Download Exercise Physiology Literature Review

BRYAN COLLEGE
THE MINIMIZATION OF DELAYED ONSET MUSCLE SORENESS
A Review of Literature Submitted for
EHS 341 Exercise Physiology
Professor: Mr. Scott Landis
by:
Miles Christian
December 8, 2014
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Minimization of Delayed Onset Muscle Soreness
Delayed Onset Muscle Soreness (DOMS) is defined by the American College of Sports
Medicine as soreness that begins to develop 12-24 hours after the exercise has been performed
and may produce the greatest pain between 24-72 hours after the exercise. Delayed Onset
Muscle Soreness is not to be associated with acute muscle soreness however, which is pain that
develops during activity (Braun, 2011). Activities related to DOMS cause muscles to lengthen
while force is applied. This is an eccentric muscle action, and some examples of eccentric
muscle actions include the lowering phase of a bicep curl exercise or the lengthening of the thigh
muscles while the limb resists the body’s momentum as it walks or jogs down a hill (Braun,
2011). One common misconception about DOMS is it’s caused from lactic acid accumulation,
but lactic acid is not a component of this process. Delayed Onset Muscle Soreness appears to be
a side effect of the repair process that develops in response to microscopic muscle damage
(Braun, 2011). The typical symptoms associated with DOMS are strength loss, pain, muscle
tenderness, stiffness, and swelling (Connolly, 2003). This literature review is aimed to identify
different strategies, techniques, and methods in the effort to minimize Delayed Onset Muscle
Soreness.
Declan A.J. Connolly, Stephen P. Sayers, and Malachy P. McHugh (2003) reviewed the
mechanisms of injury related to DOMS and exercise-induced muscle damage, and its clinical
results from DOMS often resulting from unfamiliar predominantly eccentric exercise. With both
exercise-induced muscle damage and eccentric exercise in mind, the authors explored
pharmacological treatment of DOMS using NSAIDs, therapeutic treatment of DOMS using
physical modalities, and interventions using nutritional supplements. Regarding pharmacological
treatment, the authors based their research on the inflammatory response of the tissue to
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mechanical damage. Nonsteroidal anti-inflammatory drugs were classified as a single or dual
action drug with drugs such as aspirin, naproxen, flurbiprofen, and ibuprofen being single action.
Dual action drugs included diclofenc and ketoprofen. Considering human studies, the review was
limited examining NSAIDs and their effects on DOMS, and all studies used some form of
eccentric exercise that standardized the injury protocol. Nonsteroidal anti-inflammatory drugs
use was applied to the studies either before the eccentric exercise, or after the eccentric exercise.
Many of the NSAID studies which showed no effect on DOMS included the use of ibuprofen
and flurbiprofen with one study using aspirin as well. Kuipers et al. (1985) confronted the
question of anti-inflammatory medications efficacy in the treatment of DOMS. The study used 6
subjects who were treated with 150 mg of fluribiprofen or a placebo 24 hours before eccentric
cycling and then 72 hours after exercise. There are no reported effects of flurbiprofen on DOMS,
muscle histology, or creatine kinase (CK), but there was significantly lower muscle soreness
after the second eccentric exercise bout, which occurred three weeks after the first bout. A
similar observation occurred in Donnelly et al’s study using ibuprofen. Sixteen subjects were
treated before or after a 45-minute downhill running protocol. Ibuprofen showed no effect on
DOMS, muscle strength, or endurance time, but CK activity was higher in the ibuprofen group
compared to the placebo. In two other studies, Howell et al. (1998) and Mishra et al. (1995),
results reported impaired recovery of muscle function with NSAIDs. Howell et al. (1998) treated
15 subjects after eccentric exercise of the elbow flexors using flurbiprofen or a placebo 24 hours
before and for 14 continuous days. Efficacy of flurbiprofen was not reported on DOMS,
swelling, or stiffness. In contrast to the studies showing no efficacy, Hasson et al. (1993) found
400 or 1,200 mg of ibuprofen taken 4 hours prior or in the 24 hours after eccentric exercise,
significantly enhanced recovery of muscle force and reduced DOMS 48 hours after exercise in
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the quadriceps. Donnelly et al. (1988) study treated 20 subjects with 150 mg diclofenac from 1.5
to 72 hours after exercise. Donnelly used the same downhill running bout, but it was separated
by a 10-week interval. Results showed significant reductions in measures of DOMS after the first
bout in the with the diclofenac group compared to the placebo group.
In the next piece of literature, Jon Lenn, Timothy Uhl, Carl Mattacola, Gilbert
Boisonneult, James Yates, Wissam Ibrahim, and Geza Bruckner (2002) investigated the effects
of fish oil and isoflavones on Delayed Onset Muscle Soreness. “Fish oils (FO) have been shown
to modulate the inflammatory response through alteration of the eicosanoid pathway. Isoflavones
(ISO) appear to reduce the inflammatory pathway through their role as a tyrosine kinase
inhibitor” (Lenn, 2002). With this statement in mind, the authors hypothesized the physical limits
related to DOMS could be decreased by the inflammatory response of the supplements fish oil
and isoflavones. Thirteen men and nine women were recruited and randomly assigned to three
different groups including the fish oil group, isoflavone group, and placebo group. The
participants in each group all received a 100-IU of tocopherol/tocopheryl acetate to minimize
long chain unsaturated fatty acid oxidation. The supplements were provided 30 days prior to the
exercise, and the participants exercised in four sessions lasting 30 minutes to 1 hour. The
participants were measured and monitored throughout the four exercises and then returned on
days two, four, and seven to measure muscle soreness, upper arm circumference, range of
motion, and strength. It is important to note in this research DOMS was induced by the
participant performing 50 maximal isokinetic eccentric elbow flexion contractions. In the results,
decreases in range of motion and strength were found two days post-exercise in all three groups,
and substantial increases in pain and arm circumference were found as well. Range of motion,
pain, arm circumference, and strength had significant decreases between days 2 through 7, and it
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was at day 7 when the participants returned to baseline. This article proved the model used to be
effective in inducing Delayed Onset Muscle Soreness, but failed to show any significant
differences in between treatments of exercise. The fish oils and isoflavones supplemented to the
participants showed no effect in the attempt to minimize or prevent DOMS.
Another group of researches, Stéphane Perrey, Aurélien Bringard, Sébastien Racinais,
Kostia Puchaux, and Nicolas Belluye (2008), conducted a study on graduated compression
stockings and its effect on Delayed Onset Muscles Soreness. Graduated compression stockings
are commonly used in the effort to diminish DOMS and the purpose of this article was to
determine if the graduated compression stockings minimize DOMS after eccentric walking
exercise. Two studies cited in this study, Kraemer et al. 2001a and Kraemer et al 2001b, have
shown compression garments maintaining muscle function and reducing perceived muscle
soreness post eccentric exercise. Eight men were selected to participate in the study and
completed a neuromuscular test, backward walking exercise, and then further neuromuscular
testing on the first day at the laboratory. The participants were required to wear graduated
compression stockings on days two, three, and four immediately following exercise for
approximately five hours per day assigned. The graduated compression stockings only covered
the calf on one leg, as the other leg was used as the control. M-mave, peak twitch, and maximal
voluntary torque (MVT) were measured pre and post testing, and then 2, 24, 48, and 72 hours
after exercise. Results found there was a 28 percent decrease in DOMS after 72 hours while
wearing the graduated compression stockings over the control leg. There was also a 15 percent
decrease in maximal voluntary torque of the plantar flexors of the legs directly following
exercise. “Subjective reports of muscle soreness showed an increase from baseline 2-h, 24-h and
48-h following eccentric exercise in both leg conditions (i.e., with and without GCS)” (Perrey,
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2008). Perceived muscle soreness was found to be substantially lower in the leg wearing a
graduated compression stocking, and this can be associated to Kraemer et al’s 2001a, 2001b
previous studies. Following eccentric exercise, graduated compression stockings show to
reduced DOMS, but remarkably much later post-exercise. This article has shown a significant
effect on DOMS with the graduated compression stocking for 72 hours after exercise, as well as
a small benefit for the graduated compression stocking in management of muscle function
impairment related to DOMS.
William Kirk Isabell, Earlene Durrant, William Myrer, and Shauna Anderson (1992)
examined the effects of ice massage, exercise, and the combination of ice massage with exercise
on delayed onset muscle soreness. This study was conducted with twenty-two participants,
eleven men and eleven women, and all participants reported no upper arm pain or pain in the
range of motion of the elbow joint. The study was broken down into four sections: pre-exercise
movements, induction of delayed onset muscle soreness, treatments, and post-exercise
measurements. In the first section, pre-exercise measures, isokinetic flexion, extension torque,
flexion and extension range of motion, serum creatine kinase, and perceived soreness at work
and rest were all measured as the participants performed eight to ten submaximal contractions,
and an additional strength measurement using dumbbells was used to determine the one and ten
repetition maximum. The additional strength measurement was primarily tested to induce muscle
soreness. Delayed Onset Muscle Soreness was induced in the nondominant arm by the
participants performing concentric and eccentric dumbbell curl exercises. The participants
received treatment in eight 15 minute sections administered directly after the exercise (0 hours),
2, 4, 6, 24, 48, 72, and 96 hours after exercise. Ice massage was applied to the biceps by using an
ice ball formed in a paper cup, and exercise treatment was used as the subject performed full
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range of motion flexion and extension at the elbow with only the pull on the arm and hand using
resistance. Ice massage with exercise treatment used both the ice massage treatment and exercise
treatment by combining the two treatments. The participants performed the exercise treatment
for approximately 20 seconds and then the ice massage treatment was applied for 40 seconds.
Post-exercise measurements were tested by replicating the procedures administered in the preexercise measurements and all variables were recorded at 2, 4, 6, 24, 48, 72, 96, and 120 hours.
In the results of the effects of ice massage, exercise, and ice massage with exercise, there was no
substantial evidence that provided ice, exercise, or the combination of the two aiding or
minimizing Delayed Onset Muscle Soreness. “This study provides additional support that
repeated strenuous concentric-eccentric exercise produces DOMS” (Isabell, 1992). The study
was capable of producing Delayed Onset Muscle Soreness, but the therapeutic use of ice,
exercise, and ice with exercise were not effective in the minimization of symptoms of DOMS.
While researching Delayed Onset Muscle Soreness, Lori A. Kuligowski, Frank P.
Giannantonio, and Rob O. Blanc (1998) looked at the potential of whirlpool therapy as a
therapeutic solution to minimize DOMS. In whirlpool therapy, cooling or heating of muscle
tissues happens through conduction. The temperature of the water ranges from 35 degrees
Celsius and 43 degrees Celsius for heating, while cooling temperatures range from 12 degrees
Celsius to 18 degrees Celsius. It is important to note that prior to this research, the minimization
in signs and symptoms of Delayed Onset Muscle Soreness using heat and cold application had
minimally been examined. 56 males volunteered to take apart of this investigation and there were
5 measurements on the participants’ nondominant arm at approximately 0, 24, 48, 72, and 96
hours post exercise. Range of motion, perceived soreness, and maximal voluntary isometric
contraction strength were measured on the nondominant arm, while DOMS was induced in the
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forearm flexors by determining a 1-repetition maximum increasing the weight in 5-pound
increments. The weight was eccentrically lowered in a cycle of 10 repetitions per set with a 1minute rest break. Each participant had to complete a total of 50 repetitions. The participants
were treated in four different groups including the warm whirlpool, cold whirlpool, contrast
therapy, and no treatment groups. The participants received four treatments in total with the first
treatment coming directly after the exercise, and then after 24, 48, and 72 hours. The researchers
found that cold whirlpool and contrast therapy were effective in treating DOMS as the variables
displayed decreased in delta scores, showing the groups to be closer to baseline values. “Based
on the results of this study, we conclude that the application of cold through the use of cold
whirlpool or contrast therapy is the best treatment for DOMS” (Kuligowski, 1998). Also, warm
whirlpool therapy was more efficient than no treatment in returning participants to baseline
values. In this study, the authors concluded with the recommendation that athletes with Delayed
Onset Muscle Soreness should return to activities based on muscular strength and not perceived
pain.
In the last piece of literature, the influence of vibration on Delayed Onset Muscle
Soreness was examined by authors Amir H Bakhtiary, Ziaeddin Safavi-Farokhi, Atefeh
Aminiam-Far, and A. Rezasoltani (2007). Vibration training had been researched and shown to
possibly improve muscle training, so the authors designed this study to see if vibrations training
minimized DOMS by improving muscular strength, power development strategy, improving
kinesthetic awareness, and provide insights into the effects of fatigue, within the vibrated
muscles (Bakhtiary, 2007). 50 participants, 25 male and 25 female, were selected randomly into
two separate groups with the first group being the vibration training, and the other being non
vibration training. The two groups walked down a 10 degree declined treadmill for
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approximately 30 minutes. A 50 Hz vibrator apparatus was applied to the vibration training
group on the middle line of the left and right quadriceps, and the hamstring and calf muscles for
one minute before starting the downhill walk on the treadmill. The researchers measured the
groups before the treadmill walk and 24 hours post-exercise, while also measuring isometric
maximum voluntary contraction, pressure pain threshold, and muscle soreness. The results in this
study showed a higher decrease in isometric voluntary contraction, a greater reduction in pain
threshold, a higher level of muscle soreness, and a higher mean of creatine kinase in the non
vibration training group compared to the vibration training group. This study showed no muscle
strength reduction in the isometric voluntary contraction, lower muscle soreness, and lower
levels of creatine kinase in the vibration training group. “These findings may indicate that
vibration training before eccentric exercise may help the muscles to build up a background
tension and optimal neuromuscular activity to overcome the increased passive tension within the
exercised muscles during eccentric activities” (Bakhtiary, 2007). With this in mind, vibration
training could potentially be used to minimize or control Delayed Onset Muscle Soreness in
sports activities or eccentric exercises.
The articles reviewed above are all useful in the minimization of Delayed Onset Muscle
Soreness as they provide a variety of pharmacological, therapeutic, whirlpool, and vibration
training strategies. In Connelly et al’s. (2003) pharmacological treatment to minimize DOMS,
this writer did not find anything resourceful as the study found no significant effect on DOMS.
The same thing can be said for Lenn et al’s. (2002) study as the use of fish oil and isoflavones
provided no significant effect in the attempt to minimize Delayed Onset Muscle Soreness. This
writer was surprised by Isabell et al’s. (1992) research of ice massage, exercise, and ice massage
with exercise not providing any significant results to minimize DOMS. The ice massage with
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exercise seemed to be a creative potential solution to minimize DOMS, but yet no results came
out of it. This writer was most impressed with Bahktairy et al’s. (2007) research on the influence
of vibration training on DOMS, Kuligowski et al’s. (1998) study on whirlpool therapy in the
effort to minimize DOMS, and Perrey et al’s. (2008) study to use graduated compression
stockings to minimize DOMS. Bahktiary et al’s. (2007) vibration training study showed
impressive results as there was no strength reduction in isometric voluntary contraction, lower
muscle soreness, and lower levels of creatine kinase in the vibration training group compared to
the nonvibration training group. Kuligowski et al’s. (1998) study showed significant results as
cold whirlpool and contrast therapy lowered delta scores and were effective in treating DOMS.
Along with Bahktiary and Kuligowski, Perrey et al’s (2008). study provided positive results in
the graduated compression stocking to minimize Delayed Onset Muscle Soreness. The 28
percent decrease after 72 hours in DOMS in the leg wearing the graduated compression stocking
really impressed this writer and he thinks it could be very resourceful for all types of athletes.
In conclusion, there are several techniques stated in this review of literature that can
potentially be useful for all athletes. This writer believes researchers have still not found the best
treatment to minimize Delayed Onset Muscle Soreness, and there will still have to be many
different reviews of strategies and solutions to determine the best technique. Further research of
DOMS is necessary because no technique clearly defines and states the best solution for
minimizing DOMS. As scientists, researchers, and authors continue to explore potential solutions
to treat and minimize Delayed Onset Muscle Soreness, athletes and students have these
resourceful techniques such as cold whirlpool and contrast therapy, graduated compression
stockings, and vibration training to aide in the minimization of DOMS after eccentric exercise in
their sports and activities.
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Bibliography
Bakhtiary, A., Safavi-Farokhi, Z., Aminian-Far, A., & Rezasoltani, A. (2007). Influence Of
Vibration On Delayed Onset Of Muscle Soreness Following Eccentric Exercise *
COMMENTARY. British Journal of Sports Medicine, 41(3), 145-148.
Braun, W., & Sforzo, G. (2011). Delayed Onset Muscle Soreness. Retrieved December 7, 2014,
from http://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf
Connolly, D.A.J., S.P. Sayers, & M.P. McHugh. Treatment and prevention of delayed onset
muscle soreness. J. Strength Cond. Res. 17(1):197–208. 2003.
Isabell, W., Durrant, E., Myrer, W., & Anderson, S. (1992). The Effects of Ice Massage, Ice
Massage with Exercise, and Exercise on the Prevention and Treatment of Delayed Onset
Muscle Soreness. Journal of Athletic Training, 27(3), 208-217.
Kuligowski, L., Giannantonio, F., & Blanc, R. (1998). Effect of Whirlpool Therapy on the Signs
and Symptoms of Delayed-Onset Muscle Soreness. Journal of Athletic Training, 33(3),
222-228.
Lenn, J., Uhl, T., Mattacola, C., Boissonneault, G., Yates, J., Ibrahim, W., & Bruckner, G.
(2002). The Effects Of Fish Oil And Isoflavones On Delayed Onset Muscle Soreness.
Medicine & Science in Sports & Exercise, 1605-1613.
Perrey, S., Bringard, A., Racinais, S., Puchaux, K., & Belluye, N. (2008). Graduated
Compression Stockings and Delayed Onset Muscle Soreness (P105). The Engineering of
Sport, 7, 547-554.