Sunday, September 20, 2009

DOMS Part 2 - what works to reduce/eliminate delayed onset muscle soreness:

In part 1 we looked at what DOMS is and what's been tried and DOESN'T work to reduce any of its markers from swelling to soreness to reduced ROM and force production.

In this part (II) we look at a range of strategies that seem to attenuate DOMS in a number of ways. My goal in this article is to get to an approach that requires the least gear and seems to have the most benefit.

You will be amazed! So sit back with a nice glass of milk (not kidding), maybe while having a tub (again not kidding) and welcome to the world of muscle repair.

Let's review what's measured in assessing DOMS in the literature.
  • what's in the blood: usually there are markers in the blood like creatine kinase and LDH - these are markers of muscle damage - we may have the same CK levels and have very different responses to soreness
  • then there's the subjective measures of soreness themselves using rating scales.
  • then there's the more objective bits: Range of motion and force production.
Caveat Emptor
B2D buddie Mike T. Nelson of asks the question: is the experience of soreness directly correlated to a drop in performance? Mike in conversation makes the point that pain perception being a brain thing is going to be pretty individual. So how DOMS success is measured is something to bare in mind when looking at the studies following that claim to be effective against DOMS - are we talking DOMS pain reduction (always nice) or performance in a DOMS state?

The following DOMS fighting strategies that researchers claim wins on are:
  • Gear that works on: compression
  • gear that works off: tubs
  • what works sans gear: get the heart rate up and keep it up
  • What to ingest that might help these mods further (milk, bcaa, protease?)
DOMS: better attenuation of effects - Compression
compression (and compression suits) have been studied over the past 8 years. In 2001 the well respected Kraemer and crew looked at compression for elbow flexion and saw a lot of benefit across the mutli markers of DOMS:
J Orthop Sports Phys Ther. 2001 Jun;31(6):282-90.
Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise.
Kraemer WJ, Bush JA, Wickham RB, Denegar CR, Gómez AL, Gotshalk LA, Duncan ND, Volek JS, Putukian M, Sebastianelli WJ.

The Human Performance Laboratory, Ball State University, Muncie, Ind 47306, USA.

STUDY DESIGN: A between groups design was used to compare recovery following eccentric muscle damage under 2 experimental conditions. OBJECTIVE: To determine if a compression sleeve donned immediately after maximal eccentric exercise would enhance recovery of physical function and decrease symptoms of soreness. BACKGROUND: Prior investigations using ice, intermittent compression, or exercise have not shown efficacy in relieving symptoms of delayed onset muscle soreness (DOMS). To date, no study has shown the effect of continuous compression on DOMS, yet this would offer a low cost intervention for patients suffering with the symptoms of DOMS. METHODS AND MEASURES: Twenty nonimpaired non-strength-trained women participated in the study. Subjects were matched for age, anthropometric data, and one repetition maximum concentric arm curl strength and then randomly placed into a control group (n = 10) or an experimental compression sleeve group (n = 10). Subjects were instructed to avoid pain-relieving modalities (eg, analgesic medications, ice) throughout the study. The experimental group wore a compressive sleeve garment for 5 days following eccentric exercise. Subjects performed 2 sets of 50 passive arm curls with the dominant arm on an isokinetic dynamometer with a maximal eccentric muscle action superimposed every fourth passive repetition. One repetition maximum elbow flexion, upper arm circumference, relaxed elbow angle, blood serum cortisol, creatine kinase, lactate dehydrogenase, and perception of soreness questionnaires were collected prior to the exercise bout and daily thereafter for 5 days. RESULTS: Creatine kinase was significantly elevated from the baseline value in both groups, although the experimental compression test group showed decreased magnitude of creatine kinase elevation following the eccentric exercise. Compression sleeve use prevented loss of elbow motion, decreased perceived soreness, reduced swelling, and promoted recovery of force production.

In 2006, another study seemed to reinforce these findings

The low oxidative demand and muscular adaptations accompanying eccentric exercise hold benefits for both healthy and clinical populations. Compression garments have been suggested to reduce muscle damage and maintain muscle function. This study investigated whether compression garments could benefit metabolic recovery from eccentric exercise. Following 30-min of downhill walking participants wore compression garments on one leg (COMP), the other leg was used as an internal, untreated control (CONT). The muscle metabolites phosphomonoester (PME), phosphodiester (PDE), phosphocreatine (PCr), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were evaluated at baseline, 1-h and 48-h after eccentric exercise using 31P-magnetic resonance spectroscopy. Subjective reports of muscle soreness were recorded at all time points. The pressure of the garment against the thigh was assessed at 1-h and 48-h following exercise. There was a significant increase in perceived muscle soreness from baseline in both the control (CONT) and compression (COMP) leg at 1-h and 48-h following eccentric exercise (p <>2+ or PME at any time point or between CONT and COMP legs. Eccentric exercise causes disruption of pH control in skeletal muscle but does not cause disruption to cellular control of free energy. Compression garments may alter potential indices of the repair processes accompanying structural damage to the skeletal muscle following eccentric exercise allowing a faster cellular repair
What we don't see clearly in the above piece is a measure of force production and range of motion. So more recently (2009) again, a thumbs up on attenuation from compression:
Delayed onset muscle soreness (DOMS) is a common experience following unaccustomed eccentric exercise. DOMS and associated force deficits may limit optimal performance in subsequent days. The cause of DOMS remains poorly understood, thus there is no effective treatment. Graduated compression stockings (GCS) are a commonly used intervention believed to diminish DOMS. The purpose of this study was to determine if GCS after eccentric walking exercise minimizes DOMS and associated deficits (e.g. muscle force capacity). Eight healthy subjects (age 26±4 yrs, height 175±8 cm, weight 70±5 kg) volunteered to perform a single bout of backward downhill walking exercise (duration 30 min, velocity 1 m.s-1, negative grade-25%, load 12% of body weight). Following walking exercise, subjects were required to wear 5 hours per day for 3 consecutive days GSC (SupportivTM) on one leg while the second was used as control. Muscle soreness and neuromuscular measures (M-wave, peak twitch, maximal voluntary torque or MVT) were taken pre and postwalk, then 2, 24, 48 and 72 hours post-walking exercise for the two legs. There was a 28% reduction in DOMS 72 h after exercise when wearing GCS (P<0.05)>
This list of refs is not complete, but it is largely indicative of results. Now, while some companies sell whole body compression suits - claiming a whole host of performance benefits, to my knowledge whole suits have not been tested on DOMS, but there does seem to be attenuation with compression.

DOMS pain reduction with Vibration
In a very recent (this month, Sept 2009) study, looking only at perceived pain measures, it seems that vibration plates may have considerable effect at reducing DOMS.
J Strength Cond Res. 2009 Sep;23(6):1677-82.Click here to read Links
Effect of iTonic whole-body vibration on delayed-onset muscle soreness among untrained individuals.
Rhea MR, Bunker D, Marín PJ, Lunt K.

A.T. Still University, Mesa, Arizona, 85206, USA.

Attempts to reduce or eliminate delayed-onset of muscle soreness are important as this condition is painful and debilitating. The purpose of this study was to examine the effectiveness of whole-body vibration (WBV) massage and stretching exercises at reducing perceived pain among untrained men. Sixteen adult men (age, 36.6 +/- 2.1 yr) volunteered to perform a strenuous exercise session consisting of resistance training and repeated sprints. Subjects were randomly assigned to 1 of 2 recovery groups: a group performing WBV stretching sessions or a stretching group performing static stretching without vibration. Both groups performed similar stretches, twice per day for 3 days after the workout. The vibration group performed their stretches on the iTonic platform (frequency, 35 Hz; amplitude, 2 mm). Perceived pain was measured at 12, 24, 48, and 72 hours postworkout. Statistical analyses identified a significantly lower level of reported perceived pain at all postworkout measurement times among the WBV group.
Intriguingly use of EMT (rapid pulsed contraction of muscles) has not had success in treating DOMS but this shaking does. The authors hypothesize that the reason for the effect may be enhanced local blood flow to move waste products out of the muscles faster.

Another intriguing hypothesis is around proprioception: the vibration is causing interneurons to turn down pain signaling. So perhaps an increased pain threshold is happening. Does this mean that the pain reduction is faked? and that the other usual crap around DOMS is still occurring, we just don't feel it? Is that a good idea? Unfortunately the authors do not look at the other markers of DOMS to see what effect is had on them.

DOMS Deminishment- just add water?

The above findings lead us to see that there are some strategies that actually do seem to help with DOMS. But when assessing these treatments, it seems we usually have to make a choice about the effects of care. Massage may reduce some insignificant degree of pain, but not benefit performance in terms of ROM or power generation. Well, there's been some consideration of contrast water therapy for benefiting performance.

J Strength Cond Res. 2007 Aug;21(3):697-702.Links
The effect of contrast water therapy on symptoms of delayed onset muscle soreness.
Vaile JM, Gill ND, Blazevich AJ.

Department of Physiology, Australian Institute of Sport, Canberra, Australia.

This study examined the effect of contrast water therapy (CWT) on the physiological and functional symptoms of delayed onset muscle soreness (DOMS) following DOMS-inducing leg press exercise. Thirteen recreational athletes performed 2 experimental trials separated by 6 weeks in a randomized crossover design. On each occasion, subjects performed a DOMS-inducing leg press protocol consisting of 5 x 10 eccentric contractions (180 seconds recovery between sets) at 140% of 1 repetition maximum (1RM). This was followed by a 15-minute recovery period incorporating either CWT or no intervention, passive recovery (PAS). Creatine kinase concentration (CK), perceived pain, thigh volume, isometric squat strength, and weighted jump squat performance were measured prior to the eccentric exercise, immediately post recovery, and 24, 48, and 72 hours post recovery. Isometric force production was not reduced below baseline measures throughout the 72-hour data collection period following CWT ( approximately 4-10%). However, following PAS, isometric force production (mean +/- SD) was 14.8 +/- 11.4% below baseline immediately post recovery (p < size =" 0.76)."> 0.01) differences in perceived pain between treatments. Contrast water therapy was associated with a smaller reduction, and faster restoration, of strength and power measured by isometric force and jump squat production following DOMS-inducing leg press exercise when compared to PAS. Therefore, CWT seems to be effective in reducing and improving the recovery of functional deficiencies that result from DOMS, as opposed to passive recovery.
Just to be clear on what CWT means here the authors write:
where subjects immersed their lower body to the level of the anterior superior iliac spine alternately between 2 baths—immersion for 60 seconds in cold water (8–10 degrees C) followed immediately by immersion for 120 sec- onds in hot water (40–42 degrees C); subjects alternated between the 2 baths for a total of 15 minutes.
As the authors suggest for practical applications (a nice feature of JSC articles)
The present results indicate that CWT can significantly reduce swelling. It is hypothesized that CWT The findings of this study indicate that strength, power, and symptoms of DOMS are improved following CWT compared to passive recovery. These improvements in the recovery profile support CWT as a practical and low-cost recovery strategy. Therefore, CWT appears to be a recovery strategy that could easily be adopted and integrated into athletes’ recovery programs.
The authors are also reasonably cautious about their results:
The results of the present study are the first to provide positive scientific support for the practice of CWT. While CWT has been acknowledged in sports medicine as a recovery strategy for the treatment of postacute soft- tissue injury (21), there is an apparent lack of knowledge surrounding its use as a recovery strategy to alleviate muscle soreness and enhance the recovery of various physiological factors. Although the results of the present study support the use of CWT, further research into its use is required to develop knowledge and information in the area of this recovery strategy, with an emphasis on gaining understanding into the possible physiological mechanisms of CWT. Given that the CWT protocol used in the present study was successful in minimizing force loss and promoting recovery, it could be used as a template for future studies. Despite its positive affect on muscle force generation, the long-term effects of CWT are not known. Some caution should therefore be exercised with its prolonged use until its effects on long-term muscle adaptation are fully understood.
In other words, CWT seems to have an effect in reducing non-pain symptoms of DOMS to get athletes up to force and speed faster than without it, but we don't know exactly why or how it's working. We don't want to be damaging anything, so let's keep looking at this phenomenon.

In 2008, as if hearing these cautiously optimistic ideas, another study investigates multiple types of temperature immersion:
Eur J Appl Physiol. 2008 Mar;102(4):447-55. Epub 2007 Nov 3.
Erratum in: Eur J Appl Physiol. 2008 May;103(1):121-2.

Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness.
Vaile J, Halson S, Gill N, Dawson B.

Department of Physiology, Australian Institute of Sport, PO Box 176, Belconnen, ACT, Australia.

This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced.
The happy thing is that there seem to be some benefits from all sorts of immersions: just hot, contrast and just cold. The main difference is that contrast water therapy had the best effect on all markers when checked at 24, 48 and 72 hours. Cold water only kicks in with force recovery at 48 hours. Now my personal pref, hot water, is shown to improve isometric force - that's good. But apparently that's it. Weighted squat jump, perceived pain, thigh girths and blood variables didn't change. Best on all markers though is the protocol hit upon by the 2007 study: contrast water immersion: going from short cold to longer hot, back and forth.

SO we have several modalities - vibration, if you have access to a plate, compression (with gear on ) and contrast bathing (with all gear off) that seem from repeated studies to have benefits. Of these three compression and contrast bathing have been studied most, with the most consistent results. So just for the sake of full disclosure, there's one study that says they both suck:
Med Sci Sports Exerc. 2008 Jul;40(7):1297-306.

The effects of contrast bathing and compression therapy on muscular performance.

English Institute of Sport, North East Region, Gateshead International Stadium, Gateshead, Tyne and Wear, UNITED KINGDOM.

Contrast bathing (CB) and compression garments (CG) are widely used to promote recovery. PURPOSE: To evaluate CB and CG as regeneration strategies after exercise-induced muscle damage (EIMD). METHODS: Baseline values of muscle soreness, serum creatine kinase (CK) and myoglobin (Mb), joint range of motion, limb girth, 10- or 30-m sprint, countermovement jump (CMJ), and five repetition maximum squat were completed by 26 young men who then undertook a resistance exercise challenge (REC) to induce EIMD: 6 x 10 parallel squats at 100% body weight with 5-s one repetition maximum eccentric squat superimposed onto each set. After the REC, subjects were separated into three intervention groups: CB, CG, and control (CONT). Forty-eight hours after REC, the subjects exercise performance was reassessed. CK and Mb were also measured +1, +24, and +48 h post-REC. RESULTS: CK was elevated at +24 h ( upward arrow140%; upward arrow161%; upward arrow270%), and Mb was elevated at +1 h ( upward arrow523%; upward arrow458%; upward arrow682%) in CB, CG, and CONT. Within-group large effect sizes for loge[CK] were found for CB at +24 h (0.80) and +48 h (0.84). Area under the [Mb] curve was lower in CB compared with CG and CONT (P < or =" 0.05).">

Since this finding seems to be so at odds with the rest of the literature i leave it for individual inspection and consideration.

DOMS reduction sans gear: DO MORE WORK

Is there any approach that may escape controversy? and also be a little less tool-dependent? Is there a more natural way to fight DOMS as it were?

Some of us at the gym may have tried swapping between hot and cold showers to attempt to replicate the effect of CWI protocols without a tub; i haven't seen any work that's formally checked this, but if you don't have a tub, and aren't keen on setting off a lot of water resources, there may be other approaches.

In 2006, concentric exercises were shown to help offset DOMS.
Appl Physiol Nutr Metab. 2006 Apr;31(2):126-34.Click here to read Links
Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise.
Zainuddin Z, Sacco P, Newton M, Nosaka K.

School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.

This study investigated the hypothesis that a bout of light concentric exercise (LCE) would alleviate delayed-onset muscle soreness (DOMS) and enhance recovery from muscle damage. Fourteen subjects performed two bouts of 60 maximal eccentric actions of the elbow flexors (Max-ECC) separated by 2-4 weeks. One arm performed LCE (600 elbow flexion and extension actions with minimal force generation) 1, 2, 3, and 4 d after Max-ECC; the contralateral (control) arm performed only Max-ECC. Changes in maximal isometric and isokinetic strength, range of motion (ROM), upper arm circumference, and muscle soreness and tenderness were assessed before and immediately after LCE bouts. Changes in these measures and plasma creatine kinase (CK) activity for 7 d after Max-ECC were compared between the control and LCE arms using 2-way repeated measures analysis of variance (ANOVA). Significant (p < style="color: rgb(102, 51, 0);">These results suggest that LCE has a temporary analgesic effect on DOMS, but no effect on recovery from muscle damage.
Ok, so concentrics help reduce pain, but don't do anything for performance. What about light eccentrics?
J Sci Med Sport. 2008 Jun;11(3):291-8. Epub 2007 Aug 17.Click here to read Links
A light load eccentric exercise confers protection against a subsequent bout of more demanding eccentric exercise.
Lavender AP, Nosaka K.

Graduate School of Integrated Science, Yokohama City University, Yokohama, Japan.

This study investigated the hypothesis that a light eccentric exercise (ECC) that does not induce a loss of muscle function and delayed onset muscle soreness would confer a protective effect against a more strenuous ECC. Eighteen young men were randomly placed into two groups: 10-40% (n=9) and 40% (n=9). Subjects in the 10-40% group performed ECC of the elbow flexors (six sets of five reps) using a dumbbell set at 10% of maximal isometric strength (MVC) at an elbow joint angle of 90 degrees , followed 2 days later by ECC using a dumbbell weight of 40% MVC. Subjects in the 40% group performed the 40% ECC only. Changes in MVC, range of motion (ROM), upper arm circumference (CIR), plasma creatine kinase (CK) activity and muscle soreness before, immediately after, 1-5 and 7 days following the 40% ECC were compared between groups by a two-way repeated measures ANOVA. No significant changes in any of the criterion measures were found immediately and 1-2 days after the 10% ECC. Following the 40% ECC, the 10-40% group showed significantly (P<0.05) style="color: rgb(102, 51, 0);" style="color: rgb(102, 51, 0);">These results suggest that the 10% ECC induced some protection against a subsequent bout of 40% ECC performed 2 days later. It appears that the light eccentric exercise preconditioned the muscles for exposure to the subsequent damaging eccentric exercise bout.
These low load high volume eccentrics have also been seen as a mitigating prep against DOMS. Indeed, approaches to strength building like Kenneth Jay's Beast training protocol of alternating high volume lighter load days (a variant described here) with low volume higher load days may be just right - just remember to start with the high volume.

And just to come back to the question of the value of warm ups discussed in a previous article- here's one more benefit beyond injury prevention: Warm up - light cardio pre unfamiliar eccentric exercises (this is the walking backwards on an inclined treadmill) worked to reduce perceived soreness - but that was the only measure of DOMS, but a not bad one.
Aust J Physiother. 2007;53(2):91-5.
Warm-up reduces delayed onset muscle soreness but cool-down does not: a randomised controlled trial.
Law RY, Herbert RD.

The University of Sydney, Australia.

QUESTION: Does warm-up or cool-down (also called warm-down) reduce delayed-onset muscle soreness? DESIGN: Randomised controlled trial of factorial design with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Fifty-two healthy adults (23 men and 29 women aged 17 to 40 years). INTERVENTION: Four equally-sized groups received either warm-up and cool-down, warm-up only, cool-down only, or neither warm-up nor cool-down. All participants performed exercise to induce delayed-onset muscle soreness, which involved walking backwards downhill on an inclined treadmill for 30 minutes. The warm-up and cool-down exercise involved walking forwards uphill on an inclined treadmill for 10 minutes. OUTCOME MEASURE: Muscle soreness, measured on a 100-mm visual analogue scale. RESULTS: Warm-up reduced perceived muscle soreness 48 hours after exercise on the visual analogue scale (mean effect of 13 mm, 95% CI 2 to 24 mm). However cool-down had no apparent effect (mean effect of 0 mm, 95% CI -11 to 11 mm). CONCLUSION: Warm-up performed immediately prior to unaccustomed eccentric exercise produces small reductions in delayed-onset muscle soreness but cool-down performed after exercise does not.
Note the paper only measures perceived soreness rather than looking at performance factors.

My favorite study so far in this space looks at where no other study has dared to go: the complete elimination of DOMS. Give oneself four weeks, and the participant will build in a DOMS eradicator, it seems. Bold claims.
J Strength Cond Res. 2008 Jan;22(1):212-25.
Elimination of delayed-onset muscle soreness by pre-resistance cardioacceleration before each set.
Davis WJ, Wood DT, Andrews RG, Elkind LM, Davis WB.

Division of Physical and Biological Sciences, University of California at Santa Cruz, Santa Cruz, California, USA.

We compared delayed-onset muscle soreness (DOMS) induced by anaerobic resistance exercises with and without aerobic cardioacceleration before each set, under the rationale that elevated heart rate (HR) may increase blood perfusion in muscles to limit eccentric contraction damage and/or speed muscle recovery. In two identical experiments (20 men, 28 women), well-conditioned athletes paired by similar physical condition were assigned randomly to experimental or control groups. HR (independent variable) was recorded with HR monitors. DOMS (dependent variable) was self-reported using Borg's Rating of Perceived Pain scale. After identical pre-training strength testing, mean DOMS in the experimental and control groups was indistinguishable (P > or = 0.19) for musculature employed in eight resistance exercises in both genders, validating the dependent variable. Subjects then trained three times per week for 9 (men) to 11 (women) weeks in a progressive, whole-body, concurrent training protocol. Before each set of resistance exercises, experimental subjects cardioaccelerated briefly (mean HR during resistance training, 63.7% HR reserve), whereas control subjects rested briefly (mean HR, 33.5% HR reserve). Mean DOMS among all muscle groups and workouts was discernibly less in experimental than control groups in men (P = 0.0000019) and women (P = 0.0007); less for each muscle group used in nine resistance exercises in both genders, discernible (P > 0.025) in 15 of 18 comparisons; and less in every workout, discernible (P > 0.05) in 32% (men) and 55% (women) of workouts. Most effect sizes were moderate. In both genders, mean DOMS per workout disappeared by the fourth week of training in experimental but not control groups. Aerobic cardioacceleration immediately before each set of resistance exercises therefore rapidly eliminates DOMS during vigorous progressive resistance training in athletes.

It's important to clarify the protocol: get the heart rate up before each resistance set.

Effectively, the main hypothesis of this study is that keeping an elevated heart rate throughout a workout helps reduce then eliminate DOMS. Heart rate varied between 60-84% HRR - by contrast the control group heart rate was at 20-39% HRR.

The authors suggest a two part explanation for why their protocol has such a powerful effect. In the first phase (4 weeks) of adaptation, the higher heart rate increases perfusion, getting up lactate and nutrient movement to and from the muscles, clearing out waste.
In this first stage, therefore, the increased muscle perfusion induced by pre-resistance cardioacceleration retards cellular destruction induced by eccentric contraction and/or accelerates tissue repair, limiting muscle inflammation and therefore reducing DOMS in the first few workouts.
In the second stage, post 4 weeks when the DOMS is eliminated, basically the same effects being built in phase one are in phase two established and fully operational: an expanding peripheral vascular bed is established with better capilarization meaning that repair can happen more effectively to the muscles.

In discussing this protocol with colleagues when it came out, some were concerned that doing the extra cardio would negatively impact strength work. In anticipation of just this concern, the authors ran a great follow up study to show that quite the opposite was the case. In other words, not only does this protocol sweep away DOMS, it also improves strength work. THat article is discussed in detail in Does Cardio Interfere with Strength Training: How 'bout No?

Now i'd be happy to end here with the best recommendations being that while CWI is grand it's not generally available, and so, for both the benefits of eliminating DOMS and improving strength work, the Santa Cruz group approach is optimal. But there are just a few more things to consider for improving/lessening one's DOMS experience.

DOMS: Got Milk? What about Protease or BCAAs?

In 2007, a study looked at the effect of protease used for DOMS. Now protease is most often found as an enzyme added to proteins like whey to assist in their digestion. We know that muscles use amino acids from proteins to repair muscles, so it makes sense, rather that if these enzymes are present to optimize proteins' digestion so more amino acids area available, that sounds like a good thing. But then so did having more vitamin c - and it wasn't. Protease, however, looks pretty good.

J Strength Cond Res. 2007 Aug;21(3):661-7.Links
Effects of a protease supplement on eccentric exercise-induced markers of delayed-onset muscle soreness and muscle damage.
Beck TW, Housh TJ, Johnson GO, Schmidt RJ, Housh DJ, Coburn JW, Malek MH, Mielke M.

Department of Nutrition and Health Sciences, Human Performance Laboratory University of Nebraska-Lincoln, Lincoln, Nebraska 68583, USA.

This investigation examined the effects of a protease supplement on selected markers of muscle damage and delayed-onset muscle soreness (DOMS). The study used a double-blinded, placebo-controlled, crossover design. Twenty men (mean +/- SD age = 21.0 +/- 3.1 years) were randomly assigned to either a supplement group (SUPP) or a placebo group (PLAC). All subjects were tested for unilateral isometric forearm flexion strength, hanging joint angle, relaxed arm circumference, subjective pain rating, and plasma creatine kinase activity and myoglobin concentration. The testing occurred before (TIME1), immediately after (TIME2), and 24 (TIME3), 48 (TIME4), and 72 (TIME5) hours after a bout of eccentric exercise. During these tests, the subjects in the SUPP group ingested a protease supplement. The subjects in the PLAC group took microcrystalline cellulose. After testing at TIME5 and 2 weeks of rest, the subjects were crossed over into the opposite group and performed the same tests as during visits 1-5, but with the opposite limb. Overall, isometric forearm flexion strength was greater (7.6%) for the SUPP group than for the PLAC group, despite nearly identical (difference = 0.14 N.m, p = 0.940) mean strength values before (TIME1) the eccentric exercise protocol. There were no between-group differences for hanging joint angle, relaxed arm circumference, subjective pain ratings, and plasma creatine kinase activity and myoglobin concentration from TIME1 to TIME5. These findings provided initial evidence that the protease supplement may be useful for reducing strength loss immediately after eccentric exercise and for aiding in short-term strength recovery. The protease supplement had no effect, however, on the perception of pain associated with DOMS or the blood markers of muscle damage.
So what seems to be happening is that there's an effect of protease associated with better muscle strength - reducing strength loss right after exercise - but so far that's it. Pain is still there. Go get in a cold tub.

Going a step further, it seems that pumping up the volume of milk after those eccentrics can actually accelerate muscle repair and get performance back faster than without it. Here, the authors claim that (unlike protease alone) that those important blood markers like CK and myoglobin are also better off from a dose of milk. As far as i know no one has gone head to head between CWI and Milk for increasing repair rate and decreasing DOMS, but again, if those immersion tanks aren't there, and you haven't been cardio'ing for the 4 weeks yet. This may be yet one more reason to value milk as a recovery drink. Milk offers no help for soreness however. Alas.
Appl Physiol Nutr Metab. 2008 Aug;33(4):775-83.Click here to read Links
Acute milk-based protein-CHO supplementation attenuates exercise-induced muscle damage.
Cockburn E, Hayes PR, French DN, Stevenson E, St Clair Gibson A.

Division of Sports Sciences, Northumbria University, Newcastle, UK.

Exercise-induced muscle damage (EIMD) leads to the degradation of protein structures within the muscle. This may subsequently lead to decrements in muscle performance and increases in intramuscular enzymes and delayed-onset muscle soreness (DOMS). Milk, which provides protein and carbohydrate (CHO), may lead to the attenuation of protein degradation and (or) an increase in protein synthesis that would limit the consequential effects of EIMD. This study examined the effects of acute milk and milk-based protein-CHO (CHO-P) supplementation on attenuating EIMD. Four independent groups of 6 healthy males consumed water (CON), CHO sports drink, milk-based CHO-P or milk (M), post EIMD. DOMS, isokinetic muscle performance, creatine kinase (CK), and myoglobin (Mb) were assessed immediately before and 24 and 48 h after EIMD. DOMS was not significantly different (p > 0.05) between groups at any time point. Peak torque (dominant) was significantly higher(p <>

And one more: BCAA's may be good in that they simply help reduce muscle damage, something the authors assert leads to DOMS. The authors do not claim however that BCAA's reduce DOMS, but that they sure do lots of good things related to this.

J Sports Med Phys Fitness. 2008 Sep;48(3):347-51.Links
Branched-chain amino acid supplementation does not enhance athletic performance but affects muscle recovery and the immune system.
Negro M, Giardina S, Marzani B, Marzatico F.

Pharmacobiochemistry Laboratory, Section of Pharmacology and Pharmacological Biotechnology, Department of Cellular and Molecular, Physiological and Pharmacological Sciences, University of Pavia, Pavia, Italy.

Since the 1980's there has been high interest in branched-chain amino acids (BCAA) by sports nutrition scientists. The metabolism of BCAA is involved in some specific biochemical muscle processes and many studies have been carried out to understand whether sports performance can be enhanced by a BCAA supplementation. However, many of these researches have failed to confirm this hypothesis. Thus, in recent years investigators have changed their research target and focused on the effects of BCAA on the muscle protein matrix and the immune system. Data show that BCAA supplementation before and after exercise has beneficial effects for decreasing exercise-induced muscle damage and promoting muscle-protein synthesis. Muscle damage develops delayed onset muscle soreness: a syndrome that occurs 24-48 h after intensive physical activity that can inhibit athletic performance. Other recent works indicate that BCAA supplementation recovers peripheral blood mononuclear cell proliferation in response to mitogens after a long distance intense exercise, as well as plasma glutamine concentration. The BCAA also modifies the pattern of exercise-related cytokine production, leading to a diversion of the lymphocyte immune response towards a Th1 type. According to these findings, it is possible to consider the BCAA as a useful supplement for muscle recovery and immune regulation for sports events.
And just a final aside, in another galaxy that looks at occlusion training and hypertrophy, here's one study looking at occlusion (here called Blood Flow Restriction). We won't get into the why's and wherefores of occlusion training, but here's a discussion of recent research and rationals of same.

Suffice it to showing that unlike non-occluded work, BFR can elicit DOMS from concentric and eccentric work, and resting soreness is worse in the concentric case. I would just never have thought of that.
Eur J Appl Physiol. 2009 Aug 29. [Epub ahead of print]Click here to read Links
Delayed-onset muscle soreness induced by low-load blood flow-restricted exercise.
Umbel JD, Hoffman RL, Dearth DJ, Chleboun GS, Manini TM, Clark BC.

Institute for Neuromusculoskeletal Research, Ohio University, Athens, OH, USA.

We performed two experiments to describe the magnitude of delayed-onset muscle soreness (DOMS) associated with blood flow restriction (BFR) exercise and to determine the contribution of the concentric (CON) versus eccentric (ECC) actions of BFR exercise on DOMS. In experiment 1, nine subjects performed three sets of unilateral knee extension BFR exercise at 35% of maximal voluntary contraction (MVC) to failure with a thigh cuff inflated 30% above brachial systolic pressure. Subjects repeated the protocol with the contralateral limb without flow restriction. Resting soreness (0-10 scale) and algometry (pain-pressure threshold; PPT) were assessed before and 24, 48 and 96 h post-exercise. Additionally, MVC and vastus lateralis cross-sectional area (CSA) were measured as indices of exercise-induced muscle damage. At 24-h post-exercise, BFR exercise resulted in more soreness than exercise without BFR (2.8 +/- 0.3 vs 1.7 +/- 0.5) and greater reductions in PPT (15.2 +/- 1.7 vs. 20 +/- 2.3 N) and MVC (14.1 +/- 2.5% decrease vs. 1.5 +/- 4.5% decrease) (p <= 0.05). In experiment 2, 15 different subjects performed three sets of unilateral BFR exercise at 35% MVC with one limb performing only the CON action and the contralateral performing the ECC action. The aforementioned indices of DOMS were assessed before exercise and 24, 48 and 96 h post-exercise. At 24 h post-exercise, CON BFR exercise resulted in more resting soreness than ECC BFR exercise (3.0 +/- 0.5 vs. 1.6 +/- 0.4), and a greater decrease in MVC (9.8 +/- 2.7% decrease vs. 3.4 +/- 2.5% decrease) (p <=0.05). These data suggest that knee extension BFR exercise induces mild DOMS and that BFR exercise elicits muscle damage under atypical conditions with low-tension concentric contractions.
So while BFR can have real benefits for training and for rehab in certain populations, it seems it can also get a person both coming and going with DOMS. Add that to your thoughts next time you want to squat with a tourniquet around your thighs. That said, most occlusion training is in the low load low volume region, so hmm.

Summary: Avoiding, Reducing, Eliminating DOMS

We've seen that there's more going on in DOMS than simply sore muscles. Reduced ROM, limb swelling, reduced power output and various internal effects on CK and myoglobin to name two are all triggered - in ways that fatigue alone for instance does not induce.

As for dealing with DOMS effects, when luxury affords, jumping between cold (shorter) and hot (longer. yay!) immersions is also very effective.

Passive manual therapies like acupuncture and massage seem to do nothing for DOMS but vibration plates do seem to have an effect on pain perception. Compression garments may have even greater effect.

Of all the techniques proposed, the most consistently effective, doable by anyone, DOMS reducers are active interventions, from doing light warm ups, to lighter load sets of a main eccentric movement days before, to my fave, and seemingly the most effective, doing cardio *within* a resistance workout that has that new intensity or unfamiliar level of eccentric activity to it. Doing cardio within sets (ie keeping the HR up throughout the efforts) is the only protocol to claim that within 4 weeks, DOMS can be eliminated - and strength improvements increased concurrently.

So if you want to kill off DOMS in your resistance training work, keep your heart rate up before you lift, pull or push (between 60-84% of HRR ) and after 4 weeks of that, pending keeping up the program, DOMS will be a memory and something you have to commiserate with your friends about while you escape, getting stronger while you're at it.

And possibly, if you want to amp up the recovery, throw some whey protein with protease into a glass of milk and add some BCAA's to that too, and you ought to be in a DOMS free paradise.

Happy Practicing To You

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derek said...

mc--really like these research blasts and your commentary. thanks for wading through this for the rest of us without the inclination to learn a whole new field!

quick question: what's your sense of the value of human-powered vibration drills (like Scott Sonnon's RESET protocols) in place of the vibration plates? Many on the RMAX forums have sung the praises of these for HR recovery, but on the RMAX forums they seem to attribute DOMS attenuation with daily joint mobility drills. Thoughts?

dr. m.c. said...

derek thank you

i'd love to see some research that shows joint work/ROM stuff has an effect on DOMS. IT's hard to tell from testimony on sites because there's so much else that could be going on in the workouts to attenuate doms already - familiarity, heart rate, ramping into a move, milk (?) etc

One of the hypothesizes in the vibration plate article is that the frequency of the vibration is really critical. Not sure if human generated rates are anywhere near that.

One way to do a test would be to get some willing folks on treadmills all at the same inclination and all walking backwards at the same speed.

At the end of it some folks do nothing; other folks do a specific protocol of joint mobilizations.

test at 12, 24, 48, 72 hours with the blood work, swelling, etc.

I personally have not found that joint mobility eliminates or particularly attenuates DOMS and i'm pretty religious about doing it before and within, with some work after, but maybe the key part is doing it afterwards?

RIght now i'm doing the Keep the heart rate up during the RTK protocol. We'll see what four weeks does - thought the workouts themselves are not super DOMS inducing :)

let me know what you find.
thanks for your comments.


Unknown said...

Strictly anecdotal here, but I have found that contrast showers straight after a work out seem to prevent doms big time, also with regards to mobility exercises I find that various relaxed arm and leg swings seem to work the best as they encourage relaxation and blood flow to the appendages, whereas single joint isolational type mobility not as much


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