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Treating and Preventing DOMS

tim290280

tim290280

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Treating and Preventing DOMS
Johndavid Maes, and Len Kravitz, Ph.D.

Articles Reviewed:
Connolly, D.A.J., S.P Sayers, and M.P. McHugh. Treatment and prevention of delayed onset muscle soreness. J. Strength Cond. Res. 17(1):197-298. 2003.

Szymanski, D.J. Recommendations for the avoidance of delayed-onset muscle soreness. J. Strength Cond. Res. 23(4): 7-13. 2001.

INTRODUCTION
Delayed onset muscle soreness (DOMS) is a phenomenon that has long been associated with increased physical exertion. DOMS is typically experienced by all individuals regardless of fitness level, and is a normal physiological response to increased exertion, and the introduction of unfamiliar physical activities. Due to the sensation of pain and discomfort, which can impair physical training and performance, prevention and treatment of DOMS is of great concern to coaches, trainers, and therapists. In a recent review, Szymanski (2001) provides an extensive evaluation of the mechanisms and treatments for DOMS. Although science has not established a sound and consistent treatment for DOMS, previous interventions include pharmaceuticals, pre-exercise warm-up, stretching, massage, and nutritional supplements, just to name a few. The pain and discomfort associated with DOMS typically peaks 24-48 hours after an exercise bout, and resolves within 96 hours. Generally, an increased perception of soreness occurs with greater intensity and a higher degree of unfamiliar activities. Other factors, which play a role in DOMS, are muscle stiffness, contraction velocity, fatigue, and angle of contraction. In order to minimize symptoms and optimize productivity in a physical training program it is vital to understand the proposed mechanisms of injury, which occur in DOMS. In another recent review, Connolly, Sayers, and McHugh (2003) present an explanation for the mechanisms of injury, as well as various modalities for prevention and treatment of DOMS. The purpose of this article is to provide a review of the mechanisms of injury associated with DOMS as well as an evaluation of the recommendations of various proposed treatments.

MECHANISMS of INJURY
For many years the phenomenon of DOMS has been attributed to the buildup of lactate in the muscles after an intense workout. However, this assumption has been shown to be unrelated to DOMS. The perceptions of pain and soreness that result from intense eccentric exercise are not related to lactate buildup at all. Szymanski’s review (2001) notes that blood and muscle lactate levels do rise considerably during intense eccentric and concentric exercise, however values for blood and muscle lactate return to normal within 30-60 minutes post exercise. Szymanski also notes that concentric exercise produces two-thirds more lactate than does eccentric exercise. If DOMS was brought on by the accumulation of lactate in the muscles, there would me more of an incidence of DOMS after concentric exercise than that of eccentric exercise. Furthermore, blood lactate levels drop to normal values within 60 minutes of an intense exercise bout. The symptoms of DOMS peak within 24-48 hours after an intense eccentric exercise bout when blood lactate levels have been at normal levels for a considerable amount of time.

DOMS is often precipitated predominantly by eccentric exercise, such as downhill running, plyometrics, and resistance training. In their review, Connolly et al. (2003) explain that the injury itself is a result of eccentric exercise, causing damage to the muscle cell membrane, which sets off an inflammatory response. This inflammatory response leads to the formation of metabolic waste products, which act as a chemical stimulus to the nerve endings that directly cause a sensation of pain. These metabolic waste products also increase vascular permeability and attract neutrophils (a type of white blood cell) to the site of injury. Once at the site of injury, neutrophils generate free radicals (molecules with unshared electrons), which can further damage the cell membrane. Swelling is also a common occurrence at the site of membrane injury, and can lead to additional sensations of pain. Connolly et al. also note the importance of differentiating DOMS from other injuries such as muscle strains. This difference is important to appreciate because when muscle strain is sustained from vigorous exercise, particularly eccentric exercise, it can severely worsen the injury. In contrast, in a muscle that is experiencing DOMS, continued eccentric exercise is still possible without further muscle damage. When dealing with DOMS it is important to differentiate it from muscle strains, recognizing that continued exercise is still possible with DOMS, but not with muscle strain.

Symptoms Associated With DOMS
Both Connolly et al.(2003) and Szymanski (2001) agree that typical symptoms often associated with DOMS include strength loss, pain, muscle tenderness, stiffness, and swelling. Loss of strength usually peaks within the first 48 hours of an exercise bout, with full recovery taking up to 5 days. Pain and tenderness peak within 1-3 days after exercise and typically subside within 7 days. Stiffness and swelling can peak 3-4 days after exercise and will usually resolve within 10 days. It is important to note that these symptoms are not dependant on one another and do not always present at the same time.

Proposed Interventions
Although there has been a considerable amount of research on the treatment of DOMS, to date no one treatment has proved dominant in consistently preventing or treating DOMS. Among popular interventions are pharmacological treatments using non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic treatments utilizing physical modalities such as stretching and warm-up, and interventions using nutritional supplements. The following is a discussion and evaluation of these proposed mechanisms of treatment and the prevention of DOMS.

Benefits of NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and flurbiprofen have long been considered as a treatment for alleviating the symptoms of DOMS. Theoretically, NSAIDs have a strong case for helping to combat the inflammation and swelling which occurs with exercise induced muscle damage. Despite this strong theoretical backing, research done on the effectiveness of NSAIDs has provided mixed and conflicting results. Due to inconsistencies among studies between type, dose, and timing of various NSAIDs, as well as associated negative side effects such as gastrointestinal distress, and hypertensive effects, NSAIDs do not appear to be an optimal choice for treatment of DOMS.

Benefits of Nutritional Supplementation
Nutritional supplements have also emerged as a potential treatment for DOMS. Anti-oxidant’s, such as vitamins C and E, are known to reduce the proliferation of free radicals, which are thought to be generated during the inflammatory response potentially causing more damage to an affected muscle. Connolly et al. report that the effectiveness of anti-oxidant therapy has been shown to be inconsistent among several studies examining it’s potential for treatment. Other nutritional supplements which have been investigated for treatment of DOMS include coenzyme–Q and L-carnitine, however neither supplement has been shown to effectively treat DOMS, and may even worsen symptoms.

Benefits of Warm-up
Unlike the use of NSAIDs and nutritional supplements, pre-exercise warm-up has been shown to be effective in reducing symptoms of DOMS. In his review, Szymanski (2001) notes that traditional warm-up before exercise has been suggested as a means of preparing the body for exercise, improving athletic performance, and reducing DOMS and associated muscle damage. Using a warm up to increase muscle temperature is thought to improve muscle function by leading to greater muscle elasticity, an increased resistance of muscle tissue to tearing, more relaxed muscles, an increased extensibility of connective tissues within muscle, and decreased muscle viscosity. This in turn allows for more efficient muscle contractions, which deliver increased speed and force. Szymanski also reports that several studies provide evidence of concentric warm-up before eccentric exercise, thus preparing the body for the stress caused by overloading the muscles with eccentric activity.

Szymanski (2001) adds that pre-exercise warm-up can be placed into two categories, general and specific. General warm-up is aimed at increasing core body temperature by performing movements that require the use of large muscle groups, such as calisthenics and running. Specific warm-up, mimicking the movement patterns of the actual exercises, is aimed at increasing the local muscle temperature in the muscles, which will be used in the specific sport or physical activity. Due to the benefits of warm-up it is advisable to precede an intense exercise bout with an adequate general and specific warm-up. Warm-up duration can vary greatly, depending of the intensity of physical activity, environmental conditions, and fitness level of clients (less fit people may need a longer warm-up).

Repeated-Bout Effect
In addition to warming up, Szymanski (2003) introduces the repeated-bout effect as a meaningful means of reducing DOMS. The repeated bout effect is a progressive adaptation to eccentric exercise. It has been reported that repeated bouts of lower intensity eccentric exercise performed 1-6 weeks before the initial higher intensity eccentric bouts have been shown to consistently reduce DOMS and exercise induced muscle damage. Thus, a gradual introduction of eccentric exercise, over a period of weeks, is encouraged. Szymanski states that the repeated bout effect is proposed to allow for a faster recovery of strength and range of motion in effected muscles, providing for increased resistance to damage after the first bout. It is also thought that muscle and connective tissue gradually adapt to increasing intensities of eccentric exercise, minimizing incidence and severity of DOMS.

Conclusion
With a better understanding of the causes of DOMS, the health and fitness professional is better equipped to help clients avoid it’s complications. It is hoped that the information in this article will add to the ‘tool box’ of knowledge from which personal trainers can draw from in an effort to optimize the health and fitness results obtained by their clients.
 
The Creator

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Great article! I am not a fan of NSAID's to after workouts personally. I think the body will respond to the inflammation with a release of GH. Have you heard anything about this response Tim?
 
Essensen

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Great article! I am not a fan of NSAID's to after workouts personally. I think the body will respond to the inflammation with a release of GH. Have you heard anything about this response Tim?

This was one og the arguments for not doing 'em after a workouts, but new research acutally sugests that taking antinflammatory medicine like ibuprofen can help inducing hypertrophy... but it's still somewhat new ground and nothing is settled yet.

But frequent use of NSAID's is a pretty sure way to develop stomach ulcer so I wouldn't mess around with it too often.
 
tim290280

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Yeh I'm not sold on NSAID's at anytime. The actual impact they have on your internal organs when taken for anything more than a few days is scary!! I did a bit of reading on them a couple of years ago and weaned myself off them (was taking them for my knee). They are really meant for short term or one off doses, anything more than a couple of weeks and you should question their use at all.

I've read that study Essensen and I think (from a sketchy memory) they aid hypertrophy by dulling the cortisol response that pain responses generate. But this isn't something you could do long term and still expect a response.

I haven't heard anything about a GH response Creator, only about cortisol. But I haven't looked too deeply into this. I know that inflammation responses are generally aimed towards getting blood flow to the "injured" area in order to make sure that the typical immune/injury occurs. This reference probably has more:
Acute inflammation: the underlying mechanism in delayed onset muscle soreness?
Medicine & Science in Sports & Exercise. 23(5):542-551, May 1991.
SMITH, LUCILLE L.

Abstract:
SMITH, L. L. Acute inflammation: the underlying mechanism in delayed onset muscle soreness? Med. Sci. Sports Exerc., Vol. 23, No. 5, pp. 542-551, 1991. It is well documented in animal and human research that unaccustomed eccentric muscle action of sufficient intensity and/or duration causes disruption of connective and/or contractile tissue. In humans, this appears to be associated with the sensation of delayed onset muscle soreness (DOMS). During the late 1970's, it was proposed that this sensation of soreness might be associated with the acute inflammatory response. However, subsequent research failed to substantiate this theory. The present article suggests that the results of much of the research concerning DOMS reflect events typically seen in acute inflammation. Similarities between the two events include: the cardinal symptoms of pain, swelling, and loss of function; evidence of cellular infiltrates, especially the macrophage; biochemical markers such as increased lysosomal activity and increased circulating levels of some of the acute phase proteins; and histological changes during the initial 72 h. In the final section of this paper, a theoretical sequence of events is proposed, based on research involving acute inflammation and DOMS.
This one looks good too:
ARTICLE LINKS:
Fulltext | PDF (238 K)
Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors.

Review Article

Sports Medicine. 33(2):145-164, 2003.
Cheung, Karoline 1; Hume, Patria A 1; Maxwell, Linda 2

Abstract:
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.
links should work if you have journal access
And a cat amoung the pigeons one on my search:
Exercise-induced muscle damage and inflammation: fact or fiction?
C. Malm

KEYWORDS
adaptation • biopsies • creatin kinase • immune system • immunohistochemistry • leucocytes • physical • repair

ABSTRACT
Physical exercise is necessary for maintaining normal function of skeletal muscle. The mechanisms governing normal muscle function and maintenance are vastly unknown but synergistic function of hormones, neurosignalling, growth factors, cytokines and other factors, is undoubtedly important. Because of the complex interaction among these systems the lack of complete understanding of muscle function is not surprising. The purpose of exercise-induced changes in muscle cell function is to adapt the tissue to a demand of increased physical work capacity. Some of the approaches used to investigate changes in skeletal muscle cell function are exercise and electrical stimulation in animals and human models and isolated animal muscle. From these models, it has been concluded that during physical exercise, in an intensity and duration dependent manner, skeletal muscle is damaged and subsequently inflamed. The purpose of the inflammation would be to repair the exercise-induced damage. Because of the design and methods used in a majority of these studies, concerns must be raised, and the question asked whether the paradigm of exercise-induced muscle inflammation in fact is fiction. In a majority of conducted studies, a non-exercising control group is lacking and because of the invasive nature of the sampling methods used to study inflammation it does not appear impossible that observed inflammatory events in human skeletal muscle after physical exercise are methodoligical artefacts.

Lets keep this going guys. Could get interesting santasmile
 
The Creator

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"For many years the phenomenon of DOMS has been attributed to the buildup of lactate in the muscles after an intense workout. However, this assumption has been shown to be unrelated to DOMS. The perceptions of pain and soreness that result from intense eccentric exercise are not related to lactate buildup at all."

I think this is a great point that was brought up in the article. I know this is still a very common misconception that needs to be cleared up.

Following my leg workouts I do 5 minutes of light cardio on a stationary bike and I have noticed a little improvement in my DOMS. I am always amazed at how somedays I will get terrible soreness and other days it wont be bad at all even if the workout didnt really change that much. I think there is a lot to learn about DOMS.

As far as the NSAID's go, they are obviously going to be a "band-aid" for an athlete that is experiencing soreness, especially if they need to compete before the soreness has subsided. That being said, I dont think the usage of NSAID's should become frequent in any person, especially in lifters who know better than to train a muscle that is still sore. I have never taken them for DOMS, only a couple of times for back pain following deadlifts.
 
RobbyM11

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The_KM

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Love the article, accurate and to the point. From my understanding, the inflammatorial response escalates to a slow eccentric stimuli. This despoils the cell membrane correlated within the neuromuscular junction. This sounds normal because growth is induced by adaptation, but energy is used to reconstitute the sacrolemma first, then to synthesize protein...which is pointless and sometimes even counterproductive.

Personally, I'd discredit NSAID's of being of any help to soreness. If you're conditioned, think classical and physically, then you shouldn't be experiencing soreness. Unless of course you're using a slow-rep scheme.

You can also build a tolerance to Tylenol, Advil, etc. Idk, just seems a crutch to me.

Tim, Robby, how are ya guys?
 
tim290280

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Personally, I'd discredit NSAID's of being of any help to soreness. If you're conditioned, think classical and physically, then you shouldn't be experiencing soreness. Unless of course you're using a slow-rep scheme.

You can also build a tolerance to Tylenol, Advil, etc. Idk, just seems a crutch to me.

Tim, Robby, how are ya guys?
Eccentrics and the like can give you pretty bad DOMS. But nothing that should require pain killers (unless you find it hard to sleep properly).

Speaking of pain killers how is the hand Kev? Have a good Xmas?

I'd like to say I'm well, but check my log. At least I'm enjoying a break from everything!
 
The_KM

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Eccentrics and the like can give you pretty bad DOMS. But nothing that should require pain killers (unless you find it hard to sleep properly).

Speaking of pain killers how is the hand Kev? Have a good Xmas?

I'd like to say I'm well, but check my log. At least I'm enjoying a break from everything!

Hand is doing much better! Very thankful for the results I've gotten thus far. Shouldn't be much longer before my finger is good to go! Xmas was great, got an iTouch, and being involved on a forum, I access here and BBD from it which is convenient. I'll head to your log now man.
 
RobbyM11

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Im good kev, college is annoying and boring the heck out of me but still better than anything id be doing back home.

How are you coping? I hope the hand isnt causing to much problems! A guy at my college hand his finger cut off when wrestling in a door lol, it had healed within a month I think and he was back lifting within 3-4 weeks so it shouldnt hinder you too much hopefully. Ill hit up your log sometime soon bro.
 
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