Delayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans

doi:10.1016/S0003-9993(99)90144-2

Archives of Physical Medicine and Rehabilitation

Volume 80, Issue 3, March 1999, Pages 318-323

https://doi.org/10.1016/S0003-9993(99)90144-2 Get rights and content

Abstract

Objective: To investigate the effects of two dosages of pulsed ultrasound therapy (1MHz, spatial averaged peak intensity 0.8W/cm², mark space ratio of 1: 4) on acute-stage delayed onset muscle soreness (DOMS).

Design: Double-blind, placebo-controlled, randomized trial.

Setting: Laboratory of a university physiotherapy department.

Participants: Forty-eight healthy volunteers (24 men, 24 women) with no arm pathology or pain at the time of the study.

Interventions: Subjects were randomly allocated to one of four treatment groups: control, placebo (sham insonation), low-dosage pulsed ultrasound (mean dosage 172.8J), or high-dosage pulsed ultrasound (mean dosage 345.6J). DOMS was induced in the nondominant elbow flexors in a standardized fashion through repeated eccentric exercise until exhaustion.

Main Outcome Measures: Elbow extension, flexion, and resting angles (universal goniometer), pain (visual analogue scale), mechanical pain threshold/tenderness (pressure algometer), and a McGill pain questionnaire. Measurements were taken before and after treatment each day except for the McGill pain questionnaire, which was completed at the end of the trial.

Results: Significant differences were seen between groups in relation to range of flexion (p = .0032), with the control group losing least range of flexion. There were no other significant differences between the groups.

Conclusion: No convincing evidence was found to support the use of pulsed ultrasound therapy in the management of DOMS at the parameters discussed here.

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For electrotherapy, the protocols used varied between TENS, micro-currents and interferential current, so that seven studies (Curtis et al., 2010; Denegar & Perrin, 1992; Ferguson et al., 2014; Mankovsky-Arnold, Wideman, Larivière, & Sullivan, 2013; McLoughlin et al., 2004; Rocha et al., 2012; Taylor et al., 2015) found positive outcomes while 10 studies (Akinci et al., 2020; Butterfield et al., 1997; Craig et al., 1996a; Jajtner et al., 2015; Lambert et al., 2002; Malmir et al., 2017; Minder et al., 2002; Tourville, Connolly, & Reed, 2006; Vanderthommen et al., 2007; Weber et al., 1994) found no effects. On ultrasound, two studies (Aaron et al., 2017; Hasson et al., 1990) showed significant effects, while five studies (Aytar et al., 2008; Craig et al., 1999a; Parker & Madden, 2014; Plaskett et al., 1999; Shankar et al., 2006) did not observe effects. The only study that investigated the effectiveness of short waves to improve pain did not observe significant effects on the use of this method (Northey et al., 2016).
To evaluate the impact of interventions on pain associated with DOMS.
PubMed, EMBASE, PEDro, Cochrane, and Scielo databases were searched, from the oldest records until May/2020. Search terms used included combinations of keywords related to “DOMS” and “intervention therapy”.
Healthy participants (no restrictions were applied, e.g., age, sex, and exercise level). To be included, studies should be: 1) Randomized clinical trial; 2) Having induced muscle damage and subsequently measuring the level of pain; 3) To have applied therapeutic interventions (nonpharmacological or nutritional) and compare with a control group that received no intervention; and 4) The first application of the intervention had to occur immediately after muscle damage had been induced.
One hundred and twenty-one studies were included. The results revealed that the contrast techniques (p = 0,002 I² = 60 %), cryotherapy (p = 0,002 I² = 100 %), phototherapy (p = 0,0001 I² = 95 %), vibration (p = 0,004 I² = 96 %), ultrasound (p = 0,02 I² = 97 %), massage (p < 0,00001 I² = 94 %), active exercise (p = 0,0004 I² = 93 %) and compression (p = 0,002 I² = 93 %) have a better positive effect than the control in the management of DOMS.
Low quality evidence suggests that contrast, cryotherapy, phototherapy, vibration, ultrasound, massage, and active exercise have beneficial effects in the management of DOMS-related pain.
Effects of Therapeutic Pulsed Ultrasound and Dimethylsulfoxide (DMSO) Phonophoresis on Parameters of Oxidative Stress in Traumatized Muscle
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Table 1 shows that the group that received TPU plus DMSO gel had a significant decrease in those two markers; this group showed the best results. Pulsed ultrasound is a modality that has been typically used to decrease the symptoms of inflammation and to increase the rate of healing in many conditions, mainly in muscle damage (Craig et al. 1999). Ultrasound, through its thermal and nonthermal (cavitation and acoustic streaming) mechanisms, has been implicated in stimulating soft tissue healing.
Many studies have demonstrated an increase in reactive oxygen species (ROS) and oxidative damage markers after muscle damage. Phonophoresis aims to achieve therapeutically relevant concentrations of the transdermally introduced drug in the tissues subjected to the procedure by the use ultrasound waves. The aim of the study was to evaluate the effects on the therapeutic pulsed ultrasound (TPU) together with gel-dimethylsulfoxide (DMSO) in the parameters of muscular damage and oxidative stress. Male Wistar rats were divided randomly into six groups (n = 6): sham (uninjured muscle); muscle injury without treatment; muscle injury and treatment with gel-saline (0.9%); muscle injury and treatment with gel-DMSO (15 mg/kg); muscle injury and TPU plus gel-saline; and muscle injury and TPU plus gel-DMSO. Gastrocnemius injury was induced by a single impact blunt trauma. TPU (6 min duration, frequency of 1.0 MHz, intensity of 0.8 W/cm²) was used 2, 12, 24, 48, 72, 96 and 120 h after muscle trauma. The CK and acid phosphatase activity in serum was used as an indicator of skeletal muscle injury. Superoxide anion, TBARS, protein carbonyls, superoxide dismutase (SOD) and catalase (CAT) activity was used as indicators of stress oxidative. Results showed that TPU and gel-DMSO improved muscle healing. Moreover, superoxide anion production, TBARS level and protein carbonyls levels, superoxide dismutase (SOD) and catalase (CAT) activity were all decreased in the group TPU plus gel-DMSO. Our results show that DMSO is effective in the reduction of the muscular lesion and in the oxidative stress after mechanical trauma only when used with TPU. (E-mail: [email protected])
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In patients with lateral epicondylalgia, mobilization-with-movement (MWM) is used as an intervention aimed at achieving analgesia and enhancing grip force, although the mechanisms underlying these effects are unclear. The present study investigated the acute sensory and motor effects of an MWM intervention in healthy controls with experimentally induced lateral epicondylalgia. Twenty-four subjects were randomly allocated to either a MWM or a placebo group ( $n = 12$ ). In both groups, to generate the model of lateral epicondylalgia, delayed onset muscle soreness (DOMS) was provoked in one arm 24 h prior (Day 0) to hypertonic saline-induced pain in the extensor carpi radialis brevis muscle (Day 1). Either a MWM or placebo intervention was applied during the saline-induced pain period. Saline-induced pain intensity (visual analogue scale: VAS), pain distribution and pain quality were assessed quantitatively. Pressure pain thresholds (PPTs) were recorded at the common extensor origin and the extensor carpi radialis brevis muscle. Maximal measures of grip and wrist extension force were recorded. In both groups (pooled data), DOMS was efficiently induced as demonstrated by a significant decrease in pre-exercise to pre-injection PPT at the common extensor origin (−45±19%) and at the extensor carpi radialis brevis (−61±23%; $P < 0.05$ ), and a significant decrease in maximal grip force (−25±6%) and maximal wrist extension force (−40±12%; $P < 0.001$ ). Moreover, both groups experienced a significant increase in muscle soreness (3.9±0.2; $P < 0.0001$ ) at Day 1 compared to pre-exercise. During saline-induced pain and in response to intervention, there were no significant between-group differences in VAS profiles, pain distributions, induced deep tissue hyperalgesia or force attenuation. These data suggest that the lateral glide-MWM does not activate mechanisms associated with analgesia or force augmentation in subjects with experimentally induced features simulating lateral epicondylalgia.
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^☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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ArticleDelayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans☆

Abstract

J Neurol Sci

Pain

Pain

Aust J Physiother

Pain

Delayed onset muscle soreness: lack of effect of combined phototherapy/ low intensity laser therapy at low pulse repetition rates

J Clin Laser Med Surg

Aching muscles after exercise

Lancet

Ergographic studies in muscular soreness

Am J Physiol

Observations on experimental muscular soreness

Acta Rheumatol Scand

Quantitative electromyographic investigation of the spasm theory of muscle pain

Am J Phys Med

Muscle soreness and intramuscular fluid pressure: comparison between eccentric and concentric load

J Appl Physiol

Factors in delayed muscle soreness

Med Sci Sports

Exercise induced muscle inflammation [abstract]

Fed Proc

Delayed-onset muscular soreness and plasma CPK and LDH activities after downhill running

Med Sci Sports Exerc

Myofibrillar damage following intense eccentric exercise in man

Int J Sports Med

Intramuscular pressure in the painful biceps

Clin Sci (Colch)

Acute inflammation: the underlying mechanism in delayed onset muscle soreness

Med Sci Sports Exerc

Article
Delayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans☆