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Compression garment utilization is very popular among runners despite a lack of consensus in the literature regarding a beneficial impact. The aim of the study was to investigate the impact of training and competing with compression garments on exercise-induced muscle damage and performance in ultramarathon runners.Compression garments will reduce the severity of exercise-induced muscle damage and improve performance in long-distance runners compared with control conditions.Prospective, randomized controlled trial.Level 1.The study was conducted in healthy, uninjured endurance runners (n = 41) participating in a 56-km ultramarathon. The experimental group (n = 20; 14 males, 6 females) trained for 6 weeks and participated in the race wearing below-knee compression garments while the control group (n = 21; 15 males, 6 females) did not. Participants were tested on 4 occasions for various markers of exercise-induced muscle damage and running performance.Ankle circumference measurements increased significantly less (P = 0.01, Cohen d = 0.9) in the experimental group from immediately after until 2 days post-race compared with the control group. No further statistically significant changes were detected over time in midcalf circumferences, muscle architecture, or race performance. Selected pain ratings were statistically significant and worse in the experimental group.There are limited indications of a beneficial impact of compression garments with improvements in ankle circumference measurements. No ergogenic impact was detected.There is limited evidence to support the continued utilization of commercially available below-knee compression garments during running for the purpose of muscle recovery or as a performance aid.