Introduction
For those of you turning over a new leaf for 2014 and for all who are returning to training soon, the ultimate question remains; Why do I get sore after a tough session and is there anything I can do?
Up until now, the majority of the treatment has been based on hearsay from "Make sure you do your stretches" to "Go for an easy run or walk tomorrow to loosen yourselves up". All sounds familiar but what does the evidence say? In a recent systematic review (the highest form of evidence) physiotherapeutic interventions are studied to see what is the best form of treatment for delayed onset of muscle soreness (DOMS)
Up until now, the majority of the treatment has been based on hearsay from "Make sure you do your stretches" to "Go for an easy run or walk tomorrow to loosen yourselves up". All sounds familiar but what does the evidence say? In a recent systematic review (the highest form of evidence) physiotherapeutic interventions are studied to see what is the best form of treatment for delayed onset of muscle soreness (DOMS)
What is Delayed Onset of Muscle Soreness (DOMS)?
We're all too familiar with that soreness and tightness in our muscles after a particularly tough session or a new type of exercise. But what exactly is DOMS? In a study by Clarkson et al in 1999, they described DOMS as "muscle damage caused by strenuous and unaccustomed exercise, especially exercise involving eccentric muscle contractions".
Our muscles contract in a number of ways. A concentric contraction is the one we're most familiar with where our muscle shortens (ex: our biceps shorten when we bend our elbow). An eccentric contraction is when our muscle lengthens while still exerting force (ex: a hurdler's hamstring while jumping over a hurdle is in a lengthened position but is still contracting). When one tears their hamstring, the hamstring is usually eccentrically contracting at that time.
Our muscles contract in a number of ways. A concentric contraction is the one we're most familiar with where our muscle shortens (ex: our biceps shorten when we bend our elbow). An eccentric contraction is when our muscle lengthens while still exerting force (ex: a hurdler's hamstring while jumping over a hurdle is in a lengthened position but is still contracting). When one tears their hamstring, the hamstring is usually eccentrically contracting at that time.
Unfamiliar eccentric exercise frequently results in muscle damage at both a direct (cellular) level such as elevated creatine kinase activity, and an indirect level (changes in muscle function) such as strength loss, pain, and muscle tenderness. However following recovery of this "damage", a repeated bout of the same exercises results in minimal symptoms of muscle damage and has been referred to as the "repeated bout effect". But is there anything to minimise the symptoms between your first session and the next or do we just have to wait it out?
Physiotherapeutic Interventions for DOMS
Torres et al (2012) pooled together a number of studies examining the effects of certain physiotherapy treatments for DOMS. These interventions included:
- Cryotherapy (ice)
- Stretching
- Low Intensity Exercise
- Massage
Cryotherapy
10 studies looked at the effects of cryotherapy in the form of ice baths on recovery from DOMS. The authors could find no evidence to support the use of cryotherapy.
The studies did show a decrease in muscle soreness at 48 hours (1.22cm on a 10cm visual analogue scale - pain measuring tool) and at 72 hours (2.11cm on the same scale). However as the studies were so diverse, it was difficult to pool the results therefore these statistics should not be relied upon.
The studies also noted an improvement in muscle strength at 24 hours (6.93% increase) however again as the studies were not similar in format, we cannot rely on these results.
The studies did show a decrease in muscle soreness at 48 hours (1.22cm on a 10cm visual analogue scale - pain measuring tool) and at 72 hours (2.11cm on the same scale). However as the studies were so diverse, it was difficult to pool the results therefore these statistics should not be relied upon.
The studies also noted an improvement in muscle strength at 24 hours (6.93% increase) however again as the studies were not similar in format, we cannot rely on these results.
Stretching
Nine trials studied the effects of various types of stretching on recovery from exercise-induced muscle damage. The stretching included before exercise, before and after exercise and after exercise only.
The authors however found no positive effects of any form of stretching on both muscle soreness and muscle strength following DOMS
The authors however found no positive effects of any form of stretching on both muscle soreness and muscle strength following DOMS
Low Intensity Exercise
Seven studies looked at the effects of low intensity exercises on recovery from exercise-induced muscle damage. When all the results were pooled together however, there was no significant benefits of low intensity exercises at 1, 24, 48 or 72 hours post high intensity exercise that induced muscle damage.
Massage
Nine studies analysed the effects of massage and of all the interventions, massage was the only one with positive results. Massage reduced soreness at the 24 hour stage. On average, those who had received massage as an intervention had a 0.33cm decrease on a 10cm visual analogue scale (pain measuring tool). It also increased muscle recovery by 1.87%.
You don't have to be a mathematician to realise that a 0.33cm decrease in pain and a 1.87% increase in muscle recovery does not make for vast improvements. So is there any point in massage if the benefits are so small?
You don't have to be a mathematician to realise that a 0.33cm decrease in pain and a 1.87% increase in muscle recovery does not make for vast improvements. So is there any point in massage if the benefits are so small?
Overview
The results of this review show that
Does this ring true to you? Do you find there are few benefits of the above interventions when you're suffering from exercise-induced muscle damage? Should we stick to the evidence or follow the advice passed down from generations before? Comment below and let us know what you think!
- Massage slightly improves muscle soreness and muscle recovery at the 24 hour stage following high intensity exercise
- Cryotherapy may or may not decrease muscle soreness and improve muscle strength at various stages following high intensity exercise. More evidence is needed in this area
- There is no evidence to support stretching or low intensity exercises in the prevention of DOMS
Does this ring true to you? Do you find there are few benefits of the above interventions when you're suffering from exercise-induced muscle damage? Should we stick to the evidence or follow the advice passed down from generations before? Comment below and let us know what you think!
References
Clarkson P. M., Sayers S. P. (1999) Etiology of Exercise-Induced Muscle Damage Canadian Journal of Applied Physiology, 24(3): 234-248
McHugh M. P., Connolly D. A. J., Eston R. G., Gleim G. W. (1999): Exercise-Induced Muscle Damage and Potential Mechanisms for the Repeated Bout Effect. Sports Medicine 27(3): 157-170
Torres R., Ribeiro F., Duarte J. A., Cabri J. M. H. (2012): Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: Systematic review and meta-analysis. Physical Therapy in Sport, 13(2): 101-114
McHugh M. P., Connolly D. A. J., Eston R. G., Gleim G. W. (1999): Exercise-Induced Muscle Damage and Potential Mechanisms for the Repeated Bout Effect. Sports Medicine 27(3): 157-170
Torres R., Ribeiro F., Duarte J. A., Cabri J. M. H. (2012): Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: Systematic review and meta-analysis. Physical Therapy in Sport, 13(2): 101-114