioceptive input. When you take away vision, the body has to rely more heavily on proprioception, so enhancing that channel makes more of a difference. Now, this was a tiny pilot study with only six participants, and most of the results didn’t survive rigorous statistical correction [4]. So we can’t draw firm conclusions. But the theoretical reasoning is sound, and it aligns with what clinicians report seeing in practice.

Scheper and colleagues made the point that for those with hypermobility, controlling muscle strength based on proprioceptive input may be more important than raw muscle strength alone [9]. You can be strong, but if you can’t accurately control that strength because your proprioceptive feedback is imprecise, it doesn’t translate into functional ability very well. This is something we talk about a lot when it comes to exercise programming for those with hypermobility. It’s not just about getting stronger, it’s about getting better at using the strength you already have.

The qualitative evidence supports this too. Snowdon and Dadla interviewed six allied health professionals who specialise in fabric orthoses for people with hypermobility, and three themes came through clearly: the effect is “immediate” when the garment goes on, the mechanism is thought to be proprioceptive enhancement plus joint realignment, and collaborative fitting is essential for success [8]. These are clinicians who work with these garments day in, day out, and they’re describing the same proprioceptive mechanism the research points towards.

Compression for POTS and Blood Pooling

Right, let’s talk about the vascular side. If you’re dealing with POTS or other forms of dysautonomia, the compression garment recommendation is almost universal at this point. The 2025 AGA Clinical Practice Update on hypermobile EDS explicitly lists compression garments as a first-line non-pharmacological intervention alongside increasing fluid and salt intake and exercise training [10]. That’s about as official as it gets.

The physiology makes sense. In POTS, blood pools in the lower body when you stand up, which reduces the amount returning to the heart, which drops blood pressure, which triggers that characteristic spike in heart rate. Compression garments counteract this by squeezing the veins and pushing blood upwards. A randomised crossover trial by Horiuchi and Stoner found that during three hours of sitting, blood pooling increased by 10.5% without compression stockings but only 4.3% with them [6]. That’s a roughly 59% reduction in pooling. And the blood pooling was negatively associated with stroke volume (r = -0.58), meaning less pooling meant the heart was working more efficiently [6].

However, and this is an important however, that study was done in healthy young adults, not POTS patients [6]. The results are physiologically relevant but we can’t simply assume the same numbers apply to someone whose autonomic nervous system isn’t regulating blood flow properly in the first place.

And then there’s the finding that everyone in the POTS community needs to hear. A large survey study by Mitra and colleagues looked at 358 people with POTS or neurogenic orthostatic hypotension [5]. Almost all of them (98.9%) had tried at least one type of compression garment. But only 8.9% considered them effective at managing their symptoms [5]. That’s a striking number, isn’t it? Nearly everyone tries them. Barely anyone finds them helpful.

But before you throw your compression stockings in the bin, there’s important context here. The most commonly used type of compression in that survey was leg compression (65.4%), while abdominal compression was used by only 13.4% [5]. And this matters because the evidence increasingly suggests that where you compress is more important than that you compress. Nearly a third of total blood volume can be retained in the splanchnic mesenteric bed, that’s the blood vessels around your gut and abdomen [5]. If you’re only compressing below the knee, you’re missing a huge reservoir of pooled blood.

This is one of those things where the standard advice hasn’t caught up with the evidence. Most people with POTS are still being told to buy knee-high compression socks, probably because they’re the cheapest and most accessible option. But the data suggests that waist-high compression, or dedicated abdominal compression, is likely to be far more effective. Dysautonomia International specifically recommends 20-30 mmHg or 30-40 mmHg waist-high stockings for this reason [11]. And knee-high stockings can actually cause swelling above the stocking, which isn’t exactly what you’re going for [11].

So, does compression help with POTS? Physiologically yes, almost certainly. But if most people are using the wrong type, it’s no wonder the perceived effectiveness is so low. When it comes to compression for POTS, it seems like the product is failing the patients rather than the concept being wrong. This is relevant if you’ve tried knee-high socks and given up, it might be worth trying waist-high or abdominal compression before writing the whole thing off.

Compression for Pain and Joint Stability in hEDS and HSD

Now let’s look at the evidence for compression garments specifically for pain and joint stability. This is where the most encouraging data sits, though it still comes with significant caveats.

The largest and longest study to date is a prospective observational cohort by Bénistan and colleagues, which followed 67 patients with non-vascular Ehlers Danlos syndromes (91% hypermobile type) for two years [3]. The results were genuinely impressive. Pain at the most painful joint, measured on a visual analogue scale, dropped from 71.5 at baseline to 53.5 at six months and 45.7 at two years [3]. That’s a substantial and sustained reduction. Neuropathic pain also improved, as did functional independence, and there were significant reductions in sprains and dislocations and subluxations [3]. For anyone who’s dealt with recurring subluxations, that last finding alone is worth paying attention to.

However, the balance improvement (measured by the Berg Balance Scale) showed only a trend and didn’t quite reach statistical significance (p=0.053) [3]. Close, but not quite there. And there was no significant improvement in fatigue. The study also had no control group, it was observational, so we can’t be sure the improvements were due to the compression garments specifically rather than the concurrent physiotherapy, natural disease variation, or even placebo effects. These are custom-made Cerecare garments, by the way, not off-the-shelf compression socks. That’s an important distinction.

A more recent retrospective study by Boulu and colleagues in 2025 looked at 20 adults with hEDS or HSD and found that 80% reported a reduction in pain, 53.8% reduced their use of painkillers, and 40% reported improved quality of life [1]. Interestingly, effectiveness wasn’t correlated with Beighton score [1]. So how hypermobile you are on the standard scoring system doesn’t seem to predict whether compression will help you. What did seem to predict response was how long people wore them, responders wore their garments for significantly longer than nonresponders [1].

There were also trends suggesting that people with impaired proprioception at baseline and those who experienced an “on-off” effect (more on that in a moment) were more likely to respond, but these trends didn’t reach conventional statistical significance (p=0.11 and p=0.094 respectively) [1]. The study was small, only 20 people, retrospective, and from a single centre. So promising, but we need to be measured about how much weight we put on it.

The randomised controlled trial by Bénistan and colleagues (yes, the same research group, they’ve been busy) compared physiotherapy plus compression garments against physiotherapy alone in 36 people with hEDS [2]. This is the strongest study design in the compression garment literature for this population. Compression garments immediately improved dynamic balance, and after four weeks, the physiotherapy-plus-compression group had significantly better balance than physiotherapy alone, with a large effect size of 0.93 [2]. Pain decreased in both groups, which is encouraging, but the between-group difference for pain wasn’t statistically significant [2]. So compression added a clear benefit for balance and proprioceptive function, but for pain specifically, the evidence from this particular trial is less definitive.

The “On-Off” Effect

One of the more interesting findings that’s emerging from both the clinical literature and the patient community is what’s being called the “on-off” effect. This is when someone puts on a compression garment and feels an immediate, noticeable improvement, and then when they take it off, the symptoms come straight back. It’s described by patients as something you feel within minutes, not something that builds up over weeks.

Snowdon and Dadla’s qualitative research captured this well, with clinicians describing the effect as “immediate” [8]. And in the Boulu study, all patients who reported an on-off effect were classified as responders, though the association showed only a trend towards statistical significance (p=0.094) [1]. It’s a small dataset so we shouldn’t overinterpret it, but it’s a pattern that clinicians and patients describe consistently.

Why does this matter practically? Because the on-off effect might serve as a useful quick indicator of whether compression is going to work for you. If you put on a compression garment and feel a noticeable difference within the first session, that’s a good sign. If you wear one for two weeks and notice nothing, you might be a nonresponder. Of course, this isn’t confirmed by the research yet, it’s more of a clinical observation than a proven diagnostic tool. But it’s the kind of practical insight that’s worth knowing about.

I should mention that the on-off effect is also consistent with the proprioceptive theory. If compression garments are working by providing additional sensory input to a system that has imprecise signalling, it makes sense that the effect would be immediate. You wouldn’t need weeks of “training” for the benefit to kick in, the extra sensory data is either useful to your nervous system or it isn’t. The same isn’t true for, say, strengthening exercises, which take time to produce structural changes. This immediacy is a hallmark of a sensory mechanism rather than a structural one, and it’s one of the things that makes the proprioceptive hypothesis quite compelling even though the direct evidence is still limited.

Practical Guide: What to Look For

So you’ve read the evidence and you want to try compression garments. What should you actually look for? Here’s what the research and the patient community suggest.

Compression Level

For general proprioceptive and joint support in hypermobility, moderate compression (20-30 mmHg) is the most commonly recommended starting point. For POTS-related symptoms including blood pooling and orthostatic issues, some sources recommend going to 30-40 mmHg, though this can be harder to tolerate and harder to get on. The custom-made garments used in the Bénistan studies were actually lower pressure (10-15 mmHg), which is worth noting. More pressure isn’t always better. Sometimes moderate, consistent compression that you can actually wear all day is more useful than high compression that you abandon after an hour because it’s uncomfortable.

Where to Compress

This is arguably the most important decision, especially for those with POTS. The evidence is pretty clear: knee-high compression socks are the least effective option for managing blood pooling [5] [11]. Waist-high compression stockings or dedicated abdominal compression are recommended [11]. For joint proprioception and stability, the garment needs to cover the joints you’re trying to support, which sounds obvious but means that a pair of knee-high socks won’t do much for wrist instability or spinal issues.

Custom vs. Off-the-Shelf

Most of the positive studies used custom-made garments [1] [2] [3]. That said, custom-made medical compression garments are expensive and require a clinical fitting. Off-the-shelf compression tights or leggings from brands like Jobst, Juzo, or Sigvaris are more accessible and still provide meaningful compression. It’s worth starting with off-the-shelf to see if you respond to compression at all before investing in custom options. If you do get custom garments, the research emphasises the importance of a collaborative fitting process where the garment is adjusted to your specific needs [8].

Sensory Sensitivities

This is a big one that doesn’t get enough attention. A lot of those with hypermobility also deal with sensory processing differences, and many people in the EDS community report that sensory sensitivities make compression garments extremely difficult to tolerate. Seams, textures, heat, and the feeling of tightness itself can be genuinely distressing. A trick that comes up repeatedly in the patient community is wearing compression garments inside out to avoid irritation from internal seams. It sounds small but it can make the difference between something being wearable and something going straight in the drawer.

When to Put Them On

For POTS specifically, the advice is consistent: put your compression garments on first thing in the morning, ideally before you stand up. Blood starts pooling as soon as you’re upright, so getting the compression on before that happens is more effective than trying to reverse pooling that’s already occurred. This is one of those practical details that nobody tells you until you’ve already been doing it wrong for months. Some people keep their compression garments right next to the bed so they can put them on before their feet even touch the floor. Whilst that might sound excessive, if you’re someone whose brain fog and dizziness are worst in the morning, it makes a lot of practical sense.

Getting Them On

Let’s not ignore the elephant in the room. Compression garments are hard to put on. Really hard. If you’ve got hypermobile fingers, reduced grip strength, or fatigue from a flare-up, wrestling with a pair of 30-40 mmHg compression stockings first thing in the morning can feel like an unreasonable demand. Stocking donner devices exist and they’re genuinely useful, rubber gloves can help with grip, and some brands are simply easier to get on than others. If you’ve tried compression and given up because of the practical difficulty, it’s worth trying a different product or getting a donning aid before ruling out the approach entirely.

The Honest Picture: Limitations of the Evidence

We always try to be straightforward about the state of the evidence on this blog, and when it comes to compression garments, the honest picture is this: the evidence is encouraging but it has significant limitations.

Every single study in this area has a small sample size. The largest is 67 participants [3]. The RCT had 36 [2]. Several had fewer than 20. When you’re working with samples this small, individual variation can have a large effect on the results, and findings may not generalise well to the broader population of those with hypermobility and EDS.

Blinding is impossible. You can’t give someone a placebo compression garment without them noticing. This means that expectation effects, both positive and negative, could be influencing the results in every study. When someone puts on a garment they’ve been told will help, the brain’s expectations can genuinely produce real physiological changes. We can’t rule that out.

Most studies are from single specialist centres, often the same research group in France (Bénistan and colleagues have been doing excellent work, but independent replication from other centres would strengthen the evidence considerably). And the majority of designs are observational. We have one RCT for balance [2], one crossover trial for blood pooling in healthy adults [6], and a lot of cohort studies and case reports beyond that.

Does this mean compression garments don’t work? No. The consistency of the findings across different study designs, combined with the physiological plausibility and the widespread clinical experience, suggests there’s something genuinely helpful happening. But we’re not at the point where we can say exactly who will benefit, exactly how much they’ll benefit, or exactly what protocol is optimal. When it comes to those with Ehlers-Danlos syndrome and hypermobility, the research into compression garments is still in its early stages. It’s getting better quickly, which is encouraging, but it’s not there yet.

Likewise, the 8.9% effectiveness finding from the POTS survey [5] reminds us that what works in theory doesn’t always work in practice, particularly when the products aren’t designed for the specific condition they’re being used for. A compression stocking designed to prevent DVT during a long flight and a compression garment designed to manage blood pooling in POTS are solving different problems, even if they look similar on the shelf.

Frequently Asked Questions

Do compression garments actually help hypermobility and EDS?

The evidence suggests they can, particularly for pain and joint stability. The largest study followed 67 people with non-vascular EDS for two years and found significant pain reduction (from 71.5 to 45.7 on a visual analogue scale) and fewer subluxations and sprains [3]. An RCT also showed improved balance with compression garments [2]. However, the evidence base is still small, the studies are mostly from single centres, and we don’t yet know exactly who will benefit most.

What compression level should I use for POTS?

Most recommendations suggest 20-30 mmHg as a starting point, with 30-40 mmHg for more significant symptoms [11]. Waist-high compression or abdominal compression is preferred over knee-high because blood pools throughout the entire lower body and abdomen, not just the calves [5] [11]. Starting with moderate compression you can actually tolerate is more useful than high compression you’ll stop wearing.

Why didn’t compression socks help me?

There are several possible reasons. If you were using knee-high socks, you may not have been compressing the right areas, particularly if your symptoms are related to blood pooling and low blood pressure. A large survey found that only 8.9% of POTS patients found compression effective, but most were using leg compression rather than waist-high or abdominal options [5]. You may also need a higher compression level, or you may be someone for whom compression simply doesn’t make enough of a difference.

Can compression garments improve proprioception?

This is one of the more promising theories. Studies show that compression garments can improve balance and postural control in people with hEDS [2] [4], which suggests enhanced proprioceptive input. The proposed mechanism is that the constant pressure provides the nervous system with additional sensory data, improving the body’s ability to sense joint position and movement. This is relevant because proprioceptive imprecision is a known feature of EDS [7].

How long should I wear compression garments each day?

The studies varied in their protocols, but the general guidance is to wear them during waking hours, particularly during activities where you’re upright and active. In the Bénistan RCT, participants wore garments for an average of 10.4 hours per day [2]. One finding from the Boulu study was clear: people who wore their garments for longer had better outcomes [1]. That said, if you’re finding compression intolerable, pacing your use and building up gradually is sensible.

Are custom-made compression garments worth the cost?

The best evidence comes from studies using custom-made garments [1] [2] [3], but that doesn’t necessarily mean off-the-shelf options are useless. Custom garments are fitted to your body, which means better pressure distribution and better coverage. However, they’re expensive. A practical approach is to try off-the-shelf compression first to see if you experience the “on-off” effect. If compression clearly helps, investing in custom garments makes sense for better long-term outcomes and comfort.

Putting It All Together

Compression garments aren’t a magic fix. Nothing is, and we’ve never been the kind of team that pretends otherwise. But the evidence does suggest that for a significant number of people with hypermobility, EDS, and POTS, they can make a meaningful difference to pain, joint stability, balance and potentially to blood pooling and orthostatic symptoms.

The key takeaways are: compression likely works through two mechanisms (vascular support and proprioceptive enhancement), where you compress matters more than most people realise, and if knee-high socks didn’t work for you, that doesn’t mean compression has nothing to offer. The on-off effect may be a useful early indicator of whether you’ll respond. And the evidence, whilst promising, is still limited by small studies from a small number of research groups.

If you’re considering compression garments, it’s worth discussing with your GP or physiotherapist, particularly if you’re looking at custom-made options. For those already working through an exercise programme for hypermobility, compression may be a useful addition, not a replacement for building core stability and lower limb control, but something that supports the process. And for those also managing pelvic floor issues, compression around the abdomen and pelvis can serve double duty.

And if you’re someone who’s tried compression and it hasn’t worked, don’t beat yourself up about it. Not every intervention works for every person, and there are plenty of other strategies for managing sleep, anxiety, nutrition, and the day-to-day realities of living with a condition that changes over time. The goal is always to find the combination of things that works for you, and that takes a bit of trial and error.

– The Fibro Guy Team –

References

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Bénistan K, Foy M, Gillas F, et al. Effects of compression garments on balance in hypermobile Ehlers-Danlos syndrome: a randomized controlled trial. Disability and Rehabilitation. 2023;46(21):4821-4831. https://doi.org/10.1080/09638288.2023.2209742
Bénistan K, Pontier B, Leblond C, et al. The Effectiveness of Compression Garments for Reducing Pain in Non-Vascular Ehlers-Danlos Syndromes: A Prospective Observational Cohort Study. Healthcare. 2023;11(13):1862. https://doi.org/10.3390/healthcare11131862
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Clayton HA, Jones SAH, Henriques DYP. Proprioceptive precision is impaired in Ehlers-Danlos syndrome. SpringerPlus. 2015;4:323. https://doi.org/10.1186/s40064-015-1089-1
Snowdon N, Dadla SA. Perceptions and experiences of allied health professionals of fabric orthoses for people with joint hypermobility syndromes: a qualitative study. International Journal of Therapy and Rehabilitation. 2023;30(8). https://doi.org/10.12968/ijtr.2022.0148
Scheper M, et al. The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception. Disability and Rehabilitation. 2017;39(14):1391-1397. https://doi.org/10.1080/09638288.2016.1196396
Aziz Q, Harris L, Goodman BP, et al. Clinical Practice Updates: AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome. Clinical Gastroenterology and Hepatology. 2025. https://doi.org/10.1016/j.cgh.2025.02.015
Dysautonomia International. The Skinny on Compression Stockings. 2016. https://dysautonomiainternational.org/blog/wordpress/the-skinny-on-compression-stockings/