(CNN) -- A slim 6-foot-10 Duke University forward, Mason Plumlee has taken his share of elbows to the ribs.
So before he takes the court for the Blue Devils in this year's NCAA basketball tournament, he spends a little extra time dressing in the locker room.
Plumlee and dozens of other college basketball players wear compression shirts and shorts dotted with foam and plastic shock-absorbing pads under their uniforms. There are also padded sleeves for the elbows and knees. In the past few years players have started to wear this layer of protective gear meant to feel like a second-skin in a sport that has bigger, faster and stronger athletes than ever.
"You don't want a big cherry on your hip, and for us bony people, it helps," said Plumlee. The padded shorts help protect the freshman from "hip pointers," a dreaded injury to the iliac crest of the pelvis that can cause the abdominal muscle to bleed. Said to improve circulation and reduce muscle soreness, compression material can ease an injury so excruciating that simply breathing can hurt.
"This game has become a very aggressive contact sport," said Larry Hare, the assistant athletics director at the University of Kansas. The Jayhawks won the national championship two years ago.
Adidas is outfitting Kansas and Notre Dame, among other schools, with its padded undergear TechFit. The product has been pitched by both Dwight Howard, the Orlando Magic's 6-foot-11, 265-pound center and Chicago Bulls' Derrick Rose, who is 6-foot-3 and 190 pounds. The two players were involved in one of the most violent collisions of the year when Rose drove into the lane and smashed midair into Howard.
Bulls Head Athletic Trainer Fred Tedeschi told ESPN that Rose was wearing Adidas padded shorts which the trainer surmised "probably soaked up a lot of the blow." Rose was back within days to play in the All-Star game with Howard.
"The question is, does wearing this gear really do anything?" Dr. Kevin Burroughs, the director of the Sports Medicine & Injury Center in Concord, North Carolina. He's also the team physician at J.M. Robinson High School and at Catawba College, a Division II basketball program.
Burroughs has no affiliation with the NCAA tournament or professional basketball.
"Some of the things you'll see like these products, a lot of them tend to be more fads that come and go," he said. "But anything that comes down over the edge of a bony prominence, or on the knee, makes sense. For the ribs -- there's cartilage that is a natural shock absorber so I don't know how truly affective that piece might be."
But players believe.
A few seasons ago, only one Kansas player wore padded undergear. This season, 17 Jayhawks are wearing it, Hare said. It's become a common accessory on pro players, too.
Nike has produced sleek, get-you-going commercials for Pro Combat that feature a snarling, chest-beating LeBron James. In another ad, Kobe Bryant's nostrils flare while a song befitting a movie about the apocalypse plays.
"Prepare...For...Combat" the commercial urges.
"Athletes tell us that's how they feel on game day," said Todd Van Horne, the Global Apparel Design Director for Nike apparel. "They are combat ready, locked down and ready to do battle."
Shaquille O'Neal was one of the first players to wear padding. While with the NBA's Miami Heat, 7-foot-1 O'Neal would get bruised as players fouled him and roughed him up in an effort to stop him. The Heat's trainer reportedly considered having him wear a bulletproof vest but dismissed the idea because it was too heavy.
Dwyane Wade, the Miami Heat guard who was O'Neal's teammate at the time, is the pitchman for Illinois-based McDavid, a much smaller company than Nike and Adidas (McDavid's annual revenue is $50 million, said spokesperson Rey Corpuz whose family founded the company in the late 1960s).
In 2005, McDavid put to market a technology called HexPad, a flexible, washable, lightweight series of hexagonal foam pads woven into fabric.
Nike introduced Pro Combat within the past calendar year. "We think of this as a collaborative process between the athletes and us," said Van Horne. "If they want it lighter or smoother, we go back and try to make that happen."
Corpuz told CNN that the McDavid basketball padded gear generates about $15 million annually for the company. About a year-and-a-half ago, McDavid sued Nike and Adidas for patent infringement. Adidas spokesperson Stephanie Von Allmen said the company does not comment on pending litigation.
Nike spokesperson Megan Saalfeld said the suit is "without merit."
"The process used to develop the Nike Pro Combat is so fundamentally different to other products in the marketplace that a separate patent application was filed approximately two years ago and is now pending," Saalfeld said.
Plumlee will be wearing Nike Pro Combat at Friday's game. Though NBA rules allow players to get paid to endorse products, NCAA rules prohibit players from taking money from a company or appearing to promote a product.
Plumlee isn't concerned about lawsuits or fashion. "I just do it [wear the undergear] strictly in case I land on something," he said. "I don't do it for the look or anything like that."
"It is brutal out there," Hare said. "You want to see these kids protect themselves with whatever makes them feel safer and more confident."