Sunday, October 13, 2013

DOMS - Delayed Onset Muscle Soreness: What Is DOMS & How Can It Be Managed? Science, Strategies, Supplements

Whether the text on this photo is actually true or not will be discussed in part II of this series, for now we are going to restrict ourselves to an analysis of the underlying reasons of DOMS and means to prevent that the pain becomes unbearable.
An article by Alex Leaf (CPT)

If you train regularly I’m sure you’re well aware of it, especially the morning following a heavy training session. Delayed onset muscle soreness (DOMS) is the sensation experienced upon waking the next morning and lasting upwards of 72 hours after a heavy exercise session.

It is most commonly brought about through unaccustomed eccentric muscle action causing a disruption of connective and/or contractile tissue (Cheung. 2003). It is not a singular mechanism but rather a result of several mechanisms beginning with microtrauma followed by an inflammatory response (Lewis. 2012).

Does DOMS influence exercise performance?

Although DOMS may make you rethink taking the stairs the next day, its effect on exercise is minimal. This assumes, of course, that you aren’t training the same muscles the very next day. It’s been shown that DOMS impairs force output for up to 24 hours following exercise and even alters the agonist-antagonist muscle activity through reducing motor unit discharge rates (Vila-Chã, Hassanlouei, Farina, & Falla, 2012).
A word of caution: The regular use of NSAIDs as a means to counter delayed onset muscle damage is not a sustainable strategy for any athlete who cares about the health of his intestinal tract and liver. So you better make sure to stick to occasional use, only.
The latter could be attributed to a self-protection mechanism to prevent further damage, as DOMS has also been shown to alter walking and running biomechanics (Paschalis, et al., 2007). But like I said, this only matters if you are training the same muscles the very next day. Assuming you have a rest day or are on some form of a split-routine, DOMS is not a contributor to perceived exertion (Haddad, et al., 2013).

What can be done to prevent or diminish DOMS?

Numerous treatment strategies have been investigated to help alleviate DOMS and restore maximal function to the muscles (Cheung, Hume, & Maxwell, 2003).
  • Figure 1: Disruption, inhibition, proteolysis and inflammation - these are the tree main phases trough which you will be going after a hard workout. The "thing" that hurts, though, is the inflammation in step three - the "onset" part in "DOMS" ;-)
    Nonsteroidal anti-inflammatory drugs have shown dosage-dependent effects with little reason to believe that the occasional use will negatively affect muscle growth (Ticchi, 2009). However, given their reported impairment of satellite cell activity, longer-term NSAID use may well be detrimental (Schoenfeld, 2012).
  • Warm water immersion (Hassan, 2011) but not cryotherapy (Howatson & Van Someren, 2003) has also demonstrated alleviating effects in the majority of respective trials.
  • Similarly, massage has shown varying success that is probably attributable to the type and timing of the massage. Stretching, which is also recommended as a means to prevent or even counter DOMS, on the other hand, has no science to support its effectiveness as an effective DOMS killer (Torres. 2012).
And then of course there is exercise, which has shown to be one of the most effective means of reducing the symptoms of DOMS, although the pain relief is temporary and will resume again following the cessation of exercise (Cheung, Hume, & Maxwell, 2003). More than likely this is due to the break-up and removal of waste products within the muscles via increased blood flow, and also due to an increased endorphin release during exercise (Hough, 1900).
Remember: Irrespective of whether or not DOMS may be necessary for muscle growth (this will be explicitly discussed in part II of this article), some researchers believe that the use of large amounts of anti-oxidant supplements can counter some the beneficial health effects of exercise (Peterneli & Coombes, 2011), (Ristow & Schmeisser, 2011)

What about foods, nutrients and supplements?

Suggested Read: "Pre-regeneration with a warm bath!?" | read more
The best supplement for reducing DOMS isn’t a supplement per se, but rather supplementing the workout with nutrients. Consuming milk or a milk-based carbohydrate/protein supplement immediately post-workout has been shown to limit reductions in muscle performance and symptoms of DOMS 24 and 48 hours later (Cockburn, Stevenson, Hayes, Robson-Ansley, & Howatson, 2010), and these benefits can be achieved with a mere 500 mL – roughly two cups – of milk (Cockburn, Robson-Ansley, Hayes, & Stevenson, 2012).

The reductions in muscle soreness are more than likely do to the high-quality protein of the milk rather than the carbohydrates or fats (Flakoll, Judy, Flinn, Carr, & Flinn, 2004). One study using BCAAs found that about 5g taken before a high volume squat exercise had significantly reduced levels of DOMS and preservation of power output 48 hours post-exercise compared to an isocaloric carbohydrate placebo (Shimomura, et al., 2006).  Five grams of BCAAs is the equivalent of just under 700mL – three cups – of milk, which just so happens to be the amount used in another study that found chocolate milk to reduce DOMS more so than an isocaloric carbohydrate drink (Gilson, et al., 2010). And if you aren’t a fan of milk, all this is about 20 to 25 grams of milk protein around training sessions.

More specific supplements

While it may help with DOMS, n-acetyl-cystein (NAC) is also one of the likely candidates that could theoertically blunt the exercise induced inflammation to a degree that would actually hamper the adaptive processes that's at the heart of strength, mass and performance gains (read more & learn about hormesis)
These classics these classics, there is evidence from peer-reviewed randomized controlled trials that all of the following supplements can help ameliorate / prevent DOMS, as well:
  • 1,800mg of the antioxidants EGCG and N-acetyl-cysteine taken pre-exercise were associated with less muscle soreness the next day (Kerksick. 2010),; 
  • 2g of L-carnitine L-tartrate daily (Volek. 2002), and 
  • 8g of citrulline malate prior to training (Pérez-Guisado. 2010) 
The usual suspects, vitamins C and E show mixed results, at best (McGinley, Shafat, & Donnelly, 2009). Moreover, super-dosing antioxidants may blunt the beneficial effects of exercise via interfering with important physiological processes (Peterneli & Coombes, 2011).
Part IPart II
Just a reminder: This is a two-part series on Delayed Onset Muscle Soreness. You can switch back and forth between part I "What Is DOMS & How Can It Be Managed? Science, Strategies, Supplements" & part II "No Pain, No Gain? Is DOMS Necessary to Build Muscle?" by clicking on the images to the left.
Other supplements may even increase DOMS. The most effective naturally occurring statin, Red Yeast Rice, contains lovastatin which has been shown to increase markers of muscle damage following exercise (Thompson, et al., 1997). Diuretic compounds (Cleary, Sitler, & Kendrick, Dehydration and Symptoms of Delayed-Onset Muscle Soreness in Normothermic Men, 2006) and thermogenic agents (Cleary, Sweeney, Kendrick, & Sitler, 2005) may also exacerbate DOMS if fluid intake is not adequate.
There is still one important question to answer:  We have learned that delayed onset muscle soreness is an almost inevitable consequence of microscopic muscle damage, but usually does not affect athletic performance or perceived exertion if you are not training the same muscles the next day. We also analyzed a variety of treatment strategies and supplements that may reduce DOMS. So I suppose the only question left to answer is:
Is DOMS necessary for muscular hypertrophy?
I mean, it’s “No pain, no gain…” - isn’t it? Come back to next Sunday for Part II of this two-part series and find out!
Take home messages: Let's just briefly recapitulate what we've learned already in today's first installment of this two-post series on delayed onset muscle soreness:
  • DOMS is a result of exercise induced microtrauma.
  • Eccentric and unaccustomed exercises are particularly prone to induce DOMS.
  • DOMS will impair the muscular force production immediately after a workout
  • Unless you train the same muscle group on subsequent training days, its effects on athletic performance or perceived exertion are negligible
Measures to counter DOMS include NSAIDs, warm-water immersion, massage and light exercise to mobilize the muscle. Supplements to prevent / ameliorate DOMS include (milk) protein and BCAA supplements, n-acetyl-cysteine, l-carnitine tartrate, citrulline and green tea (EGCG). Statins and statin-like OTC supplements such as red yeast rice, but also diuretics and some thermogenic agents can increase DOMS.
  • Cheung, K., Hume, P., & Maxwell, L. (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports Medicine, 33(2), 145-164. 
  • Cleary, M. A., Sitler, M. R., & Kendrick, Z. V. (2006). Dehydration and Symptoms of Delayed-Onset Muscle Soreness in Normothermic Men. Journal of Athletic Training, 41(1), 36-45.
  • Cleary, M. A., Sweeney, L. A., Kendrick, Z. V., & Sitler, M. R. (2005). Dehydration and symptoms of delayed-onset muscle soreness in hyperthermic males. Journal of Athletic Training, 40(4), 288-297. 
  • Cockburn, E., Robson-Ansley, P., Hayes, P. R., & Stevenson, E. (2012). Effect of volume of milk consumed on the attenuation of exercise-induced muscle damage. European Journal of Applied Physiology, 112(9), 3187-3194.
  • Cockburn, E., Stevenson, E., Hayes, P. R., Robson-Ansley, P., & Howatson, G. (2010). Effect of milk-based carbohydrate-protein supplement timing on the attenuation of exercise-induced muscle damage. Applied Physiology, Nutrition, and Metabolism, 35(3), 270-277.
  • Flakoll, P. J., Judy, T., Flinn, K., Carr, C., & Flinn, S. (2004). Postexercise protein supplementation improves health and muscle soreness during basic military training in marine recruits. Journal of Applied Physiology, 96(3), 951-956
  • Gilson, S. F., Saunders, M. J., Moran, C. W., Moore, R. W., Womack, C. J., & Todd, M. K. (2010). Effects of chocolate milk consumption on markers of muscle recovery following soccer training: a randomized cross-over study. Journal of the International Society of Sports Nutrition, 7(19).
  • Haddad, M., Chaouachi, A., Wong, d. P., Castagna, C., Hambli, M., Hue, O., & Chamari, K. (2013). Influence of fatigue, stress, muscle soreness and sleep on perceived exertion during submaximal effort. Physiology & Behavior, 119, 185-189..
  • Hassan, E. S. (2011). Thermal therapy and delayed onset muscle soreness. The Journal of Sports Medicine and Physical Fitness, 51(2), 249-254. 
  • Hough, T. (1900). ERGOGRAPHIC STUDIES IN MUSCULAR FATIGUE AND SORENESS. Journal of the Boston Society of Medical Sciences, 5(3), 81-92. 
  • Howatson, G., & Van Someren, K. A. (2003). Ice massage. Effects on exercise-induced muscle damage. The Journal of Sports Medicine and Physical Fitness, 43(4), 500-505. 
  • Kerksick, C. M., Kreider, R. B., & Willoughby, D. S. (2010). Intramuscular adaptations to eccentric exercise and antioxidant supplementation. Amino Acids, 39(1), 219-232.
  • Lewis, P. B., Ruby, D., & Bush-Joseph, C. A. (2012). Muscle soreness and delayed-onset muscle soreness. Clinics in sports medicine, 31(2), 255-262. 
  • McGinley, C., Shafat, A., & Donnelly, A. E. (2009). Does antioxidant vitamin supplementation protect against muscle damage? Sports Medicine, 39(12), 1011-1032.
  • Paschalis, V., Giakas, G., Baltzopoulos, V., Jamurtas, A. Z., Theoharis, V., Kotzamanidis, C., & Koutedakis, Y. (2007). The effects of muscle damage following eccentric exercise on gait biomechanics. Gait & Posture, 25(2), 236-242
  • Pérez-Guisado, J., & Jakeman, P. M. (2010). Citrulline malate enhances athletic anaerobic performance and relieves muscle soreness. Journal of Strength and Conditioning Research, 24(5), 1215-1222.
  • Peterneli, T. T., & Coombes, J. S. (2011). Antioxidant supplementation during exercise training: beneficial or detrimental? Sports Medicine, 41(12), 1043-1069.
  • Ristow, M., & Schmeisser, S. (2011). Extending life span by increasing oxidative stress. Free Radic Biol Med, 51(2).
  • Schoenfeld, B. J. (2012). The use of nonsteroidal anti-inflammatory drugs for exercise-induced muscle damage: implications for skeletal muscle development. Sports Medicine, 42(12), 1017-1028.
  • Shimomura, Y., Yamamoto, Y., Bajotto, G., Sato, J., Murakami, T., Shimomura, N., . . . Mawatari, K. (2006). Nutraceutical effects of branched-chain amino acids on skeletal muscle. The Journal of Nutrition, 136(2), 529S-532S. 
  • Thompson, P. D., Zmuda, J. M., Domalik, L. J., Zimet, R. J., Staggers, J., & Guyton, J. R. (1997). Lovastatin increases exercise-induced skeletal muscle injury. Metabolism, 46(10), 1206-1210.
  • Ticchi, S. J. (2009). The effect of nonsteroidal anti-inflammatory drugs on muscle recovery and strength after injury. The University of Toledo
  • Torres, R., Ribeiro, F., Alberto Duarte, J., & Cabri, J. M. (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. 
  • Vila-Chã, C., Hassanlouei, H., Farina, D., & Falla, D. (2012). Eccentric exercise and delayed onset muscle soreness of the quadriceps induce adjustments in agonist–antagonist activity, which are dependent on the motor task. Experimental Brain Research, 216(3), 385-395.
  • Volek, J. S., Kraemer, W. J., Rubin, M. R., Gómez, A. L., Ratamess, N. A., & Gaynor, P. (2002). L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress. American Journal of Physiology - Endocrinology and Metabolism, 282(2), E474-E482.