Showing posts with label delayed onset muscle soreness. Show all posts
Showing posts with label delayed onset muscle soreness. Show all posts
Sunday, September 20, 2009
DOMS Part 2 - what works to reduce/eliminate delayed onset muscle soreness:
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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.
B2D buddie Mike T. Nelson of extremehumanperformance.com 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:
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:
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.
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.
In 2008, as if hearing these cautiously optimistic ideas, another study investigates multiple types of temperature immersion:
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:
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.
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.
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.
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 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.
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.
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.
B2D buddie Mike T. Nelson of extremehumanperformance.com 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?)
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.In 2006, another study seemed to reinforce these findings
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. wkraemer@bsu.edu
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.
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 repairWhat 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 LinksIntriguingly 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.
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. mrhea@atsu.edu
Attempts to reduce or eliminate delayed-onset of muscle soreness are important asthis 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.
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.Just to be clear on what CWT means here the authors write:
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.
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.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.
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. jo.vaile@ausport.gov.au
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.
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. duncan.french@eis2win.co.uk
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).">
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 LinksOk, so concentrics help reduce pain, but don't do anything for performance. What about light eccentrics?
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.
J Sci Med Sport. 2008 Jun;11(3):291-8. Epub 2007 Aug 17.Click here to read LinksThese 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.
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.
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.Note the paper only measures perceived soreness rather than looking at performance factors.
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.
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. jackson@MiracleWorkout.com
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.LinksSo 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.
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. tbeck@unlserve.unl.edu
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.
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 LinksTweet Follow @begin2dig
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. e.cockburn@unn.ac.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.LinksAnd 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.
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.
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 LinksSo 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.
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.
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
Related Posts
- Delayed Onset Muscle Soreness (Part 1): What Is It and What Doesn't Work to reduce, attenuate or eliminate it
- Occlusion training: how to and why you might try it
- Does Cardio Interfere with Strength Training: How 'Bout No
- Lots more Perfusion: Review of Viking Warrior Conditioning
- What's a warm up and why do one?
- protein blends (with protease) for vegan and omnivore alike
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DOMS Part 1: What is Delayed Onset Muscle Soreness (DOMS) and what doesn't work to reduce/eliminate it
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Ever get sore a day or two after a workout? Muscle pain, muscle soreness or muscle stiffness that is felt 12-48 hours after exercise is usually known as Delayed Onset Muscle Soreness or DOMS. The tell tale signs of DOMS are sore muscles, unable to move such muscles in normal range of motion, reduced strength in those limbs. It usually happens after trying out a new workout or doing new type of physical activity, or if the intensity of 
a familiar activity goes up up.
Exactly what's happening in DOMS that creates the soreness and related effects is still speculation, but regardless of cause what might reduce or eliminate its effects has been studied from multiple approaches. This article has two parts (1) what it is and what doesn't work to reduce doms (this article); (2) what actually does seem to work to reduce or eliminate doms.
In part 1, this one, there's a summary about what is known about it. We then looks at what seems not to work at all, what actually makes DOMS worse. In Part II we look at what seems to mitigate its effects on performance but not pain, or vice versa, and what may actually really eliminate it from occurring (that part is very hair of the dog). If you'd just like the program of what works, skip to Part II, Summary, right now because a lot of suggestions on the rest of the web (like cool down or stretch after exercise) are just wrong. Knowing what doesn't work - since all the proposals are so sensible, but so useless, is interesting too.
So next time you're in a shower room argument about be sure to cool down and stretch it out or have a hot shower or get a massage, take an aspirin or vitamin c, you'll be able to say bollocks, as you are able to move freely two days after that intense training session while your peers are hobbling.
DOMS Review of the Known
DOMS is brought on by
In normal circumstances, eccentric muscle work that is either at a new intensity level or is a new eccentric-loaded movement brings on DOMS. In some studies, for instance, DOMS has been successfully induced by backwards walking down an 13 degree inclined treadmill.
DOMS effects
The most obvious effects of DOMS are that they occur 12-48 hours after the activity; DOMS hurts with the consequent effect being a decreased range of motion, increased size from swelling, and less power to work in the effected muscles. The effected muscles are most often the big leg muscles and to lesser degree, calves, but DOMS is not restricted to the lower body.
Beneath the manifested physical effects are the physiological ones that are less clear: changes in creatine kinase for instance, amount of inflammation, degree of muscle fiber damage. Whether or not an intervention mitigates the effects of DOMS is usually measured by perceived soreness, but also less subjective range of motion and force production. In some cases the physiological markers like CK levels pre and post are also checked. In some cases we'll see that treatments can decrease the DOMS effect on ROM and power, but do nothing to eliminate the duration/intensity of the pain.
DOMS physiological causes
This section is based on a great overview by sports fitness advisor of research from the 70's up to about 2006, the authors show that by about the mid-80's any thoughts that lactic acid buildup in the muscles was the cause of DOMS was put to rest. Likewise in the 80's and early 90's the main theories that seem to be still active are DOMS is either muscle cell damage (ruptured cells spilling contents into muscle fibers), muscle fiber damage, where the repair process at sensitive nerve endings is the pain signal, or an inflammatory (Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc. 1995 Jul;27(7):1022-32) response. The latter suggests that the 48 hour period when DOMS hits is the peak time for cell death (Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529-38).
In other words no one knows the exact mechanism for DOMS - a review of the literature i've done to 2009 suggests this is still the case.
I cannot find the reference, alas, but my favorite hypothesis to date has been that the pain is actually the building up of the new muscle fiber material where other fibers are getting pushed out of the way as new tissue comes in. If anyone knows of the reference, please let me know.
DOMS - unpredictable degree of effect
What we do know at this point is that, as of March 2009, we don't have the appropriate scales to predict "Onset, intensity, and duration of DOMS" in 87% of a tested population. SO we can bring it on, but we don't know exactly how it's going to effect participants.
While we can't yet predict how long and how intense DOMS will be, we know alot more about where it actually acts in the muscluature: the bits further away from the center of the body - the distal ends of the muscles.
In 2003, nothing that had been tried really worked - and i've found a few studies recently that show we can make it worse. And while the review abstract says that NSAIDS (ibuprofen, etc) and antioxidants have potential, that hope has been fleeting. Antioxidants like Vit C have not been shown in clinical trials to work (Close GL, Ashton T, Cable T, Doran D, Holloway C, McArdle F, MacLaren DP. Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process. Br J Nutr. 2006 May;95(5):976-81). Likewise, NSAIDS have been shot down again:
Even while asking that question, the authors suggest there's no reason to think that what we know doesn't work in non-elite athletic populations will work in elite athletes. Really the questions these researchers want to know about are physiological effects: any way to say how much longer before elite athletes can get back to optimal work post DOMS?
Making DOMS worse? You betcha
Despite the warning above, researchers have indeed found a couple ways to indeed make the pain of DOMS worse: we can make it hurt more - in 2005 with hyperbaric chambers:
In the realm of what doesn't help, it's intriguing to see how frequently massage of various kinds has been investigated. Sufficiently so that one might be able to say that it doesn't help. In 2005, for instance, one article claimed success for massage by saying that range of motion and perceived tenderness, as well as CK levels were all better in the massage group. It's always nice to be less sore. But what did not occur was any impact on recovery of ROM or muscle strength.
Really? Let's try that again, and not to put too fine a point on the null effect:
In Part II we'll consider what does work. There is hope. There is technology, but especially, there is Heart (Rate).
Citations:
CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
Hedayatpour, N., Falla, D., Arendt-Nielsen, L., & Farina, D. (2010). Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction Scandinavian Journal of Medicine & Science in Sports, 20 (1), 145-153 DOI: 10.1111/j.1600-0838.2008.00866.x
Connolly DA, Sayers SP, & McHugh MP (2003). Treatment and prevention of delayed onset muscle soreness. Journal of strength and conditioning research / National Strength & Conditioning Association, 17 (1), 197-208 PMID: 12580677
McAnulty, S., McAnulty, L., Nieman, D., Morrow, J., Dumke, C., & Henson, D. (2007). Effect of NSAID on Muscle Injury and Oxidative Stress International Journal of Sports Medicine, 28 (11), 909-915 DOI: 10.1055/s-2007-964966
Cheung K, Hume P, & Maxwell L (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports medicine (Auckland, N.Z.), 33 (2), 145-64 PMID: 12617692
Barnett A (2006). Using recovery modalities between training sessions in elite athletes: does it help? Sports medicine (Auckland, N.Z.), 36 (9), 781-96 PMID: 16937953
COUDREUSE, J. (2004). Douleurs musculaires posteffort Annales de R�adaptation et de M�decine Physique, 47 (6), 290-298 DOI: 10.1016/j.annrmp.2004.05.012
Bennett M, Best TM, Babul S, Taunton J, & Lepawsky M (2005). Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane database of systematic reviews (Online) (4) PMID: 16235376
Micklewright D (2009). The effect of soft tissue release on delayed onset muscle soreness: a pilot study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 10 (1), 19-24 PMID: 19218075
Zainuddin Z, Newton M, Sacco P, & Nosaka K (2005). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of athletic training, 40 (3), 174-80 PMID: 16284637
Herbert RD, & de Noronha M (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane database of systematic reviews (Online) (4) PMID: 17943822
Barlas, P., Robinson, J., Allen, J., & Baxter, G. (2000). Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness Clinical Physiology, 20 (6), 449-456 DOI: 10.1046/j.1365-2281.2000.00280.x
Itoh, K., Ochi, H., & Kitakoji, H. (2008). Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) – a pragmatic trial Chinese Medicine, 3 (1) DOI: 10.1186/1749-8546-3-14
Hübscher, M., Vogt, L., Bernhörster, M., Rosenhagen, A., & Banzer, W. (2008). Effects of Acupuncture on Symptoms and Muscle Function in Delayed-Onset Muscle Soreness The Journal of Alternative and Complementary Medicine, 14 (8), 1011-1016 DOI: 10.1089/acm.2008.0173 Tweet Follow @begin2dig
Ever get sore a day or two after a workout? Muscle pain, muscle soreness or muscle stiffness that is felt 12-48 hours after exercise is usually known as Delayed Onset Muscle Soreness or DOMS. The tell tale signs of DOMS are sore muscles, unable to move such muscles in normal range of motion, reduced strength in those limbs. It usually happens after trying out a new workout or doing new type of physical activity, or if the intensity of a familiar activity goes up up.Exactly what's happening in DOMS that creates the soreness and related effects is still speculation, but regardless of cause what might reduce or eliminate its effects has been studied from multiple approaches. This article has two parts (1) what it is and what doesn't work to reduce doms (this article); (2) what actually does seem to work to reduce or eliminate doms.
In part 1, this one, there's a summary about what is known about it. We then looks at what seems not to work at all, what actually makes DOMS worse. In Part II we look at what seems to mitigate its effects on performance but not pain, or vice versa, and what may actually really eliminate it from occurring (that part is very hair of the dog). If you'd just like the program of what works, skip to Part II, Summary, right now because a lot of suggestions on the rest of the web (like cool down or stretch after exercise) are just wrong. Knowing what doesn't work - since all the proposals are so sensible, but so useless, is interesting too.
So next time you're in a shower room argument about be sure to cool down and stretch it out or have a hot shower or get a massage, take an aspirin or vitamin c, you'll be able to say bollocks, as you are able to move freely two days after that intense training session while your peers are hobbling.
DOMS Review of the Known
DOMS is brought on by
In normal circumstances, eccentric muscle work that is either at a new intensity level or is a new eccentric-loaded movement brings on DOMS. In some studies, for instance, DOMS has been successfully induced by backwards walking down an 13 degree inclined treadmill.
DOMS effects
The most obvious effects of DOMS are that they occur 12-48 hours after the activity; DOMS hurts with the consequent effect being a decreased range of motion, increased size from swelling, and less power to work in the effected muscles. The effected muscles are most often the big leg muscles and to lesser degree, calves, but DOMS is not restricted to the lower body.
Beneath the manifested physical effects are the physiological ones that are less clear: changes in creatine kinase for instance, amount of inflammation, degree of muscle fiber damage. Whether or not an intervention mitigates the effects of DOMS is usually measured by perceived soreness, but also less subjective range of motion and force production. In some cases the physiological markers like CK levels pre and post are also checked. In some cases we'll see that treatments can decrease the DOMS effect on ROM and power, but do nothing to eliminate the duration/intensity of the pain.
DOMS physiological causes
This section is based on a great overview by sports fitness advisor of research from the 70's up to about 2006, the authors show that by about the mid-80's any thoughts that lactic acid buildup in the muscles was the cause of DOMS was put to rest. Likewise in the 80's and early 90's the main theories that seem to be still active are DOMS is either muscle cell damage (ruptured cells spilling contents into muscle fibers), muscle fiber damage, where the repair process at sensitive nerve endings is the pain signal, or an inflammatory (Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc. 1995 Jul;27(7):1022-32) response. The latter suggests that the 48 hour period when DOMS hits is the peak time for cell death (Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529-38).
In other words no one knows the exact mechanism for DOMS - a review of the literature i've done to 2009 suggests this is still the case.
I cannot find the reference, alas, but my favorite hypothesis to date has been that the pain is actually the building up of the new muscle fiber material where other fibers are getting pushed out of the way as new tissue comes in. If anyone knows of the reference, please let me know.
DOMS - unpredictable degree of effect
What we do know at this point is that, as of March 2009, we don't have the appropriate scales to predict "Onset, intensity, and duration of DOMS" in 87% of a tested population. SO we can bring it on, but we don't know exactly how it's going to effect participants.
Clin J Pain. 2009 Mar-Apr;25(3):239-43.Characteristics of DOMS
Can muscle soreness after intensive work-related activities be predicted?
Soer R, Geertzen JH, van der Schans CP, Groothoff JW, Reneman MF.
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands. r.soer@cvr.umcg.nl
OBJECTIVES: It is currently unknown whether specific determinants are predictive for developing delayed onset muscle soreness (DOMS) after heavy work-related activities. The aim of this study was to analyze whether personal characteristics and performance measures are predictive for onset, intensity, and duration of DOMS after performing work-related activities during a Functional Capacity Evaluation in healthy participants. METHODS: Included in this study were 197 healthy participants (102 men, 95 women), all working within a broad range of professions. Five groups of predictors were tested in a multiple regression analysis model: personal variables, self-reported activity, self-reported health, perceived effort during the test, and objective outcomes of the test. Twenty-three independent variables were selected and tested with a backward regression analysis. RESULTS: The onset of DOMS could be explained for 7% by the variables: sex and the work index of the Baecke questionnaire. Variance of intensity of DOMS could be explained for 13% by the variables: age, sex, and VO2max. Variance in duration of DOMS could be explained for 8% by the variables: sex and reported emotional role limitations. Onset, intensity, and duration of DOMS remain unpredictable for 87% or more. CONCLUSIONS: The results demonstrate that the intensity and duration of self-reported DOMS can only minimally be predicted from the candidate predictors used in this study.
While we can't yet predict how long and how intense DOMS will be, we know alot more about where it actually acts in the muscluature: the bits further away from the center of the body - the distal ends of the muscles.
Med Sci Sports Exerc. 2008 Feb;40(2):326-34.Click here to read LinksIn case one is curious, DOMS is different in effect than muscular fatigue when muscular activity is viewed using a similar EMG set up to the above study. The power generated in muscle repair goes up in a fatigued muscle; it's totally nuked in a DOMS - effected muscle.
Sensory and electromyographic mapping during delayed-onset muscle soreness.
Hedayatpour N, Falla D, Arendt-Nielsen L, Farina D.
Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, Aalborg, Denmark.
PURPOSE: The aim of this human study was to apply novel topographical mapping techniques to investigate sensory and EMG manifestations of delayed-onset muscle soreness (DOMS) in multiple locations of the quadriceps. METHODS: Bipolar surface EMG signals were recorded from 11 healthy men with 15 pairs of electrodes located at 10, 20, 30, 40, and 50% of the distance from the medial, superior, and lateral border of the patella to the anterior superior iliac spine. Subjects performed sustained isometric knee extensions at 40% of the maximal force (MVC) until task failure before, 24 h, and 48 h after eccentric exercise. Pressure-pain thresholds (PPT) were assessed at the 15 locations where the EMG was recorded. RESULTS: Time to task failure was reduced after the eccentric exercise (mean +/- SD, 56.6 +/- 23 s before the eccentric exercise; 34.3 +/- 18.9 s at 24 h after exercise; and 34.3 +/- 14.4 s at 48 h after exercise). During the postexercise sustained contractions, EMG average rectified value (ARV) significantly decreased over time (P < style="color: rgb(102, 51, 0);">ONCLUSION: Novel topographical mapping of both surface EMG and PPT of the quadriceps showed site-dependent effects of eccentric exercise, probably attributable to variations in the morphological and architectural characteristics of the muscle fibers. Greater manifestations of DOMS in the distal region of the quadriceps may indicate a greater susceptibility of this region to further injury after eccentric exercise.
Scand J Med Sci Sports. 2008 Nov 3.Reducing DOMS - overview from 2003 - it's better; it's worse
Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction.
Hedayatpour N, Falla D, Arendt-Nielsen L, Farina D.
Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark.
An increase to above-baseline levels of electromyography (EMG) mean power spectral frequency (MPF) has been observed previously during muscle recovery following fatiguing contractions and has been explained by membrane hyperpolarization due to increased activation of the Na(+)-K(+) pump. It is hypothesized that this membrane mechanism is impaired by muscle fiber damage following eccentric exercise. Thus, the aim of the study was to investigate surface EMG signal characteristics during recovery from fatigue after eccentric exercise. Ten healthy subjects performed sustained isometric knee extensions at 40% of the maximal torque (MVC) until task failure before, immediately after and 24 and 48 h after eccentric exercise. Bipolar surface EMG signals were recorded from six locations over the quadriceps during the sustained isometric contraction and during 3-s long contractions at 40% MVC separated by 1-min intervals for 15 min (recovery). Before the eccentric exercise, MPF of EMG signals increased to values above baseline during recovery from the fatiguing isometric contraction (P<0.001), style="color: rgb(102, 51, 0);">In conclusion, delayed-onset muscle soreness abolished the supranormal increase in EMG MPF following recovery from fatigue.
J Strength Cond Res. 2003 Feb;17(1):197-208.Linksmore from 2003:nothing works
Treatment and prevention of delayed onset muscle soreness.
Connolly DA, Sayers SP, McHugh MP.
Human Performance Laboratory, University of Vermont, Burlington, Vermont 05401, USA. dconnoll@zoo.uvm.ed
Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.
In 2003, nothing that had been tried really worked - and i've found a few studies recently that show we can make it worse. And while the review abstract says that NSAIDS (ibuprofen, etc) and antioxidants have potential, that hope has been fleeting. Antioxidants like Vit C have not been shown in clinical trials to work (Close GL, Ashton T, Cable T, Doran D, Holloway C, McArdle F, MacLaren DP. Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process. Br J Nutr. 2006 May;95(5):976-81). Likewise, NSAIDS have been shot down again:
Int J Sports Med. 2007 Nov;28(11):909-15. Epub 2007 May 31.Click here to read LinksInrtiguingly another review in 2003 of DOMS literature seems more accurate about interpretations of the existing research at that time:
Effect of NSAID on muscle injury and oxidative stress.
McAnulty S, McAnulty L, Nieman D, Morrow J, Dumke C, Henson D.
Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC 28608, USA. mcanltysr@appstate.edu
Indirect markers of muscle damage and delayed onset muscle soreness were examined and correlated to changes in oxidative stress, plasma antioxidant potential, and use or nonuse of non-steroidal anti-inflammatory drugs in 60 ultra-marathoners following the Western States Endurance Run. Blood was collected prior to and immediately following the race and analyzed for muscle damage by creatine phosphokinase and oxidative stress by F (2)-isoprostanes, protein carbonyls, and lipid hydroperoxides and antioxidant potential by the ferric reducing ability of plasma. Subjects recorded delayed onset muscle soreness during the week following the race. Lipid hydroperoxide concentrations were unchanged, but F (2)-isoprostanes, protein carbonyls, ferric reducing ability of plasma, creatine phosphokinase, and delayed onset muscle soreness increased significantly postrace. Protein carbonyls were significantly higher postrace in nonsteroidal anti-inflammatory drug users versus nonusers.
Sports Med. 2003;33(2):145-64.In the above reference, a phase of adaptation is proposed to mitigate the effects of DOMS, while a few years on in 2006, some researchers suggest that what we know about DOMS behaviour may be biased by the population, and raises the question would the results be any different if studies were restricted to elite athlete populations?
Delayed onset muscle soreness : treatment strategies and performance factors.
Cheung K, Hume P, Maxwell L.
School of Community Health and Sports Studies, Auckland University of Technology, Auckland, New Zealand.
Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.
Even while asking that question, the authors suggest there's no reason to think that what we know doesn't work in non-elite athletic populations will work in elite athletes. Really the questions these researchers want to know about are physiological effects: any way to say how much longer before elite athletes can get back to optimal work post DOMS?
Sports Med. 2006;36(9):781-96.LinksAnd in 2004 there's a lovely caveat to say that because we are so in the dark about the cause of DOMS we should be very careful about what we give a go as it might make things worse - especially as DOMS disappears 2-10 days (!) before "complete functional recovery"
Using recovery modalities between training sessions in elite athletes: does it help?
Barnett A.
Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Brisbane, Queensland, Australia. abarnett@hku.hk
Achieving an appropriate balance between training and competition stresses and recovery is important in maximising the performance of athletes. A wide range of recovery modalities are now used as integral parts of the training programmes of elite athletes to help attain this balance. This review examined the evidence available as to the efficacy of these recovery modalities in enhancing between-training session recovery in elite athletes. Recovery modalities have largely been investigated with regard to their ability to enhance the rate of blood lactate removal following high-intensity exercise or to reduce the severity and duration of exercise-induced muscle injury and delayed onset muscle soreness (DOMS). Neither of these reflects the circumstances of between-training session recovery in elite athletes. After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between the training sessions of athletes. The majority of studies examining exercise-induced muscle injury and DOMS have used untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of elite athletes. Even without considering the above limitations, there is no substantial scientific evidence to support the use of the recovery modalities reviewed to enhance the between-training session recovery of elite athletes. Modalities reviewed were massage, active recovery, cryotherapy, contrast temperature water immersion therapy, hyperbaric oxygen therapy, nonsteroidal anti-inflammatory drugs, compression garments, stretching, electromyostimulation and combination modalities. Experimental models designed to reflect the circumstances of elite athletes are needed to further investigate the efficacy of various recovery modalities for elite athletes. Other potentially important factors associated with recovery, such as the rate of post-exercise glycogen synthesis and the role of inflammation in the recovery and adaptation process, also need to be considered in this future assessment.
Ann Readapt Med Phys. 2004 Aug;47(6):290-8.Things have certainly changed in that attenuation since 2004, but what we've also improved our knowledge around: how to make DOMS worse.
Coudreuse JM, Dupont P, Nicol C.
Service de medecine du sport, CHU Salvator, APHM, 249, boulevard Sainte-Marguerite, 13009 Marseille, France. jean-marie.coudreuse@mail.ap-hm.fr
Muscle intolerance to exercise may result from different processes. Diagnosis involves confirming first the source of pain, then potential pathological myalgia. Delayed-onset muscle soreness (DOMS), commonly referred as tiredness, occurs frequently in sport. DOMS usually develops 12-48 h after intensive and/or unusual eccentric muscle action. Symptoms usually involve the quadriceps muscle group but may also affect the hamstring and triceps surae groups. The muscles are sensitive to palpation, contraction and passive stretch. Acidosis, muscle spasm and microlesions in both connective and muscle tissues may explain the symptoms. However, inflammation appears to be the most common explanation. Interestingly, there is strong evidence that the progression of the exercise-induced muscle injury proceeds no further in the absence of inflammation. Even though unpleasant, DOMS should not be considered as an indicator of muscle damage but, rather, a sign of the regenerative process, which is well known to contribute to the increased muscle mass. DOMS can be associated with decreased proprioception and range of motion, as well as maximal force and activation. DOMS disappears 2-10 days before complete functional recovery. This painless period is ripe for additional joint injuries. Similarly, if some treatments are well known to attenuate DOMS, none has been demonstrated to accelerate either structural or functional recovery. In terms of the role of the inflammatory process, these treatments might even delay overall recovery
Making DOMS worse? You betcha
Despite the warning above, researchers have indeed found a couple ways to indeed make the pain of DOMS worse: we can make it hurt more - in 2005 with hyperbaric chambers:
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004713.Click here to read LinksWe can make it worse with soft tissue release, too (that was a surprise):
Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury.
Bennett M, Best TM, Babul S, Taunton J, Lepawsky M.
Prince of Wales Hospital, Department of Diving and Hyperbaric Medicine, Barker Street, Randwick, New South Wales 2031, Australia. m.bennett@unsw.edu.au
BACKGROUND: Soft tissue injuries (including muscle damage after unaccustomed exercise) are common and are often associated with athletic activity. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere. OBJECTIVES: To assess the benefits and harms of HBOT for treating soft tissue injury, including delayed onset muscle soreness (DOMS). SEARCH STRATEGY: We searched the following in July 2004: CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTIHM and reference lists from relevant articles. Relevant journals were handsearched and researchers in the field contacted. SELECTION CRITERIA: Randomised trials comparing the effect on closed soft tissue injury (including DOMS) of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy). DATA COLLECTION AND ANALYSIS: Four reviewers independently evaluated study quality and extracted data. Most of the data presented in the review were extracted from graphs in the trial reports. MAIN RESULTS: Nine small trials involving 219 participants were included. Two trials compared HBOT versus sham therapy on acute closed soft tissue injuries (ankle sprain and medial collateral knee ligament injury respectively). The other seven trials examined the effect of HBOT on DOMS following eccentric exercise in unconditioned volunteers.All 32 participants of the ankle sprain trial returned to their normal activities. There were no significant differences between the two groups in time to recovery, functional outcomes, pain, or swelling. There was no difference between the two groups in knee function scores in the second acute injury trial; however, intention-to-treat analysis was not possible for this trial.Pooling of data from the seven DOMS trials showed significantly and consistently higher pain at 48 and 72 hours in the HBOT group (mean difference in pain score at 48 hours [0 to 10 worst pain] 0.88, 95% CI 0.09 to 1.67, P = 0.03) in trials where HBOT was started immediately. There were no differences between the two groups in longer-term pain scores or in any measures of swelling or muscle strength.No trial reported complications of HBOT but careful selection of participants was evident in most trials. AUTHORS' CONCLUSIONS: There was insufficient evidence from comparisons tested within randomised controlled trials to establish the effects of HBOT on ankle sprain or acute knee ligament injury, or on experimentally induced DOMS. There was some evidence that HBOT may increase interim pain in DOMS. Any future use of HBOT for these injuries would need to have been preceded by carefully conducted randomised controlled trials which have demonstrated effectiveness.
Phys Ther Sport. 2009 Feb;10(1):19-24. Epub 2008 Dec 16.LinksDOMS: what else doesn't help but doesn't make it worse.
The effect of soft tissue release on delayed onset muscle soreness: a pilot study.
Micklewright D.
Department of Biological Sciences, The University of Essex, Wivenhoe Park, Colchester, Essex CO43SQ, UK. dpmick@essex.ac.uk
OBJECTIVES: To examine soft tissue release (STR) as an intervention for delayed onset muscle soreness (DOMS). DESIGN: A mixed-subjects experimental design was used. Participants performed 4 x 20 eccentric elbow extensions at 80% of 1RM. Participants received either STR (50%) or no treatment (50%). DOMS measurements were taken before the elbow extensions and at 0, 24, and 48 h afterwards. SETTING: The study was conducted at the University of Essex exercise physiology laboratory. PARTICIPANTS: Twenty male participants, unaccustomed to strength conditioning, completed the study. MAIN OUTCOME MEASURES: DOMS was evaluated using relaxed joint angle (RJA), active range of motion (AROM), passive range of motion (PROM), and arm girth measurements. Soreness ratings were measured using a 100 mm visual analogue scale (VAS). RESULTS: In both conditions there were post-DOMS task increases in VAS ratings (p < style="color: rgb(102, 51, 0);">STR exacerbates the DOMS sensation yet does not seem to improve the rate of recovery during the first 48 h.
In the realm of what doesn't help, it's intriguing to see how frequently massage of various kinds has been investigated. Sufficiently so that one might be able to say that it doesn't help. In 2005, for instance, one article claimed success for massage by saying that range of motion and perceived tenderness, as well as CK levels were all better in the massage group. It's always nice to be less sore. But what did not occur was any impact on recovery of ROM or muscle strength.
J Athl Train. 2005 Jul-Sep;40(3):174-80.In 2007, in a survey of stretching/DOMS studies that looked at impact on soreness of massage, however, shows that the effects of stretching are very small (.5 on a 100 point scale)
Comment in:
J Athl Train. 2005 Jul-Sep;40(3):186-90.
Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.
Zainuddin Z, Newton M, Sacco P, Nosaka K.
Edith Cowan University, Joondalup, Western Australia, Australia.
CONTEXT: Delayed-onset muscle soreness (DOMS) describes muscle pain and tenderness that typically develop several hours postexercise and consist of predominantly eccentric muscle actions, especially if the exercise is unfamiliar. Although DOMS is likely a symptom of eccentric-exercise-induced muscle damage, it does not necessarily reflect muscle damage. Some prophylactic or therapeutic modalities may be effective only for alleviating DOMS, whereas others may enhance recovery of muscle function without affecting DOMS. OBJECTIVE: To test the hypothesis that massage applied after eccentric exercise would effectively alleviate DOMS without affecting muscle function. DESIGN: We used an arm-to-arm comparison model with 2 independent variables (control and massage) and 6 dependent variables (maximal isometric and isokinetic voluntary strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness). A 2-way repeated-measures analysis of variance and paired t tests were used to examine differences in changes of the dependent variable over time (before, immediately and 30 minutes after exercise, and 1, 2, 3, 4, 7, 10, and 14 days postexercise) between control and massage conditions. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten healthy subjects (5 men and 5 women) with no history of upper arm injury and no experience in resistance training. INTERVENTION(S): Subjects performed 10 sets of 6 maximal isokinetic (90 degrees x s(-1)) eccentric actions of the elbow flexors with each arm on a dynamometer, separated by 2 weeks. One arm received 10 minutes of massage 3 hours after eccentric exercise; the contralateral arm received no treatment. MAIN OUTCOME MEASURE(S): Maximal voluntary isometric and isokinetic elbow flexor strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness. RESULTS: Delayed-onset muscle soreness was significantly less for the massage condition for peak soreness in extending the elbow joint and palpating the brachioradialis muscle (P < .05). Soreness while flexing the elbow joint (P = .07) and palpating the brachialis muscle (P = .06) was also less with massage. Massage treatment had significant effects on plasma creatine kinase activity, with a significantly lower peak value at 4 days postexercise (P < .05), and upper arm circumference, with a significantly smaller increase than the control at 3 and 4 days postexercise (P < .05). However, no significant effects of massage on recovery of muscle strength and ROM were evident. CONCLUSIONS: Massage was effective in alleviating DOMS by approximately 30% and reducing swelling, but it had no effects on muscle function.
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004577.THe findings of the survey seem to be confirmed in yet another massage oriented study that shows massage may somewhat mitigate perceived soreness, but not significantly, and there is no effect on the other key markers of ROM and swelling.
Stretching to prevent or reduce muscle soreness after exercise.
Herbert RD, de Noronha M.
University of Sydney, School of Physiotherapy, PO Box 170, Lidcombe, NSW, Australia, 1825. R.Herbert@fhs.usyd.edu.au
BACKGROUND: Many people stretch before or after (or both) engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. OBJECTIVES: The aim of this review was to determine effects of stretching before or after exercise on the development of post-exercise muscle soreness. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to April 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), CINAHL (1982 to May 2006), SPORTDiscus (1949 to May 2006), PEDro (to May 2006) and reference lists of articles. SELECTION CRITERIA: Eligible studies were randomised or quasi-randomised studies of any pre-or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS), provided the stretching was conducted soon before or soon after exercise. To be eligible studies must have assessed muscle soreness or tenderness. DATA COLLECTION AND ANALYSIS: Methodological quality of the studies was assessed using the Cochrane Bone, Joint and Muscle Trauma Group's methodological quality assessment tool. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in a fixed-effect meta-analysis. MAIN RESULTS: Of the 10 included studies, nine were carried out in laboratory settings using standardised exercise protocols and one involved post-exercise stretching in footballers. All participants were young healthy adults. Three studies examined the effects of stretching before exercise and seven studies investigated the effects of stretching after exercise. Two studies, both of stretching after exercise, involved repeated stretching sessions at intervals of greater than two hours. The duration of stretching applied in a single session ranged from 40 to 600 seconds.All studies were small (between 10 and 30 participants received the stretch condition) and of questionable quality.The effects of stretching reported in individual studies were very small and there was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness one day after exercise by, on average, 0.5 points on a 100-point scale (95% CI -11.3 to 10.3; 3 studies). Post-exercise stretching reduced soreness one day after exercise by, on average, 1.0 points on a 100-point scale (95% CI -6.9 to 4.8; 4 studies). Similar effects were evident between half a day and three days after exercise. AUTHORS' CONCLUSIONS: The evidence derived from mainly laboratory-based studies of stretching indicate that muscle stretching does not reduce delayed-onset muscle soreness in young healthy adults.
Chir Narzadow Ruchu Ortop Pol. 2008 Jul-Aug;73(4):261-5.No change from any previous work on massage, not matter how frequently it's tested or from what angle it seems. And just to add some current studies to previous work, acupuncture doesn't help any factor:
[Effects of massage on delayed-onset muscle soreness]
[Article in Polish]
Bakowski P, Musielak B, Sip P, Biegański G.
Studenckie Koło Medycyny Sportowej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu. pawelbakowski@o2.pl
INTRODUCTION: Delayed onset muscle soreness (DOMS) is the pain or discomfort often felt 12 to 24 hours after exercising and subsides generally within 4 to 6 days. Once thought to be caused by lactic acid buildup, a more recent theory is that it is caused by inflammatory process or tiny tears in the muscle fibers caused by eccentric contraction, or unaccustomed training levels. Exercises that involve many eccentric contractions will result in the most severe DOMS. MATERIAL AND METHODS: Fourteen healthy men with no history of upper arm injury and no experience in resistance training were recruited. The mean age, height, and mass of the subjects were 22.8 +/- 1.2 years, 178.3 +/- 10.3 cm, and 75.0 +/- 14.2 kg, respectively. Subjects performed 8 sets of concentric and eccentric actions of the elbow flexors with each arm according to Stay protocol. One arm received 10 minutes of massage 30 minutes after exercise, the contralateral arm received no treatment. Measurements were taken at 9 assessment times: pre-exercise and postexercise at 10 min, 6, 12, 24, 36, 48, 72 and 96 hours. Dependent variables were range of motion, perceived soreness and upper arm circumference. RESULTS: There was noticed difference in perceived soreness across time between groups. The analysis indicated that massage resulted in a 10% to 20% decrease in the severity of soreness, but the differences were not significant. Difference in range of motion and arm circumference was not observed. CONCLUSIONS: Massage administered 30 minutes after exercises could have a beneficial influence on DOMS but without influence on muscle swelling and range of motion.
Clin Physiol. 2000 Nov;20(6):449-56.While the 2000 study seems to come up with a big fat zero, in 2008, two groups showed some relieve from DOMS pain associated with acupuncture. The second group looked at other DOMS factors like muscle force and confirmed earlier work: no effect.
Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness.
Barlas P, Robinson J, Allen J, Baxter GD.
Physiotherapy Subject Group, School of Health and Social Sciences, Coventry University, UK.
The effect of acupuncture upon experimentally induced delayed onset muscle soreness (DOMS) was assessed in a placebo-controlled study under blinded conditions. Volunteers (n = 48; 24 M & 24 F) were randomly allocated to one of four groups: control (20 min rest), placebo (minimal needling at non-acupuncture points), treatment group 1 (acupuncture at classic acupuncture points) and treatment group 2 (acupuncture at 'tender' points). DOMS was induced in the elbow flexors of the non-dominant arm using a standardized eccentric exercise regime. Measurements of elbow range of movement (flexion, extension, relaxed angle), and pain as well as visual analogue scores (VAS), tenderness (using a pressure algometer) were employed as indices of treatment efficacy. Measurements of elbow range of movement and tenderness were made prior to DOMS induction on the first day, and repeated pre- and post-treatment on subsequent days; pain was assessed using visual analogue scales post-induction and post-treatment on the first day, and pre- and post-treatment thereafter. For all conditions, subjects rested supine for a period of 20 min, during which treatment was delivered according to group allocation. Repeated measures and one-way analysis of variance (ANOVA) demonstrated no significant interactive (AB) effects, except for visual analogue scores (P = 0.0483); one factor ANOVA on the second day of the experiment (pre-treatment) indicated significant differences between the control and all other groups. However, such differences were not found on any other day of the experiment. It is concluded that acupuncture has little effect upon the cardinal signs and symptoms of DOMS, at least under the conditions of the current experiment.
Chin Med. 2008 Nov 25;3:14.
Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) - a pragmatic trial.
Itoh K, Ochi H, Kitakoji H.
Department of Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Hiyoshi-cho, Nantan, Kyoto 629-0392, Japan. k_itoh@meiji-u.ac.jp.
ABSTRACT: BACKGROUND: Acupuncture is used to reduce inflammation and decrease pain in delayed onset muscle soreness (DOMS). This study investigates the efficacy of acupuncture on the symptoms of DOMS. METHODS: Thirty subjects were assigned randomly to there groups, namely the control, non-tender point and tender point groups. Measurement of pain with full elbow flexion was used as indices of efficacy. Measurements were taken before and after exercise, immediately after treatment and seven days after treatment. RESULTS: Significant differences in visual analog scores for pain were found between the control group and tender point group immediately after treatment and three days after exercise
Really? Let's try that again, and not to put too fine a point on the null effect:
J Altern Complement Med. 2008 Oct;14(8):1011-6.SO That's what doesn't work: massage, stretching, acupuncture, cool downs, vitamin C or NSAIDS.
Effects of acupuncture on symptoms and muscle function in delayed-onset muscle soreness.
Hübscher M, Vogt L, Bernhörster M, Rosenhagen A, Banzer W.
Department of Sports Medicine, Goethe-University, Frankfurt/Main, Germany. m.huebscher@sport.uni-frankfurt.de
OBJECTIVE: This study was done to investigate the effects of a standardized acupuncture treatment on symptoms and muscle function in exercise-induced delayed-onset muscle soreness (DOMS). METHODS: A prospective, randomized, controlled, observer and subject-blinded trial was undertaken. Twenty-two (22) healthy subjects (22-30 years; 10 males and 12 females) were randomly assigned to three treatment groups: real acupuncture (deep needling at classic acupuncture points and tender points; n = 7), sham-acupuncture (superficial needling at nonacupuncture points; n = 8), and control (no needling; n = 7). DOMS of the nondominant elbow-flexors was experimentally induced through eccentric contractions until exhaustion. The outcome measures were pain perception (visual analogue scale; VAS; range: 0-10 cm), mechanical pain threshold (MPT; pressure algometer), and maximum isometric voluntary force (MIVF; force transducer). Treatment was applied immediately, 24 and 48 hours after DOMS induction. Measurements of MPT and MIVF were made prior to DOMS induction as well as before and after every treatment session. VAS data were acquired after DOMS induction as well as pre- and post-treatment. Final pain, MPT, and MIVF measurements were performed 72 hours after DOMS induction. RESULTS: Following nonparametric testing, there were no significant differences between groups in outcome measures at baseline. After 72 hours, pain perception (VAS) was significantly lower in the acupuncture group compared to the sham acupuncture and control subjects. However, the mean MPT and MIVF scores were not significantly different between groups. CONCLUSIONS: Although acupuncture seemed to have no effects on mechanical pain threshold and muscle function, it proved to reduce perceived pain arising from exercise-induced muscle soreness.
In Part II we'll consider what does work. There is hope. There is technology, but especially, there is Heart (Rate).
Related Posts
Citations:
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CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
Hedayatpour, N., Falla, D., Arendt-Nielsen, L., & Farina, D. (2010). Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction Scandinavian Journal of Medicine & Science in Sports, 20 (1), 145-153 DOI: 10.1111/j.1600-0838.2008.00866.x
Connolly DA, Sayers SP, & McHugh MP (2003). Treatment and prevention of delayed onset muscle soreness. Journal of strength and conditioning research / National Strength & Conditioning Association, 17 (1), 197-208 PMID: 12580677
McAnulty, S., McAnulty, L., Nieman, D., Morrow, J., Dumke, C., & Henson, D. (2007). Effect of NSAID on Muscle Injury and Oxidative Stress International Journal of Sports Medicine, 28 (11), 909-915 DOI: 10.1055/s-2007-964966
Cheung K, Hume P, & Maxwell L (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports medicine (Auckland, N.Z.), 33 (2), 145-64 PMID: 12617692
Barnett A (2006). Using recovery modalities between training sessions in elite athletes: does it help? Sports medicine (Auckland, N.Z.), 36 (9), 781-96 PMID: 16937953
COUDREUSE, J. (2004). Douleurs musculaires posteffort Annales de R�adaptation et de M�decine Physique, 47 (6), 290-298 DOI: 10.1016/j.annrmp.2004.05.012
Bennett M, Best TM, Babul S, Taunton J, & Lepawsky M (2005). Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane database of systematic reviews (Online) (4) PMID: 16235376
Micklewright D (2009). The effect of soft tissue release on delayed onset muscle soreness: a pilot study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 10 (1), 19-24 PMID: 19218075
Zainuddin Z, Newton M, Sacco P, & Nosaka K (2005). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of athletic training, 40 (3), 174-80 PMID: 16284637
Herbert RD, & de Noronha M (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane database of systematic reviews (Online) (4) PMID: 17943822
Barlas, P., Robinson, J., Allen, J., & Baxter, G. (2000). Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness Clinical Physiology, 20 (6), 449-456 DOI: 10.1046/j.1365-2281.2000.00280.x
Itoh, K., Ochi, H., & Kitakoji, H. (2008). Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) – a pragmatic trial Chinese Medicine, 3 (1) DOI: 10.1186/1749-8546-3-14
Hübscher, M., Vogt, L., Bernhörster, M., Rosenhagen, A., & Banzer, W. (2008). Effects of Acupuncture on Symptoms and Muscle Function in Delayed-Onset Muscle Soreness The Journal of Alternative and Complementary Medicine, 14 (8), 1011-1016 DOI: 10.1089/acm.2008.0173 Tweet Follow @begin2dig
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