Dove Magazine

What evidence would convince me skinny jeans are bad for health?

You’ve probably seen recent headlines decrying that staple of teens and hipsters everywhere (regardless of gender), the skinny jeans, as being bad for your health, after an article in the Journal of Neurology, Neurosurgery and Psychiatry.

The article was a case study of a woman who, after helping a relative move house, found that her legs and ankles were weak, to the point where she fell and couldn’t get up again. She had spent the day squatting for prolonged periods of time, whilst wearing skinny jeans. The doctors concluded she had compartment syndrome, where compressed muscles and nerves can cease to function properly. She was cut out of the offending trousers and had to spend four days in hospital recovering.

Pretty scary stuff. So should we be chucking out our tight trousers, and praying for a return to flares? Not just yet. In terms of strength of evidence, a case study like this of just one patient is at the bottom of the pyramid of evidence. And it’s pretty obvious why – if only one person wearing skinny jeans reports a problem, out of the huge number of people who wear them, this suggests that actually it’s a pretty rare occurrence and most people are just fine.

Slightly stronger evidence might be gleaned via the use of statistics. I could plot the sales of skinny jeans over the past few decades, and compare that to the rates of incidences like the one that befell this poor woman. If the rate of hospitalisation for compartment syndrome increased at the same time as sales of skinny jeans did, this might give us a clue. This type of design is called an ecological study, but it’s still not very convincing. There’s no way of knowing whether the people in hospital are the same ones that are wearing the skinny jeans.

In an ideal world, what I’d want to do would be to take a random group of people, and assign their clothing for them, then sit back and see whether the ones given skinny jeans experience health problems, but the ones given baggy trousers don’t. I think I’d be unlikely to find a group of people willing to let me dress them for the length of time I’d need to run this experiment for to get any meaningful results though. Which means if I wanted to investigate this question I’d probably have to collect data on what people choose to do.

There are a few ways to do this. I could find a group of people hospitalised for compartment syndrome, and a matched group who weren’t, and then ask each about whether they wear skinny jeans. This is a “case control” study, but the problem is, those who have compartment syndrome might be more likely to report wearing skinny jeans, as they’re probably trying to work out why they got it, so might have been thinking about their clothing choices much more than the other group. This is called recall bias and is a big limitation of such studies.

I could also take a large group of people and ask them about whether they’d ever had compartment syndrome, and whether they’d worn skinny jeans, either at one time point, or following them up over time. It’s usually better to follow people up over time, as then you can be sure that the so-called cause (wearing skinny jeans) happens before the “effect” (compartment syndrome). This might not be too much of a problem here, because it’s unlikely that people who had suffered with compartment syndrome would wear skinny jeans because of this, but in some cases where causation could be in either direction, this is problematic. What’s more of a limitation in the case of skinny jeans is that it seems likely that the outcome of compartment syndrome is really rare. Given how popular skinny jeans are, and how unlikely the outcome is to occur, I would need an absolutely huge sample to be able to draw any really meaningful conclusions.

So far I’ve really focussed on the limitations, so what would convince me that skinny jeans caused compartment syndrome? Handily, there are a list of criteria for establishing causation, which are named after their developer, Bradford-Hill. Here’s how the current evidence stack up.

Strength: This means the strength of the statistical association between skinny jeans and compartment syndrome. At the moment there are no statistics at all, so this scores a big fat zero.

Consistency: Given there is currently one case study with nothing to compare it to, again there is no score here.

Specificity: This means the likelihood that skinny jeans are the only possible cause of compartment syndrome. This certainly isn’t true. Zero again.

Temporality: Skinny jeans use happens before compartment syndrome does. Here, we can give a point.

Biological gradient: I suppose in this instance this would mean the tighter the jeans, the more likely a person would be to get compartment syndrome. No evidence that that’s the case.

Plausibility: Is there a mechanism by which skinny jeans could cause compartment syndrome? This case study suggests that you would have to do a lot of squatting in them in order for that to be the case, so this is debatable.

Coherence: This means evidence from lots of different fields of research all agrees. As we only have one case study this can’t be judged. Another zero.

Experiment: As I haven’t yet run my “RCT of skinny jeans on the incidence of compartment syndrome”, this is zero again.

Consideration of alternative explanations: The case report itself mentions that a common cause of compartment syndrome is squatting for long periods, so it could be the case that the skinny jeans were neither necessary nor sufficient to cause the woman’s injury in the first place. Zero once more.

There you have it. The evidence in support of a causal link between skinny jeans and compartment syndrome is currently very weak indeed. Of course, lack of evidence of a link doesn’t mean the same thing as evidence of a lack of a link! However, given the popularity of the skinny jeans, I think it’s unlikely we have a demon trouser on our hands. Better advice might be “if you’re helping relatives move house, wear appropriate clothing and make sure you take regular breaks”. –theguardian-

 

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