Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage.

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

Effect of Beetroot Juice Supplementation on Muscle Soreness and Performance Recovery after Exercise-Induced Muscle Damage in Female Volleyball Players.

BACKGROUND: Beetroot juice (BRJ) contains various bioactive compounds suggested to be effective in improving athlete recovery. However, the number of studies evaluating the effects of BRJ on recovery and muscle soreness (MS) indicators in female athletes is limited. Therefore, the present study aimed to determine the effects of BRJ consumption on the performance recovery indicators and MS after exercise-induced muscle damage (EIMD) in female volleyball players. METHODS: Twelve young female volleyball players were evaluated in this study. We utilized a randomized, cross-over, and double-blind design during two phases with a 30-day interval (wash-out). During each phase, EIMD was performed first, followed by BRJ or placebo (PLA) supplementation for two days (eight servings of 50 mL). Recovery monitoring of performance indicators and MS was performed after EIMD. The results of wall-sit, V sit and reach (VSFT), vertical jump height (VJH), pressure pain threshold (PPT), and thigh swelling (Sw-T) tests were recorded 48 h after EIMD. Also, the Perceived Muscle Soreness was recorded using the visual analog scale (VAS) 12 (MS-12 h), 24 (MS-24 h), and 48 (MS-48 h) hours after EIMD. RESULTS: The data were analyzed using two-way repeated measures of ANOVA at p < 0.05. Compared to PLA, BRJ supplementation improves wall-sit performance after EIMD (p < 0.05), while reducing Sw-T and perceived muscle soreness (p < 0.05). However, no significant difference was observed between PLA and BRJ in VJH and VSFT performance after EIMD (p > 0.05). CONCLUSIONS: Our findings indicate that the consumption of BRJ in female volleyball players can be useful for improving some recovery indicators, such as muscle endurance, perceived muscle soreness, and tissue edema, after EIMD.

Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis examined the effects of foam roller or stick massage performed after exercise-induced muscle damage protocols on indirect markers of muscle damage compared to a non-intervention control group in healthy individuals. METHODS: PubMed, Biblioteca Virtual em Saúde, Scopus, Google Scholar, and Cochrane Library database were searched in August 2, 2020, with last update on February 21, 2021. Were included clinical trials involving healthy adult individuals who received foam roller/stick massage versus a non-intervention group and evaluated indirect markers of muscle damage. Risk of bias was assessed by the Cochrane Risk of Bias tools. Standardized mean differences with 95% confidence intervals were used to measure the foam roller/stick massage effect on muscle soreness. RESULTS: The five included studies investigated 151 participants (136 men). Overall, the studies presented a moderate/high risk of bias. A between-groups meta-analysis showed no significant difference between massage and non-intervention control groups on muscle soreness immediately after (0.26 [95%CI: 0.14; 0.65], p = 0.20), 24 h (-0.64 [95%CI: 1.34; 0.07], p = 0.08), 48 h (-0.35 [95%CI: 0.85; 0.15], p = 0.17), 72 h (-0.40 [95%CI: 0.92; 0.12], p = 0.13), and 96 h (0.05 [95%CI: 0.40; 0.50], p = 0.82) after an exercise-induced muscle damage protocol. Moreover, the qualitative synthesis showed that foam roller or stick massage had no significant effect on range of motion, muscle swelling, and maximal voluntary isometric contraction recovery. CONCLUSION: In conclusion, the current literature appears to not support the advantage of foam roller or stick massage to improve recovery of muscle damage indirect markers (muscle soreness, range of motion, muscle swelling, and maximal voluntary isometric contraction) compared to a non-intervention control group in healthy individuals. Furthermore, due to the heterogeneity of the methodological designs among the included studies, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on foam roller or stick massage to draw any definite conclusions. REVIEW PROTOCOL NUMBER: The study was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) on August 2, 2020, with last update on February 21, 2021. Protocol number: CRD2017058559.

Effects of Acute Vitamin C plus Vitamin E Supplementation on Exercise-Induced Muscle Damage in Runners: A Double-Blind Randomized Controlled Trial.

Considering the existing controversy over the possible role of acute antioxidant vitamins in reducing exercise-induced muscle damage (EIMD), this doubled-blind, randomized and controlled trial aimed to determine whether supplementation with vitamins C and E could mitigate the EIMD in endurance-trained runners (n = 18). The exercise protocol involved a warm-up followed by 6 to 8 bouts of 1 km running at 75% maximum heart rate (HRmax). Two hours before the exercise protocol, participants took the supplementation with vitamins or placebo, and immediately afterwards, blood lactate, rate of perceived exertion and performance were assessed. At 24 h post-exercise, CK, delayed onset muscle soreness and performance were determined (countermovement jump, squat jump and stiffness test). The elastic index and vertical stiffness were calculated using a stiffness test. Immediately after the exercise protocol, all participants showed improved maximum countermovement jump, which only persisted after 24 h in the vitamin group (p < 0.05). In both groups, squat jump height was significantly greater (p < 0.05) immediately after exercise and returned to baseline values after 24 h. The elastic index increased in the vitamin group (p < 0.05), but not in the placebo group. In both groups, lactate levels increased from pre- to immediately post-exercise (p < 0.05), and CK increased from pre- to 24 h post-exercise (p < 0.05). No significant differences between groups were observed in any of the variables (p > 0.05). Vitamin C and E supplementation does not seem to help with EIMD in endurance-trained individuals.

Omega-3 fatty acids enhance the beneficial effect of BCAA supplementation on muscle function following eccentric contractions.

Background: This study investigated the combined effect of branched-chain amino acids (BCAA) and fish oil (FO) on muscle damage caused by eccentric contractions (ECCs) of the elbow flexors, with a special focus on muscular function. Methods: Twenty-nine untrained male participants were enrolled in this double-blind, placebo-controlled, parallel study. The participants were randomly assigned to the placebo (PL) group (n = 9), BCAA supplement group (n = 10), and BCAA+FO supplement group (n = 10). The BCAA+FO group consumed eicosapentaenoic acid (EPA) 600 mg and docosahexaenoic acid (DHA) 260 mg per day for 8 weeks, while the BCAA and BCAA+FO groups consumed 9.6 g per day for 3 days prior to and until 5 days after ECCs. Participants performed six sets of 10 ECCs at 100% maximal voluntary contraction (MVC) using dumbbells. Changes in MVC torque, range of motion (ROM), muscle soreness using visual analog scales, upper circumference, muscle thickness, echo intensity, and serum creatine kinase (CK) were assessed before, immediately after, and 1, 2, 3, and 5 days after ECCs. Results: The MVC torque was significantly higher in the BCAA+FO group than in the PL group immediately after ECCs (p < 0.05) but not in the BCAA group. Both BCAA and BCAA+FO groups showed greater ROM and lower muscle soreness than the PL group (p < 0.05). CK was significantly lower in the BCAA group than in the PL group at 5 days after ECCs (p < 0.05). Conclusions: This study reveals that supplementation with BCAA and FO may favorably impact immediate recovery of peak torque production. Alternatively, in comparison to PL group, BCAA supplementation favorably reduces creatine kinase.

Effect of curcumin supplementation on exercise-induced muscle damage: a narrative review.

Curcumin, a natural polyphenol extracted from turmeric, is a potent antioxidant and anti-inflammatory agent. In the past few decades, curcumin's ability to impact chronic inflammatory conditions such as metabolic syndrome, arthritis, and cancer has been widely researched, along with growing interest in understanding its role in exercise-induced muscle damage (EIMD). EIMD impacts individuals differently depending on the type (resistance exercise, high-intensity interval training, and running), intensity, and duration of the exercise. Exercise disrupts the muscles' ultrastructure, raises inflammatory cytokine levels, and can cause swelling in the affected limb, a reduction in range of motion (ROM), and a reduction in muscular force-producing capacity. This review focuses on the metabolism, pharmacokinetics of various brands of curcumin supplements, and the effect of curcumin supplementation on EIMD regarding muscle soreness, activity of creatine kinase (CK), and production of inflammatory markers. Curcumin supplementation in the dose range of 90-5000 mg/day can decrease the subjective perception of muscle pain intensity, increase antioxidant capacity, and reduce CK activity, which reduces muscle damage when consumed close to exercise. Consumption of curcumin also improves muscle performance and has an anti-inflammatory effect, downregulating the production of pro-inflammatory cytokines, including TNF-α, IL-6, and IL-8. Curcumin may also improve oxidative capacity without hampering training adaptations in untrained and recreationally active individuals. The optimal curcumin dose to ameliorate EIMD is challenging to assess as its effect depends on the curcumin concentration in the supplement and its bioavailability.

Acute Floatation-REST Improves Perceived Recovery After a High-Intensity Resistance Exercise Stress in Trained Men.

PURPOSE: The aim of the present investigation was to determine whether a 1-h floatation-restricted environmental stimulation therapy (floatation-REST) session could augment recovery from high-intensity resistance exercise (6 × 10 back squats, 2-min rest) known to induce significant metabolic, adrenergic, and mechanical stress. METHODS: Eleven healthy resistance-trained males (age, 22.5 ± 2.3 yr; height, 176.4 ± 6.0 cm; weight, 85.7 ± 6.2 kg; back squat one-repetition maximum, 153.1 ± 20.1 kg; strength-to-weight ratio, 1.8 ± 0.2) completed the within-subject, crossover controlled study design. Participants completed two exercise testing blocks separated by a 2-wk washout. In one block, the high-intensity resistance exercise protocol was followed by a 1-h floatation-REST session, whereas recovery in the alternate block consisted of a passive sensory-stimulating control. Markers of metabolic stress, neuroendocrine signaling, structural damage, inflammation, and perceptions of soreness, mood state, and fatigue were assessed over a 48-h recovery window. RESULTS: Floatation-REST significantly attenuated muscle soreness across recovery ( P = 0.035) with greatest treatment difference immediately after the intervention ( P = 0.002, effect size (ES) = 1.3). Significant differences in norepinephrine ( P = 0.028, ES = 0.81) and testosterone ( P = 0.028, ES = 0.81) immediately after treatment revealed the modification of neuroendocrine signaling pathways, which were accompanied by greater improvements in mood disturbance ( P = 0.029, ES = 0.81) and fatigue ( P = 0.001, ES = 1.04). CONCLUSIONS: Because no adverse effects and significant and meaningful benefits were observed, floatation-REST may prove a valuable intervention for managing soreness and enhancing performance readiness after exercise.

Dexamethasone and Nutraceutical Therapy Can Reduce the Myalgia Due to COVID-19 - a Systemic Review of the Active Substances that Can Reduce the Expression of Interlukin-6.

Background: Myalgia reflects generalized inflammation and cytokine response and can be the onset symptom of 36% of patients with COVID-19. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF- α) levels in plasma and upper respiratory secretions directly correlate with the magnitude of viral replication, fever, and respiratory and systemic symptoms, including musculoskeletal clinical manifestations. Objective: The aim of our work is to report literature scientific investigation clinical protocol to reduce the immunomodulation and inflammatory response nutraceutical therapy associated with dexamethasone and how can reduce the expression of Interlukina-6(IL-6) and myalgia due to COVID-19. Methods: We searched in Pubmed and Cochrane the nautriceutical drugs to treat the immune modulation of organism to COVID-19. We put these keywords: immune inflammation, desease descriptions, epidemiology COVID-19; immunomodulations; IL-6; Rheumatic Symptoms; Joint; Musculoskeletal Disorders; dexamethasone; Polydatin; Zinc; Melatonin; N- Acetyl Cysteine; Colostrum; L- Glutamine; Vitamin D3. Results: We found 61 papers. All the authors analyze them. After the Analyze we suggest the use of response nutraceutical therapy associated with dexamethasone can reduce the expression of Interlukina-6(IL-6) and myalgia due to COVID-19. Conclusion: According the scientific literature nutraceutical therapy associated with dexamethasone can reduce the expression of Interlukina-6(IL-6) and myalgia due to COVID-19.

Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis.

OBJECTIVE: To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis. METHODS: Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers. RESULTS: A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first. CONCLUSION: Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

Effects of Beetroot Supplementation on Recovery After Exercise-Induced Muscle Damage: A Systematic Review.

CONTEXT: Beetroots have antioxidant and anti-inflammatory properties, which may help attenuate inflammation and oxidative stress, enhancing recovery from exercise-induced muscle damage (EIMD). OBJECTIVE: To evaluate the effects of beetroot supplementation on oxidative stress, inflammation, and recovery after EIMD. DATA SOURCES: SPORTDiscus, PubMed, Web of Science, and Scopus databases were searched, and hand-searching was performed by looking to relevant studies that were cited in other studies. STUDY SELECTION: For a study to be included in this review, the following inclusion criteria had to be met: (1) research conducted with human participants, (2) original articles in peer-reviewed publications, (3) original studies that had investigated beetroot supplementation intervention on muscle damage and recovery, (4) research conducted with 1 control/placebo group, and (5) articles published from inception to October 2020. STUDY DESIGN: Systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Two of the 4 authors independently extracted data and assessed the methodological quality of the articles with the PEDro scale. All discrepancies were resolved through a consensus meeting. RESULTS: A total of 9 studies were included in this review. The methodological quality of the included studies ranged from moderate to high. Most of the studies found a better recovery of functional variables and muscle soreness, but improvements in markers of muscle damage, inflammation, and oxidative stress were not reported. CONCLUSION: The existing evidence suggests that a short-term beetroot supplementation has the potential to accelerate recovery of functional measures and muscle soreness, but further research is needed to clarify if a longer supplementation period (with some days before exercise and some days after) could also promote recovery of markers of muscle damage, inflammation, and oxidative stress.

The use of BCAA to decrease delayed-onset muscle soreness after a single bout of exercise: a systematic review and meta-analysis.

Branched-chain amino acids (BCAA) are used as a recovery method after exercise-induced muscle damage (EIMD). Although data suggest that BCAA may alleviate the delayed-onset muscle soreness (DOMS) evoked by EIMD, there is no consensus about the most effective supplementation protocol. To investigate the effects of BCAA on DOMS after a single exercise session that caused EIMD, a systematic review and meta-analysis were conducted on the effectiveness of BCAA supplementation to reduce DOMS symptoms in healthy subjects after a single session of EIMD. Randomized clinical trials (RCT) were searched in Medline, Cochrane Library, Science Direct, SciELO, LILACS, SciVerse Scopus, Springer Link journals, Wiley Online Library, and Scholar Google, until May 2021. Ten RCTs were included in the systematic review and nine in the meta-analysis. Seven studies demonstrated that BCAA reduced DOMS after 24 to 72 h. BCAA doses of up to 255 mg/kg/day, or in trained subjects, for mild to moderate EIMD, could blunt DOMS symptoms. However, high variability between studies due to training status, different doses, time of treatment, and severity of EIMD do not allow us to conclude whether BCAA supplementation is efficient in untrained subjects, applied acutely or during a period of pre to post days of EIMD, and at higher doses (> 255 mg/kg/day). The overall effects of BCAA on DOMS after a single session of exercise were considered useful for improving muscle recovery by reducing DOMS in trained subjects, at low doses, in mild to moderate EIMD, and should not be administered only after the EIMD protocol.

Creatine supplementation effect on recovery following exercise-induced muscle damage: A systematic review and meta-analysis of randomized controlled trials.

Exercise-induced muscle damage (EIMD) causes increased soreness, impaired function of muscles, and reductions in muscle force. Accumulating evidence suggests the beneficial effects of creatine on EIMD. Nevertheless, outcomes differ substantially across various articles. The main aim of this meta-analysis was to evaluate the effect of creatine on recovery following EIMD. Medline, Embase, Cochrane Library, Scopus, and Google Scholar were systematically searched up to March 2021. The Cochrane Collaboration tool for examining the risk of bias was applied for assessing the quality of studies. Weighted mean difference (WMD), 95% confidence interval (CI), and random-effects model, were applied for estimating the overall effect. Between studies, heterogeneity was examined using the chi-squared and I2 statistics. Nine studies met the inclusion criteria. Pooled data showed that creatine significantly reduced creatine kinase (CK) concentration overall (WMD = -30.94; 95% CI: -53.19, -8.69; p = .006) and at three follow-up times (48, 72, and 96 hr) in comparison with placebo. In contrast, effects were not significant in lactate dehydrogenase (LDH) concentration overall (WMD = -5.99; 95% CI: -14.49, 2.50; p = .167), but creatine supplementation leaded to a significant reduction in LDH concentrations in trials with 48 hr measurement of LDH. The current data indicate that creatine consumption is better than rest after diverse forms of damaging and exhaustive exercise or passive recovery. The benefits relate to a decrease in muscle damage indices and improved muscle function because of muscle power loss after exercise. PRACTICAL APPLICATIONS: Creatine supplementation would be effective in reducing the immediate muscle damage that happens <24, 24, 48, 72, and 96 hr post-exercise. In the current meta-analysis, the positive effects of creatine could cause a decrease in CK concentration overall. But, due to high heterogeneity and the medium risk of bias for articles, we suggest that these results are taken into account and the facts are interpreted with caution by the readers.

The Effects of Crocodile Blood Supplementation on Delayed-Onset Muscle Soreness.

Delayed-onset muscle soreness (DOMS) is associated with increases in acute inflammatory and biochemical markers, muscle swelling, pain, and reduced functional performance. This study aimed to investigate the preventative effects of crocodile blood supplementation on DOMS induced by eccentric exercise. Sixteen healthy males were randomly allocated to either a crocodile blood (CB, n = 8) or a placebo (PL, n = 8) treatment. Participants receiving the CB treatment consumed four capsules of freeze-dried CB powder (1 g day-1) over 18 days. Participants receiving the other treatment were administered a placebo over the same period. An eccentric exercise protocol was performed, and functional performance, visual analogue scale (VAS)-measured pain, knee range of movement (ROM), thigh circumference (swelling), and cytokines, enzymes, and biochemical parameters were assessed immediately after exercise as well as after 24 h, 48 h, and 72 h. CB supplementation could significantly maintain maximum voluntary isometric contraction (MVIC) at 24 h (p = 0.001) and 48 h after exercise (p = 0.001) when comparing values at different times for the CB group. In the CB group, thigh circumference decreased only immediately after eccentric exercise (p = 0.031) in comparison with pre-eccentric exercise values. An 18-day supplementation (1 g day-1) of crocodile blood does aid in the maintenance of functional performance and muscle swelling after eccentric exercise. Our data indicate that 1 g day-1 of crocodile blood supplementation should be safe for human consumption.

Consumption of New Zealand Blackcurrant Extract Improves Recovery from Exercise-Induced Muscle Damage in Non-Resistance Trained Men and Women: A Double-Blind Randomised Trial.

BACKGROUND: Blackcurrant is rich in anthocyanins that may protect against exercise-induced muscle damage (EIMD) and facilitate a faster recovery of muscle function. We examined the effects of New Zealand blackcurrant (NZBC) extract on indices of muscle damage and recovery following a bout of strenuous isokinetic resistance exercise. METHODS: Using a double-blind, randomised, placebo controlled, parallel design, twenty-seven healthy participants received either a 3 g·day-1 NZBC extract (n = 14) or the placebo (PLA) (n = 13) for 8 days prior to and 4 days following 60 strenuous concentric and eccentric contractions of the biceps brachii muscle on an isokinetic dynamometer. Muscle soreness (using a visual analogue scale), maximal voluntary contraction (MVC), range of motion (ROM) and blood creatine kinase (CK) were assessed before (0 h) and after (24, 48, 72 and 96 h) exercise. RESULTS: Consumption of NZBC extract resulted in faster recovery of baseline MVC (p = 0.04), attenuated muscle soreness at 24 h (NZBC: 21 ± 10 mm vs. PLA: 40 ± 23 mm, p = 0.02) and 48 h (NZBC: 22 ± 17 vs. PLA: 44 ± 26 mm, p = 0.03) and serum CK concentration at 96 h (NZBC: 635 ± 921 UL vs. PLA: 4021 ± 4319 UL, p = 0.04) following EIMD. CONCLUSIONS: Consumption of NZBC extract prior to and following a bout of eccentric exercise attenuates muscle damage and improves functional recovery. These findings are of practical importance in recreationally active and potentially athletic populations, who may benefit from accelerated recovery following EIMD.

Evaluation of the Efficacy of Supplementation with Planox® Lemon Verbena Extract in Improving Oxidative Stress and Muscle Damage: A Randomized Double-Blind Controlled Trial.

Excessive exercise load can cause muscle soreness and fatigue, as well as inflammation and oxidative stress. Lemon verbena (Aloysia triphylla; Lippia citriodora) is often used as a spice in tea or beverages. Its leaves are rich in polyphenols, which have antioxidant and anti-inflammatory bioactivities. In the present study, we investigated whether supplementation with Planox® lemon verbena extract (LVE) could improve muscle damage and biochemical indicators after exhaustive exercise challenge. All subjects (30 males and 30 females) underwent a double-blind trial and were randomly divided into a placebo group (0 mg/human/day) and an LVE supplement group (400 mg/human/day), with gender-equal distribution. All subjects started supplementation 10 days before exhaustive exercise and continued it until all tests were completed. Before the intervention, after the exhaustive exercise, and on the following 3 days, the participants underwent 12-minute Cooper running/walking; blood collection; assessments of pain, muscle stiffness, maximum jump heights, and isometric maximum muscle strength. The results showed that supplementation with LVE effectively increased GPx and reduced CK, IL-6, 8-OHdG and muscle pain after the exhaustive exercise, but it had significant effect on strength recovery. In summary, LVE is a safe and edible natural plant extract that can reduce muscle damage and soreness after exercise. This trial was registered at clinicaltrials.gov as NCT04742244.

The Effect of Protein Supplementation versus Carbohydrate Supplementation on Muscle Damage Markers and Soreness Following a 15-km Road Race: A Double-Blind Randomized Controlled Trial.

We assessed whether a protein supplementation protocol could attenuate running-induced muscle soreness and other muscle damage markers compared to iso-caloric placebo supplementation. A double-blind randomized controlled trial was performed among 323 recreational runners (age 44 ± 11 years, 56% men) participating in a 15-km road race. Participants received milk protein or carbohydrate supplementation, for three consecutive days post-race. Habitual protein intake was assessed using 24 h recalls. Race characteristics were determined and muscle soreness was assessed with the Brief Pain Inventory at baseline and 1-3 days post-race. In a subgroup (n = 149) muscle soreness was measured with a strain gauge algometer and creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations were measured. At baseline, no group-differences were observed for habitual protein intake (protein group: 79.9 ± 26.5 g/d versus placebo group: 82.0 ± 26.8 g/d, p = 0.49) and muscle soreness (protein: 0.45 ± 1.08 versus placebo: 0.44 ± 1.14, p = 0.96). Subjects completed the race with a running speed of 12 ± 2 km/h. With the Intention-to-Treat analysis no between-group differences were observed in reported muscle soreness. With the per-protocol analysis, however, the protein group reported higher muscle soreness 24 h post-race compared to the placebo group (2.96 ± 2.27 versus 2.46 ± 2.38, p = 0.039) and a lower pressure muscle pain threshold in the protein group compared to the placebo group (71.8 ± 30.0 N versus 83.9 ± 27.9 N, p = 0.019). No differences were found in concentrations of CK and LDH post-race between groups. Post-exercise protein supplementation is not more preferable than carbohydrate supplementation to reduce muscle soreness or other damage markers in recreational athletes with mostly a sufficient baseline protein intake running a 15-km road race.

4-week eicosapentaenoic acid-rich fish oil supplementation partially protects muscular damage following eccentric contractions.

BACKGROUND: We previously showed 8-week of fish oil supplementation attenuated muscle damage. However, the effect of a shorter period of fish oil supplementation is unclear. The present study investigated the effect of fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for 4 weeks on muscular damage caused by eccentric contractions (ECCs) of the elbow flexors. METHODS: Twenty-two untrained men were recruited in this double-blind, placebo-controlled, parallel design study and the subjects were randomly assigned to the EPA and DHA group (EPA and DHA, n = 11) and placebo group (PL, n = 11). They consumed either EPA 600 mg and DHA 260 mg per day or placebo supplement for 4 weeks prior to exercise. Subjects performed 60 ECCs at 100 % maximal voluntary contraction (MVC) using a dumbbell. Changes in MVC torque, range of motion (ROM), upper arm circumference, muscle soreness, echo intensity, muscle thickness, serum creatine kinase (CK), and interleukin-6 (IL-6) were assessed before exercise; immediately after exercise; and 1, 2, 3, and 5 days after exercise. RESULTS: ROM was significantly higher in the EPA and DHA group than in the PL group immediately after performing ECCs (p < 0.05). No differences between groups were observed in terms of MVC torque, upper arm circumference, muscle soreness, echo intensity, and thickness. A significant difference was observed in serum CK 3 days after ECCs (p < 0.05). CONCLUSIONS: We concluded that shorter period EPA and DHA supplementation benefits joint flexibility and protection of muscle fiber following ECCs.

The Effect of Creatine Supplementation on Markers of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Human Intervention Trials.

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20-60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (<30 min, 24, 48, 72, and 96 hr; p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: -1.06; 95% confidence interval [-1.97, -0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p < .01) heterogeneity was identified for all outcome measures at various follow-up times. In conclusion, creatine supplementation does not accelerate recovery following exercise-induced muscle damage; however, well-controlled studies with higher sample sizes are warranted to verify these conclusions. Systematic review registration (PROSPERO CRD42020178735).

Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials.

OBJECTIVE: The aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS). METHODS: We followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis. RESULTS: A total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to -0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to -0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to -0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to -0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to -0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to -0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to -0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16). CONCLUSIONS: The current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.

Massage enhances recovery following exercise-induced muscle damage in older adults.

To examine efficacy of cold water immersion (CWI) and massage as recovery techniques on joint position sense, balance, and fear of falling following exercise-induced muscle damage in older adults. Seventy-eight older men and women performed a single bout of strength training on the calf muscles (3 exercises with 4 sets of 10 reps with 75% of 1RM) to induce muscle damage. After the damaging exercise, participants received either a 15-minute massage on calf muscles, or a CWI of the lower limb in cold water (15 ± 1°C) for 15 minute, or passive rest. Interventions were applied immediately after the exercise protocol and at 24, 48, and 72 hours post-exercise. Muscle pain, calf muscle strength, joint position sense, dynamic balance, postural sway, and fear of falling were measured at each time point. Repeated application of massage after EIMD relieved muscle pain, attenuated the loss of muscle strength and joint position senses, reduce balance impairments, and fear of falling in older adults (P ≤ .05). However, repeated applications of CWI, despite relieving muscle pain (P ≤ .05), did not attenuate the loss of muscle strength, joint position senses, balance impairments, and fear of falling. CWI had only some modest effects on muscle pain, but massage attenuated EIMD symptoms and the related impairments in muscle strength, joint position sense, balance, and postural sway in untrained older individuals. Therefore, older exercisers who plan to participate in strength training can benefit from massage for recovery from muscle damage indices and balance to decrease falling risk during the days following strength training.