Sunday, September 20, 2009
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:
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
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Friday, September 18, 2009
What is a Warm Up and (why) do we need one ? Research and Practice Overview
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Do you warm up before you work out? what's part of your warm up? do you know what backs up that practice? The point of this article is to look at what a warm up is in terms of performance enhancement, injury prevention and even DOMS reduction - and what it isn't, too. We'll look at what kinds of things you can do for a warm up to customize yours to your practice.
The Idea Behind the Warm Up
The main idea behind a warm up is literally to warm up
the core temperature of the body and get blood flowing to the extremities rather than focusing on the internal organs and brain as it does when we're just sitting around. The warm up alerts the muscles and tissues about new demands to be hitting other parts of the body.
Performance Benefit When warm, he muscles can contract and release faster when the body is warm, less resistance within the system when warm, so easier to do a move/less fuel taken, less taxing (movement economy). Likewise better oxygen uptake when blood is flowing, so all around better perfromance.
Warm Enough? A traditional heuristic of being ready to go is that we have broken a sweat. That the body's internal cooling mechanism has kicked in, which means when combinded with light activities pre work out, that blood is perfusing all systems - and also (in the z-health sense) that the body is better prepared to move (see threat modulation in this post).
When muscles are warmed up by blood profusion they contract and relax more readily. Likewise stretching those muscles) is easier. Any increased activity also starts a hormonal response that prepares the body to flee, which means the carbs (and fats) needed for the work ahead are getting prepped to be available.
The Warm Up as Different Activity to Main Activity
All this sounds simple enough and seems to make good sense, but there's usually an uber reason as to why we go through this systems prep. The usual rationale is: in order to prevent injury. The logic seems pretty fair: if the body is physically more ready to do work when it's been prepped, it's less likely for the demands of that work to cause harm. Hence riding a bike for ten minutes causes one to break a sweat and have the resulting body prepping benefits. The idea here is that a bike or jumping rope is a safe way to get all these systems firing.
The warm up activity is traditionally different from the actual activity about to be practiced. Why? The thinking seems to be (and i stress seems; i have no hard and fast evidence for this) that the actual activity - whether kicking a ball in a soccer game or lifting weights - is somehow riskier for the unprepared body than something as constrained as riding a stationary bike .
Stretching? How does that Warm Up the Core?
It's challenging in the literature to find discussions of warm ups that don't include stretching. In fact in some
places when we see warm up, people mean stretching. It seems this minimize risk during the warm up by doing something safe like stationary biking has lead to using static stretching as part of most warm ups. That's even slower than biking, and it's also stretching muscles which is what a warm up is supposed to help. Stretching seems to be the anti-warm up, however. How does stretching raise heart rate or get the blood circulating? How does it *warm* up the system? It doesn't, really. But it's not neutral either. Indeed some suggest that static stretching (like simply bending over and trying to touch one's toes - holding that) has been shown to have some negative effects on strength performance. And in simple muscle testing, pre and post static stretching, we usually see strength drop. Here's a recent example.
A very recent article suggests, however, there are more individual differences in response to types of warm up/stretch activities that we may have thought, but not in the actual final outcome - the vertical jump:
Unlike the study previous to these two, one uses static stretching, too. And it does not suggest that static stretching is detrimental to power outcomes; indeed nothing seems better or worse on outcomes, but that dynamic is better than static for enhancing performance. Just not necessarily hugely (to statistical significance).
We'll come back to consideration of dynamic stretching by contrast to static stretching in a moment, but for now it's important to note that static stretching as a warm up has been seen to have a negative effect on muscular strength (not what we want before lifting a heavy weight) but not on vertical jump height.
So static stretching before a physical activity does not seem to be a great idea (going from detrimental to neutral). But based on what we've said are the physiological reasons for carrying out a warm up, is "static stretching = strength reducing" the same as saying a warm up is a bad idea?
Is a warm up unnecessary or unavoidable?
When folks say they don't warm up, physiologically this is not necessarily the case. What folks are actually doing is not doing an activity for warm up that is separate from their main event. But, just to state the obvious, when we start our work out we go through the same physiological changes induced by a formal warm up: heart moves up, core temp goes up, perfusion gets underway and hormones for fat mobilization are released. We just happen to initiate that process within the Formal Activity of Interest rather than before it. In other words, the first minutes of the activity becomes the warm up. It's an essential consequence of movement.
Just to take kettlebell'ing as an example: remember in a warm up the idea is to move the blood from the core to the periphery (and get the core temp up) assuming the periphery is where there is demand for muscular support. But in most kettlebell moves, most of the muscular activity takes place not too far from the core. KB moves, such as the swing, are also great for getting perfusion going - potentially more so than using a stationary bike since a swing is whole body work, and potentially more safely than doing a bunch of jumping jacks as there's no impact. WIthin a few swings the heart is up, the blood is circulating, the hormones are moving. The KB embodies its own warm up.
Of course the same is true in any sports activities: as one begins to move, one warms up, but we might ask is there greater value in a formal warm up outside the context of the formal activity. Unlike the stand in one spotness of a kettlebell swing or a barbell deadlift, in a sport, we are moving within a space, relying more on our senses and muscular responses, especially if navigating obstacles like other players.
In the sports context, the argument for warm ups is very much focused on prepping the body to reduce injury. For instance, if one's out on the field before warming up, goes to kick a ball, the extremity does not have the blood supply, it tweaks, the athlete goes down, that's a preventable injury. Does the research support the philosophy? It's not clear. There is indeed a bit of a tug of war as to whether studies of sports show that warm ups (that do other things than stretching) actually reduce injury.
For instance, a survey published only a couple years ago suggests that we just did't know; we just don't have the evidence:
Aside: Brett Jones and Gray Cook may suggest that injury rates may have nothing to do with warm ups or not, but whether or not the population tested had greater or lesser asymmetries in their individual movements. Their work suggests that injury rates in football teams goes down with that change alone.
I'd also like to know when in an event injuries usually happen: well into play or when a player steps onto the field?
A year after the above review was published, another survey came out saying we do have a clearer picture about warm ups, and a key element depends on how we define warm up and injury, and by the way we define it, we see some pretty clear injury reducing benefit:
Aside from injury reduction, there's one place where a warm up may also have benefit: reducing delayed onset muscle soreness in a very particular (but non unusual) case, unaccustomed eccentric effort.
Summary of Results: So what do we know about Warm Ups When and Where?
In cases like swinging a kettlebell or powerlifting, there's reason to see the activity itself as a warm up: the actions are progressive/iterative/repetitious, and by trained practitioners, safe. They are therefore going to have the effect of warming up the person.
In a sports context, where other factors that the push or the pull come into play taxing the body, perceptual systems and mind, the literature tends to be moving towards support of warm ups that are richer than simply stretching. The most current study (2009) shows that considering factors like neuromuscular control are a good idea.
Recommendation: What is a Warm up again?
With respect to the warming up of the body, in activites like kettlebell work, the action of the main repetitious activity effectively creates its own warm up. But there's more going on, as the latest research article sited above shows, when injury reduction is a goal beyond optimum performance. The article mentions neuromuscular control.
If we look at something like Enter the Kettlebell, the core text on learning how to begin (and sustain) practice with kettlebells (review/overview), practitioners are advised to being a session with range of motion work like pumps and halos. These moves take the body through the range of motion they'll be performing in the working sets. They do so enabling user-paced control. The pump works the hip flexors and spine at a much slower pace and lighter force than applied in a swing. The halos take the shoulders through a larger range of motion than presses will use, with weight, and with two handed control. The weight adds load to the joint motion.
These are safe ways to fire off the mechanorecptors in the joints and muscles and prep the body for the work to come. This is neuromuscular preparation.
Some of us likewise find performance benefits from doing Z-Health I-Phase movement matching mobility work throughout our reps/sets or during breaks in a sport activity. Part of the Z-Health philosophy here is that *practicing* range of motion movements that may be common in one's sport while in a safe space helps prep the body for being more responsive, less threatened in a real situation. An example may be before a press doing shoulder circles with the arm in the sticking point position of the press.
Dynamic vs static stretching came up in some of the articles above. A dynamic stretch is something like a walking lunge. Note that the walking lunge exaggerates the range of motion of a walking or potentially a running stride. This lunge may well be mainly effective because of its mechanoreception firing, more so than the local phenomena of stretching a muscle fiber (especially in a cold bod where the blood hasn't started to flow more to that limb to support the stretch).
It may well be possible to replicate the effect of big dynamic stretch sets with neuromuscular work like the Z-Health drills for the same or enhanced benefit for being so mapped to the sport movements. I only have anecdotal evidence of working with clients and observing Z-Health trainers during an RKC cert achieve similar hip range of motion improvements with toe pulls than with dynamic or static lunges. Smaller faster gesture seemed to offer the same effect.
In more active sports where awareness of terrain and others comes into play, S-phase practice also trains the perceptual systems so that they too have been rep'd under high cognitive loads to be able to perform better in live obstacle-charged environments.
Might these neuro-muscular approaches be considered "warm ups" ?
In the sense that some of the joint work does not physically warm up the core of the body, likely not, but in the sense of that these movements prepare the body (and all its interconnected systems) to respond in a less threat-ful (where we tighten up) and thus less injury inducing way, yes (more about threat and the neuromatrix in this article).
So perhaps if we see warm ups as a kind of threat reduction practice that prepares the body optimally for the work it's about to do - so that it feels as safe as possible to do it no matter the complexity or intensity of the situation, that may help us think through what kinds of activities best match prepping the kinds of practice we're doing.
Heuristics for Building an Appropriate Warm Up Practice:
UPDATE:
one place i have found improved performance is warming up prior to a snatch test or long cycle clean and jerks - not a lot - but ten or so reps both sides, three minutes before starting works wonders. Thanks to Coach Randy Hauer for the tip. Related in discussion of heart rate monitors and kb work
Related Posts/Resources
Citations
Do you warm up before you work out? what's part of your warm up? do you know what backs up that practice? The point of this article is to look at what a warm up is in terms of performance enhancement, injury prevention and even DOMS reduction - and what it isn't, too. We'll look at what kinds of things you can do for a warm up to customize yours to your practice.The Idea Behind the Warm Up
The main idea behind a warm up is literally to warm up
the core temperature of the body and get blood flowing to the extremities rather than focusing on the internal organs and brain as it does when we're just sitting around. The warm up alerts the muscles and tissues about new demands to be hitting other parts of the body.Performance Benefit When warm, he muscles can contract and release faster when the body is warm, less resistance within the system when warm, so easier to do a move/less fuel taken, less taxing (movement economy). Likewise better oxygen uptake when blood is flowing, so all around better perfromance.
Warm Enough? A traditional heuristic of being ready to go is that we have broken a sweat. That the body's internal cooling mechanism has kicked in, which means when combinded with light activities pre work out, that blood is perfusing all systems - and also (in the z-health sense) that the body is better prepared to move (see threat modulation in this post).
When muscles are warmed up by blood profusion they contract and relax more readily. Likewise stretching those muscles) is easier. Any increased activity also starts a hormonal response that prepares the body to flee, which means the carbs (and fats) needed for the work ahead are getting prepped to be available.
The Warm Up as Different Activity to Main Activity
All this sounds simple enough and seems to make good sense, but there's usually an uber reason as to why we go through this systems prep. The usual rationale is: in order to prevent injury. The logic seems pretty fair: if the body is physically more ready to do work when it's been prepped, it's less likely for the demands of that work to cause harm. Hence riding a bike for ten minutes causes one to break a sweat and have the resulting body prepping benefits. The idea here is that a bike or jumping rope is a safe way to get all these systems firing.
The warm up activity is traditionally different from the actual activity about to be practiced. Why? The thinking seems to be (and i stress seems; i have no hard and fast evidence for this) that the actual activity - whether kicking a ball in a soccer game or lifting weights - is somehow riskier for the unprepared body than something as constrained as riding a stationary bike .
Stretching? How does that Warm Up the Core?
It's challenging in the literature to find discussions of warm ups that don't include stretching. In fact in some
places when we see warm up, people mean stretching. It seems this minimize risk during the warm up by doing something safe like stationary biking has lead to using static stretching as part of most warm ups. That's even slower than biking, and it's also stretching muscles which is what a warm up is supposed to help. Stretching seems to be the anti-warm up, however. How does stretching raise heart rate or get the blood circulating? How does it *warm* up the system? It doesn't, really. But it's not neutral either. Indeed some suggest that static stretching (like simply bending over and trying to touch one's toes - holding that) has been shown to have some negative effects on strength performance. And in simple muscle testing, pre and post static stretching, we usually see strength drop. Here's a recent example.Alan J. Pearce1 Contact Information, Dawson J. Kidgell2, James Zois3 and John S. Carlson1In other words, these folks are pretty clear that static stretching is NOT good in the context a vertical jump. Even more work published this past year says that passive stretching has zero impact on vertical jump performance. Interesting that it's at least not "detrimental" which the above authors found with static.
Accepted: 23 September 2008 Published online: 11 October 2008
Abstract Evidence suggests that static stretching inhibits muscular power. However, research does not reflect practice whereby individuals follow up stretching with secondary activity. This study investigated muscular power following stretching, and after a second bout of activity. Participants (n = 13) completed 3 randomized testing sessions which included a 5 min warm-up, followed by a vertical jump (VJ) on a force platform; an intervention (static stretching, dynamic, or control), followed by a second VJ. Participants then completed a series of movements, followed by a VJ, up to 60 min post activity. Immediately following the intervention, there was a 10.7% difference in VJ between static and dynamic stretching. The second warm up bout increased VJ height following the dynamic intervention, whereas the static stretching condition did not show any differences. The novel finding from this study demonstrates a second exercise bout does not reverse the effects of static stretching and is still detrimental to VJ.
1: J Strength Cond Res. 2008 Nov;22(6):1826-31.LinksThe important thing in the above is that static stretching was not considered. So in the case of a vertical jump, PNF (passive, being done to) or dynamic or nothing - all after a jog - make no difference.
The effects of proprioceptive neuromuscular facilitation and dynamic stretching techniques on vertical jump performance.
Christensen BK, Nordstrom BJ.
The purpose of this study was to investigate the effects of 3 different warm-ups on vertical jump performance. The warm-ups included a 600-m jog, a 600-m jog followed by a dynamic stretching routine, and a 600-m jog followed by a proprioceptive neuromuscular facilitation (PNF) routine. A second purpose was to determine whether the effects of the warm-ups on vertical jump performance varied by gender. Sixty-eight men and women NCAA Division I athletes from North Dakota State University performed 3 vertical jumps on a Just Jump pad after each of the 3 warm-up routines. The subjects were split into 6 groups and rotated between 3 warm-up routines, completing 1 routine each day in a random order. The results of the 1-way repeated measures analysis of variance showed no significant differences in the combined (p = 0.927), men's (p = 0.798), or women's (p = 0.978) results. The results of this study showed that 3 different warm-ups did not have a significant affect on vertical jumping. The results also showed there were no gender differences between the 3 different warm-ups.
A very recent article suggests, however, there are more individual differences in response to types of warm up/stretch activities that we may have thought, but not in the actual final outcome - the vertical jump:
J Strength Cond Res. 2009 Sep;23(6):1811-9.Click here to read Linksand related
Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women.
Curry BS, Chengkalath D, Crouch GJ, Romance M, Manns PJ.
The purpose of this study was to compare three warm-up protocols--static stretching, dynamic stretching, and light aerobic activity--on selected measures of range of motion and power in untrained females and to investigate the sustained effects at 5 and 30 minutes after warm-up. A total of 24 healthy females (ages 23-29 years) attended one familiarization session and three test sessions on nonconsecutive days within 2 weeks. A within-subject design protocol with the testing investigators blinded to the subjects' warm-up was followed. Each session started with 5 minutes of light aerobic cycling followed by pretest baseline measures. Another 5 minutes of light aerobic cycling was completed and followed by one of the three randomly selected warm-up interventions (static stretching, dynamic stretching, or light aerobic activity). The following posttest outcome measures were collected 5 and 30 minutes following the intervention: modified Thomas test, countermovement jump, and isometric time to peak force knee extension measured by dynamometer. Analysis of the data revealed significant time effects on range of motion and countermovement jump changes. No significant differences (p > 0.05) were found between the warm-up conditions on any of the variables. The variation in responses to warm-up conditions emphasizes the unique nature of individual reactions to different warm-ups; however, there was a tendency for warm-ups with an active component to have beneficial effects. The data suggests dynamic stretching has greater applicability to enhance performance on power outcomes compared to static stretching.
Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA. jaggersj@mailbox.sc.eduAbstract
Stretching before performance is a common practice among athletes in hopes of increasing performance and reducing the risk of injury. However, cumulative results indicate a negative impact of static stretching and proprioceptive neuromuscular facilitation (PNF) on performance; thus, there is a need for evaluating other stretching strategies for effective warm-up. The purpose of this study was to compare the differences between two sets of ballistic stretching and two sets of a dynamic stretching routine on vertical jump performance. Twenty healthy male and female college students between the ages of 22 and 34 (24.8 +/- 3 years) volunteered to participate in this study. All subjects completed three individual testing sessions on three nonconsecutive days. On each day, the subjects completed one of three treatments (no stretch, ballistic stretch, and dynamic stretch). Intraclass reliability was determined using the data obtained from each subject. A paired samples t-test revealed no significant difference in jump height, force, or power when comparing no stretch with ballistic stretch. A significant difference was found on jump power when comparing no stretch with dynamic stretch, but no significant difference was found for jump height or force. Statistics showed a very high reliability when measuring jump height, force, and power using the Kistler Quattro Jump force plate. It seems that neither dynamic stretching nor ballistic stretching will result in an increase in vertical jump height or force. However, dynamic stretching elicited gains in jump power poststretch.
Unlike the study previous to these two, one uses static stretching, too. And it does not suggest that static stretching is detrimental to power outcomes; indeed nothing seems better or worse on outcomes, but that dynamic is better than static for enhancing performance. Just not necessarily hugely (to statistical significance).
We'll come back to consideration of dynamic stretching by contrast to static stretching in a moment, but for now it's important to note that static stretching as a warm up has been seen to have a negative effect on muscular strength (not what we want before lifting a heavy weight) but not on vertical jump height.
So static stretching before a physical activity does not seem to be a great idea (going from detrimental to neutral). But based on what we've said are the physiological reasons for carrying out a warm up, is "static stretching = strength reducing" the same as saying a warm up is a bad idea?
Is a warm up unnecessary or unavoidable?
When folks say they don't warm up, physiologically this is not necessarily the case. What folks are actually doing is not doing an activity for warm up that is separate from their main event. But, just to state the obvious, when we start our work out we go through the same physiological changes induced by a formal warm up: heart moves up, core temp goes up, perfusion gets underway and hormones for fat mobilization are released. We just happen to initiate that process within the Formal Activity of Interest rather than before it. In other words, the first minutes of the activity becomes the warm up. It's an essential consequence of movement.
Just to take kettlebell'ing as an example: remember in a warm up the idea is to move the blood from the core to the periphery (and get the core temp up) assuming the periphery is where there is demand for muscular support. But in most kettlebell moves, most of the muscular activity takes place not too far from the core. KB moves, such as the swing, are also great for getting perfusion going - potentially more so than using a stationary bike since a swing is whole body work, and potentially more safely than doing a bunch of jumping jacks as there's no impact. WIthin a few swings the heart is up, the blood is circulating, the hormones are moving. The KB embodies its own warm up.
Of course the same is true in any sports activities: as one begins to move, one warms up, but we might ask is there greater value in a formal warm up outside the context of the formal activity. Unlike the stand in one spotness of a kettlebell swing or a barbell deadlift, in a sport, we are moving within a space, relying more on our senses and muscular responses, especially if navigating obstacles like other players.
In the sports context, the argument for warm ups is very much focused on prepping the body to reduce injury. For instance, if one's out on the field before warming up, goes to kick a ball, the extremity does not have the blood supply, it tweaks, the athlete goes down, that's a preventable injury. Does the research support the philosophy? It's not clear. There is indeed a bit of a tug of war as to whether studies of sports show that warm ups (that do other things than stretching) actually reduce injury.
For instance, a survey published only a couple years ago suggests that we just did't know; we just don't have the evidence:
J Sci Med Sport. 2006 Jun;9(3):214-20. Epub 2006 May 6.Click here to read LinksThe above is an important result: it says there are only five studies that meet the warm up criteria and of those 3 say yes two say no.
Does warming up prevent injury in sport? The evidence from randomised controlled trials?
Fradkin AJ, Gabbe BJ, Cameron PA.
BACKGROUND: The practice of warming up prior to exercise is advocated in injury prevention programs, but this is based on limited clinical evidence. It is hypothesised that warming up will reduce the number of injuries sustained during physical activity. METHODS: A systematic review was undertaken. Relevant studies were identified by searching Medline (1966-April 2005), SPORTDiscus (1966-April 2005) and PubMed (1966-April 2005). This review included randomised controlled trials that investigated the effects of warming up on injury risk. Studies were included only if the subjects were human, and only if they utilised other activities than simply stretching. Studies reported in languages other than English were not included. The quality of included studies was assessed independently by two assessors. RESULTS: Five studies, all of high quality (7-9 (mean=8) out of 11) reported sufficient data (quality score>7) on the effects of warming up on reducing injury risk in humans. Three of the studies found that performing a warm-up prior to performance significantly reduced the injury risk, and the other two studies found that warming up was not effective in significantly reducing the number of injuries. CONCLUSIONS: There is insufficient evidence to endorse or discontinue routine warm-up prior to physical activity to prevent injury among sports participants. However, the weight of evidence is in favour of a decreased risk of injury. Further well-conducted randomised controlled trials are needed to determine the role of warming up prior to exercise in relation to injury prevention.
Aside: Brett Jones and Gray Cook may suggest that injury rates may have nothing to do with warm ups or not, but whether or not the population tested had greater or lesser asymmetries in their individual movements. Their work suggests that injury rates in football teams goes down with that change alone.
I'd also like to know when in an event injuries usually happen: well into play or when a player steps onto the field?
A year after the above review was published, another survey came out saying we do have a clearer picture about warm ups, and a key element depends on how we define warm up and injury, and by the way we define it, we see some pretty clear injury reducing benefit:
Sports Med. 2007;37(12):1089-99.A year after that, a survey shows that even static stretching in a sports context doesn't stop all kinds of injuries but it does seem to reduce incidents of muscular-tendinous (like a groin pull) type injury in a sports context.
Warm-up and stretching in the prevention of muscular injury.
Woods K, Bishop P, Jones E.
Muscular injury is one of the major problems facing today's athletes, both recreational and professional. Injuries to skeletal muscle represent >30% of the injuries seen in sports medicine clinics. As a result, it is imperative to utilise the most effective means to aid in deterring these injuries. However, there are conflicting opinions regarding methods of reducing muscular injury through warm-up and stretching techniques.Therefore, the purpose of this article is to examine the potential of a warm-up and/or stretching routine in deterring muscular injury during physical activity. The article examines a variety of studies regarding warm-up, stretching and muscular injury. The article also provides a definition of warm-up and stretching to provide clarity on this topic. Many of the differences within previous research were due to conflicting definitions. We also address this issue by examining research on muscular injury and physical adaptations to muscular injury and training.This article provides contradictory evidence to conclusions that have been drawn in previous review articles, which determined that warm-up and/or stretching protocols did not deter injury. The research included here conveys that certain techniques and protocols have shown a positive outcome on deterring injuries. As a result, a warm-up and stretching protocol should be implemented prior to physical activity. The routine should allow the stretching protocol to occur within the 15 minutes immediately prior to the activity in order to receive the most benefit. In addition, current information regarding improvements in flexibility is reviewed.
Res Sports Med. 2008;16(3):213-31.And most recently, looking just at stretching and injury we see more support for stretching.
A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise-related injury.
Small K, Mc Naughton L, Matthews M.
A systematic review of the literature was undertaken to assess the efficacy of static stretching as part of the warm-up for the prevention of exercise-related injuries. Computer-aided literature search for articles post-1990 and pre-January 2008 related to static stretching and injury prevention using MEDLINE, SPORT Discus, PubMed, and ScienceDirect databases. All relevant randomised clinical trials (RCTs) and controlled clinical trials (CCTs) satisfying inclusion/exclusion criteria were evaluated by methodological assessment to score the studies using accredited criteria. Seven out of 364 studies met the inclusion/exclusion criteria. All four RCTs concluded that static stretching was ineffective in reducing the incidence of exercise-related injury, and only one of the three CCTs concluded that static stretching did reduce the incidence of exercise-related injury. Three out of the seven studies noted significant reductions in musculotendinous and ligament injuries following a static stretching protocol despite nonsignificant reductions in the all-injury risk. All RCTs scored over 50 points (maximum possible score = 100), whereas all CCTs scored under 45 points. There is moderate to strong evidence that routine application of static stretching does not reduce overall injury rates. There is preliminary evidence, however, that static stretching may reduce musculotendinous injuries.
Br J Sports Med. 2009 Jun 11.And in the same year, getting back to warm ups for sports again where studies of warm ups have also included more than just stretching, the trend seems again to say it's a good idea. The important thing is to see what's meant by warm up.
A pragmatic randomised trial of stretching before and after physical activity to prevent injury and soreness.
Jamtvedt G, Herbert RD, Flottorp S, Odgaard-Jensen J, Håvelsrud K, Barratt A, Mathieu E, Burls A, Oxman AD.
OBJECTIVE: To determine the effects of stretching before and after physical activity on risks of injury and soreness in a community population. DESIGN: Internet-based pragmatic randomised trial conducted between January 2008 and January 2009. SETTING: International. PARTICIPANTS: 2,377 adults who regularly participated in physical activity. INTERVENTIONS: Participants in the stretch group were asked to perform 30-second static stretches of 7 lower limb and trunk muscle groups before and after physical activity for 12 weeks. Participants in the control group were asked not to stretch. Main outcome measurements: Participants provided weekly on-line reports of outcomes over 12 weeks. Primary outcomes were any injury to the lower limb or back, and bothersome soreness of the legs, buttocks or back. Injury to muscles, ligaments and tendons was a secondary outcome. RESULTS: Stretching did not produce clinically important or statistically significant reductions in all-injury risk (HR = 0.97, 95% CI 0.84 to 1.13), but did reduce the risk of experiencing bothersome soreness (mean risk of bothersome soreness in a week was 24.6% in the stretch group and 32.3% in the control group; OR = 0.69, 95% CI 0.59 to 0.82). Stretching reduced the risk of injuries to muscles, ligaments and tendons (incidence rate of 0.66 injuries per person-year in the stretch group and 0.88 injuries per person-year in the control group; HR = 0.75, 95% CI 0.59 to 0.96). CONCLUSION: Stretching before and after physical activity does not appreciably reduce all-injury risk, but probably reduces the risk of some injuries, and does reduce the risk of bothersome soreness. Trial registration: anzctr.org.au 12608000044325.
BMJ. 2008 Dec 9;337:a2469. doi: 10.1136/bmj.a2469.The key thing to note in the above article is that the warm up was doing considerably more than looking at raising core temperature: it focused on strength, awareness and neuromuscular control during movement. This sounds very reminiscent of what z-health s-phase training teaches athletes in devising approaches to practice in safe environments the kinds of loads placed on perceptual as well as neuro-muscular systems in competition.
Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial.
Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE.
OBJECTIVE: To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football. DESIGN: Cluster randomised controlled trial with clubs as the unit of randomisation. SETTING: 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months). PARTICIPANTS: 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group). INTERVENTION: A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements. MAIN OUTCOME MEASURE: Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip). RESULTS: During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83). CONCLUSION: Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.
Aside from injury reduction, there's one place where a warm up may also have benefit: reducing delayed onset muscle soreness in a very particular (but non unusual) case, unaccustomed eccentric effort.
1: Aust J Physiother. 2007;53(2):91-5.In the above study, warm up consisted of walking uphill (3degrees) on a treadmill at 4-5km/h for 10 minutes. We'll look at DOMS in more detail in another article.
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.
Summary of Results: So what do we know about Warm Ups When and Where?
In cases like swinging a kettlebell or powerlifting, there's reason to see the activity itself as a warm up: the actions are progressive/iterative/repetitious, and by trained practitioners, safe. They are therefore going to have the effect of warming up the person.In a sports context, where other factors that the push or the pull come into play taxing the body, perceptual systems and mind, the literature tends to be moving towards support of warm ups that are richer than simply stretching. The most current study (2009) shows that considering factors like neuromuscular control are a good idea.
Recommendation: What is a Warm up again?
With respect to the warming up of the body, in activites like kettlebell work, the action of the main repetitious activity effectively creates its own warm up. But there's more going on, as the latest research article sited above shows, when injury reduction is a goal beyond optimum performance. The article mentions neuromuscular control.
If we look at something like Enter the Kettlebell, the core text on learning how to begin (and sustain) practice with kettlebells (review/overview), practitioners are advised to being a session with range of motion work like pumps and halos. These moves take the body through the range of motion they'll be performing in the working sets. They do so enabling user-paced control. The pump works the hip flexors and spine at a much slower pace and lighter force than applied in a swing. The halos take the shoulders through a larger range of motion than presses will use, with weight, and with two handed control. The weight adds load to the joint motion.
These are safe ways to fire off the mechanorecptors in the joints and muscles and prep the body for the work to come. This is neuromuscular preparation.
Some of us likewise find performance benefits from doing Z-Health I-Phase movement matching mobility work throughout our reps/sets or during breaks in a sport activity. Part of the Z-Health philosophy here is that *practicing* range of motion movements that may be common in one's sport while in a safe space helps prep the body for being more responsive, less threatened in a real situation. An example may be before a press doing shoulder circles with the arm in the sticking point position of the press.
Dynamic vs static stretching came up in some of the articles above. A dynamic stretch is something like a walking lunge. Note that the walking lunge exaggerates the range of motion of a walking or potentially a running stride. This lunge may well be mainly effective because of its mechanoreception firing, more so than the local phenomena of stretching a muscle fiber (especially in a cold bod where the blood hasn't started to flow more to that limb to support the stretch).
It may well be possible to replicate the effect of big dynamic stretch sets with neuromuscular work like the Z-Health drills for the same or enhanced benefit for being so mapped to the sport movements. I only have anecdotal evidence of working with clients and observing Z-Health trainers during an RKC cert achieve similar hip range of motion improvements with toe pulls than with dynamic or static lunges. Smaller faster gesture seemed to offer the same effect.
In more active sports where awareness of terrain and others comes into play, S-phase practice also trains the perceptual systems so that they too have been rep'd under high cognitive loads to be able to perform better in live obstacle-charged environments.
Might these neuro-muscular approaches be considered "warm ups" ?
In the sense that some of the joint work does not physically warm up the core of the body, likely not, but in the sense of that these movements prepare the body (and all its interconnected systems) to respond in a less threat-ful (where we tighten up) and thus less injury inducing way, yes (more about threat and the neuromatrix in this article).
So perhaps if we see warm ups as a kind of threat reduction practice that prepares the body optimally for the work it's about to do - so that it feels as safe as possible to do it no matter the complexity or intensity of the situation, that may help us think through what kinds of activities best match prepping the kinds of practice we're doing.
Heuristics for Building an Appropriate Warm Up Practice:
- Neuro-muscular practice like range of motion work - I-Phase, loaded controlled range of motion work - for all movement performance activities seems a good idea
- For activities where the movements are repeated such that they themselves warm up the body and keep the body warm, they seem to act as that core temp upping, blood circulating, hormone pumping action. The action is the warm up.
- For more cognitively demanding activities like a field sport especially where there is more stopping and starting, a more formal core temp raising practice (like some KB swings) may also be appropriate to combine with the neuro-muscular work
- Test and Retest: what helps the athlete (that's you and me) best reduce threat (often seen as restricted movement) and enhance performance (more open, relaxed movement) of perfect reps, or perfectly "efficient" movement?
UPDATE:
one place i have found improved performance is warming up prior to a snatch test or long cycle clean and jerks - not a lot - but ten or so reps both sides, three minutes before starting works wonders. Thanks to Coach Randy Hauer for the tip. Related in discussion of heart rate monitors and kb work
Related Posts/Resources
- ALL ABOUT DOMS: what is it and doesn't work to cure it; what does work
- Perfect Rep and Movement Efficiency
- I-Phase - what is it
- S-phase: the complete athlete DVD
- Enter the Kettlebell review
- US Kettlebells || UK Kettlebells
Citations
Pearce, A., Kidgell, D., Zois, J., & Carlson, J. (2008). Effects of secondary warm up following stretching European Journal of Applied Physiology, 105 (2), 175-183 DOI: 10.1007/s00421-008-0887-3Tweet Follow @begin2dig
Christensen BK, & Nordstrom BJ (2008). The effects of proprioceptive neuromuscular facilitation and dynamic stretching techniques on vertical jump performance. Journal of strength and conditioning research / National Strength & Conditioning Association, 22 (6), 1826-31 PMID: 18815572
FRADKIN, A., GABBE, B., & CAMERON, P. (2006). Does warming up prevent injury in sport?The evidence from randomised controlled trials? Journal of Science and Medicine in Sport, 9 (3), 214-220 DOI: 10.1016/j.jsams.2006.03.026
Jaggers JR, Swank AM, Frost KL, & Lee CD (2008). The acute effects of dynamic and ballistic stretching on vertical jump height, force, and power. Journal of strength and conditioning research / National Strength & Conditioning Association, 22 (6), 1844-9 PMID: 18841078
Woods K, Bishop P, & Jones E (2007). Warm-up and stretching in the prevention of muscular injury. Sports medicine (Auckland, N.Z.), 37 (12), 1089-99 PMID: 18027995
Weldon, S. (2003). The efficacy of stretching for prevention of exercise-related injury: a systematic review of the literature Manual Therapy, 8 (3), 141-150 DOI: 10.1016/S1356-689X(03)00010-9
Jamtvedt, G., Herbert, R., Flottorp, S., Odgaard-Jensen, J., Havelsrud, K., Barratt, A., Mathieu, E., Burls, A., & Oxman, A. (2009). A pragmatic randomised trial of stretching before and after physical activity to prevent injury and soreness British Journal of Sports Medicine DOI: 10.1136/bjsm.2009.062232
Law RY, & Herbert RD (2007). Warm-up reduces delayed onset muscle soreness but cool-down does not: a randomised controlled trial. The Australian journal of physiotherapy, 53 (2), 91-5 PMID: 17535144
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