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Recovering from Delayed Onset Muscle Soreness

Recovering from Delayed Onset Muscle Soreness

26 June 2024

Delayed onset muscle soreness (DOMS) is defined as ‘ultrastructural damage of muscle cells due to unfamiliar sporting activities or eccentric exercise, which leads to further protein degradation, apoptosis and local inflammatory response’ (Hotfiel et. al 2018) The micro tears caused by eccentric movements can impact performance by reducing joint range of motion and alter muscle recruitment patterns. This can increase risk of a soft tissue injury but treatment strategies for DOMS remain uncertain. Common treatment strategies include anti-inflammatories, massage and cryotherapy. Seidel et. al investigated the optimum treatment for DOMS and found non-steroidal anti-inflammatory drugs did reduce the pain but delayed the recovery.  Other interventions were examined (nutritional and physical) and found that there was a reduction in inflammation but no treatment aided muscle regeneration. (Seidel et. al, 2012)

Massage can be an effective tool to aid recovery from DOMS, however most research states the type and timing of the massage is important.  Hilbert et. al found that there was a reduction in muscle soreness 48 hours post exercise when massage is administered 2 hours after exercise, (Hilbert et. al, 2003). However, Visconti et. al found massage to be an effective tool to reduce DOMS during the onset of symptoms (Visconti et. al, 2015).

Cryotherapy has conflicting research on the effectiveness to alleviate DOMS. For example, Eston and Peters studied the use of cold-water immersion for recovery. They found 2-3 days post exercise, participants who used cold water immersion had increased joint range and reduced creatine kinase activity compared to the control group. However, both groups presented with muscle tenderness, swelling and reduced isometric strength 3 days following exercise. Howaston and Van Someren investigated the impact of ice massage therapy on DOMs, however discovered it is not an effective treatment due to only noticing creatine kinase reduction at 72 hours (Bishop et. al, 2008).

Evidence suggests adapting your exercise programme is the most efficient method to alleviate DOMS however the analgesic effect has been shown to be temporary (Zainuddin et. al, 2011). Cheung et. al suggests when exercising on a daily basis, one should reduce intensity and duration of exercise 1-2 days following DOMS. Training body parts that are less affected by DOMS and progressively overloading eccentric exercises over a 1 to 2 week period are efficient methods to manage DOMS (Cheung et. al 2003).

Reference List

Bishop, P.A., Jones, E. and Woods, A.K. (2008). Recovery From Training: A Brief Review. Journal of Strength and Conditioning Research, [online] 22(3), pp.1015–1024. doi:https://doi.org/10.1519/jsc.0b013e31816eb518.

Cheung, K., Hume, P.A. and Maxwell, L. (2012). Delayed Onset Muscle Soreness. Sports Medicine, [online] 33(2), pp.145–164. doi:https://doi.org/10.2165/00007256-200333020-00005.

Hilbert, J.E., Sforzo, G.A. and Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, [online] 37(1), pp.72–75. doi:https://doi.org/10.1136/bjsm.37.1.72.

Hotfiel, T., Freiwald, J., Hoppe, M., Lutter, C., Forst, R., Grim, C., Bloch, W., Hüttel, M. and Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletzung · Sportschaden, 32(04), pp.243–250. doi:https://doi.org/10.1055/a-0753-1884.

Seidel, E., Rother, M., Hartmann, J., Rother, I., Schaaf, T., Winzer, M., Fischer, A. and Regenspurger, K. (2012). Eccentric Exercise and Delayed Onset of Muscle Soreness (DOMS) – an Overview. Physikalische Medizin, Rehabilitation Medizin, Kurortmedizin, 22(02), pp.57–63. doi:https://doi.org/10.1055/s-0032-1304576.

Visconti, L., Capra, G., Carta, G., Forni, C. and Janin, D. (2015). Effect of massage on DOMS in ultramarathon runners: A pilot study. Journal of Bodywork and Movement Therapies, [online] 19(3), pp.458–463. doi:https://doi.org/10.1016/j.jbmt.2014.11.008.

Zainuddin, Z., Sacco, P., Newton, M. and Nosaka, K. (2006). Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Applied Physiology, Nutrition, and Metabolism, 31(2), pp.126–134. doi:https://doi.org/10.1139/h05-010.

Man raising his arm behind his head while his shoulder is assessed
The Posterior Oblique Sling

The Posterior Oblique Sling

29 May 2024

The posterior oblique sling (POS) comprises the latissimus dorsi and contralateral gluteus maximus which is connected through thoracolumbar fascia, erector spinae, multifidus and bicep femoris. This activation pattern provides stability of the lumbopelvic region by transferring force through the trunk. For insistence, erectus spinae generates force whereas the multifidus creates stability. The posterior oblique sling is thought aid recovery from lower back pain (LBP) and is often a fundamental part of rehabilitation despite minimal research on the topic (Kang and Hwang, 2019). However, most recent research suggests patients with LBP have abnormal motor recruitment in the lumbopelvic region (Kim et. al, 2014); therefore, activating the POS may offer spinal mobility, stability and prevent LBP (Kang and Hwang, 2019).

Prone hip extension (PHE) is a useful measure to assess and activate the POS. In healthy individuals, one should be able to maintain neutral lumbar and pelvic position during PHE, however patients with LBP have been found to have altered lumbar and pelvic movement. This in turn can cause lumbopelvic dysfunction, spinal instability and postural disturbance (Kim et. al, 2014). For example, Kang and Hwang found patients with LBP often have delayed onset of gluteus maximus and earlier onset of bicep femoris (Kang and Hwang, 2019).  When the gluteus maximus does not activate, there is a loss of pelvis control which can cause the contralateral latissimus dorsi to become dominant. Therefore, to aid lumbopelvic control, practitioners can manipulate the PHE to focus on the less dominant muscle (Kim et. al, 2014).

Lee et. al altered the PHE technique to assess the impact this has on POS. The PHE was compared to abdominal drawing in maneuverer prone hip extension (ADIM PHE). The ADIM PHE had increased contralateral latissimus dorsi and ipsilateral gluteus maximus compared to hip extension, whereas PHE had increased ipsilateral erector spinae and ipsilateral bicep femoris ((Lee et. al, 2020). Lee et. al also compared PHE to PHE with hip abduction and knee flexion. They discovered the contralateral latissimus dorsi, ipsilateral erector spinae and gluteus maximus electromyography was higher with phone hip extension with hip abduction and knee flexion than PHE (Lee et. al, 2019). Therefore, depending on the clinical presentation of the patient, practitioners can isolate specific muscle groups within the POS. PHE with hip internal rotation and shoulder internal rotation and shoulder extension with 1lb dumbbell was found to be the optimal PHE variation for POS activation to aid recovery with LBP (Kang and Hwang, 2019).

This research highlights the importance of using PHE as an assessment and treatment tool to identify weakness within the POS and then adapting the PHE to support recovery from LBP.

Reference List

Kang, D. and Hwang, Y.-I. (2019). Comparison of Muscle Activities of the Posterior Oblique Sling Muscles among Three Prone Hip Extension Exercises with and without Contraction of the Latissimus dorsi. Journal of The Korean Society of Physical Medicine, 14(3), pp.39–45. doi:https://doi.org/10.13066/kspm.2019.14.3.39.

Kim, J.-W., Kang, M.-H. and Oh, J.-S. (2013). Patients With Low Back Pain Demonstrate Increased Activity of the Posterior Oblique Sling Muscle During Prone Hip Extension. PM&R, 6(5), pp.400–405. doi:https://doi.org/10.1016/j.pmrj.2013.12.006.

Lee, J.-K., Hwang, J.-H., Kim, C.-M., Lee, J.K. and Park, J.-W. (2019). Influence of muscle activation of posterior oblique sling from changes in activation of gluteus maximus from exercise of prone hip extension of normal adult male and female. Journal of Physical Therapy Science, 31(2), pp.166–169. doi:https://doi.org/10.1589/jpts.31.166.

Lee, J.-K., Lee, J.-H., Kim, K.-S. and Lee, J.-H. (2020). Effect of abdominal drawing-in maneuver with prone hip extension on muscle activation of posterior oblique sling in normal adults. Journal of Physical Therapy Science, 32(6), pp.401–404. doi:https://doi.org/10.1589/jpts.32.401.

Athlete lifting a barbell in a dimly lit gym
Musculoskeletal Disorders in Menopausal Women

Musculoskeletal Disorders in Menopausal Women

8 May 2024

Menopause causes a deficiency in oestrogen which can result in an increased risk of cardiovascular disease, cancer, cognitive decline, chronic obstructive pulmonary disease, diabetes, metabolic syndrome, depression, sleep disturbances, vasomotor symptoms, migraines and musculoskeletal disorders. The most common musculoskeletal disorders in menopausal women are osteoporosis, sarcopenia and osteoarthritis (Dijk et.al, 2015).

During the menopausal transition, there is an increase of muscle degeneration which can progress to sarcopenia. The decrease in oestrogen and testosterone leads to ‘neuromuscular junction insufficiency, myofiber loss, mitochondrial dysfunction’ (Buckinx and Aubertin-Leheudre, 2022) and reduced muscle regeneration.  These physiological changes increase fat deposits in muscle and increase the difficulty in achieving hypertrophy and maintaining muscle mass (Buckinx and Aubertin-Leheudre, 2022). The prevalence of osteoporosis in menopausal women is extremely high, as more than two million women have osteoporosis in England and Wales. After the menopause, prevalence rises with age from approximately 2% at 50 years to more than 25% at 80 years’ (Peto and Allaby, 2013) This is likely due to the osteoclastic resorption activity increases and the osteoblastic activity decreases, resulting in more bone being absorbed than being formed (Ji and Yu, 2015).

There is an abundance of research illustrating the impact menopause has on osteoporosis and sarcopenia, however there is limited evidence on the impact of osteoarthritis on musculoskeletal disorders (Watt, 2018). However, Richmond et. al found oestrogen receptors in articular cartilage which potentially demonstrates a relationship between oestrogen and articular cartilage health. Zhang et al. discovered that oestrogen has a positive impact on cartilage. These studies illustrate there is relationship between oestrogen and cartilage however unable to identify an explanation for the clinical significance (Hame and Alexander, 2013). Lower back pain (LBP) is also more common in postmenopausal women than men who are within the same age group. This is most likely due to oestrogen deficiency causing postmenopausal women to have increased prevalence of disc degeneration; therefore, resulting in increased risk of spondylolisthesis and facet joint osteoarthritis. Also due to higher rates of osteoporosis in postmenopausal women, osteoporosis related spine fracture, especially at thoracolumbar junction, can cause LBP (Wang, 2017).

There is a wealth of research showing the importance of menopausal women participating in exercise to reduce the risk of musculoskeletal disorders and prevent the worsening of symptoms (Grindler et. al 2015). For example, Mendoza et. al found that exercise reduces osteoarticular pain in postmenopausal women with fibromyalgia or breast cancer (Mendoza et. al, 2016). Research suggests a combination of high impact exercises and weight training is optimal to increase muscle mass and bone density, alongside medical intervention such as hormone replacement therapy and supplementation. Metcalfe et .al found the combination of adding calcium, hormone replacement therapy and weight bearing movement increases bone mass density and muscle strength for post- menopausal women. The weight bearing movements included stair climber or stepping alongside resistance training and balance exercises to reduce the risk of osteoporosis, sarcopenia and fractures (Metcalfe et. al, 2001). Hettchen et. al 2021 also demonstrated the positive impact exercise has on early postmenopausal women with osteopenia or osteoporosis and disorders related to menopausal transition. The exercise regime included a combination of high intensity training, jumping sequences and velocity resistance training (Hettchen et. al 2021).  The evidence illustrates the importance of physical activity for menopausal women, however more research is required to see the impact menopause has on other musculoskeletal disorders.

Reference List

 

Woman jogging outdoors in a teal top
Why exercise is good for your joints

Why exercise is good for your joints

29 April 2024

Close-up of a person's flexed forearm and elbow
Photo by Towfiqu barbhuiya on Unsplash
It comes as no surprise that exercise has an endless list of benefits for our body; it reduces the risk of heart diseases, helps maintain your blood sugar and insulin levels, improves your mental health and mood, and increases strength and flexibility whilst reducing pains and combatting fatigue. However, the benefits of exercise for our joints is often overlooked.
The most common example of the advantages of exercise for our joints is in people with arthritis. Let’s look at this in more detail.
Arthritis is a common condition that results in substantial pain and inflammation to the joints, with over ten million people in the UK alone suffering from this condition. It can affect people of all ages and is categorised into different types depending on the location of the inflammation. The most prevalently discussed types of arthritis are osteoarthritis and rheumatoid arthritis, both of which we provide treatment for at Opus. We discuss the types of arthritis in more detail here.
During exercise, people with arthritis and joint pain describe a significant reduction in their pain alongside a notable increase in their range of motion. But how does physical activity exert these effects? Below are five benefits that exercise yields and how this is advantageous to the joints:
  1. Synovial fluid lubricates the joint. Each joint in the body is surrounded by soft tissue, also known as the synovial membrane, that is capable of producing fluid. This fluid acts as a lubricant, enabling the bones at each joint to slide past one another in a smooth motion. During exercise, the circulation of this fluid is increased and, therefore, reduces any pain at the joint.
  2. Blood flow increases. During physical activity, our heart increases at a much faster pace. This results in an increase in blood circulation throughout the body, including at the joints. This exposes the synovial membrane to an increased and steady supply of both oxygen and nutrients.
  3. Joint-repair genes are switched on. This is a relatively unresearched area; however, studies have shown that genes play a significant role in joint repair, with these being activated by physical activity and joint movement.
  4. Cellular waste is removed. During exercise, a process called autophagy is triggered. Autophagy refers to the biological process in which damaged cells are broken down and removed. The build-up of these cells at the joint can often cause severe pain and limits movement; therefore, ensuring these are removed can instantly decrease the pain experienced.
  5. Increase in muscle mass. It is no surprise that exercise strengthens muscles, ligaments, and tendons in the body; this includes those surrounding the joints. When these elements are strong, they behave like a brace, protecting the join from harm. Moreover, physical activity also increases your overall range of motion, enabling your joints to withstand more pressure.
At Opus, we can assess the root cause of your joint pain and recommend specific sports medicine-backed exercises to lessen this discomfort. Beyond this, we also provide regenerative treatments that may provide long-term pain relief. Get in touch to discuss how we can assist you on your journey.
Why are injuries so common in athletes?

Why are injuries so common in athletes?

25 April 2024

Group of women sprinting on an outdoor athletics track
Photo by Jonathan Chng on Unsplash

Sports injuries are extremely common, with figures estimating that amongst the younger population alone, over 3.5 million children and teens are injured each year as part of organised sports or physical activity. This does not even account for unreported injuries. Given their prevalence, it is important that we understand why injuries are more common amongst athletes and those that regularly participate in sporting activities so that we can prevent and treat these accordingly.

A sports injury can occur as a result of several scenarios, including accidents, impact, insufficient training, improper equipment, lack of conditioning, or poor warming up and stretching, to name a few.
Although joint injuries represent the most common site of damage, accounting for both sprains and strains, any part of your body can get injured during physical activity. When we exercise, a significant number of our muscles and tendons are involved; therefore, the chances of developing an injury are much greater.
Moreover, especially during competitive sporting activities, we tend to stretch our bodies and push ourselves farther than we usually would, resulting in us moving in ways that we often wouldn’t. Although this can be harmless, in some instances, this leaves our muscles and tendons torn, damaged, and in pain.

In athletes, the above factors are exacerbated, with the most common sports injuries amongst this population being:

  1. Strains: A strain is defined as an injury to either a muscle or a tendon that primarily results from overuse, force, or stretching. The severity of the injury depends on the nature of its cause, with strains ranging from a simple overstretching of the muscle or tendon to a partial or complete tear.
  2. Sprains: Alongside strains, sprains represent the most common type of injury across all sports, being especially common amongst athletes. A sprain is characterised by a torn muscle or ligament that results from overuse or excessive force, whether that be a collision, a fall, or other causes.
  3. Knee injuries: Damage to the knee joint is most common in contact sports and is usually caused by a sprain, strain or tendonitis. There are a vast number of different conditions that may result from an injury to the knee, including ACL tears, MCL/LCL ruptures, runner’s knee, IT band syndrome and jumper’s knee, anterior knee pain, and patella-femoral maltracking.
  4. Fractures: The most prevalent fractures seen amongst athletes are fractured wrists, hands, collarbones, and bones in the ankle and feet. The highest rate of fractures is seen in contact sports, such as football and rugby.
  5. Tennis elbow: If you experience persistent pain around the outside of your elbow, you may be suffering from tennis elbow. This injury primarily results from overuse of the forearm due to a repetitive or strenuous activity; however, it may sometimes occur following force to the elbow.
  6. Plantar fasciitis: Do you have pain in the bottom of your foot? Or around your heel and arch? This may be plantar fasciitis. Plantar fasciitis is one of the most common causes of heel pain and arises following inflammation of the thick band of tissue that runs across the bottom of your foot, connecting the heel bone to the toes. This injury is most common in endurance athletes, such as runners
  7. Back injuries: It is estimated that 80% of UK adults experience back pain at some point during their lives. Back pain is most common in athletes that participate in sports that have frequent hypertension of the lumbar spine, including gymnastics and football. The primary issue with back injuries is that athletes can cause strain to other parts of their bodies if they change their techniques to reduce the pain experienced.
  8. Concussion: Injuries to the head and neck represent the most frequent catastrophic sports injury, with concussion being the most common athletic head injury. In the UK, an estimated 8.5% of all concussion-related hospital admissions are of sporting origin.
At Opus, we treat a range of sports injuries with our novel techniques, including elbow, hand and wrist sports injuries, shoulder injuries, foot and ankle damage, knee injuries, shin splints and stress fractures, hip sports injuries, neck and back pain, and sprains and strains. Contact us today to discuss your needs and how we can assist you on your journey.
Skier’s Thumb: A common injury amongst winter athletes

Skier’s Thumb: A common injury amongst winter athletes

16 April 2024

Skier upside down mid-jump against a blue sky
Photo by Vidar Nordli-Mathisen on Unsplash

What is Skier’s thumb?

Thumb ligament injuries are common occurrences and occur when the ligaments that support the thumb are stretched beyond their limit and tear, as with a sprain. The injury itself is to the ligaments at the joint located at the base of the thumb, known as the MP joint. When the thumb is forcefully bent sideways, it can result in a tear to the ulnar collateral ligament. Skier’s thumb, in particular, is a condition common amongst winter athletes.

Depending on the severity of the sprain, categorised as three different grades, pain may or may not occur at the time of the injury. However, bruising, tenderness, and swelling around the base of the thumb are to be expected. Moreover, the characteristic symptom of Skier’s thumb is difficulty grasping items between the thumb and index finger.

    • Grade 1 sprain (mild). The ligaments are stretched but do not appear torn.
    • Grade 2 sprain (moderate). The ligaments are partially torn and may result in some loss of function.
    • Grade 3 sprain (severe). The ligaments are completely torn and is described as a significant injury. This type of sprain requires medical or surgical interventions and can result in lasting loss of function. 

    Treatment

    The treatment of a sprained thumb entirely depends on the severity of the injury, the timing, and whether or not there is arthritis present in the joint. At Opus, we also consider your activity levels, your job requirements, and individual preferences. There are two primary routes of treatment; nonoperative and operative.
    1. Non-surgical treatment. This represents the most common route of treatment for patients with Skier’s thumb and often involves splinting and casting. Typically, a sprained thumb takes between four and six weeks for the ligament to heal sufficiently for light use. However, it is important to consider that for more intense activities, such as sports, it may take substantially longer.
    2. Operative interventions. In some instances, where either the ligament does not heal adequately with non-surgical treatments or the severity of the injury is too great, surgery may be considered. In these cases, the treatment will involve repairing the torn ligament back down to the bone using sutures.

    More recently, a third option for treatment has been proposed: regenerative medicine. We have discussed the roles of platelet rich plasma and mesenchymal stem cell therapy in regenerative medicine in previous updates, which you can find here. Introducing stem cells to the site of the thumb injury can speed up the healing process exponentially and has been used to accelerate the recovery of several sporting figures across the globe.

    Sprained thumbs, although not usually a significant injury, still require medical intervention. When diagnosed and treated accordingly, the vast majority of patients will heal without any additional complications. However, if ignored, the thumb may heal incorrectly and cause long-term problems, including chronic instability, weakness, and arthritis. Get in touch with our team at Opus to ensure that the ligament is correctly healed and your recovery journey is as seamless as possible.