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

Effects of hyperbaric oxygen on recovery from exercise-induced muscle damage in humans

OBJECTIVE

To determine whether hyperbaric oxygen (HBO) therapy could accelerate recovery from exercise-induced muscle damage in humans.

DESIGN

Pretest-posttest design with random assignment to either a treatment (HBO) or placebo control (sham) group.

SETTING

University of Alberta and Misericordia Hospital, Edmonton.

PARTICIPANTS

12 healthy male students (24.2 +/- 3.2 years) who were unaccustomed to strenuous eccentric exercise of the calf muscles.

INTERVENTIONS

All subjects performed a strenuous eccentric exercise protocol designed to elicit muscle damage within the right gastrocnemius muscle. Subjects subsequently received either HBO (100% oxygen at 253 kPa [2.5 ATA] for 60 min; n = 6) or sham (atmospheric air at 132 kPa [1.3 ATA] for 60 min; n = 6) treatment conditions. The first treatment was administered 3-4 hours after damage, with a second and third at 24 and 48 hours after the first, respectively.

MAIN OUTCOME MEASURES

Dependent variables included peak torque at 0.52 radians/s, peak isometric torque, and muscular endurance using isokinetic dynamometry; muscle cross-sectional area using magnetic resonance imaging; inorganic phosphate levels and T2 relaxation time using 31P and 1H magnetic resonance spectroscopy; pain sensation and unpleasantness using the Descriptor Differential Scale. These variables were assessed at baseline and until day 5 postdamage.

RESULTS

There was little evidence of a difference in recovery rate between the HBO and sham groups. Faster recovery was observed in the HBO group only for isometric peak torque and pain sensation and unpleasantness.

CONCLUSIONS

HBO cannot be recommended as an effective method of treatment of this form of muscle injury.

Eccentric exercise effect on blood oxidative-stress markers and delayed onset of muscle soreness

PURPOSE

This study examined the effects of a single bout of high-intensity eccentric exercise (EE) on blood protein carbonyls, glutathione status, and muscle damage indicators to ascertain whether blood markers of oxidative stress are elevated at the time delayed onset of muscle soreness (DOMS) occurs.

METHODS

Eight healthy men (26.5 +/- 1.5 yr) performed 60 eccentric contractions at approximately 135-150% dominant arm maximum isometric force (MIF) using their nondominant arm elbow flexors. DOMS, range of motion (ROM), MIF, and blood were obtained before, immediately after, and 24, 48, 72, and 96 h after the EE. Blood samples were analyzed for plasma creatine kinase (CK) activity, and protein carbonyls (PC), and erythrocyte glutathione status.

RESULTS

A significant decrease in MIF occurred at all times after the EE. ROM decreased from 24 to 96 h, and DOMS increased 24 to 72 h in the nondominant arm as indicated by a repeated measure ANOVA. Plasma CK activity peaked at 72 h (1620 +/- 500 IU x L(-1)) compared with baseline (154 +/- 27 IU x L(-1). Erythrocyte-reduced glutathione (GSH) concentration was not significantly affected by the EE but tended to decrease 23% by 24 h and continued at this level for 96 h. Oxidized glutathione (GSSG) and total glutathione were unchanged over time. A significant increase in plasma PC occurred at 24 and 48 h after eccentric exercise.

CONCLUSIONS

The results suggest that 60 EE at 135-150% MIF can result in DOMS, with decreased muscle function and increases in plasma PC at 24 and 48 h without alterations in blood glutathione status.

Responses of human elbow flexor muscles to electrically stimulated forced lengthening exercise

This study developed an electrical stimulation model for human elbow flexors to examine eccentric exercise-induced muscle damage and adaptation. Male students (n=17) were randomly placed into one of two groups; isometric (ES-ISO, n=8) and eccentric (ES-ECC, n=9). The elbow joint was fixed at 90 degrees (1.57 rad) and the elbow flexors stimulated percutaneously by an electronic muscle stimulator for 5 s through two electrodes placed over the muscles for ES-ISO. In ES-ECC, the muscles were stimulated similarly to the ES-ISO, but the elbow joint was forcibly extended from an elbow flexed (90 degrees 1.57 rad) to a full-extended position (180 degrees, 3.14 rad) in 3 s. Maximal voluntary isometric force, range of motion, upper arm circumference, muscle thickness by ultrasonography, muscle soreness, plasma creatine kinase and aspartate aminotransferase activities were assessed before and for 4 days after exercise. ES-ECC produced significantly larger changes in all criterion measures compared with ES-ISO (P < 0.01). These findings confirmed that eccentric muscle actions induced muscle damage, but isometric contractions resulted in little or no damage. Six subjects from the ES-ECC group repeated the same eccentric exercise (ECC2) 2 weeks after the first bout (ECC1), and changes in the criterion measures were compared between the bouts. Changes in all criterion measures after ECC2 were significantly smaller than ECC1 (P < 0.01). These results suggest that the first eccentric exercise produced a protective effect against muscle damage in the subsequent eccentric exercise bout, which does not involve adaptations in the central nervous system.

Concentric or eccentric training effect on eccentric exercise-induced muscle damage

PURPOSE

The purpose of this study was to compare changes in muscle damage indicators following 24 maximal eccentric actions of the elbow flexors (Max-ECC) between the arms that had been previously trained either eccentrically or concentrically for 8 wk.

METHODS

Fifteen subjects performed three sets of 10 repetitions of eccentric training (ECC-T) with one arm and concentric training (CON-T) with the other arm once a week for 8 wk using a dumbbell representing 50% of maximal isometric force of the elbow flexors (MIF) determined at the elbow joint of 90 degrees (1.57 rad). The dumbbell was lowered from a flexed (50 degrees, 0.87 rad) to an extended elbow position (180 degrees, 3.14 rad) in 3 s for ECC-T, and lifted from the extended to the flexed position in 3 s for CON-T. Max-ECC was performed 4 wk after CON-T and 6 wk after ECC-T. Changes in MIF, range of motion (ROM), upper arm circumference (CIR), muscle soreness (SOR), and plasma creatine kinase (CK) activity were compared between the ECC-T and CON-T arms.

RESULTS

The first ECC-T session produced larger decreases in MIF and ROM, and larger increases in CIR and SOR compared with CON-T. CK increased significantly (P < 0.01) and peaked 4 d after the first training session, but did not increase in the following sessions. All measures changed significantly (P < 0.01) following Max-ECC; however, the changes were not significantly different between ECC-T and CON-T arms.

CONCLUSION

These results showed that ECC-T did not mitigate the magnitude of muscle damage more than CON-T, and CON-T did not exacerbate muscle damage.

Effects of a 7-day eccentric training period on muscle damage and inflammation

PURPOSE

This study examined the effects of a 7-d repeated maximal isokinetic eccentric training period on the indicators of muscle damage and inflammatory response.

METHODS

Twenty-two college-age males were randomly assigned to eccentric training (ET) (N = 12) and control groups (CON) (N = 10). The initial exercise was 30 repetitions of maximal voluntary isokinetic eccentric contraction (ECC1) on nondominant elbow flexors with Cybex 6000 at 60 degrees.s-1 angular velocity. The ET group performed the same exercise for the following 6 consecutive days (referred to as ECC2 to ECC7) after ECC1. Upper arm circumference (CIR), range of motion (ROM), and maximal isometric force (MIF) were measured before, immediately after, and every 24 h for 7 consecutive days after ECC1. Plasma creatine kinase (CK), lactate dehydrogenase (LDH), glutamic oxaloacetate transaminase (GOT), leukocyte counts, and serum interleukin-1beta and -6 (IL-1beta, IL-6) levels were assessed before; at 2 h; and at 1, 3, 4, 6, and 7 d after ECC1. Muscle soreness was measured before and for 7 consecutive days after ECC1.

RESULTS

The ECC1 produced significant changes in most of the measures for both groups (P < 0.05), with the exception of leukocyte counts (P > 0.05). No indicators of increased damage (P > 0.05) were found from ECC2 to ECC7 for the ET group.

CONCLUSION

Continuous intensive isokinetic eccentric training performed with damaged muscles did not exacerbate muscle damage and inflammation after ECC1. In addition, a muscular "adaptation effect" may occur as early as 24 h after ECC1, as shown by the ET group's performance for 6 consecutive days after ECC1.

How long does the protective effect on eccentric exercise-induced muscle damage last?

PURPOSE

One bout of eccentric exercise produces an adaptation that reduces muscle damage in subsequent bouts. Because it is not known how long this adaptation lasts, the present study investigated the maximal length of the attenuated changes in muscle damage indicators after high-force eccentric exercise.

METHODS

Male students (N = 35) were placed into three groups and performed two bouts of eccentric exercise of the nondominant elbow flexors separated by either 6 (N = 14), 9 (N = 11), or 12 (N = 10) months. Maximal isometric force (MIF), range of motion (ROM), upper arm circumference (CIR), muscle soreness (SOR), and plasma creatine kinase activity (CK) were measured before and for 5 d after exercise. Magnetic resonance (MR) images of the transverse and longitudinal scans of the upper arm were taken 4 d after exercise. Changes in the criterion measures were compared between the first and second bouts and between groups by a two-way repeated measures ANOVA.

RESULTS

A faster recovery in MIF was evident after a second bout performed at 6 or 9 months, and reduced SOR as well as smaller increases in CIR, CK, and T2 relaxation time of MR images also occurred after the second exercise bout at 6 months compared with initial responses. No significant differences between the bouts were found for ROM, and the 12-month group did not show any repeated bout effect.

CONCLUSION

These results show that the repeated bout effect for most of the criterion measures lasts at least 6 months but is lost between 9 and 12 months.

Influences of repetitive muscle contractions with different modes on tendon elasticity in vivo

The present study aimed to investigate the effects of repetitive muscle contractions on the elasticity of human tendon structures in vivo. Before and after each endurance test, the elongation of the tendon and aponeurosis of vastus lateralis muscle (L) was directly measured by ultrasonography while the subjects performed ramp isometric knee extension up to maximal voluntary isometric contraction (MVC). Six male subjects performed muscle endurance tests that consisted of knee extension tasks with four different contraction modes: 1) 50 repetitions of maximal voluntary eccentric action for 3 s with 3 s of relaxation (ET1), 2) three sets of 50 repetitions of MVC for 1 s with 3 s of relaxation (ET2), 3) 50 repetitions of MVC for 3 s with 3 s of relaxation (ET3), and 4) 50 repetitions of 50% MVC for 6 s with 6 s of relaxation (ET4). In ET1 and ET2, there were no significant differences in L values at any force production levels between before and after endurance tests. In the cases of ET3 and ET4, however, the extent of elongation after the completion of the tests tended to be greater. The L values above 330 N in ET3 and 440 N in ET4, respectively, were significantly greater after endurance tests than before. These results suggested that the repeated longer duration contractions would make the tendon structures more compliant and that the changes in the elasticity might be not be affected by either muscle action mode or force production level but by the duration of action.

Exercise induced muscle damage and recovery assessed by means of linear and non-linear sEMG analysis and ultrasonography

This study was aimed at investigating the time-course and recovery from eccentric (EC) exercise induced muscle damage by means of surface electromyography (sEMG), ultrasonography (US), and blood enzymes. Five subjects (EC Group) performed two bouts of 35 EC maximum contractions with the biceps brachii of their non dominant arm, five subjects were tested without performing EC (Control Group: CNT). The maximal isometric force (MVC) was measured. Force and sEMG signals were recorded during 80% MVC isometric contractions. In EC and CNT subjects US assessment on non-dominant biceps brachii was performed; creatin kinase (CK) and lactic dehydrogenasis (LDH) plasma levels were also assessed. Force, sEMG and CK-LDH measurements were performed before EC and after it periodically for 4 weeks. The sEMG was analysed in time and frequency domains; a non-linear analysis (Lyapunov 1st exponent, L1) of sEMG was also performed. After EC, the MVC was reduced by 40% on average with respect to the pre-EC values. A significant decrease in the initial frequency content, and in the MDF and L1 decay (13-42% less than the pre-EC values, respectively) was also observed. The sEMG amplitude (Root Mean Square, RMS) was unchanged after EC. The US revealed an increase in muscle belly thickness and in local muscle blood flow after EC. A complete recovery of all the considered parameters was achieved in two weeks. In conclusion sEMG analysis was confirmed as an early indicator of muscle damage. Muscle recovery from damage is followed by both sEMG and US and this may have useful clinical implications. Non linear analysis (L1) was revealed to be sensitive to early sEMG modifications induced by EC as well as able to follow the post EC changes in the sEMG.

Exercise-induced muscle damage and inflammation: fact or fiction?

Physical exercise is necessary for maintaining normal function of skeletal muscle. The mechanisms governing normal muscle function and maintenance are vastly unknown but synergistic function of hormones, neurosignalling, growth factors, cytokines and other factors, is undoubtedly important. Because of the complex interaction among these systems the lack of complete understanding of muscle function is not surprising. The purpose of exercise-induced changes in muscle cell function is to adapt the tissue to a demand of increased physical work capacity. Some of the approaches used to investigate changes in skeletal muscle cell function are exercise and electrical stimulation in animals and human models and isolated animal muscle. From these models, it has been concluded that during physical exercise, in an intensity and duration dependent manner, skeletal muscle is damaged and subsequently inflamed. The purpose of the inflammation would be to repair the exercise-induced damage. Because of the design and methods used in a majority of these studies, concerns must be raised, and the question asked whether the paradigm of exercise-induced muscle inflammation in fact is fiction. In a majority of conducted studies, a non-exercising control group is lacking and because of the invasive nature of the sampling methods used to study inflammation it does not appear impossible that observed inflammatory events in human skeletal muscle after physical exercise are methodological artefacts.

Impact of muscle injury and accompanying inflammatory response on thermoregulation during exercise in the heat

This study examined whether muscle injury and the accompanying inflammatory responses alter thermoregulation during subsequent exercise-heat stress. Sixteen subjects performed 50 min of treadmill exercise (45-50% maximal O(2) consumption) in a hot room (40 degrees C, 20% relative humidity) before and at select times after eccentric upper body (UBE) and/or eccentric lower body (LBE) exercise. In experiment 1, eight subjects performed treadmill exercise before and 6, 25, and 30 h after UBE and then 6, 25, and 30 h after LBE. In experiment 2, eight subjects performed treadmill exercise before and 2, 7, and 26 h after LBE only. UBE and LBE produced marked soreness and significantly elevated creatine kinase levels (P < 0.05), but only LBE increased (P < 0.05) interleukin-6 levels. In experiment 1, core temperatures before and during exercise-heat stress were similar for control and after UBE, but some evidence for higher core temperatures was found after LBE. In experiment 2, core temperatures during exercise-heat stress were 0.2-0.3 degrees C (P < 0.05) above control values at 2 and 7 h after LBE. The added thermal strain after LBE (P < 0.05) was associated with higher metabolic rate (r = 0.70 and 0.68 at 2 and 6-7 h, respectively) but was not related (P > 0.05) to muscle soreness (r = 0.47 at 6-7 h), plasma interleukin-6 (r = 0.35 at 6-7 h), or peak creatine kinase levels (r = 0.22). Local sweating responses (threshold core temperature and slope) were not altered by UBE or LBE. The results suggest that profuse muscle injury can increase body core temperature during exercise-heat stress and that the added heat storage cannot be attributed solely to increased heat production.

Validity of diagnostic ultrasound as a measure of delayed onset muscle soreness

STUDY DESIGN

Repeated measures were taken to evaluate delayed onset muscle soreness (DOMS) following eccentric bicep contractions of the nondominant arm at 140% of 1 repetition maximum (RM) while the dominant arm served as control.

OBJECTIVES

To explore the usefulness of a noninvasive method to assess delayed onset muscle soreness.

BACKGROUND

Although many methods have been proposed to assess DOMS, most are somewhat subjective or require a blood sample. This study compared the assessment of DOMS following eccentric exercise using common assessment techniques with diagnostic ultrasound (US).

METHODS AND MEASURES

Forty nonimpaired women (18-40 years) used a Cybex isotonic biceps curl machine to eccentrically lower, using their nondominant arm, 140% of their dominant arm 1 RM to induce muscle soreness. Four assessment methods, (1) goniometry assessing spontaneous muscle shortening (SMS); (2) subjective muscle soreness ratings (MSRs); (3) serum creatine kinase (CK); and (4) diagnostic US scans of muscle cross-sectional area (CSA), were conducted at 5 different assessment times: (1) pre-eccentric exercise; (2) postexercise; (3) 24 hours postexercise; (4) 48 hours postexercise; and (5) 72 hours postexercise.

RESULTS

Significant differences existed across assessment times for 3 of the 4 assessment techniques, CK, SMS, and MSR.

CONCLUSIONS

Previously published methodologies used to assess DOMS (CK, SMS, and MSR) were able to provide consistent and expected results relative to the onset and progression of soreness with a high degree of relatedness (r = 0.48-0.84). However, it appeared that the ability to assess muscle soreness by diagnostic US, as evidenced by intramuscular swelling, was limited. Thus, the technique was not sensitive enough to detect any statistically significant changes in muscle CSA.

Craniofacial pain and motor function: pathogenesis, clinical correlates, and implications

Many structural, behavioral, and pharmacological interventions imply that favorable treatment effects in musculoskeletal pain states are mediated through the correction of muscle function. The common theme of these interventions is captured in the popular idea that structural or psychological factors cause muscle hyperactivity, muscle overwork, muscle fatigue, and ultimately pain. Although symptoms and signs of motor dysfunction can sometimes be explained by changes in structure, there is strong evidence that they can also be caused by pain. This new understanding has resulted in a better appreciation of the pathogenesis of symptoms and signs of the musculoskeletal pain conditions, including the sequence of events that leads to the development of motor dysfunction. With the improved understanding of the relationship between pain and motor function, including the inappropriateness of many clinical assumptions, a new literature emerges that opens the door to exciting therapeutic opportunities. Novel treatments are expected to have a profound impact on the care of musculoskeletal pain and its effect on motor function in the not-too-distant future.

MR measurements of muscle damage and adaptation after eccentric exercise

The purposes of this study were, first, to clarify the long-term pattern of T2 relaxation times and muscle volume changes in human skeletal muscle after intense eccentric exercise and, second, to determine whether the T2 response exhibits an adaptation to repeated bouts. Six young adult men performed two bouts of eccentric biceps curls (5 sets of 10 at 110% of the 1-repetition concentric maximum) separated by 8 wk. Blood samples, soreness ratings, and T2-weighted axial fast spin-echo magnetic resonance images of the upper arm were obtained immediately before and after each bout; at 1, 2, 4, 7, 14, 21, and 56 days after bout 1; and at 2, 4, 7 and 14 days after bout 2. Resting muscle T2 [27.6 +/- 0.2 (SE) ms] increased immediately postexercise by 8 +/- 1 ms after both bouts. T2 peaked 7 days after bout 1 at 47 +/- 4 ms and remained elevated by 2.5 ms at 56 days. T2 peaked lower (37 +/- 4 ms) and earlier (2-4 days) after bout 2, suggesting an adaptation of the T2 response. Peak serum creatine kinase values, pain ratings, and flexor muscle swelling were also significantly lower after the second bout (P < 0.05). Total volume of the imaged arm region increased transiently after bout 1 but returned to preexercise values within 2 wk. The exercised flexor compartment swelled by over 40%, but after 2 wk it reverted to a volume 10% smaller than that before exercise and maintained this volume loss through 8 wk, consistent with partial or total destruction of a small subpopulation of muscle fibers.

Adverse events associated with eccentric exercise protocols: six case studies

PURPOSE

Rhabdomyolysis is a condition characterized by muscle damage and degeneration of muscle cells after strenuous, overexertion exercise. Although the incidence of severe rhabdomyolysis is rare, this condition can be dangerous and even fatal. Eccentric exercise protocols are currently being used to induce and study mild forms of muscle damage. However, serious adverse events can occur in these laboratory investigations. The purpose of this report was to expose some of the adverse events resulting from performance of eccentric exercise protocols to study muscle damage in humans.

METHODS

The following case studies involved an eccentric exercise protocol where two sets of 25 maximal eccentric actions of the elbow flexors were performed, separated by a 5-min rest period.

RESULTS

Case reports are presented that reveal prolonged losses in the ability of the muscle to generate force lasting 43-47 d, extreme swelling of the exercised arm lasting several weeks, and greatly elevated serum creatine kinase levels.

CONCLUSIONS

Although adverse events resulting from eccentric exercise are rare, our laboratory has observed a 3% incidence rate during the past year. Investigators should be knowledgeable of the sequelae of events that are associated with muscle damage after high-force eccentric exercise and take appropriate precautions.

Increase in blood bradykinin concentration after eccentric weight-training exercise in men

The purpose of this study was to verify the possible appearance in the blood of bradykinin (BK) and des-Arg(9)-bradykinin (des-Arg(9)-BK) after eccentric exercise in 13 male subjects. Eccentric exercise (5 x 10 leg presses at 120% maximal voluntary concentric contraction) resulted in muscle damage and inflammation, as suggested by the significant increase in serum creatine kinase activity (from 204 +/- 41 to 322 +/- 63 U/l 12 h postexercise) and by severe lasting pain, which also peaked at 12 h postexercise. Blood BK and des-Arg(9)-BK concentrations were measured by competitive enzyme immunoassays using highly specific polyclonal rabbit IgG. Des-Arg(9)-BK concentration was not modified (preexercise: 44 +/- 14 pmol/l; pooled postexercise: 47 +/- 4 pmol/l). In contrast, BK concentration significantly increased immediately after the exercise session (68 +/- 9 vs. 42 +/- 3 pmol/l preexercise) and returned to basal values at 12, 24, and 48 h (pooled value: 40 +/- 4 pmol/l). This observation suggests that the inflammatory process due to eccentric exercise-induced muscle damage could be mediated in part by BK.

Relationship between muscle swelling and stiffness after eccentric exercise

PURPOSE

The time courses of muscle compartmental swelling and passive stiffness change were measured to determine whether muscle compartmental swelling accounted for increased stiffness.

METHODS

Eleven untrained female college students exercised eccentrically by lowering a weight with their elbow flexors. Measurements of muscle compartment volume, stiffness, relaxed elbow angle, circumference, and pain were recorded before exercise, immediately after exercise, and 1-5, 7, 9, and 11 d after exercise. Muscle compartment volume was calculated from cross-sectional ultrasound images taken along the upper arm. Stiffness was measured using a device that extended the elbow and recorded the torque required to hold the forearm at successive angles.

RESULTS

Elbow flexor volume increased gradually to peak on the fourth day (26.1 +/- 4.3%, P < 0.05) and then decreased to baseline values over days 7-11. Stiffness increased immediately after exercise (59.9 +/- 14.1%, P < 0.05) and remained at or above this level until decreasing to pre-exercise levels over days 7-11.

CONCLUSIONS

This suggests that muscle swelling does not account for the sudden increase in stiffness of the elbow flexor muscles within the first 48 h after exercise but may play a role in the subsequent time course of stiffness.