Delayed Onset Muscle Pain Research Articles

Update: Delayed Onset Muscle Soreness (DOMS) – Muscle Biomechanics, Pathophysiology and Therapeutic Approaches

The term Delayed Onset Muscle Soreness (DOMS) refers to a complex injury entity which is based on ultrastructural injury patterns. The injury is usually harmless and heals within a few days without sequelae. However, at the time of the manifestation there are (sometimes considerable) performance limitations and the risk of possible secondary injuries is increased. Thus, prevention and treatment of DOMS, especially in high-performance sports, are of particular value. Insights into muscle biomechanics are necessary to understand the background and mechanisms of DOMS. The definition and classification of overload-related muscle injuries has not yet been uniformly determined. Fluid transitions between physiological, metabolic and neuromuscular fatigue as well as the actual occurrence of injuries with clinical symptoms make clear delineation difficult. The “Munich Classification” terms Delayed Onset Muscle Soreness (DOMS) as Type 1b muscle injury, “delayed onset muscle pain”. The central target of prevention of DOMS is to prevent or alleviate the onset of the initial damage, known as “Exercise Induced Muscle Damage” (EIMD). In case of manifest DOMS, the intention is both to relieve the attendant symptoms and to promote rapid restoration of muscle function. In clinical practice as in scientific research, diverse procedures and interventions have proven valuable, whereby especially physical therapy procedures like cryotherapy, heat therapy or compression therapy show promising study results.

Subacute Influence of Body Cooling on the Perception of Delayed Onset Muscle Pain

Objective: To investigate the subacute influence of the use of body cooling by immersion in cold water on the perception of Delayed Muscle Pain (DOMS), in the posterior leg muscles, 24, 48 and 72 hours after carrying out a three-course muscle fatigue protocol. series of repetitions until concentric failure of the bilateral plantar flexion and dorsiflexion movement. Methods: 22 untrained participants (age: 20.4±1.7 years; body mass: 65.91±15.38kg; height: 166.86±8.47cm) participated in an effort protocol that consisted of three sets of repetitions until concentric failure of the leg muscles, of plantar flexion and bilateral dorsiflexion movement, with one's own body weight. After one minute, through a draw, one of the legs was designated for immersion, up to the height of the popliteal fold, in a vat of ice water (between 12 and 14º C), during three stages of 5 minutes with a 1 minute break between each stage, totaling 15 minutes of immersion. At the same time, the other leg remained in passive recovery, serving as control. After 24, 48 and 72 hours, the individuals were evaluated regarding the perception of DOMS, in both legs, with an analog pressure algometer (pressure of 6kgf/cm²). The perception of pain was signaled by the participants using the Pain Visual Analogue Scale (VAS). Results and conclusions: No statistically significant differences (p<0.05) were found between body cooling and passive recovery, in both groups, in the assessment of perception of DOMS 24, 48 and 72 hours after the exercise protocol.

Effects of Delayed-Onset Muscle Pain on Respiratory Muscle Function.

Delayed-onset muscle soreness (DOMS) has been widely examined in the peripheral muscles; however, studies showing the potential effects of DOMS on respiratory function are limited. DOMS in trunk muscles has a negative effect on respiratory function parameters, respiratory muscle strength, respiratory muscle endurance, and exercise capacity. Prospective cohort study. Level 2. In 24 healthy participants with a mean age of 21 ± 2 years, DOMS was induced for the trunk muscles with a load equal to 80% of the maximum repetitive voluntary contraction. Pulmonary function parameters, respiratory muscle strength and endurance, exercise capacity, pain, fatigue, and dyspnea perception severity were recorded before DOMS and at 24 and 48 hours after DOMS. After DOMS, decreases were observed in respiratory function parameters, namely, forced vital capacity, forced expiratory volume in the first second, vital capacity, and 25% to 75% flow rate value of forced expiratory volume (25% to 75%) (P = 0.02, P = 0.02, P < 0.01, P = 0.01, respectively). Maximal inspiratory pressure and exercise capacity also decreased (P = 0.02, P < 0.01, respectively). No difference was observed between all 3 measurements of maximal expiratory pressure (MEP) and MEP% values (P1 = P2 = P3 ≥ 0.99). The results of the respiratory muscle endurance tests did not reveal a significant difference in terms of load and time in all 3 conditions (P > 0.05). After DOMS, there was a 4% to 7.5% decrease in respiratory function parameters, and a 6.6% decrease in respiratory muscle strength. The occurrence of DOMS before a competition can have a detrimental impact on pulmonary performance. Hence, it is imperative to consider this factor when devising training and exercise programs. In addition, the development of treatment protocols becomes crucial if DOMS arises.

Effectiveness of green tea extract (Camellia sinensis) capsule supplementation for post-exercise muscle recovery in healthy adults: a systematic review protocol.

The objective of the review is to evaluate the effectiveness of green tea extract (Camellia sinensis) capsule supplementation compared with placebo for post-exercise muscle pain and muscle recovery in healthy adults. Green tea extract is popularly consumed by athletes and practitioners of physical activity, as it is easily accessible in supermarkets and health food stores. It is a source of catechins, which assist the endogenous antioxidant system in combating free radicals produced during exercise that can lead to oxidative stress and, therefore, muscle damage and delayed-onset muscle pain. However, there is no consensus on the effect of green tea extract and the ideal and safe dosage to promote muscle recovery. Studies on the effectiveness of supplementation with green tea extract capsules compared with placebo in post-exercise muscle pain and muscle recovery in healthy adults will be included. Studies that are associated with any other source of polyphenols with green tea extract will be excluded. Studies will be identified using the following databases: Cochrane Library, PubMed, Embase, Web of Science, Virtual Health Library, SPORTDiscus, Science Direct, and Scopus. OpenGrey, DART-Europe, and Google Scholar will be used to identify unpublished studies. Studies published in English, French, Spanish, or Portuguese will be included. There will be no restriction on the date of publication. Two authors will independently screen titles and abstracts following previously defined eligibility criteria. After excluding irrelevant studies, the authors will read the full texts of any articles potentially eligible for further evaluation. Any disagreements will be resolved by discussion or by consulting a third author. The included studies will be assessed on their methodological quality using the appropriate JBI critical appraisal checklist, and the data will be extracted by the two authors. A meta-analysis will be performed using a random effects or fixed effects model. The heterogeneity of the data will be calculated. This review will follow the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to classify the certainty of the evidence. PROSPERO CRD42020138772.

(327) Exactly What You Think: Perceived Threat and Challenge Predict Quantitative Sensory Testing Outcomes in Temporomandibular Joint Disorder

While perceived threat (anticipated harm) and challenge (test of abilities) have been previously found to predict pain intensity ratings to thermal stimuli in healthy populations, few studies have assessed the relationship between threat and challenge and experimental pain outcomes in patients with chronic pain. This study examined associations of perceived threat and challenge on quantitative sensory testing (QST) outcomes in patients with temporomandibular joint disorder (TMJD) and healthy controls. In the present study, 40 adults with TMJD (n = 35 female, mean age = 30.4, SD = 6.19) and 22 healthy controls (n = 18 female, mean age = 27.8, SD = 7.07) provided separate ratings of threat and challenge immediately prior to completing painful heat, pressure, and punctate QST. Participants provided ratings of pain intensity following each stimulus. In both patients with TMJD and healthy controls, challenge ratings correlated with ratings of thermal pain intensity (r= .30, p = .02), while ratings of both challenge and threat correlated with ratings of pressure and punctate pain intensity (r’s = .36 - .50, p’s .05). These results replicate and extend prior research by demonstrating that perceived threat and challenge of a QST procedure can predict pain outcomes in patients with chronic pain. Future research should explore relationships between perceptions of threat and challenge with other QST modalities (i.e., delayed-onset muscle pain, electric pain), and explore how perception of QST parameters may influence pain chronicity. Supported by NIDCRR00DE022368-03.

(528) The influence of fear of pain on activity-induced exacerbation of delayed onset muscle pain

Little is known regarding the influence of fear of pain on acute exacerbations of pain during activity, which is reported in several chronic pain conditions. Thus, the purpose of this study was to investigate the influence of fear of pain on pain perception during activity and at rest after induced delayed onset muscle pain (DOMP) of the bicep. Forty-two young healthy adults completed 2 consecutive days of testing. On Day 1, subjects completed the State-Trait Anxiety Inventory –Trait version (STAI-T), the Pain Catastrophizing Scale (PCS), and the Fear of Pain Questionnaire (FPQ-III). Then, subjects performed an eccentric exercise protocol of the non-dominant elbow flexors to induce DOMP. At baseline and 24 hours after the eccentric exercise protocol, bicep pain was assessed at rest and during elbow flexion, and extension. Subjects were then randomly assigned to perform 20 minutes of either standardized activity of the painful muscles (elbow flexion/extension with a 1lb dumbbell), non-standardized activity of the painful muscles (elbow flexion/ extension while playing Nintendo Wii Boxing), or quiet rest. Subjects rated their worst pain during the activity/rest. Step-wise regression models considered baseline pain measures and scores on the STAI-T, PCS, and FPQ-III as predictors of DOMP at rest and elbow flexion/extension 24 hours later. Bivariate correlations examined the relationship between fear of pain and worst pain during 20 minutes of activity or rest. FPQ-III scores significantly predicted DOMP at rest (b=.481) and pain during elbow extension (b=.445), and were significantly related to worst pain during 20 minutes of rest (r=.853) and standardized elbow flexion/extension activity (r=.733). These results confirm the influence of fear of pain on DOMP while at rest and provide novel evidence showing that greater fear of pain is also associated with greater activityinduced exacerbations of DOMP, with the exception of pain reported while playing Wii Boxing.

Prior Eccentric Exercise Augments Muscle Pain and Perception of Effort During Cycling Exercise

This study examined the effects of exercise-induced muscle damage (EIMD) on the physiological and perceptual responses to 30 minutes of submaximal cycling at 60% of oxygen consumption (VO2 peak). Ten participants completed two 30-minute bouts of cycling, one before and one 48 hours after performance of strenuous (24 contractions with 120% of concentric 1-repeition maximum) eccentric exercise. Eccentric exercise resulted in a significant delayed-onset muscle pain (1.6±1.6 mm to 44.8±20 mm on a 100-mm visual analog scale; P<0.001) and a 15% (P<0.001) reduction in maximal strength 48 hours after exercise. Ratings of quadriceps muscle pain (1.99±0.42 vs. 3.30±0.56; P=0.003) and perceived exertion (RPE; 13.0±0.30 vs. 13.8±0.61; P=0.02) were elevated during cycling after EIMD at identical work rates. No changes were observed in VO2 (29.6±4.6 vs. 30.2±4.4 mL/kg/min; P=0.41), heart rate (154±15 vs. 155±9 beats/min; P=0.58), and ventilation (57.2±12.1 vs. 59.8±12.7 L/min; P=0.13) during exercise after EIMD. The mean change in RPE was significantly correlated (r=0.56; P<0.01) with the change in muscle pain during cycling and delayed-onset pain during resistance exercise (r=0.86; P<0.01), but did not correlate with changes in VO2, heart rate, ventilation, and maximal strength. These findings indicate the elevations in RPE after EIMD are likely a consequence of the EIMD with the most likely explanation being an increase in localized pain before and during cycling exercise.

Exercise-induced Pain Intensity Predicted by Pre-exercise Fear of Pain and Pain Sensitivity

Our primary goals were to determine whether preexisting fear of pain and pain sensitivity contributed to post-exercise pain intensity. Delayed-onset muscle pain was induced in the trunk extensors of 60 healthy volunteers using an exercise paradigm. Levels of fear of pain and experimental pain sensitivity were measured before exercise. Pain intensity in the low back was collected at 24 and 48 hours post-exercise. Participants were grouped based on pain intensity. Group membership was used as the dependent variable in separate regression models for 24 and 48 hours. Predictor variables included fear, pain sensitivity, torque lost during the exercise protocol, and demographic variables. The final models predicting whether a participant reported clinically meaningful pain intensity at 24 hours only included baseline fear of pain at each level of pain intensity tested. The final model at 48 hours included average baseline pain sensitivity and the loss of muscle performance during the exercise protocol for 1 level of pain intensity tested (greater than 35 mm of 100 mm). Combined, these findings suggest that the initial reports of pain after injury may be more strongly influenced by fear whereas the inflammatory process and pain sensitivity may play a larger role for later pain intensity reports.

Pressure and Activity-related Allodynia in Delayed-onset Muscle Pain

Muscle pain from different activities was tested with the muscle pain expected to vary in ways that may clarify mechanisms of activity-induced exacerbation of myofascial pain. Participants [N=20; 45% women; 23 y old (SD=2.09)] consented to participate in a 6 session protocol. Bilateral muscle pain ratings and pressure pain thresholds (PPTs) were collected before and for 4 days after lengthening (ie, eccentric) muscle contractions were completed with the nondominant elbow flexors to induce delayed-onset muscle pain. The muscle pain ratings were collected with the arms in several conditions (eg, resting, moving, and contracting in a static position) and PPTs were collected with the arms. In the ipsilateral arm, muscle pain ratings at rest and during activity significantly increased whereas PPTs significantly decreased after the eccentrics (ηs=0.17 to 0.54). The greatest increases in pain occurred during arm extension without applied load, in which there was more stretching but less force than isometrics. In the contralateral arm, neither muscle pain nor PPTs changed from baseline. These results resemble earlier electrophysiology studies showing differential sensitization across stimuli and support that increased depth of information about aggravating activities from clinical patients is needed.

Post exercise ice water immersion: Is it a form of active recovery?

Ice water immersion and contrast temperature water immersion therapy post exercise is fast becoming a common practice among athletes involved in a variety of sports. Several mechanisms have been put forth to explain the rationale for its use. However, there is still a lack of evidence from a sufficiently large-scale trial to support the routine practice and formal incorporation into certain sporting guidelines. We describe here two athletes who applied the therapy post exercise and presented to the Emergency Department with delayed onset muscle pain.

Counterpoint: Estrogen and Sex do not Significantly Influence Post-Exercise Indexes of Muscle Damage, Inflammation, and Repair

Exercise-induced muscle damage (EIMD) occurs following strenuous, novel exercise and is assessed directly via tissue analysis and characterized indirectly by muscle dysfunction, inflammation, delayed onset muscle soreness, and increased levels of muscle proteins [e.g., creatine kinase (CK),

Appraisals of pain from controlled stimuli: Relevance to quantitative sensory testing

Sensory testing has been advocated for the diagnosis, prognosis, and outcome evaluation of pain patients, but responses to controlled stimuli have not been well correlated to clinical pain. As an initial step for improving the clinical relevance of sensory testing, this investigation compared appraisals of and responses to controlled pain stimuli. A prospective within subjects design was used. Heat, ischaemic, and delayed-onset muscle pain were induced in the upper extremity of 44 participants (47.7% women) during four experimental sessions. The threat of heat and ischaemic pain was higher than delayed-onset muscle pain (F(2,86) = 5.30, p<.01, eta(2) = .11). Threat, challenge, predictability, and controllability were related to heat pain most consistently. The affective-sensory ratios of ischaemic and delayed-onset muscle pain resembled those of clinical pain and were higher than heat pain (F(2,84) = 11.64, p<.01, eta(2) = .22). Delayed-onset muscle pain meaningfully affected daily activities, which correlated to delayed-onset muscle pain ratings (rs = .60-.68, ps <.001). Heat stimuli may be well suited for instructional manipulations of appraisals to improve the clinical relevance of quantitative sensory testing and delayed-onset muscle pain's effects on daily activities are clinically relevant.

(138) Effect of lower leg eccentric actions on the nociceptive flexion (R-III) reflex, foot tremor, and delayed onset muscle pain

(138) Effect of lower leg eccentric actions on the nociceptive flexion (R-III) reflex, foot tremor, and delayed onset muscle pain

Effects of neuromuscular electrical stimulation of the knee extensor muscles on muscle soreness and different serum parameters in young male athletes: preliminary data

Aim:To evaluate the effects of neuromuscular electrical stimulation (NMES) on muscle soreness and on a variety of serum parameters during and after NMES of knee extensor muscles of young, well...

Relationships Among Delayed-Onset Muscle Pain And Other Indicators Of Muscle Damage

Relationships Among Delayed-Onset Muscle Pain And Other Indicators Of Muscle Damage

Efficacy of Farabloc as an analgesic in primary fibromyalgia

The goal of our study was to determine the efficacy of Farabloc, an electromagnetic shielding fabric compared to placebo fabric when worn as a nightgown, as an analgesic in patients hospitalized with fibromyalgia. In a rheumatologic and rehabilitation hospital, we performed a phase 1, single-blind study of patients using Farabloc (F) or placebo (P) gowns for 8 h per night during the 20-day hospitalization and a phase 2, single-blind crossover study of patients using both F and P gowns randomly and alternatively switching after 10 of 21 days hospitalization (phase 1: 42 F, mean age 49.02 years, 35 female, 7 male; 84 P, mean age 48.08 years, 72 female, 12 males; phase 2: 25 F/P, P/F, or P/P, mean age 44.0 years, 24 female, 1 male). The study involved randomly selected and blinded use of hospital gown 8 h per night of either F or P fabric. The main outcome measures were changes from admission or midpoint to discharge in quantity of pain (QN), quality of pain (QL), and paracetamol use (PU). In phase 1, all three variables significantly favored F over P when using paired t test, two sample t test, Mann-Whitney, and analysis of covariance tests. QN was reduced (F = -2.03 -/+ 0.99*, P = 0.59 -/+ 0.71). QL was reduced (F = -10.64 -/+ 5.69*, P = -2.54 -/+ 3.40). PU was reduced (F = 10.69 -/+ 6.68*, P = 26.12 -/+ 9.37). In phase 2, comparing midpoint to discharge levels in the three variables again favored P/F over F/P and P/P (>0.001): QN (P/F +16.00 -/+ 8.35* F/P -13.27 -/+ 11.40), QL (P/F +8.71 -/+ 4.75* F/P -6.55 -/+ 5.59), and PU (F -9.29 -/+ 4.39* P -18.00 -/+ 5.27) (*p = <0.001). Patients with fibromyalgia had less pain after sleeping in a gown made of Farabloc than with a placebo fabric. This suggests that Farabloc, an electromagnetic shielding fabric, has analgesic properties in fibromyalgia. Reduced pain observation is consistent with previous studies in phantom limb pain and delayed onset muscle pain. Limitations of this study include single blind design, small sample size, and in phase 2, a lack of washout period and a F/F group.

Caffeine Attenuates Delayed-Onset Muscle Pain and Force Loss Following Eccentric Exercise

This double-blind, placebo-controlled, repeated-measures experiment examined the effects of a 5 mg . kg(-1) body weight dose of caffeine on delayed-onset muscle pain intensity and force loss in response to 64 eccentric actions of the dominant quadriceps induced by electrical stimulation. Low caffeine-consuming college-aged females (n = 9) ingested caffeine or placebo 24 and 48 hours following electrically stimulated eccentric exercise of the quadriceps. One hour after ingestion, maximal voluntary isometric contractions (MVIC) and submaximal voluntary eccentric actions were used to determine force loss during activation of damaged quadriceps and whether caffeine attenuates muscle pain intensity. Pain intensity was measured using a 0 to 100 visual analog scale. Caffeine produced a large (12.7 raw visual analog scale [VAS] units; -48%; Cohen's d effect size = -0.88), statistically significant hypoalgesia during the MVIC (t = -2.52; df = 8; P = .036). The reduction in pain scores during submaximal voluntary eccentric movements was smaller (7.8 raw VAS units; -26%, d = -0.34), as was the increase in MVIC force (4.4%; d = 0.13). Eccentric exercise occurs when skeletal muscles produce force while being lengthened. For example, the biceps brachii muscles act eccentrically when a cup of coffee is lowered from the mouth to a tabletop. This experiment found that caffeine (equal to approximately 2 cups of brewed coffee) could produce a large reduction in pain resulting from eccentric exercise-induced, delayed-onset muscle injury. This finding may improve the quality of life of individuals who experience skeletal muscle pain after engaging in unaccustomed, eccentrically biased exercise.

Cognitive Appraisals of the Meaning of Delayed-Onset Muscle Pain

Pain is associated with reduced exercise adherence and the meaning of pain has been theorized to influence pain response. PURPOSE:This investigation examined participants' cognitive appraisals of the harmful or beneficial nature of delay ed-onset muscle pain and the relationships among these appraisals, delay ed-onset muscle pain ratings, and self-reported exercise behavior. METHODS:Participants(N = 113, 58.4% women) described their cognitive appraisals of delayed-onset muscle pain, their most recent delay ed-onset muscle pain experience, and their self-reported leisure exercise behavior. In addition, a subset of the participants (n = 63, 71.4% women) completed 3 sets of 10 eccentric repetitions with their non-dominant arms to induce delayed-onset muscle pain, which was measured by pain intensity and pain unpleasantness ratings at 48 hrs post-exercise. RESULTS: Few participants viewed delayed-onset muscle pain as generally representing harmful muscle damage (2.7%) so analyses were restricted to the most common appraisals of the delayed-onset muscle pain as representing beneficial muscle adaptation (64.6%) and as representing a combination of both harmful damage and beneficial adaptation (28.3%). These cognitive appraisals of delayed-onset muscle pain were not related to total self-reported leisure exercise, but the appraisals significantly explained 6.8% of recalled muscle pain intensity, F(1,84) = 6.09, p < .05, and 4.4% of recalled muscle pain unpleasantness from the participants' most recent delayed-onset muscle pain experience, F(1,84) = 3.85, p = .05. More specifically, viewing the delayed-onset muscle pain as representing both harmful damage and beneficial adaptation was related to higher pain ratings than viewing the pain as representing only beneficial adaptation. However, cognitive appraisals were not related to the induced muscle pain intensity or pain unpleasantness at 48-hrs post-exercise. CONCLUSIONS:These healthy participants largely viewed delayed-onset muscle pain as representing beneficial muscle adaptation and their cognitive appraisals were not related to self-reported leisure time exercise behavior. The relationships between cognitive appraisals and recalled or actual delayed-onset muscle pain ratings were divergent, which may have been due to collecting appraisals of delayed-onset pain in an abstract sense instead of collecting specific appraisals of the induced delayed-onset muscle pain. Future studies comparing the meaning and effects of personally-experienced delayed-onset muscle pain within healthy and clinical samples are warranted.

Caffeine Attenuates Delayed Onset Muscle Pain Following Eccentric Exercise

PURPOSE: This double-blind, placebo-controlled, repeated measures experiment examined the effects of a 5 mg.kg−1 body weight dose of caffeine on delayed onset muscle pain intensity and force loss in response to 64 eccentric actions of the dominant quadriceps induced by electrical stimulation METHODS: Low caffeine consuming college-aged females (N=9) ingested caffeine or placebo 24 and 48 hours following electrically stimulated eccentric exercise of the quadriceps. One hour after ingestion, maximal voluntary isometric contractions (MVIC) and submaximal voluntary eccentric actions (SVEA) were used to determine whether caffeine attenuates muscle pain intensity or force loss during activation of damaged quadriceps. Pain intensity was measured using a 0 to 100 visual analog scale (VAS). RESULTS: Caffeine produced a large (12.7 raw VAS units; −48%; d=−0.88) statistically significant hypoalgesia during the MVIC (t=−2.52; df=8; p=0.030. The reduction in pain scores during SVEA was smaller (7.8 raw VAS units; −26%; d=−0.34) as was the increase in MVIC force (4.4%; d=0.13). CONCLUSIONS: Caffeine can produce large reductions in pain resulting from eccentric exercise induced delayed onset muscle injury.

EFFECT OF ECCENTRIC STRENGTH TESTING ON DELAYED-ONSET MUSCLE PAIN

Dannecker, E.A., P.D. O'Connor, J.W. Atchison, and M.E. Robinson. Effect of eccentric strength testing on delayedonset muscle pain. J. Strength Cond. Res. 19(4):888–892. 2005.—This investigation was designed to determine the effect of eccentric strength testing on delayed-onset muscle pain in 20 untrained university students. Initially, eccentric strength testing (5-repetition maximum [5RM]) was performed bilaterally. Next, 1 arm completed 3 sets of 10 eccentric repetitions to induce delayed-onset muscle pain. Then, in a subsequent session, whichever arm previously performed only the 5RM test completed the 5RM test a second time and the 3 sets of 10 eccentric repetitions. Statistical analyses supported significantly increased pain intensity and unpleasantness across 48 hours post-5RM test alone. However, pain intensity and unpleasantness after the eccentric training bouts were significantly lower in the arm that performed 2 5RM tests than the arm that performed only 1. Thus, the eccentric strength testing produced delayed-onset muscle pain and protected against future delayed-onset muscle pain. These effects should be considered when such testing is used in baseline strength assessments.