Changes in indicators of inflammation after eccentric exercise of the elbow flexors

Muscle as an endocrine organ: focus on muscle-derived interleukin-6

Skeletal muscle has recently been identified as an endocrine organ. It has, therefore, been suggested that cytokines and other peptides that are produced, expressed, and released by muscle fibers and exert paracrine, autocrine, or endocrine effects should be classified as "myokines." Recent research demonstrates that skeletal muscles can produce and express cytokines belonging to distinctly different families. However, the first identified and most studied myokine is the gp130 receptor cytokine interleukin-6 (IL-6). IL-6 was discovered as a myokine because of the observation that it increases up to 100-fold in the circulation during physical exercise. Identification of IL-6 production by skeletal muscle during physical activity generated renewed interest in the metabolic role of IL-6 because it created a paradox. On one hand, IL-6 is markedly produced and released in the postexercise period when insulin action is enhanced but, on the other hand, IL-6 has been associated with obesity and reduced insulin action. This review focuses on the myokine IL-6, its regulation by exercise, its signaling pathways in skeletal muscle, and its role in metabolism in both health and disease.

Plyometric exercise increases serum indices of muscle damage and collagen breakdown

The aim of the present study was to examine the effect of acute plyometric exercise on indices of muscle damage and collagen breakdown. Nine untrained men performed an intense bout of plyometric jumping exercises (experimental group) and nine men remained at rest (control group). Seven days before and 24, 48, and 72 hours after plyometric exercise or rest, several physiological and biochemical indices of muscle damage and two biochemical indices of collagen damage were determined. No significant changes in concentric and eccentric peak torque of knee extensors and flexors or flexion and extension range of motion were found after the plyometric exercise. Delayed-onset muscle soreness increased 48 hours after exercise. Creatine kinase increased 48 and 72 hours post exercise, whereas lactate dehydrogenase increased 24, 48, and 72 hours post exercise. Serum hydroxyproline increased 24 hours post exercise, peaked at 48 hours, and remained elevated up to 72 hours post exercise. Hydroxylysine (which was measured only before exercise and at 48 hours) was found increased 48 hours post exercise. No differences were found in any physiological or biochemical index in the control group. Intense plyometric exercise increased muscle damage, delayed-onset muscle soreness, and serum indices of collagen breakdown without a concomitant decrease in the functional capacity of muscles. Hydroxyproline and hydroxylysine levels in serum seem promising measures for describing exercise-induced collagen degradation. Coaches need to keep in mind that by using plyometric activities, despite the increased muscle damage and collagen turnover that follow, it is not necessarily accompanied by decreases in skeletal muscle capacity.

Time-course of changes in inflammatory and performance responses following a soccer game

OBJECTIVE

: To study the effects of a single soccer game on indices of performance, muscle damage, and inflammation during a 6-day recovery period.

DESIGN

: Participants were assigned to either an experimental group (E, played in the game; n = 14) or a control group (C, did not participate in the game; n = 10).

SETTING

: Data were collected on a soccer field and at the Physical Education and Sports Science laboratory of the Democritus University of Thrace before and after the soccer game.

PARTICIPANTS

: Twenty-four elite male soccer players (age, 20.1 +/- 0.8 years; height, 1.78 +/- 0.08 m; weight, 75.2 +/- 6.8 kg).

MAIN OUTCOME MEASUREMENTS

: Muscle strength, vertical jumping, speed, DOMS, muscle swelling, leukocyte count, creatine kinase (CK), lactate dehydrogenase (LDH), C-reactive protein (CRP), cortisol, testosterone, cytokines IL-6 and IL-1b, thioburbituric acid-reactive substances (TBARS), protein carbnyls (PC), and uric acid (UA).

RESULTS

: Performance deteriorated 1 to 4 days post-game. An acute-phase inflammatory response consisted of a post-game peak of leukocyte count, cytokines, and cortisol, a 24-hour peak of CRP, TBARS, and DOMS, a 48-hour peak of CK, LDH, and PC, and a 72-hour peak of uric acid.

CONCLUSION

: A single soccer game induces short-term muscle damage and marked but transient inflammatory responses. Anaerobic performance seems to deteriorate for as long as 72-hour post-game. The acute phase inflammatory response in soccer appears to follow the same pattern as in other forms of exercise. These results clearly indicate the need of sufficient recovery for elite soccer players after a game.

Monitoring muscle oxygenation after eccentric exercise-induced muscle damage using near-infrared spectroscopy

Eccentric exercise (EE), a common type of muscular activity whereby muscles lengthen and contract simultaneously, is associated with higher levels of force but may also evoke muscle damage. We investigated the hypothesis that unaccustomed EE might impair muscle oxygenation and muscle blood flow in healthy adults. Ten healthy males performed a bout of 70 maximal eccentric contractions of the elbow flexors. Before and after EE on day 1 and over the next 6 days, maximum voluntary isometric torque (MVT), serum creatine kinase (CK), and the changes in muscle oxygen saturation, blood flow, and oxygen uptake (using near-infrared spectroscopy) within the biceps brachii were assessed. MVT decreased, whereas muscle soreness and CK increased after EE (p < 0.05). Mean resting oxygen saturation increased by 22% after acute EE, and remained elevated by 5%–9% for the following 6 days. During isometric contractions, significant decreases were observed in oxygen desaturation and re-saturation kinetics after EE and these declines were also significantly prevalent over the following 6 days. Both muscle blood flow and oxygen uptake increased significantly after acute EE, but recovered on the next day. This study revealed some prolonged alterations in muscle oxygenation at rest and during exercise after EE, which might be due to a decrease in muscle oxygen consumption, an increase in oxygen delivery, and (or) a combination of both. However, both oxygen consumption and blood flow recovered within 24 h after the eccentric exercise session, and therefore, the reason(s) for the changes in tissue oxygen saturation remain unknown.

Sarcolemmal excitability as investigated with M-waves after eccentric exercise in humans

It has been shown that intensive eccentric muscle actions lead to prolonged loss of muscle force and sarcolemmal damage. This may lead to a reduction in the excitability of the sarcolemma and contribute to the functional deficit. Experiments were carried out to test sarcolemmal excitability after eccentric elbow flexor exercise in humans. Electrically elicited surface compound muscle action potential (M-wave) properties from 30s stimulation trains (20Hz) were analyzed in biceps brachii muscle immediately after, 1h and 48h after the exercise. M-wave area, amplitude, root mean square and duration were reduced immediately after the eccentric exercise. However, no such reduction could be observed 48h after the exercise, although the maximal voluntary isometric and eccentric torques were still depressed by 12.2+/-9% (P<0.001) and 17.7+/-9% (P<0.001), respectively. Acute increase in plasma concentrations of K(+) and Ca(2+) were also observed after the eccentric exercise. These findings suggest that eccentric exercise may acutely decrease sarcolemmal excitability, which seems to be partially related to increased extracellular ion concentrations. However, disturbance of sarcolemmal excitability is not the major factor determining eccentric exercise induced prolonged loss of muscle strength, because no prolonged impairment was observed in any of the studied M-wave parameters.

Comparative MRI analysis of T2 changes associated with single and repeated bouts of downhill running leading to eccentric-induced muscle damage

Although the exact mechanisms are still unclear, it is commonly acknowledged that acute eccentric exercise alters muscle performance, whereas the repetition of successive bouts leads to the disappearance of the deleterious signs. To clarify this issue, we measured blood creatine kinase and lactate dehydrogenase activities and proton transverse relaxation time (T2) in various leg muscles 72 h after single and repeated bouts of exhausting downhill running sessions (-15 degrees , 1.5 km/h) with either 4 or 7 days elapsed between bouts. After a single exercise bout, T2 and enzyme activities initially increased and recovered rapidly. When exercise bouts were repeated over a short time period (4 days), initial changes did not recover and endurance time throughout additional exercise sessions was significantly reduced. On the contrary, with a longer resting time between exercises (7 days), the endurance time of additional running sessions was significantly longer and muscle changes (T2 increase, muscle edema, and enzyme activity changes) slowly and completely reversed. Significant correlations were found between T2 changes and enzyme activities. T2 changes in the soleus and gastrocnemius muscle heads were differently affected by lengthening contractions, suggesting a muscle specificity and indicating that muscle alterations might be linked to different anatomical properties, such as fiber pennation angles, typology, and/or the exhausting nature of the downhill running sessions. We documented a "less muscle injury" effect due to the repetition of exercise bouts at a low frequency (i.e., 1 session per week) in accordance with the delayed muscle inflammation. This effect was not observed when the between-exercise resting time was shorter.

Metabolic and anti-inflammatory benefits of eccentric endurance exercise - a pilot study

BACKGROUND

Eccentric endurance exercise (e.g. hiking downwards) is less strenuous than concentric exercise (e.g. hiking upwards) but its potential to reduce cardiovascular risk is unknown.

MATERIALS AND METHODS

We randomly allocated 45 healthy sedentary individuals (16 men and 29 women, mean age 48 years) to one of two groups, one beginning with two months of hiking upwards, the other with two months of hiking downwards the same route, with a crossover for a further two months. For the opposite way, a cable car was used where compliance was recorded electronically. The difference in altitude was 540 metres; the distance was covered three to five times a week. Fasting and postprandial metabolic profiles were obtained at baseline and after the two month periods of eccentric and concentric exercise, respectively.

RESULTS

Forty-two of the 45 participants completed the study; the compliance rate was therefore 93%. Compared with baseline, eccentric exercise lowered total cholesterol (by 4.1%; P = 0.026), low-density lipoprotein (LDL) cholesterol (by 8.4%, P = 0.001), Apolipoprotein B/Apolipoprotein A1 ratio (by 10.9%, P < 0.001), homeostasis model assessment of insulin resistance scores (by 26.2%, P = 0.017) and C-reactive protein (by 30.0%; P = 0.007); the magnitude of these changes was comparable to that of concentric exercise. Eccentric exercise improved glucose tolerance (by 6.2%, P = 0.023), whereas concentric exercise improved triglyceride tolerance (by 14.9%, P = 0.022).

CONCLUSIONS

Eccentric endurance exercise is a promising new exercise modality with favourable metabolic and anti-inflammatory effects and is well applicable to sedentary individuals.

Elderly patients and high force resistance exercise--a descriptive report: can an anabolic, muscle growth response occur without muscle damage or inflammation?

BACKGROUND AND PURPOSE

Elderly individuals participate in resistance exercise to induce an anabolic response and grow muscle to help overcome functional deficits. It is thought that a muscle damage and inflammatory response to resistance exercise is a necessary prerequisite for an anabolic and muscle growth response.

METHODS

This is a descriptive study of 11 elderly individuals in rehabilitation who underwent a 2-3x/week high force resistance exercise that used eccentric contractions. Serum measures of muscle damage, inflammation, and an anabolic response are reported along with changes in muscle mass as measured with dual energy X-ray absorptiometry.

RESULTS

Negative work increased >3-fold during the 11 weeks of resistance exercise. There were no significant changes in the damage measure of serum creatine kinase (pretraining: 18.5 +/- 1.2 Sigma units/ml; post-training: 19.2 +/- 1.1 Sigma units/ml). Proinflammatory tumor necrosis factor-alpha values remained within normal range (<4.0 pg/ml) throughout the 11 weeks of training. A nonsignificant trend for an anabolic increase (65%) in insulin like growth factor-1 was noted along with a significant increase (6%) in thigh muscle mass.

CONCLUSIONS

Neither damage, nor inflammation appear to be prerequisites for inducing anabolic and muscle growth responses in elderly individuals undergoing a high force resistance exercise with eccentric contractions.

Eccentric exercise increases EMG amplitude and force fluctuations during submaximal contractions of elbow flexor muscles

The purpose of this study was to determine the effect of eccentric exercise on the ability to exert steady submaximal forces with muscles that cross the elbow joint. Eight subjects performed two tasks requiring isometric contraction of the right elbow flexors: a maximum voluntary contraction (MVC) and a constant-force task at four submaximal target forces (5, 20, 35, 50% MVC) while electromyography (EMG) was recorded from elbow flexor and extensor muscles. These tasks were performed before, after, and 24 h after a period of eccentric (fatigue and muscle damage) or concentric exercise (fatigue only). MVC force declined after eccentric exercise (45% decline) and remained depressed 24 h later (24%), whereas the reduced force after concentric exercise (22%) fully recovered the following day. EMG amplitude during the submaximal contractions increased in all elbow flexor muscles after eccentric exercise, with the greatest change in the biceps brachii at low forces (3–4 times larger at 5 and 20% MVC) and in the brachialis muscle at moderate forces (2 times larger at 35 and 50% MVC). Eccentric exercise resulted in a twofold increase in coactivation of the triceps brachii muscle during all submaximal contractions. Force fluctuations were larger after eccentric exercise, particularly at low forces (3–4 times larger at 5% MVC, 2 times larger at 50% MVC), with a twofold increase in physiological tremor at 8–12 Hz. These data indicate that eccentric exercise results in impaired motor control and altered neural drive to elbow flexor muscles, particularly at low forces, suggesting altered motor unit activation after eccentric exercise.

Localization and quantification of muscle damage by magnetic resonance imaging following step exercise in young women

Eccentric exercise affects muscles differentially according to intensity, duration, and previous exposure to the specific exercise activity. We used T2-weighted magnetic resonance imaging sequences to localize and quantify muscle damage following step exercise and to determine correlations between transverse relaxation time (T2) and other markers of muscle damage. Eight women performed two-step exercise bouts (30 min) separated by 8 weeks. Blood samples, MR scans, measurements of muscle strength, and muscle soreness were obtained immediately before, after, and up to 9 days after each bout. Resting muscle T2 (40.3+/-0.6 ms) increased exclusively in m. Adductor magnus (AM) in the thigh performing eccentric contractions and peaked 3 days after bout 1 (73.5+/-9.7 ms, P<0.05). Plasma creatine kinase (CK) activity peaked on day 3 after bout 1 and correlated with T2 in AM (r=0.96, P<0.001). After bout 2 CK and T2 were almost unaffected. This indicates that T2-weighted MRI can be applied to identify muscles from which enzymes are being released into the circulation.

Eccentric muscle contractions induce greater oxidative stress than concentric contractions in skeletal muscle

The purpose of this study was to examine oxidative stress in skeletal muscle after eccentric and concentric muscle contractions. Eight-week-old Institute of Cancer Research (ICR) mice (n = 90) were divided into 3 groups: eccentric muscle contraction group (ECC, n = 42), concentric muscle contraction group (CON, n = 42), and control group (pre, n = 6). The tibialis anterior muscle was stimulated via the peroneal nerve to contract either eccentrically or concentrically. The tibialis anterior muscle was isolated before and 0, 6, 12, 18, 24, 72, and 168 h after muscle contraction. Immediately after muscle contractions, thiobarbituric acid reactive substances (TBARS) in skeletal muscle significantly increased (p < 0.05) in both ECC and CON conditions. However, in the ECC group alone, the TBARS level peaked at 12 and 72 h after the contractions. There was greater migration of mononuclear cells in ECC than in CON muscle. In addition, there was a correlation between TBARS in skeletal muscle and migration of mononuclear cells in ECC muscle (r = 0.773, p < 0.01), but this correlation was not apparent in CON muscle (r = 0.324, p = 0.12). The increased mononuclear cells may reflect inflammatory cells. These data suggest that eccentric muscle contraction induces greater oxidative stress in skeletal muscle, which may in turn be due to enhanced generation of reactive oxygen species (ROS) by migrating inflammatory cells.

A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease

Background

Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters.

Methods

13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca²⁺, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation.

Results

Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca²⁺, Mg, and Fe were found in TAO.

Conclusion

This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side and tendon snapping. We propose that eccentric muscle action over time can be the basis for a low grade inflammatory condition. The general implications of this model and its relations to Zn and Se will be discussed.

IGF-II gene region polymorphisms related to exertional muscle damage

We examined the association of a novel single-nucleotide polymorphism (SNP) in IGF-I (IGF-I -C1245T located in the promoter) and eight SNPs in the IGF-II gene region with indicators of muscle damage [strength loss, muscle soreness, and increases in circulating levels of creatine kinase (CK) and myoglobin] after eccentric exercise. We also examined two SNPs in the IGF binding protein-3 (IGFBP-3). The age, height, and body mass of the 151 subjects studied were 24.1 +/- 5.2 yr, 170.8 +/- 9.9 cm, and 73.3 +/- 17.0 kg, respectively. There were no significant associations of phenotypes with IGF-I. IGF-II SNP (G12655A, rs3213216) and IGFBP-3 SNP (A8618T, rs6670) were not significantly associated with any variable. The most significant finding in this study was that for men, IGF-II (C13790G, rs3213221), IGF-II (ApaI, G17200A, rs680), IGF-II antisense (IGF2AS) (G11711T, rs7924316), and IGFBP-3 (-C1592A, rs2132570) were significantly associated with muscle damage indicators. We found that men who were 1) homozygous for the rare IGF-II C13790G allele and rare allele for the ApaI (G17200A) SNP demonstrated the greatest strength loss immediately after exercise, greatest soreness, and highest postexercise serum CK activity; 2) homozygous wild type for IGF2AS (G11711T, rs7924316) had the greatest strength loss and most muscle soreness; and 3) homozygous wild type for the IGF2AS G11711T SNP showed the greatest strength loss, highest muscle soreness, and greater CK and myoglobin response to exercise. In women, fewer significant associations appeared.

Altering the Length-Tension Relationship with Eccentric Exercise

The effects of eccentric exercise on muscle injury prevention and athletic performance are emerging areas of interest to researchers. Of particular interest are the adaptations that occur after a single bout, or multiple bouts of eccentric exercise. It has been established that after certain types of eccentric exercise, the optimum length of tension development in muscle can be shifted to longer muscle lengths. Altering the length-tension relationship can have a profound influence on human movements. It is thought that the length-tension relationship is influenced by the structural makeup of muscle. However, the mechanism responsible for the shift in optimum length is not readily agreed upon. Despite the conflict, several studies have reported a shift in optimum length after eccentric exercise. Unfortunately, very few of these studies have been randomised, controlled training studies, and the duration of the shift has not yet been established. Nonetheless, this adaptation may result in greater structural stability at longer muscle lengths and consequently may have interesting implications for injury prevention and athletic performance. Both contentions remain relatively unexplored and provide the focus of this review.

Dynamics of indirect symptoms of skeletal muscle damage after stretch-shortening exercise

Healthy untrained men (age 20.4+/-1.7 years, n=20) volunteered to participate in an experiment in order to establish dynamics of indirect symptoms of skeletal muscle damage (ISMD) (decrease in maximal isometric voluntary contraction torque (MVCT) and torque evoked by electrostimulation at different frequencies and at different quadriceps muscle length, height (H) of drop jump (DJ), muscle soreness and creatine kinase (CK) activity in the blood) after 100 DJs from 0.75 m height performed with maximal intensity with an interval of 20s between the jumps (stretch-shortening exercise, SSE). All ISMDs remained even 72 h after SSE (P<0.01-0.001). The muscle experienced greater decrease (P<0.01) in torque evoked by electrostimulation (at low stimulation frequencies and at short muscle length in particular) after SSE than neuromuscular performance (MVCT and H of DJ) which demonstrated secondary decrease (P<0.01) in neuromuscular performance during the first 48 h after SSE. Within 24-72 h after the SSE the subjects felt an acute muscle pain (5-7 points approximately) and the CK activity in the blood was significantly increased up to 1200 IU/L (P<0.001). A significant correlation between decrease in MVCT and H of DJ 24-48 h after SSE on the one hand and muscle soreness registered within 24-48 h after SSE on the other was observed, whereas correlation between the other indirect symptoms of skeletal muscle damage was not significant.

Influence of vibration on delayed onset of muscle soreness following eccentric exercise

Delayed onset muscle soreness (DOMS), which may occur after eccentric exercise, may cause some reduction in ability in sport activities. For this reason, several studies have been designed on preventing and controlling DOMS. As vibration training (VT) may improve muscle performance, we designed this study to investigate the effect of VT on controlling and preventing DOMS after eccentric exercise.

METHODS

Fifty healthy non-athletic volunteers were assigned randomly into two experimental, VT (n = 25) and non-VT (n = 25) groups. A vibrator was used to apply 50 Hz vibration on the left and right quadriceps, hamstring and calf muscles for 1 min in the VT group, while no vibration was applied in the non-VT group. Then, both groups walked downhill on a 10 degrees declined treadmill at a speed of 4 km/hour. The measurements included the isometric maximum voluntary contraction force (IMVC) of left and right quadriceps muscles, pressure pain threshold (PPT) 5, 10 and 15 cm above the patella and mid-line of the calf muscles of both lower limbs before and the day after treadmill walking. After 24 hours, the serum levels of creatine-kinase (CK), and DOMS level by visual analogue scale were measured.

RESULTS

The results showed decreased IMVC force (P = 0.006), reduced PPT (P = 0.0001) and significantly increased mean of DOMS and CK levels in the non-VT group, compared to the VT group (P = 0.001).

CONCLUSION

A comparison by experimental groups indicates that VT before eccentric exercise may prevent and control DOMS. Further studies should be undertaken to ascertain the stability and effectiveness of VT in athletics.

Is isometric strength loss immediately after eccentric exercise related to changes in indirect markers of muscle damage?

This study tested the hypothesis that the magnitude of maximal isometric strength (MVC) loss immediately following eccentric exercise (MVC-post) would relate to changes in other indirect markers of muscle damage following exercise. Eighty-nine men were recruited from the same student population and performed 24 maximal eccentric actions of the elbow flexors. Commonly used markers of muscle damage such as relaxed and flexed elbow joint angles, range of motion (ROM), upper-arm circumference, muscle soreness, and plasma creatine kinase (CK) activity were measured before, immediately after, and 1-4 d after exercise. Pearson's product-moment correlation coefficients (r) between change in MVC-post and other markers of muscle damage, as well as MVC during recovery days, were calculated. Changes in MVC-post ranged from -72.8% to -17.6%, and correlated significantly (p < 0.01) with MVC at 1 (r = 0.59), 2 (0.63), 3 (0.61), and 4 (0.62) d after exercise. Reduction in MVC-post also correlated significantly (p < 0.05) with changes in relaxed (r = 0.50) and flexed elbow joint angles (-0.40), ROM (0.55), arm circumference (-0.45), peak palpation (-0.34) and extension muscle soreness (-0.48), and peak CK activity (-0.59). However, the r values were not necessarily high, and MVC-post poorly reflected the distribution of some measures, such as peak CK activity (124 - 50 440 IU x L(-1). These results suggest that MVC-post is not a strong correlate of the changes in markers of muscle damage following eccentric exercise of the elbow flexors.

Variability in muscle damage after eccentric exercise and the repeated bout effect

The first purpose of this study was to determine a possible explanation for the variability in the response to eccentric exercise by having participants repeat the same exercise 1 year apart. The second purpose was to examine whether initial injury in response to eccentric exercise was associated with the extent of the repeated bout effect (RBE). Male students performed 30 eccentric contractions (ECC) of the elbow flexors using a dumbbell set at 80% of the pre-exercise maximal isometric force (MIF). Participants were then classified into low (LR; n=6), medium (MR; n=6), high (HR; n=5), and higher (HrR; n=7) based on the increase in blood creatine kinase (CK) activity. A year later, participants repeated this exercise (ECC30). Four days after ECC30, participants performed 70 eccentric contractions (ECC70). Range of motion, MFI upper arm circumference, soreness, and blood CK activity were measured before and up to 9 days after each bout. The change in the criterion measures following ECC and ECC30 were similar for each group. There were no further changes in all parameters after ECC70 for MR, HR, and HrR, although there was a small increase in CK after ECC70 for LR. LR showed a smaller RBE after ECC70 compared with the other groups. It is concluded that participants who exercised 1 year apart showed remarkably similar responses between the bouts. The extent of the RBE following the second bout for the LR group is less for participants who demonstrate the least evidence of muscle damage after a first exercise bout.

Ventilatory and circulatory responses at the onset of exercise after eccentric exercise

The purpose of this study was to clarify whether delayed onset muscle soreness (DOMS) and muscle damage after eccentric exercise (ECC) could affect the ventilatory and circulatory responses at the onset of exercise, and whether those effects would continue after the disappearance of DOMS. Ten males participated in this study. We measured ventilatory and circulatory responses at the onset of exercise, for the first 20 s, during knee extension-relaxation voluntary exercise (VOL) and passive movement (PAS), which was achieved by the experimenter alternatively pulling ropes connected to the subjects' ankles for the same period and frequency as during VOL. VOL and PAS were performed before, 2 days after, and 7 days after ECC. The following results were found: (1) the gain of minute ventilation at the onset of VOL at 2 days after ECC was significantly larger than that of before ECC; (2) the gain of minute ventilation at 7 days after ECC during both VOL and PAS was also enhanced significantly as compared to that of before ECC; and (3) heart rate and blood pressure responses were unchanged throughout the experimental period. In conclusion, ventilatory response at the onset of exercise is augmented during DOMS and EIMD after ECC and the enhanced ventilatory response continued after the disappearance of DOMS. It is suggested that enhanced ventilatory response during exercise after ECC is attributed to at least the changes in neural factors and that the mechanisms inducing these augmented ventilatory responses should be different during the period after ECC.

Serum creatine kinase levels and renal function measures in exertional muscle damage

PURPOSE

Serum creatine kinase (CK) levels are commonly used to judge the severity of muscle damage and to determine when to hospitalize patients who present with symptoms of exertional rhabdomyolysis in order to prevent renal failure. However, no CK standard exists because of the limited information available regarding exercise-induced CK elevation and renal function. This study determined the magnitude of CK elevation and the effect on renal function produced by exercise in a large subject group.

METHODS

Blood samples were obtained from 203 volunteers who performed 50 maximal eccentric contractions of the elbow flexor muscles. The samples, taken before and 4, 7, and 10 d after exercise, were analyzed for markers of muscle damage (CK, myoglobin (Mb), lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase and for measures of renal function (creatinine, blood urea nitrogen, phosphorus, potassium, osmolality, and uric acid).

RESULTS

All indicators of muscle damage increased significantly after exercise (P < 0.01). CK levels were 6420, 2100, and 311% above baseline on days 4, 7, and 10 after the exercise, respectively (P < 0.01), and Mb was 1137, 170, and 28% above baseline on days 4, 7, and 10 after exercise, respectively (P < 0.01). Of the 203 participants, 111 had CK values at 4 d postexercise > 2,000 U x L(-1) and 51 had values > 10,000 U x L(-1), levels used to diagnose myopathy (e.g., statin myositis) and rhabdomyolysis, respectively. There were no significant increases in any measure of renal function. Despite marked CK and Mb elevations in some subjects, none experienced visible myoglobinuria or required treatment for impaired renal function.

CONCLUSIONS

Exertional muscle damage produced by eccentric exercise in healthy individuals can cause profound CK and Mb elevations without renal impairment.

Effects of number of eccentric muscle actions on first and second bouts of eccentric exercise of the elbow flexors

This study compared changes in indirect markers of muscle damage following eccentric exercise of the elbow flexors among the exercises consisting of different number of eccentric actions. Sixty male athletes were placed into one of the six groups (n=10 per group) based on the number of eccentric actions for the first (ECC1) and second exercise bouts (ECC2). Single bout groups (30, 50, and 70) performed ECC1 only, and repeated bout groups (30-30, 50-50, and 70-70) performed ECC2 3 days after ECC1. Another 10 male athletes performed different number of eccentric actions for ECC1 (30) and ECC2 (70) separated by 3 days (30-70). Changes in maximal isometric strength (MVC), range of motion (ROM), upper arm circumference (CIR), serum creatine kinase activity, myoglobin, and nitric oxide concentrations and muscle soreness for 10 days following ECC1 were compared among groups by two-way repeated measures ANOVA. Changes in MVC, ROM, and CIR following ECC1 were significantly (P<0.05) smaller for the groups that performed 30 eccentric actions compared with other groups. No significant differences between 30 and 30-30, 50 and 50-50, and 70 and 70-70 were evident for the changes in the measures for 10 days following ECC1 except for the acute decreases in MVC and ROM immediately after ECC2 for the repeated bout groups. The 30-30 and 30-70 groups showed similar changes in all criterion measures. It is concluded that recovery from eccentric exercise is not retarded by the second bout of eccentric exercise regardless of the number of eccentric actions.

Changes in the soleus muscle architecture after exhausting stretch-shortening cycle exercise in humans

This study focused on the architectural changes in the muscle-tendon complex during the immediate and secondary (delayed) reductions of performance (bimodal recovery) caused by an exhaustive rebound type stretch-shortening cycle (SSC) exercise. The isometric plantar flexor torque during maximum voluntary contraction (MVC) was measured together with recording of electromyography (EMG) and ultrasonography from the soleus muscle before (BEF), after (AFT), 2 h (2H), 2 and 8 days (2D, 8D) after the SSC exercise (n=8). The performance variables (MVC torque and EMG activation) followed the bimodal recovery patterns. This was not the case in the changes of the fascicle length and muscle thickness. The relative torque changes in MVC correlated positively (R=0.78, P=0.02) to the corresponding averaged EMG changes between BEF and 2H (BEF-->2H); the significance disappeared in the comparison between 2H and 2D (2H-->2D), during which period MVC showed a secondary reduction. The relative torque changes in MVC showed no correlation with the changes in muscle thickness between BEF-2H. However, this correlation between 2H-2D was negative (R=-0.85, P<0.01). The fascicle shortening/average EMG ratio in MVC increased at 2H, and then decreased more at 2D than 2H (P<0.05). Thus, the secondary performance decline was not related to the corresponding EMG reduction but to the increased muscle thickness, which peaked at 2D. The results suggest clearly that the secondary decline in MVC could be related to the increase in muscle volume.

Attenuation of protective effect against eccentric exercise-induced muscle damage

A single bout of eccentric exercise confers a long-lasting protective effect against subsequent bouts of the same exercise. This study investigated how the protective effect was lessened when the interval between the initial and secondary exercise bouts was increased from 4 to 12 weeks. Thirty young men performed two bouts of 12 maximal eccentric actions of the elbow flexors of the nondominant arm separated by either 4 (n = 9), 8 (n = 10), or 12 (n = 11) weeks. Maximal isometric strength, flexed and relaxed elbow joint angles, range of motion, upper arm circumference, muscle soreness, plasma creatine kinase (CK), and myoglobin (Mb) were measured before, immediately after, and for 4 days after exercise. Changes in criterion measures were compared between bouts for each group and among groups by two-way repeated-measures ANOVA. There were no significant differences among groups in the changes in all measures following the first bout. Significantly (p < 0.05) smaller responses in all measures were observed after the second bout as compared with first bout for the 4 and 8 weeks, but only in strength, muscle soreness, CK, and Mb for the 12 weeks. It was concluded that some aspects of the protective effect were attenuated after 8 weeks, and the factors responsible for the effect vary among the measures.

Skeletal muscle damage with exercise and aging

Skeletal muscle comprises the largest organ system in the human body and is essential for force generation and movement. Skeletal muscle is subjected to considerable stresses during everyday use. However, muscle has the unique ability to adapt and remodel to provide protection against such stresses. This adaptation occurs at the structural through to the cellular level, which includes changes in transcription of a range of protective proteins. Failure in such processes can be catastrophic. This failure in adaptation is particularly notable in older individuals. Our skeletal muscles become smaller and weaker as we age. This loss of muscle bulk results in a reduced capacity to generate force and results in a loss of the ability to undertake everyday tasks. This article describes the normal adaptive responses of muscle in younger individuals to the stress of various forms of exercise and the implications of a failure of these adaptive responses in the elderly.

Effects of eccentric exercise-induced muscle injury on blood levels of platelet activating factor (PAF) and other inflammatory markers

It has been reported that exercise with eccentric contractions can induce damage and inflammation in human muscle tissue, the severity of which depends on the duration and the intensity of exercise. Platelet activating factor (PAF) is a potent inflammatory mediator implicated in a series of pathophysiological conditions. We sought to investigate the relationship between PAF and eccentric exercise induced muscle damage. Thirteen healthy, recreationally active male subjects (27.5+/-3.78 year) performed 36 maximum voluntary eccentric contractions on a motorized muscle dynamometer using the elbow flexor muscles of the non-dominant arm. Venous blood samples were collected immediately before and after exercise at 2, 24, 48, 72 and 96 h. PAF was isolated, purified and determined by a platelet aggregation assay. Serum levels of creatine kinase (CK), lactate dehydrogenase (LDH), C-reactive protein (CRP) and complement C3 (C3), plasma level of fibrinogen and whole blood level of leukocytes (and their subsets) were determined. Established indicators of muscle damage as maximum isometric torque (MIT), range of motion (ROM), relaxed arm angle (RANG), flexed arm angle (FANG), arm circumference (CIRC) and muscle soreness were also measured at the same time points. PAF, leukocytes, CK and LDH were elevated after exercise, while other biochemical parameters such as CRP, C3 and fibrinogen were unchanged. We also observed an inverse association between PAF and MIT and ROM, as well as a positive association with other markers of muscle injury, i.e. CK, LDH, FANG and CIRC (all P's<0.05). Our findings may imply a role for PAF in the mechanism of eccentric exercise induced muscle damage.

Partial Protection against Muscle Damage by Eccentric Actions at Short Muscle Lengths

PURPOSE

This study investigated the hypothesis that maximal eccentric actions at a short muscle length would fail to confer a protective effect against muscle damage induced by maximal eccentric exercise at a long muscle length.

METHODS

Eleven males performed 24 maximal eccentric actions of the nondominant elbow flexors over a short extension range from an elbow joint angle of 0.87-1.74 rad (S-ECC) followed 4 wk later by eccentric actions at a long range of 2.27-3.14 rad (L-ECC). A second group of 11 males performed L-ECC on two occasions using the nondominant arm separated by 4 wk. Changes in maximal isometric strength, range of motion, upper arm circumference, muscle soreness, plasma creatine kinase and aspartate aminotransferase activities, and B-mode ultrasound images were compared between bouts and between groups by two-way repeated measures ANOVA.

RESULTS

All measures changed significantly (P < 0.01) after the first bout; however, the effects were significantly (P < 0.01) smaller after S-ECC compared with L-ECC. The second bout resulted in significantly (P < 0.01) reduced changes in all measures compared with the first bout in the subjects who performed L-ECC on both occasions. The subjects who performed S-ECC in the first bout displayed significantly smaller changes after L-ECC than those seen after L-ECC alone, with the degree of attenuation being around 50-70%.

CONCLUSION

Contrary to the hypothesis, S-ECC provided partial but effective protection against L-ECC. This result suggests adaptations associated with the repeated bout effect were also produced after S-ECC, but the degree of adaptations was not as strong as that by L-ECC. Eccentric exercise at a short extension range can be used as a strategy to present severe muscle damage.

The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers

Physical activity is associated with a reduced incidence of coronary disease, but the mechanisms mediating this effect are not defined. There has been considerable recent interest in inflammation in the pathogenesis of cardiovascular disease. Some of the beneficial role of physical activity may result from its effects on the inflammatory process. We searched PubMed for articles published between 1975 through May 2004 using the terms exercise, physical activity, or physical fitness combined with C-reactive protein, inflammation, inflammatory markers, or cytokines. The review revealed 19 articles on the acute inflammatory response to exercise, 18 on cross-sectional comparisons of subjects by activity levels, and 5 examining prospectively the effects of exercise training on the inflammatory process. Exercise produces a short-term, inflammatory response, whereas both cross-sectional comparisons and longitudinal exercise training studies demonstrate a long-term "anti-inflammatory" effect. This anti-inflammatory response may contribute to the beneficial effects of habitual physical activity.

ACTN3 and MLCK genotype associations with exertional muscle damage

Strenuous exercise results in damage to skeletal muscle that is manifested in delayed muscle pain, prolonged strength loss, and increases in muscle proteins in the blood, especially creatine kinase (CK) and myoglobin (Mb). Some individuals experience profound changes in these variables in response to standard laboratory exercise or recreational activities. We proposed that variations in genes coding for two myofibrillar proteins [alpha-actinin 3 (ACTN3) and myosin light chain kinase (MLCK)] may explain the large variability in the response to muscle-damaging exercise. We hypothesized that subjects with specific single nucleotide polymorphisms (SNPs) in ACTN3 and MLCK would show a greater loss in muscle strength and/or a greater increase in blood CK and Mb in response to eccentric exercise. Blood from 157 subjects who performed a standard elbow flexion eccentric exercise protocol was tested for association between genotypes of ACTN3 (1 SNP tested: R577X) and MLCK (2 SNPs tested: C49T and C37885A) and changes in blood CK and Mb and isometric strength. Subjects possessing the ACTN3-deficient genotype (XX) had lower baseline CK compared with the heterozygotes (P = 0.035). After the eccentric exercise, those subjects homozygous for the MLCK 49T rare allele had a significantly greater increase in CK and Mb (P < 0.01) compared with the heterozygotes, and those heterozygous for MLCK C37885A had a significantly greater increase in CK compared with the homozygous wild type (P < 0.05). There was only one subject homozygous for the rare MLCK 37885A allele. MLCK C37885A was also associated with postexercise strength loss (P < 0.05); the heterozygotes demonstrated greater strength loss compared with the homozygous wild type (CC). These results show that variations in genes coding for specific myofibrillar proteins influence phenotypic responses to muscle damaging exercise.

Immune Alterations, Lipid Peroxidation, and Muscle Damage Following a Hill Race

Hill races usually include large downhill running sections, which can induce significant degrees of muscle damage in a field setting. This study examined the link between muscle damage, oxidative stress, and immune perturbations following a 7-km mountainous hill race with 457 m of ascent and 457 m of descent. Venous blood samples were taken from 7 club level runners before, immediately after, and 48 hrs postrace. Samples were analysed for total and differential leukocyte counts, markers of muscle damage (CK), lipid peroxidation (MDA), and acute phase proteins (CRP; fibrinogen; α-1-ACT). The total antioxidant status (TEAC) and plasma levels of the proinflammatory cytokines IL-6, IL-8, and TNF-α were also determined. Subjective pain reports, and plasma activities of CK, MDA, and circulatory monocytes reached peak values at 48 hrs postrace (p <  0.05). TEAC and the cytokine IL-8 increased immediately after the race (p <  0.05). Plasma TNF-α remained unchanged (p > 0.05). Despite the reports of muscle damage and soreness, no evidence of an acute phase response was observed (p > 0.05), which may be explained by the failure of the race to induce a plasma TNF-α response. Future studies should examine the link between muscle damage, oxidative stress, and the acute phase response following hill races of longer duration with larger eccentric components. Key words: acute phase response, cytokines, antioxidant capacity, creatine kinase, field study

Static magnetic fields neither prevent nor diminish symptoms and signs of delayed onset muscle soreness

OBJECTIVE

To determine whether application of a commercially available static magnetic field would alter the signs and/or symptoms of delayed onset muscle soreness (DOMS) produced by exhaustive eccentric exercise.

DESIGN

A double-blinded, randomized, and placebo-controlled study, with subjects serving as their own controls.

SETTING

An outpatient physical therapy and performance center.

PARTICIPANTS

Twenty-three healthy volunteers (18 women; mean age, 30 y; range, 18-40 y; 5 men; mean age, 29 y; range, 19-39 y).

INTERVENTION

After exhaustive eccentric exercise of both the right and left elbow flexor muscle groups, subjects received daily treatment with either a 350G magnet or a placebo device for 5 consecutive days.

MAIN OUTCOME MEASURES

Outcome variables, including anthropometric measurements, perceived discomfort, and muscle force production, were compared using linear mixed models.

RESULTS

Arm circumference, relaxed elbow flexion angle, and pain increased, whereas active elbow flexion angle and maximal isometric torque decreased transiently before returning to near baseline. No significant difference in outcome variables existed between the treated and control arms. Participants reported less pain in both treated and control arms after each session, suggesting a placebo effect.

CONCLUSIONS

Static magnetic fields were no more effective than placebo in preventing DOMS.

Protection against muscle damage in competitive sports players: the effect of the immunomodulator AM3

Strenuous physical exercise of the limb muscles commonly results in damage, especially when that exercise is intense, prolonged and includes eccentric contractions. Many factors contribute to exercise-induced muscle injury and the mechanism is likely to differ with the type of exercise. Competitive sports players are highly susceptible to this type of injury. AM3 is an orally administered immunomodulator that reduces the synthesis of proinflammatory cytokines and normalizes defective cellular immune fractions. The ability of AM3 to prevent chronic muscle injury following strenuous exercise characterized by eccentric muscle contraction was evaluated in a double-blind and randomized pilot study. Fourteen professional male volleyball players from the First Division of the Spanish Volleyball League volunteered to take part. The participants were randomized to receive either placebo (n=7) or AM3 (n=7). The physical characteristics (mean+/-s) of the placebo group were as follows: age 25.7+/-2.1 years, body mass 87.2+/-4.1 kg, height 1.89+/-0.07 m, maximal oxygen uptake 65.3+/-4.2 ml.kg(-1).min(-1). Those of the AM3 group were as follows: age 26.1+/-1.9 years, body mass 85.8+/-6.1 kg, height 1.91+/-0.07 m, maximal oxygen uptake 64.6+/-4.5 ml.kg(-1).min(-1). All participants were evaluated for biochemical indices of muscle damage, including concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, creatine kinase (CK) and its MB fraction (CK-MB), myoglobin, lactate dehydrogenase, urea, creatinine and gamma-glutamyltranspeptidase, both before and 30 days after treatment (over the peak of the competitive season). In the placebo group, competitive exercise (i.e. volleyball) was accompanied by significant increases in creatine kinase (494+/-51 to 560+/-53 IU.l(-1), P < 0.05) and myoglobin (76.8+/-2.9 to 83.9+/-3.1 microg.l(-1), P < 0.05); aspartate aminotransferase (30.8+/-3.0 to 31.1+/-2.9 IU.l(-1)) and lactate dehydrogenase (380+/-31 to 376+/-29 IU.l(-1)) were relatively unchanged after the 30 days maximum effort. AM3 not only inhibited these changes, it led to a decrease from baseline serum concentrations of creatine kinase (503+/-49 to 316+/-37 IU.l(-1), P < 0.05) and myoglobin (80.1+/-3.2 to 44.1+/-2.6 IU.l(-1), P < 0.05), as well as aspartate aminotransferase (31.1+/-3.3 to 26.1+/-2.7 IU.l(-1), P < 0.05) and lactate dehydrogenase (368+/-34 to 310+/-3 IU.l(-1), P < 0.05). The concentration of CK-MB was also significantly decreased from baseline with AM3 treatment (11.6+/-1.2 to 5.0+/-0.7 IU.l(-1), P < 0.05), but not with placebo (11.4+/-1.1 to 10.8+/-1.4 IU.l(-1)). In conclusion, the use of immunomodulators, such as AM3, by elite sportspersons during competition significantly reduces serum concentrations of proteins associated with muscle damage.

MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage

The aim of this study was to monitor the effects of topical heat and/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8/group). Isometric strength testing, pain ratings, and multi-echo magnetic resonance imaging of the thigh were performed before and at 2, 3, 4, 8, and 15 days following the exercise. Increased T2 relaxation time, muscle swelling, pain ratings, and strength loss confirmed significant muscle damage during the post-exercise period. Pain ratings and muscle volume recovered to baseline by 15 days, although muscle strength remained lower [77 (4) vs. 95 (3) kg pre-exercise, mean (SE)] and T2 values higher [32.2 (0.8) vs. 28.6 (0.2) ms pre-exercise]. Our results indicate that heat and/or static stretching does not consistently reduce soreness, swelling or muscle damage. The practical implication of our findings is that clinicians should be aware that prescribing heat and/or static stretching following intense eccentric or unaccustomed exercise will not enhance the recovery of damaged muscles.

Neuromuscular function after exercise-induced muscle damage: theoretical and applied implications

Exercise-induced muscle damage is a well documented phenomenon particularly resulting from eccentric exercise. When eccentric exercise is unaccustomed or is performed with an increased intensity or duration, the symptoms associated with muscle damage are a common outcome and are particularly associated with participation in athletic activity. Muscle damage results in an immediate and prolonged reduction in muscle function, most notably a reduction in force-generating capacity, which has been quantified in human studies through isometric and dynamic isokinetic testing modalities. Investigations of the torque-angular velocity relationship have failed to reveal a consistent pattern of change, with inconsistent reports of functional change being dependent on the muscle action and/or angular velocity of movement. The consequences of damage on dynamic, multi-joint, sport-specific movements would appear more pertinent with regard to athletic performance, but this aspect of muscle function has been studied less often. Reductions in the ability to generate power output during single-joint movements as well as during cycling and vertical jump movements have been documented. In addition, muscle damage has been observed to increase the physiological demand of endurance exercise and to increase thermal strain during exercise in the heat. The aims of this review are to summarise the functional decrements associated with exercise-induced muscle damage, relate these decrements to theoretical views regarding underlying mechanisms (i.e. sarcomere disruption, impaired excitation-contraction coupling, preferential fibre type damage, and impaired muscle metabolism), and finally to discuss the potential impact of muscle damage on athletic performance.

MR properties of excised neural tissue following experimentally induced inflammation

Changes in the MR parameters of inflamed neural tissue were measured in vitro. Tumor necrosis factor-alpha (TNF-alpha) was injected into rat sciatic nerves to induce inflammation with negligible axonal loss and demyelination. The MR parameters, such as T1/T2 relaxation and magnetization transfer (MT), were measured 2 days after TNF-alpha injection and were found to be substantially different from those of normal nerves. The average T1/T2 relaxation times increased, whereas the MT ratio (MTR) and the quantitative MT parameter M0B (which describes the semisolid pool of protons) decreased. The MR parameters correlated very well with the extracellular volume fraction (EM) of neural tissue evaluated by quantitative histopathology. The multicomponent T2 relaxation was shown to provide the best quantitative assessment of changes in neural tissue microstructure, and allowed us to distinguish between the processes of inflammation and demyelination. In comparison, the MT measurements were less successful due to competing contributions of demyelination and pH-sensitive changes in the MT effect.

Strength training in older women: early and late changes in whole muscle and single cells

In order to examine the relative contribution of neural- and muscle-based adaptation to strength training, we studied early (2 weeks) and later (12 weeks) effects of strength training on muscle size and strength and type I single-fiber size and contractility in 14 elderly women (aged 68-79 years) and seven young controls. Older subjects were randomized to training (n = 7) or control (n = 7) groups. Strength did not change, but whole muscle size increased significantly after 2 weeks. After 12 weeks, strength, whole muscle size, and specific force all increased. No changes occurred in the control group. In single fibers, no changes in size and contractility were noted after 2 weeks, but specific force was higher in the training group after 12 weeks. Early adaptations to strength training in elderly women cannot be attributed to changes at the cellular level and therefore occur primarily in the central nervous system. Later, cellular adaptations in specific force track closely whole muscle changes.

Molecular responses of human muscle to eccentric exercise

We examined the effect of eccentric exercise on the transcriptome of skeletal muscle in three male human volunteers who performed 300 concentric contractions with one leg and 300 eccentric contractions with the opposite leg. Vastus lateralis muscle biopsies were taken from both legs at 4-8 h after exercise, and expression was profiled by using 12000 gene Affymetrix U95Av2 microarrays. We found a high concordance of expression responses to eccentric contractions between our human and rat data from a previous study (Chen YW, Nader GA, Baar KR, Fedele MJ, Hoffman EP, and Esser KA. J Physiol 545: 27-41, 2002) ( approximately 50% of gene expression changes shared between species). Potential human-specific changes included greater inflammatory responses [chemokine (C-C motif) ligand 2, C/EBP delta, and IL-1 receptor] and vascular remodeling (tenascin C and lipocortin II). Induction of c-fos and lipocortin II were confirmed at the protein level, with c-fos localized to myofiber nuclei and lipocortin II to intramuscular capillaries. We also confirmed the eccentric-induced expression of six transcripts by quantitative RT-PCR (cardiac ankyrin-repeated protein, chemokine ligand 2, CCAAT/enhancer binding protein delta, IL-1 receptor, tenascin C, and cysteine-rich angiogenic inducer 61). These data provide the first characterization of the transcriptional response of skeletal muscle to eccentric exercise in humans and represent a preliminary step in understanding the molecular processes underlying muscle remodeling (including a new focus on rapid changes in the capillary bed) and inflammatory responses after damaging lengthening contractions.

Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport

Muscles operate eccentrically to either dissipate energy for decelerating the body or to store elastic recoil energy in preparation for a shortening (concentric) contraction. The muscle forces produced during this lengthening behavior can be extremely high, despite the requisite low energetic cost. Traditionally, these high-force eccentric contractions have been associated with a muscle damage response. This clinical commentary explores the ability of the muscle-tendon system to adapt to progressively increasing eccentric muscle forces and the resultant structural and functional outcomes. Damage to the muscle-tendon is not an obligatory response. Rather, the muscle can hypertrophy and a change in the spring characteristics of muscle can enhance power; the tendon also adapts so as to tolerate higher tensions. Both basic and clinical findings are discussed. Specifically, we explore the nature of the structural changes and how these adaptations may help prevent musculoskeletal injury, improve sport performance, and overcome musculoskeletal impairments.

Delayed onset muscle soreness : treatment strategies and performance factors

Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.

Functional changes of human quadriceps muscle injured by eccentric exercise

The present study evaluated functional changes of quadriceps muscle after injury induced by eccentric exercise. Maximal isometric torque of quadriceps and the surface electromyography (root mean square, RMS, and median frequency, MDF) of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles were examined before, immediately after and during the first 7 days after injury. Serum creatine kinase (CK) levels and magnetic resonance imaging (MRI) were used to identify muscle injury. The subject was used as her own control and percent refers to pre-injury data. Experiments were carried out with a sedentary 23-year-old female. Injury was induced by 4 bouts of 15 maximal isokinetic eccentric contractions (angular velocity of 5 /s; range of motion from 40 to 110 of knee flexion). The isometric torque of the quadriceps (knee at 90 flexion) decreased 52% immediately after eccentric exercise and recovered on the 5th day. The highest reduction of RMS occurred on the 2nd day after injury in both VL (63%) and VMO (66%) and only VL recovered to the pre-injury level on the 7th day. Immediately after injury, the MDF decreased by 5 and 3% (VMO and VL, respectively) and recovered one day later. Serum CK levels increased by 109% on the 2nd day and were still increased by 32% on the 7th day. MRI showed large areas of injury especially in the deep region of quadriceps. In conclusion, eccentric exercise decreased the isometric torque and electromyographic signals of quadriceps muscle, which were recovered in one week, despite the muscle regeneration signals.

Peripheral opioid analgesia in experimental human pain models

This placebo-controlled, double-blind crossover study assessed whether exclusive activation of peripheral opioid receptors results in significant pain reduction. To achieve opioid activity restricted to the periphery, we used a short-term (2 h) low dose infusion of morphine-6-beta-glucuronide (M6G) because M6G does not pass the blood-brain barrier during this time in amounts sufficient to induce CNS effects. The lack of central opioid effects of M6G was confirmed by a lack of change of the pupil size and absence of other opioid-related CNS effects. As a positive control, morphine was infused at a dosage that definitely produced CNS effects. This was evident by a rapid decrease of the pupil size and by other typical opioid-related side effects including nausea, vomiting, itchiness, hiccup and sedation. Three different pain models were employed to evaluate the analgesic effects: (i) cutaneous inflammatory hyperalgesia induced by briefly freezing a small skin area to -30 degrees C ('freeze lesion'); (ii) muscle hyperalgesia induced by a series of concentric and eccentric muscle contractions (DOMS model; delayed onset of muscle soreness); and (iii) pain induced by electrical current (5 Hz sinus stimuli of 0-10 mA). M6G significantly reduced cutaneous hyperalgesia in the 'freeze lesion' model as assessed with von Frey hairs. It also reduced muscle hyperalgesia in the DOMS model. Electrical pain, however, was not affected by M6G. Morphine was significantly more active in the 'freeze lesion' and DOMS model, and also significantly increased the electrical pain threshold and tolerance. Subcutaneous tissue concentrations of M6G and morphine as assessed with microdialysis were about half those of the respective plasma concentrations. The results of the study indicate that M6G has antihyperalgesic effects in inflammatory pain through activation of peripheral opioid receptors. Since this occurs at concentrations that do not cause central opioid effects, M6G might be useful as a peripheral opioid analgesic.

Effects of warm-up before eccentric exercise on indirect markers of muscle damage

PURPOSE

To test whether active and passive warm-up conducted before eccentric exercise attenuates clinical markers of muscle damage.

METHODS

Untrained subjects were exposed to one of five conditions: low-heat passive warm-up (N = 10), high-heat passive warm-up (N = 4), or active warm-up (N = 9), preceding eccentric exercise; eccentric exercise without warm-up (N = 10); or high-heat passive warm-up without eccentric exercise (N = 10). Passive warm-up of the elbow flexors was achieved using pulsed short-wave diathermy, and active warm-up was achieved by concentric contraction. Creatine kinase (CK) activity, strength, range of motion, swelling, and muscle soreness were observed before treatment (baseline) and 24, 48, 72, and 168 h after treatment.

RESULTS

High-heat passive warm-up without eccentric exercise did not affect any marker of muscle damage and was used as our control group. Markers of muscle damage were not different between groups that did or did not conduct warm-up before eccentric exercise. The active warm-up and eccentric groups exhibited a greater circumferential increase than controls (P < 0.0002), however, that was not observed after passive warm-up. Additionally, the active warm-up group exhibited a greater CK response than controls at 72 h (P < 0.05). The high-heat passive warm-up before eccentric exercise group exhibited significant change from controls at the least number of time points, but due to a small sample size (N = 4), these data should be viewed as preliminary.

CONCLUSION

Our observations suggest that passive warm-up performed before eccentric exercise may be more beneficial than active warm-up or no warm-up in attenuating swelling but does not prevent, attenuate, or resolve more quickly the other clinical symptoms of eccentric muscle damage as produced in this study.

Exercise-induced muscle damage in humans

Exercise-induced muscle injury in humans frequently occurs after unaccustomed exercise, particularly if the exercise involves a large amount of eccentric (muscle lengthening) contractions. Direct measures of exercise-induced muscle damage include cellular and subcellular disturbances, particularly Z-line streaming. Several indirectly assessed markers of muscle damage after exercise include increases in T2 signal intensity via magnetic resonance imaging techniques, prolonged decreases in force production measured during both voluntary and electrically stimulated contractions (particularly at low stimulation frequencies), increases in inflammatory markers both within the injured muscle and in the blood, increased appearance of muscle proteins in the blood, and muscular soreness. Although the exact mechanisms to explain these changes have not been delineated, the initial injury is ascribed to mechanical disruption of the fiber, and subsequent damage is linked to inflammatory processes and to changes in excitation-contraction coupling within the muscle. Performance of one bout of eccentric exercise induces an adaptation such that the muscle is less vulnerable to a subsequent bout of eccentric exercise. Although several theories have been proposed to explain this "repeated bout effect," including altered motor unit recruitment, an increase in sarcomeres in series, a blunted inflammatory response, and a reduction in stress-susceptible fibers, there is no general agreement as to its cause. In addition, there is controversy concerning the presence of sex differences in the response of muscle to damage-inducing exercise. In contrast to the animal literature, which clearly shows that females experience less damage than males, research using human studies suggests that there is either no difference between men and women or that women are more prone to exercise-induced muscle damage than are men.

A 2 week routine stretching programme did not prevent contraction-induced injury in mouse muscle

Most athletes stretch as part of their training regimen and it is commonly believed that this practice prevents muscle injury. We tested this belief using an animal model, in situ mouse extensor digitorum longus (EDL) muscle. One lower hindlimb was slowly stretched for 1 min on alternate days for 12 days; the other leg served as a control. The mouse was lightly anaesthetized during the stretching protocol (isofluorane). Both legs were tested in situ by measuring maximum isometric force and maximum work before and after an eccentric contraction that was designed to cause a contraction-induced injury. The difference between a contraction before and after (i.e. the deficit) was used as a measure of damage caused by the eccentric contraction. There was a threshold for force deficit at a peak to peak eccentric excursion amplitude of 19.5 % (i.e. L(o) +/- 9.75 %, where L(o) is muscle length at peak isometric force). There was a significant increase in force deficit, work deficit, and curve shift with an increase in eccentric excursion amplitude above the threshold. There was no statistical difference in the force deficit, work deficit, or curve shift between the stretched leg and the control leg (P > 0.05). A routine stretching programme, at least at the intensities employed in this experiment, did not prevent contraction-induced injury in the in situ mouse EDL muscle.

Do muscles function as adaptable locomotor springs?

During normal animal movements, the forces produced by the locomotor muscles may be greater than, equal to or less than the forces acting on those muscles, the consequences of which significantly affect both the maximum force produced and the energy consumed by the muscles. Lengthening (eccentric)contractions result in the greatest muscle forces at the lowest relative energetic costs. Eccentric contractions play a key role in storing elastic strain energy which, when recovered in subsequent contractions, has been shown to result in enhanced force, work or power outputs. We present data that support the concept that this ability of muscle to store and recover elastic strain energy is an adaptable property of skeletal muscle. Further, we speculate that a crucial element in that muscle spring may be the protein titin. It too seems to adapt to muscle use, and its stiffness seems to be`tuned' to the frequency of normal muscle use.

Muscle damage and soreness after endurance exercise of the elbow flexors

PURPOSE

This study investigated changes in indirect markers of muscle damage after endurance exercise of the elbow flexors and compared the changes with those after maximal eccentric actions (Max-ECC) of the elbow flexors.

METHODS

Eighteen male students rhythmically lifted (1 s) and lowered (1 s) a light dumbbell (1.1-1.8 kg: 9% of MIF) in 60-180 degrees of elbow joint angle for 2 h (2-h Ex). Maximal isometric force (MIF), relaxed (RANG) and flexed elbow joint angles (FANG), upper-arm circumference (CIR), muscle soreness (SOR), B-mode ultrasound (US), and plasma creatine kinase (CK) activity were assessed before and immediately after, and up to 96 h after exercise.

RESULTS

All measures were altered significantly (P < 0.05) after 2-h Ex in a similar time course to Max-ECC; however, changes in RANG, FANG, CIR, US, and CK (peak: 356 +/- 121 IU.L-1) were significantly (P < 0.05) smaller compared with those after Max-ECC. SOR developed immediately after 2-h Ex and peaked 24-48 h after exercise. MIF dropped to 44.1% of the preexercise level, which was significantly (P < 0.05) lower than that after Max-ECC (58.1%), immediately postexercise. MIF recovered to 79.8% at 24 h, and 97.8% at 96 h postexercise, which was a significantly (P < 0.05) faster recovery compared with that of Max-ECC (73.1% at 96 h).

CONCLUSION

These results showed low-intensity continuous muscle contractions (3600 times) resulted in muscle damage; however, the magnitude of the muscle damage was less severe, and the recovery was faster compared with 12 maximal eccentric muscle actions.