Review Article J Bas Res Med Sci 2020; 7(4):4-11.

New aspects of cellular adaptation in physical activity: A delayed muscle approach

Mahdieh Nassiri Ovanaki1, Mehran Ghahramani2*

1. Department of Physiology, Central Tehran Branch, Islamic Azad University,Tehran, Iran 2. Department of Exercise Physiology, Gilan-E-Gharb Branch, Islamic Azad University, Gilan-E- Gharb, Iran

*Corresponding author: Tel: +98 9188342771 Fax: +98 8343227555 Address: Department of Exercise Physiology, Gilan-E-Gharb Branch, Islamic Azad University, Gilan-E- Gharb , Iran E-mail: [email protected] Received ; 18/08/2019 revised; 25/10/2019 accepted; 5/11/2019

Abstract

The purpose of the present study was to investigate the context of new aspects of cellular adaptation in physical activity with a focus on delayed pain approach, the nature and types of pain, several preventive and non-pharmacological approaches to delayed onset muscle soreness (DOMS) and to achieve a desirable conclusion and provide more relevant information from previous research. In this study, articles were searched in specialized databases and 30 related articles were selected based on inclusion and exclusion criteria, and cellular adaptation in physical activity with a focus on delayed muscle pain approach was investigated. Mechanical and metabolic stress is the cause of injury during participation in an unfamiliar activity. Mechanical and metabolic stress may trigger pathological responses to activity-induced muscle damage. The suggested cause of metabolic muscle injury has been the inadequate production of mitochondrial ATP, ischemia, hypoxia and changes in ion concentration. The present study showed that physical activity is, in general, among the methods that can be effective in the prevention and treatment of delayed muscle soreness including: massage, cryotherapy, hydrotherapy, use of nonsteroidal anti-inflammatory drugs, antioxidant use, warm-up and cool-down, stretching movements before and after the activity, avoiding new and unfamiliar activities, starting activities gradually and lightly .Resistance activity causes muscle damage by increasing creatine kinase enzymes, lactate dehydrogenase. Accordingly, resistance training, especially extracorporeal contraction, produces oxygen-free radicals and lipid peroxidation, eventually leading to muscle tissue damage and subsequent inflammatory processes.

Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 Keywords: Physical activity, Delayed onset muscle soreness, Cellular adaptation

Introduction of beginner athletes, who are just starting out, are simply avoiding physical activity One of the muscle injuries that has been because of this soreness or discomfort, or at involving sports physiologists for years is least are looking for conditions that they delayed onset muscle soreness (DOMS), will no longer experience it. being called delayed because it does not The phenomenon of DOMS not only occur immediately after physical activity, prevents athletes from participating in but from hours to days after a session of exercise programs, but also acts as a intense physical activity. Many people who deterrent to the display of exercise skills. do not exercise physically experience some Concerns among sports coaches, form of delayed onset muscle soreness. physiologists, and other sports medicine Evidence shows that a significant number Copyright © 2020 Journal of Basic Research in Medical Science. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0International License(https://creativecommons.org/licenses/by-nc/4.0/)which permits copy and redistribute the material, in any medium or format, provided the original work is properly cited.

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Review Article J Bas Res Med Sci 2020; 7(4):4-11.

practitioners are about the existence of Existing reports suggest that soreness soreness and most likely performance- occurs after heavy, unusual activity attenuating factors, and in particular the associated with extrovert contractions, thus increased risk of injury to athletes due to among activities that possess the reduced strength from DOMS, and hence aforementioned specificity we can note they are interested in preventing or walking and running downhill (2, 3), minimizing the effects of DOMS on the specific plyometric (2,3) and shortest time possible. extrovert contractions during weight An effective and beneficial treatment for training (1-3). DOMS will enhance athletic performance and accelerate the return of non-athletes to Types of Muscle Soreness daily living activities. There are generally two types of muscle Sports coaches and physiotherapists have soreness known: a) acute muscle soreness recommended different therapeutic b) delayed-onset muscle soreness. approaches for the treatment of the skeletal A) Acute muscle soreness: This type of muscles involved, but there is limited muscle soreness occurs during and evidence to prove the effectiveness of some immediately after physical activity and may strategies; also there is little research with be due to decreased flow to the active contradictory results to compare the muscles (local anemia) (4-6). effectiveness of different therapeutic plans Another look at the etiology of acute and determine which are more effective and muscle soreness suggests that the soreness more practical in a shorter time. Of course, may be due to the accumulation of one method of relieving soreness is being metabolic end products such as H+ or lactic sedentary, but because the athlete must acid and tissue swelling, which results from reach his or her highest capacity in terms of fluid transfer from the blood plasma into the strength, range of motion and feeling no tissues. This is the same as feeling of pain in the least amount of time, specialists muscle bulking that athletes experience are looking for methods to eliminate these after endurance or strength training; in

Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 unwanted side effects that are faster than general, soreness and contusion usually inactive rest. Thus, the necessity of develop within minutes or hours of identifying and applying the most exercise, which is why they are called acute appropriate method for the specific contusion (1,4-6). purposes of each exercise seems essential (1). Characteristics of that Occur During or Immediately After Physical Activity The nature of Muscle Soreness It occurs during introvert contractions and Muscle soreness may be experienced by the same length (2,3). Blockage of the everyone after doing physical activity. bloodstream causes pain and intensifies Muscle pain or muscle soreness is an pain (4-6). With the cessation of exercise unpleasant condition in the muscle that is and normalization of blood flow, the pain associated with feelings of pain, stiffness, subsides rapidly. Chemicals released from and cramping in the muscles muscle contraction stimulate the free ends involved. of type VI nerve fibers that cause pain. The

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Review Article J Bas Res Med Sci 2020; 7(4):4-11.

more energy consumed to do the task, the B) Biochemical or laboratory (covert) greater the pain from it. Pain is most likely symptoms, including: release of enzymes caused by substances such as acids (lactate (creatine kinase, lactate dehydrogenase) (7) or pyruvate), ions, proteins, and hormones increase in myoglobin, hydroxyproline, that are associated with muscle contraction white blood cells, macrophages and (4-6). monocytes (7) change in the plasma level and and increase in prostaglandins Summary of the Mechanisms of Pain and changes in catecholamines and cortisol Created During Physical Activity hormone. Prostaglandins and increase the Theories of delayed onset muscle soreness sensitivity of pain receptors but do not comprised of theory, muscle directly cause pain. The severity of pain is contusion theory, torn tissue theory or not related to the extent of tissue damage construction damage theory (6), connective but to the severity and speed of tissue tissue theory (7), enzyme diffusion theory, injury. Mechanisms of pain creation in tissue fluid theory, theory of free radicals, tissue injury: release of bradykinin or theory of waste overproduction (7), and proteolytic enzymes. Mechanisms of theory of inflammation. ischemic pain: lactate production, Location of Delayed Onset Muscle bradykinin or proteolytic enzymes. Soreness Mechanism of pain in muscle spasms. Direct pressure on the receivers. Muscle Any overused may develop ischemia due to pressure on the vessels and DOMS, for example after a long run increased energy consumption by the downhill (2), the person will feel pain in the muscle. Slow pain is one of the most hip and knee flexor and extensor muscles. important mechanisms of incremental Intense activity (especially extrovert levels of brain awakening by stimulating activity) causes injury or trauma to the the reticular formation of the brainstem. muscle, junction of the muscle and tendon This is why sleeping is difficult for the or both, where tenderness and pain are often

Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 person who is in pain. felt in the distal part of the muscle at the tendon junction and then spread throughout Delayed Onset Muscle Soreness the muscle (9). Actually, damage to the Another type of muscle soreness that is felt lower one-thirds of the muscle (far from the one or two days after a session of intense trunk) is most likely due to the fact that the physical activity is called delayed onset order of placement of the fibers relative to muscle soreness, because the pain does not the longitudinal axis in this area is the occur immediately after training (1, 5). The highest angle, that is, the muscle has the objective symptoms of delayed onset highest tension. As such, the fibers’ risk of muscle soreness (DOMS) can be examined injury to mechanical shock is increased in two parts: (1,8). A) Functional (overt) symptoms, including: Prevention and Treatment of Delayed Onset feeling pain, swelling and restriction of Muscle Soreness movement and reduction of joint range of motion and loss of muscle strength. Physical activity

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The general hypothesis that muscle Stretching soreness is reduced by physical activity has been studied for several years. Sub- Researchers examined the effect of maximal introvert activity does not cause stretching before and after physical activity tissue damage and produces much less on DOMS and obtained different results. intramuscular pressure than extrovert Falkner et al. stated that the cause of DOMS muscle activity, whereas extrovert muscle is muscle and stretching relieves activity increases pressure and adds to the cramps. But recent evidence does not movement of intravascular fluid into the support the theory of muscle cramping, and interstitial space of trained muscle fibers. it is generally believed that muscle damage Slow active movement is most likely to be is a direct and indirect cause of muscle pain the most effective method of reducing (9). swelling and excretion of fluid accumulated It is also believed that stretching after in the injured site due to increased range of physical activity can cause the accumulated motion and putting pressure on the site of excess fluid to disperse due to muscle injury injury. Although some studies disagree and reduce pain, but later research has with introvert therapy as a treatment, it has shown that the peak time of swelling (5 been reported, following sub-maximal days after physical activity) is not in line introvert activity, to induce a decrease in with the peak time of cramping (2 - 3 days DOMS, and an increase in muscle function. after physical activity), so such a Overall, researchers have provided conclusion cannot be valid. evidence that show high-speed voluntary Electromyographic findings indicate a muscle contraction reduces DOMS and decrease in the electrical activity of the related symptoms and delays the return of muscle during slow and static stretching, muscle function to its original state. which may be another reason for So far, the most effective treatment for demonstrating muscle relaxation after DOMS is the preceding extravert exercise stretching (1,8). Static stretching is on the same muscle group. Performing one preferable to throwing stretching for the following reasons: less muscle tissue

Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 bout of extravert exercise provides a muscle adaptation that makes it more resistant to vulnerability, less energy requirement, and post-exercise injury (1,8,11). Bennett et al. avoiding fatigue or muscle pain and (2005), examining the effect of yoga relieving it (9). training on DOMS, stated that performing Massage yoga training before extravert exercise decreased DOMS compared to the The effect of exercise massage on DOMS individual who did yoga training 24 hours return to baseline has been investigated by after extravert exercise (10). several researchers. In all studies except one, massage was administered Dietary supplements immediately, 24 or 48 hours after physical Carbohydrate diet, Vitamin C (4,5), activity. Russian sports therapists betahydroxy beta methyl butyrate (HMB) advocated the effectiveness of massage 1 to and alpha-ketoisocaproic acid (KIC), 3 hours after intense physical activity, vitamin E (7,12). although its logical and scientific reason has not been established.

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Review Article J Bas Res Med Sci 2020; 7(4):4-11.

Smith et al. suggested that a significant oxygen, and also reduces the speed of pain decrease in DOMS following a three-hour message to the sensory cortex by reducing massage after extravert activity may be due the nerve impulse flow in the sensory to neutrophils activity by mechanical nerves. Substances that are released as a massage or an increase in serum cortisol result of inflammation cause pain, and the (13). Glick et al. examined the effect of muscle becomes contused. Ice as an anti- massage on DOMS and swelling and inflammatory agent reduces muscle restore of muscle function and expressed contraction and eliminates tension. The that finger massage for 10 minutes restores cold also reduces the activity of the Golgi muscle function to its original state. tendon organs, which are inhibitors of Researchers have also suggested using receptors, and anesthetizes pain receptors. Swiss-based massage for DOMS treatment Following acute tissue lesions, the use of and stated that massage increases blood cold has been suggested to reduce flow and lymph and reduces blood lactate inflammation and muscle cramps. levels compared to passive rest (1,8). Cryotherapy is effective in improving soft The results of research show that the tissue damage because of its ability to mechanical effect of massage on muscle reduce the response to circulation, soreness is due to degradation of metabolic inflammation, edema and intravascular waste and sediment, increase of local pressure. Ice massage causes the greatest circulation and decrease of pain. In decrease in intramuscular temperature addition, massage significantly reduces the compared to other cryotherapy treatments amount of blood lactate compared to (1,8). passive rest, but its effect on improving flexibility is low. In addition, using Transcutaneous Electrical Nerve alcoholic compounds can increase the Stimulation (TENS or TNS) effect of massage. Massage with hot water There is a new method to relieve pain which pressure increases the release of proteins is called T.N.S. In most cases the flow from the muscle tissue into the bloodstream frequency is between 50 and 150 Hz, the

Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 and helps maintain neuromuscular flow intensity is between 12 and 30 mA and function. On the other hand, light exercise the excitation time is about 100 to 500 with muscles with DOMS is more likely to microseconds. A group of researchers improve muscle blood flow and temporarily believe that the use of T.N.S stimuli reduce DOMS more effectively than secretes a set of chemical or morphine-like massage (1,8,14-17). chemicals, such as serotonin, endorphin and Cryotherapy enkephalin, which have properties (8). The effects of low frequency When damage and swelling occur, the TENS on delayed contusion were studied blood circulation of the site is disrupted and by Gyulik et al 30-minute treatment of two the healing process is delayed due to beats per second at 300 μs had a significant insufficient oxygen supply. By reducing decrease in pain sensation and a significant local metabolism and the damaged organ increase in range of motion (7,8,18). need for oxygen, cryotherapy blocks the process of degradation due to lack of Herbal Treatment

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The use of herbal remedies, especially (35 to 45° C) not only does not improve the Arnica Montana, goes back to the 16th symptoms of DOMS but also exacerbates it century. Arnica Montana, commonly (5). known as the mountain pearl, is a plant of which 271 medicines with 33 different uses Discussion are made. Using this drug can relieve pain Exercise and sport participation are an and treat rheumatism, soft tissue trauma, important factor in reducing the risk of , inflammation, venous many diseases and physical problems such insufficiency, infection and heart disease. as cardiovascular disease, hypertension and Arnica Montana can be used in oils, obesity. In addition, they are effective in sublingual tablets and tinctures. The effects treating many mental disorders such as of Arnica Montana tablets on blood anxiety and depression as well as increasing enzymes and muscle soreness of marathon self-confidence and self-esteem. Exercise runners were investigated. There was no affects the body and mind, and physical and significant difference in blood enzyme psychological factors subsequently affect levels of Arnica Montana and control exercise and athletic performance. Muscle groups, but muscle pain was decreased in soreness is one of the problems that athletes the Arnica Montana group. face and is often associated with a decrease Another study of subjects with coronary in exercise performance and causes the artery failure revealed the efficacy of athlete to find a way to get rid of the pain. topical use of Arnica Montana. The effect The percentage of muscle soreness depends of Arnica Montana tablets and oils on on various factors such as level of DOMS was similar to NSAIDs. It appears competition, duration and intensity of that m any studies are needed on the activity, age and individual differences beneficial effects of this herbal medicine, (7,21). especially in the setting of inflammation It is believed that excessive stretching of the and trauma of soft tissue (5). reduces a person's voluntary Heat and water Treatment Instruments and muscular strength (22). This issue Downloaded from jbrms.medilam.ac.ir at 6:03 IRST on Sunday September 26th 2021 confirms the effect of the performed Hot water showers, steam baths, regular methods (especially stretching movements) baths, local baths, the use of dry heat such on the Golgi tendon organ and connective as optical heat and saunas, increasing tissue and the result that the decrease in temperatures using exothermic means are muscle strength is due to the decrease in methods that are mentioned in limited deep receptor function in post-eccentric sources and little is known about their contraction days and has a negative effect effects. The only research carried out in this on nerve function (7). area dates back to 1988. Elsewhere, in a It has been stated that warming can reduce study, 56 German male students reported the adhesion of muscle tissues and due to its that cold jacuzzi at temperatures between mechanical function, it can affect the 12.8 and 18.3° C for 20 minutes after amount of initial damage. Warming can extravert exercise was more effective than reduce the adhesion of muscle tissues and hot jacuzzi and mixed treatment. be effective in the amount of initial damage Researchers also suggest that hot jacuzzi due to its mechanical function. Increased

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blood flow may be able to limit (2,3,8,19,20), the pain and contusion after inflammatory responses and thus be able to the first bout of exercise is undeniable and limit the effects of secondary damage after may prevent athletes from participating in eccentric activity. However, an increase in training programs or be a deterrent to his muscle temperature has been reported to be sporting skills. the most important factor yet Lu and Introducing existing strategies for the Herbert consider the observed effect to be prevention and treatment of delayed onset weak. Consistent with the results the above muscle soreness, including pharmacological and non-pharmacological aforementioned studies, High and Holi did treatments of DOMS, can help coaches and not observe a difference in the rate of peak athletes to overcome this problem and pain that is also consistent with the results improve the performance of both beginner of Law et al., (23,24). and professional athletes.

Conclusion Acknowledgments

Although the muscles of the body tend to We appreciate those colleagues and adapt to repeat an unfamiliar activity researchers helped us with this article.

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