DOMS and EIMD: separate

conditions?

By Jonathan Luke

Initial Purpose

• To investigate the acute effects of a high volume, low intensity workout on DOMS in eccentrically injured individuals.

• Due to limitations of time, equipment, and protocol this treatment was not tested.

Case study

• Instead, a case study was produced in which an individual

exhibited clear positive symptoms of DOMS, without

accompanying signs of EIMD.

“Differential diagnosis: the distinguishing of a disease or condition from others presenting with similar signs and symptoms.”

(Merriam-Webster)

Background

• Delayed Onset Muscle Soreness (DOMS)

• The subjective experience of pain or soreness localized to a muscle group while at rest, on stretch, or during contraction.

• Cause: Eccentric or unaccustomed exercise

• Onset at 12 to 24 hours.

• Peaks 1-3 days prior to onset and lasts 3-7 days

• (Nosaka, 2002)

Background

• Exercise Induced Muscle Damage (EIMD) • Causes: Eccentric or unaccustomed exercise

• Symptoms:

• Strength losses • Soreness (DOMS) • Stiffness • Edema • Structural disruption (Fig .1)

• Peak symptoms: 1-5 days prior to damage

• Some symptoms measurable as long as 30 days

• (Howatson, 2008)

Figure 1. Myofibril damage (Lieber, 1999)

DOMS and EIMD in Literature

In reference to injuries resulting from eccentric exercise:

“[E]ven a cursory perusal of the literature demonstrates that a wide variety of criteria for muscle injury has been employed, and that there has been no general agreement on the best methods for quantifying the pathology.”

(Warren, 1999)

Laboratory Markers

• Papers referring to DOMS

• Soreness or pain

• Strength (typically MVC)

• Joint angles and ROM

• CK and other blood-borne proteins

• Papers referring to EIMD or damage

• Soreness or pain

• Strength (typically MVC)

• Joint angles and ROM

• CK and other blood-borne proteins

MRI evaluations

• Limited number of studies using T2 relaxation times

• All report

• Significant increase in T2 relaxation times

• Significant increase in delayed onset pain

• Significant decreases in strength

• Only one employs a submaximal exercise protocol

• Reported high group variability in pain ratings and T2 times

• (Evans, 1998)

Methods: Measurement Protocols • MRI

• T2 relaxation times

• Measure of muscle damage (Foley, 1999; Jayaraman, 2004)

• Strength tests

• Isometric MVC (Interpolated Twitch Technique at 90 degrees)

• Performed on a Cybex Dynamometer

• Perceived pain

• 100mm Visual Analog Scale (VAS)

Fig 3. A 100mm VAS. Raters place a mark upon the line best representing their pain along the spectrum.

Methods: Injury Protocols

• Knee Extensions: Quadriceps

• Intensity: 80% Concentric 1RM

• 3 second eccentric lowering with one leg

• Concentric raising with opposite leg

• 5 sets / 2 min rest

Methods: Injury Protocols

• Moderate protocol

• Sets of 10 repetitions

• Did not reach failure

• Did not produce DOMS

• Heavy protocol

• Sets conducted to concentric failure

• Produced DOMS

• Subject P

Methods: Time Course

• Baseline

• Eccentric exercise protocol

• 30 min post

• 24 hr post

• 48 hr post

Results: Pain

Subject Subject P

Eccentric leg Concentric leg

Pre 0 0

Post 8 0

24 56 2

48 60 2

Perceived pain ratings, VAS scores (mm).

Results: T2 relaxation times

0

20

40

60

Pre Post 24HR 48HR

Re

lati

ve in

cre

ase

fro

m b

ase

lin

e (%

) Increases in T2 relaxation times in Subject P

Eccentric leg

Concentric leg

Jayaraman et al

Results: T2 relaxation times

(Jayaraman, et al., 2004) Subject P

Results: Isometric strength

50

60

70

80

90

100

Pre Post 24HR 48HR

Pe

rce

nt o

f b

ase

lin

e to

rqu

e (%

)

Change in MVC torque relative to baseline in

Subject P

Eccentric leg

Concentric leg

Jayaraman et al

Results: Voluntary activation

70

80

90

100

Pre Post 24HR 48HR

% V

olu

nta

ry a

ctiv

atio

n

Estimated voluntary activation in Subject P

Eccentric leg

Concentric leg

Results: Potentiation

0

20

40

60

80

100

120

Pre Post 24HR 48HR

Pe

rce

nt o

f b

ase

lin

e to

rqu

e (%

)

Change in potentiated twitch torque relative to baseline

Subject Peccentric leg

Subject Pconcentric leg

Explanations

• High inter-subject perceived pain and T2 variability

• Reported in Evans, et al (1998)

• May be statistical chance that a single subject showed no clear decrement in strength or increase in T2 relaxation times

• Alternatively,

• DOMS reproducible without muscle damage

• DOMS and EIMD share an MOI but not a direct cause

• A differential diagnosis for DOMS and EIMD may exist

Precedents

• Evans, et al (1998) did not find a significant correlation between change in T2 and pain with muscle damage

• In a review, Warren, et al (1999) found pain did not correlate well with muscle damage

• Nosaka, et al (2002) found pain did not reflect the magnitude of muscle damage; suggesting, “DOMS may not be directly related to muscle damage and subsequent inflammation.”

• Yu, et al (2004) proposed myofibriller disruption associated with DOMS in literature represented remodeling, not damage

Implications

• Further research is required

• If the results can be replicated, may indicate a differential diagnosis exists between DOMS and EIMD

• If replicated, DOMS in the absence of EIMD should be confirmed through other markers of structural damage (i.e. blood proteins, myofibriller damage)

• If confirmed, DOMS in absence of EIMD should be investigated and described to aid in the understanding of causes and potential treatments

References • Differential diagnosis. (n.d.). In Merriam-Webster Online. Retrieved from

http://www.merriam-webster.com/dictionary/differential%20diagnosis • Evans, G., Haller, R., Wyrick, P., Parkey, R., Fleckenstein, J. (1998). Submaximal delayed-

onset muscle soreness: correlations between MR imaging findings and clinical measures. Radiology. 208, 815-820.

• Foley, J., Jayaraman, R., Prior, B., Pivarnik, J., & Meyer, R. (1999). MR measurements of muscle damage and adaptation after eccentric exercise. Journal of Applied Physiology. 87, 2311-2318.

• Howatson, G. & Someren, K. (2008). The prevention and treatment of exercise-induced muscle damage. Sports Medicine. 38(6), 483-503.

• Jayaraman, R., Reid, R., Foley, J., Prior, B., Dudley, G., Weingand, K., & Meyer, R. (2004). MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage. European Journal of Applied Physiology. 93, 30-38.

• Liber, R., & Friden, J. (1999). Mechanisms of muscle injury after eccentric contraction. Journal of Science and Medicine in Sport. 2(3), 253-265.

• Nosaka, K., Newton, M., Sacco, P. (2002). Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage. Scandinavian Journal of Medicine and Science in Sports. 12, 337-346.

• Warren, G., Lowe, D., Armstrong, R. (1999). Measurement tools used in the study of eccentric contraction-induced injury. Sports Medicine. 27(1), 43-59.

• Yu, J., Carlsson, L., Thornell, L. (2004). Evidence for myofibril remodeling as opposed to myofibril damage in human muscles with DOMS: an ultrastructural and immunoelectron microscopic study. Histochemistry and Cell Biology. 121, 219-227.