Compression stockings, leggings and bandages press against the skin with forces that can mean the difference between therapeutic relief and outright discomfort, yet designers have long lacked detailed maps of where the human leg actually tolerates that squeeze. A new laboratory study published in Fashion and Textiles has now measured, point by point, how much pressure it takes before pressure becomes pain, and how much can be borne before it becomes unbearable, across 22 anatomical sites on the lower limbs of young adults. The results reveal striking gender differences and a clear anatomical geography of sensitivity that could reshape how next-generation compression garments are engineered.
Researchers recruited 20 healthy participants aged 19 to 27, ten men and ten women, all non-professional athletes with no history of skin disease, leg injury or cardiovascular conditions in the previous year. The men averaged 21.2 years of age, 67.0 kilograms and 175.3 centimeters in height, while the women averaged 20.9 years, 52.5 kilograms and 160.3 centimeters. Each participant’s left limb was tested at 22 sites distributed across five longitudinal levels, from the ankle-proximal region up through the lower shank, mid-shank, upper shank and sub-popliteal area just below the knee, and at four circumferential orientations: anterior, posterior, medial and lateral. The longitudinal levels were chosen to align with the compression hosiery standard RAL-GZ 387/1, tying the laboratory measurements directly to industrial practice.
The measurement tool was a hand-held pressure algometer with a one-centimeter-diameter probe, a device widely recognized for reliability in pressure sensitivity testing. Pressure was applied at a controlled rate of 30 plus or minus 5 kilopascals per second, and participants signaled the moment pressure turned to pain, defining the pressure pain threshold, or PPT, and the maximum pressure they could bear, the pressure pain tolerance, or PPTo, by pressing a trigger button that recorded the value. Thresholds were measured three consecutive times at each site while participants stood; tolerance was measured twice per site after a sufficient rest. Testing was split across two sessions at least seven days apart to minimize fatigue, with site order randomized. The team then analyzed the data with linear mixed-effects models, treating participant as a random intercept, and adjusted all pairwise comparisons using the Holm-Bonferroni method.
The headline finding is a dramatic gender gap. Average pressure pain thresholds along the lower limbs reached 282.8 plus or minus 45.0 kilopascals in men but only 163.3 plus or minus 25.7 kilopascals in women, meaning men’s thresholds were 73.2 percent higher, with a very large effect size (Hedges’ g = 3.123, 95 percent CI [1.842, 4.405], p < 0.001). Tolerance told the same story: men averaged 545.5 plus or minus 88.1 kilopascals against 372.8 plus or minus 54.0 kilopascals in women, roughly 46 percent higher (Hedges’ g = 2.264, 95 percent CI [1.170, 3.358], p < 0.001). Statistical models confirmed significant main effects of gender on both measures with no significant gender-by-site interaction, indicating the gap was consistent across every one of the 22 tested locations rather than confined to particularly tender spots.
Anatomy mattered just as much as sex. Around the circumference of the leg, the anterior and lateral regions, over the tibialis anterior and fibularis longus, generally showed higher thresholds and tolerance, while the medial and posterior regions, dominated by the gastrocnemius calf muscle, were markedly more sensitive. Post-hoc comparisons showed pressure pain threshold was significantly higher on the anterior side than the medial (mean difference 63.85 kPa, p < 0.001) and posterior sides (39.99 kPa, p = 0.003), and higher on the lateral than the medial (59.53 kPa, p < 0.001) and posterior sides (35.67 kPa, p = 0.007). For tolerance, the anterior site exceeded both the medial (121.66 kPa, p < 0.001) and posterior sites (92.10 kPa, p = 0.016), and the lateral side likewise surpassed the medial (98.29 kPa, p < 0.001). The medial side emerged as the most sensitive and least tolerant orientation overall.
Along the length of the leg, the picture was subtler. Both longitudinal level and circumferential orientation showed significant main effects on threshold and tolerance, but Bonferroni-adjusted comparisons between individual longitudinal levels revealed no significant threshold differences once correction was applied. For tolerance, however, the lower shank at the upper ankle was significantly higher than the sub-popliteal region (mean difference 86.67 kPa, 95 percent CI [5.59, 167.76], p = 0.027). The single most vulnerable location was site 1, the gastrocnemius at the sub-popliteal level just below the knee crease, which recorded the lowest tolerance in both sexes: about 381 kilopascals in men and 283 kilopascals in women. At the other extreme, tolerance peaked at the fibularis longus of the mid-shank in men (726.5 kilopascals) and at the extensor hallucis longus of the lower shank in women (490.9 kilopascals).
Despite the overall gap between the sexes, the spatial pattern of sensitivity was strikingly similar in men and women. Threshold values at corresponding sites correlated positively between genders (r-squared = 0.51), as did tolerance values (r-squared = 0.55), and threshold and tolerance correlated within each gender (r-squared = 0.59 for men, 0.53 for women), all statistically significant. In practical terms, a location that is tender for one sex tends to be tender for the other, and individuals with higher pain thresholds also tend to have higher tolerances. The authors argue this supports site-specific design rules that can be generalized across genders, with the absolute pressure levels simply scaled down for female users.
The design implications are concrete. Commercial compression garments typically deliver 15 to 40 millimeters of mercury, with mild compression around 15 to 20 millimeters of mercury for everyday support and moderate to firm compression of 20 to 40 millimeters of mercury prescribed for conditions such as varicose veins or lymphedema. Excessive pressure can impair blood flow and cause muscle fatigue, while insufficient pressure undermines therapeutic benefit, and ill-fitting garments can cause skin irritation, discomfort and reduced compliance. The new maps suggest compression should be reduced in medial and proximal regions and especially avoided near the popliteal fossa, while relatively greater pressure can be applied over the anterior and lateral leg where tolerance is higher. The authors also propose a gradient that decreases from the distal shank toward the knee crease, complementing the conventional graduated profile that is highest at the ankle and decreases proximally to manage venous hypertension.
The researchers are careful about what their method can and cannot show. Algometer pressure is a localized, steadily increasing force, not the continuous distributed load of a worn garment, so the sensitivity patterns are design-relevant rather than a direct simulation of wear. The study also did not directly measure muscle thickness, adipose thickness, tissue stiffness or nerve distribution, so the observed variations may reflect differences in these unmeasured factors, and the authors call for further research with direct measurements to confirm the mechanisms. The sample was limited to healthy young adults on a single limb, and the authors note that age, ethnicity, sleep and lifestyle factors known to influence pain sensitivity were outside the study’s scope, making the reported values reference data for this population rather than universal constants.
Even with those caveats, the study fills a genuine gap: few previous investigations have systematically compared pressure sensitivity across multiple lower-limb regions and between genders in young adults, a group with growing use of lower-body compression wear. By identifying where pain first appears and where tolerance runs out, the work offers clinicians, physiotherapists and product developers an evidence base for zoned compression, padding over the medial and posterior calf, firmer support over bony regions like the anterior tibia, and gender-adjusted pressure specifications. Advanced seamless knitting technologies, the authors note, could integrate such multiple functional zones without seams, turning a map of human pain sensitivity into a blueprint for garments that compress effectively without hurting the people who need them.
Subject of Research: Pressure pain threshold and tolerance mapping across lower-limb anatomical sites in young adults
Article Title: Pressure pain threshold and tolerance in the lower limbs of young adults: insights for ergonomic design of compression garments
Article References: Choudhury, M. M., Liu, R., Wu, X., Patwary, A. U. Z., & Zhou, D. (2026). Pressure pain threshold and tolerance in the lower limbs of young adults: insights for ergonomic design of compression garments. Fashion and Textiles, 13(1), Article 29. https://doi.org/10.1186/s40691-026-00480-z
Image Credits: AI Generated
DOI: 10.1186/s40691-026-00480-z
Keywords: pressure pain threshold, compression garments, ergonomics, lower limb, gender differences, algometer, gastrocnemius, wearable textiles, pressure sensitivity, graduated compression, young adults, biomechanics
News Source: Denise Maddox. (October 29, 2026). Where Compression Garments Hurt Most: New Pain Maps Reveal Gender and Anatomy Divide. Scienmag.
