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Fu C, Xia Y, Wang B, Zeng Q, Pan S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 2024; 15:67. [PMID: 38424366 PMCID: PMC10904698 DOI: 10.1186/s13244-024-01619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The main generator of delayed onset muscle soreness (DOMS) is still unknown. This study aimed to clarify the main generator of DOMS. METHODS Twelve participants performed eccentric exercise (EE) on lower legs. MRI and ultrasound were used to assess changes of calf muscle and deep fascia before and after EE. These results were then compared to the muscle pain level. RESULTS Compared to baseline, muscle pain peaked at 24-48 h after EE (downstairs 22.25 ± 6.196, 57.917 ± 9.298, F = 291.168, p < 0.01; resting 5.833 ± 1.899, 5.083 ± 2.429, F = 51.678, p < 0.01). Shear wave speed (SWE) of the deep fascia and T2 values of the gastrocnemius muscle and deep fascia all increased and peaked at 48 h after EE (1.960 ± 0.130, F = 22.293; 50.237 ± 2.963, F = 73.172; 66.328 ± 2.968, F = 231.719, respectively, p < 0.01). These measurements were positively correlated with DOMS (downstairs: r = 0.46, 0.76, 0.87, respectively, p < 0.001; resting: r = 0.42, 0.70, 0.77, respectively, p < 0.001). There was a significant positive correlation between SWE and T2 values of deep fascia (r = 0.54, p < 0.01). CONCLUSION DOMS is a common result of muscle and fascia injuries. Deep fascia edema and stiffness play a crucial role in DOMS, which can be effectively evaluated MR-T2 and SWE. CRITICAL RELEVANCE STATEMENT Delayed-onset muscle soreness is a common result of muscle and deep fascia injuries, in which the edema and stiffness of the deep fascia play a crucial role. Both MRI and shear wave elastography can be effectively used to evaluate soft tissue injuries. KEY POINTS • The deep fascia is the major pain generator of delayed-onset muscle soreness. • There is a significant correlation between fascia injury and delayed-onset muscle soreness. • MRI and shear wave elastography are preferred methods for assessing fascia injuries.
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Affiliation(s)
- Congcong Fu
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yu Xia
- Department of Medical Ultrasonic, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bingshan Wang
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qiang Zeng
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China.
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Moraes TR, Veras FP, Barchuk AR, Nogueira ESC, Kanashiro A, Galdino G. Spinal HMGB1 participates in the early stages of paclitaxel-induced neuropathic pain via microglial TLR4 and RAGE activation. Front Immunol 2024; 15:1303937. [PMID: 38384464 PMCID: PMC10879568 DOI: 10.3389/fimmu.2024.1303937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Chemotherapy-induced neuropathic pain (CINP) is one of the main adverse effects of chemotherapy treatment. At the spinal level, CINP modulation involves glial cells that upregulate Toll-like receptor 4 (TLR4) and signaling pathways, which can be activated by pro-inflammatory mediators as the high mobility group box-1 (HMGB1). Objective To evaluate the spinal role of HMGB1 in the paclitaxel-induced neuropathic pain via receptor for advanced glycation end products (RAGE) and TLR4 activation expressed in glial cells. Methods Male C57BL/6 Wild type and TLR4 deficient mice were used in the paclitaxel-induced neuropathic pain model. The nociceptive threshold was measured using the von Frey filament test. In addition, recombinant HMGB1 was intrathecally (i.t.) injected to confirm its nociceptive potential. To evaluate the spinal participation of RAGE, TLR4, NF-kB, microglia, astrocytes, and MAPK p38 in HMGB1-mediated nociceptive effect during neuropathic pain and recombinant HMGB1-induced nociception, the drugs FPS-ZM1, LPS-RS, PDTC, minocycline, fluorocitrate, and SML0543 were respectively administrated by i.t. rout. Microglia, astrocytes, glial cells, RAGE, and TLR4 protein expression were analyzed by Western blot. ELISA immunoassay was also used to assess HMGB1, IL-1β, and TNF-α spinal levels. Results The pharmacological experiments demonstrated that spinal RAGE, TLR4, microglia, astrocytes, as well as MAPK p38 and NF-kB signaling are involved with HMGB1-induced nociception and paclitaxel-induced neuropathic pain. Furthermore, HMGB1 spinal levels were increased during the early stages of neuropathic pain and associated with RAGE, TLR4 and microglial activation. RAGE and TLR4 blockade decreased spinal levels of pro-inflammatory cytokines during neuropathic pain. Conclusion Taken together, our findings indicate that HMGB1 may be released during the early stages of paclitaxel-induced neuropathic pain. This molecule activates RAGE and TLR4 receptors in spinal microglia, upregulating pro-inflammatory cytokines that may contribute to neuropathic pain.
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Affiliation(s)
- Thamyris Reis Moraes
- Pain Neuroimmunobiology Laboratory, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Flavio Protasio Veras
- Pain Neuroimmunobiology Laboratory, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Angel Roberto Barchuk
- Integrative Animal Biology Laboratory, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - Alexandre Kanashiro
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, United States
| | - Giovane Galdino
- Pain Neuroimmunobiology Laboratory, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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Wang MJ, Jing XY, Wang YZ, Yang BR, Lu Q, Hu H, Kang L. Exercise, Spinal Microglia and Neuropathic Pain: Potential Molecular Mechanisms. Neurochem Res 2024; 49:29-37. [PMID: 37725293 PMCID: PMC10776684 DOI: 10.1007/s11064-023-04025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
As one of the most common neuropathic disorders, neuropathic pain often has a negative impact on patients with persistent pain, mood disorders and sleep disturbances. Currently, neuropathic pain is not treated with any specific drug, instead, drugs for other diseases are used as replacements in clinics, but most have adverse effects. In recent years, the role of spinal cord microglia in the pathogenesis of neuropathic pain has been widely recognized, and they are being explored as potential therapeutic targets. Spinal microglia are known to be involved in the pathogenic mechanisms of neuropathic pain through purine signaling, fractalkine signaling, and p38 MAPK signaling. Exercise is a safe and effective treatment, and numerous studies have demonstrated its effectiveness in improving neurological symptoms. Nevertheless, it remains unclear what the exact molecular mechanism is. This review summarized the specific molecular mechanisms of exercise in alleviating neuropathic pain by mediating the activity of spinal microglia and maintaining the phenotypic homeostasis of spinal microglia through purine signaling, fractalkine signaling and p38 MAPK signaling. In addition, it has been proposed that different intensities and types of exercise affect the regulation of the above-mentioned signaling pathways differently, providing a theoretical basis for the improvement of neuropathic pain through exercise.
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Affiliation(s)
- Min-Jia Wang
- Institute of Sports Medicine and Health, Chengdu Sports University, Chengdu, 610041, China
| | - Xin-Yu Jing
- Department of Postpartum Rehabilitation, Sichuan Jinxin Women and Children Hospital, Chengdu, 610041, China
| | - Yao-Zheng Wang
- Institute of Sports Medicine and Health, Chengdu Sports University, Chengdu, 610041, China
| | - Bi-Ru Yang
- Institute of Sports Medicine and Health, Chengdu Sports University, Chengdu, 610041, China
| | - Qu Lu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, China
| | - Hao Hu
- Institute of Sports Medicine and Health, Chengdu Sports University, Chengdu, 610041, China
| | - Liang Kang
- Institute of Sports Medicine and Health, Chengdu Sports University, Chengdu, 610041, China.
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Borghi SM, Zaninelli TH, Saraiva-Santos T, Bertozzi MM, Cardoso RDR, Carvalho TT, Ferraz CR, Camilios-Neto D, Cunha FQ, Cunha TM, Pinho-Ribeiro FA, Casagrande R, Verri WA. Brief research report: Repurposing pentoxifylline to treat intense acute swimming-Induced delayed-onset muscle soreness in mice: Targeting peripheral and spinal cord nociceptive mechanisms. Front Pharmacol 2023; 13:950314. [PMID: 36703752 PMCID: PMC9871252 DOI: 10.3389/fphar.2022.950314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
In this study, we pursue determining the effect of pentoxifylline (Ptx) in delayed-onset muscle soreness (DOMS) triggered by exposing untrained mice to intense acute swimming exercise (120 min), which, to our knowledge, has not been investigated. Ptx treatment (1.5, 4.5, and 13.5 mg/kg; i.p., 30 min before and 12 h after the session) reduced intense acute swimming-induced mechanical hyperalgesia in a dose-dependent manner. The selected dose of Ptx (4.5 mg/kg) inhibited recruitment of neutrophils to the muscle tissue, oxidative stress, and both pro- and anti-inflammatory cytokine production in the soleus muscle and spinal cord. Furthermore, Ptx treatment also reduced spinal cord glial cell activation. In conclusion, Ptx reduces pain by targeting peripheral and spinal cord mechanisms of DOMS.
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Affiliation(s)
- Sergio M. Borghi
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil,Center for Research in Health Science, University of Northern Paraná, Londrina, Brazil,*Correspondence: Sergio M. Borghi, ; Waldiceu A. Verri Jr,
| | - Tiago H. Zaninelli
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Telma Saraiva-Santos
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Mariana M. Bertozzi
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Renato D. R. Cardoso
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Thacyana T. Carvalho
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Camila R. Ferraz
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Doumit Camilios-Neto
- Department of Biochemistry and Biotechnology, Exact Sciences Center, State University of Londrina, Londrina, Brazil
| | - Fernando Q. Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Thiago M. Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Felipe A. Pinho-Ribeiro
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, Center of Health Sciences, State University of Londrina, Londrina, Brazil
| | - Waldiceu A. Verri
- Department of Pathology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil,*Correspondence: Sergio M. Borghi, ; Waldiceu A. Verri Jr,
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Sonkodi B. Psoriasis, Is It a Microdamage of Our "Sixth Sense"? A Neurocentric View. Int J Mol Sci 2022; 23:ijms231911940. [PMID: 36233237 PMCID: PMC9569707 DOI: 10.3390/ijms231911940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
Psoriasis is considered a multifactorial and heterogeneous systemic disease with many underlying pathologic mechanisms having been elucidated; however, the pathomechanism is far from entirely known. This opinion article will demonstrate the potential relevance of the somatosensory Piezo2 microinjury-induced quad-phasic non-contact injury model in psoriasis through a multidisciplinary approach. The primary injury is suggested to be on the Piezo2-containing somatosensory afferent terminals in the Merkel cell−neurite complex, with the concomitant impairment of glutamate vesicular release machinery in Merkel cells. Part of the theory is that the Merkel cell−neurite complex contributes to proprioception; hence, to the stretch of the skin. Piezo2 channelopathy could result in the imbalanced control of Piezo1 on keratinocytes in a clustered manner, leading to dysregulated keratinocyte proliferation and differentiation. Furthermore, the author proposes the role of mtHsp70 leakage from damaged mitochondria through somatosensory terminals in the initiation of autoimmune and autoinflammatory processes in psoriasis. The secondary phase is harsher epidermal tissue damage due to the primary impaired proprioception. The third injury phase refers to re-injury and sensitization with the derailment of healing to a state when part of the wound healing is permanently kept alive due to genetical predisposition and environmental risk factors. Finally, the quadric damage phase is associated with the aging process and associated inflammaging. In summary, this opinion piece postulates that the primary microinjury of our “sixth sense”, or the Piezo2 channelopathy of the somatosensory terminals contributing to proprioception, could be the principal gateway to pathology due to the encroachment of our preprogrammed genetic encoding.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Sciences, 1123 Budapest, Hungary
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Sonkodi B, Pállinger É, Radovits T, Csulak E, Shenker-Horváth K, Kopper B, Buzás EI, Sydó N, Merkely B. CD3+/CD56+ NKT-like Cells Show Imbalanced Control Immediately after Exercise in Delayed-Onset Muscle Soreness. Int J Mol Sci 2022; 23:ijms231911117. [PMID: 36232420 PMCID: PMC9569472 DOI: 10.3390/ijms231911117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose of the study was to carry out an immunophenotypical characterization with a special focus on natural killer cells of junior swimmers from the Hungarian National Swim Team before and after an intensive acute exercise. Nineteen swimmers, ten females and nine males, completed the exercise protocol. Sixteen swimmers experienced delayed-onset muscle soreness. Most of our findings substantiated earlier results, such as the increase in the percentage of the CD3−/CD56+ natural killer cells and the CD3−/CD56dim+ NK cells, and the decrease in the percentage of CD3+ T cells among lymphocytes after the exercise protocol. The drop of natural killer cell activity back to the pre-exercise level was in line with earlier findings. Interestingly, the percentage of CD3+/CD56+ NKT-like cells did not change significantly in those three swimmers who did not report delayed-onset muscle soreness. On the contrary, the percentage of CD3+/CD56+ NKT-like cells among lymphocytes increased in fourteen and decreased in two swimmers reporting delayed-onset muscle soreness. This study for the first time demonstrated a link between the delayed-onset muscle soreness and the imbalanced control of CD3+/CD56+ NKT-like cells among lymphocytes. However, validation of this association in a larger sample size study will be necessary.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
- Correspondence:
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | | | - Bence Kopper
- Faculty of Kinesiology, Hungarian University of Sports Science, 1123 Budapest, Hungary
| | - Edit I. Buzás
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary
- HCEMM-SU Extracellular Vesicle Research Group, 1089 Budapest, Hungary
- ELKH-SE Translational Extracellular Vesicle Research Group, 1089 Budapest, Hungary
| | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, 1122 Budapest, Hungary
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Sonkodi B. Should We Void Lactate in the Pathophysiology of Delayed Onset Muscle Soreness? Not So Fast! Let’s See a Neurocentric View! Metabolites 2022; 12:metabo12090857. [PMID: 36144262 PMCID: PMC9505902 DOI: 10.3390/metabo12090857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 01/01/2023] Open
Abstract
The pathophysiology of delayed onset muscle soreness is not entirely known. It seems to be a simple, exercise-induced delayed pain condition, but has remained a mystery for over 120 years. The buildup of lactic acid used to be blamed for muscle fatigue and delayed onset muscle soreness; however, studies in the 1980s largely refuted the role of lactate in delayed onset muscle soreness. Regardless, this belief is widely held even today, not only in the general public, but within the medical and scientific community as well. Current opinion is highlighting lactate’s role in delayed onset muscle soreness, if neural dimension and neuro-energetics are not overlooked. By doing so, lactate seems to have an essential role in the initiation of the primary damage phase of delayed onset muscle soreness within the intrafusal space. Unaccustomed or strenuous eccentric contractions are suggested to facilitate lactate nourishment of proprioceptive sensory neurons in the muscle spindle under hyperexcitation. However, excessive acidosis and lactate could eventually contribute to impaired proprioception and increased nociception under pathological condition. Furthermore, lactate could also contribute to the secondary damage phase of delayed onset muscle soreness in the extrafusal space, primarily by potentiating the role of bradykinin. After all, neural interpretation may help us to dispel a 40-year-old controversy about lactate’s role in the pathophysiology of delayed onset muscle soreness.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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Delayed Onset Muscle Soreness and Critical Neural Microdamage-Derived Neuroinflammation. Biomolecules 2022; 12:biom12091207. [PMID: 36139045 PMCID: PMC9496513 DOI: 10.3390/biom12091207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 02/06/2023] Open
Abstract
Piezo2 transmembrane excitatory mechanosensitive ion channels were identified as the principal mechanotransduction channels for proprioception. Recently, it was postulated that Piezo2 channels could be acutely microdamaged on an autologous basis at proprioceptive Type Ia terminals in a cognitive demand-induced acute stress response time window when unaccustomed or strenuous eccentric contractions are executed. One consequence of this proposed transient Piezo2 microinjury could be a VGLUT1/Ia synaptic disconnection on motoneurons, as we can learn from platinum-analogue chemotherapy. A secondary, harsher injury phase with the involvement of polymodal Aδ and nociceptive C-fibers could follow the primary impairment of proprioception of delayed onset muscle soreness. Repetitive reinjury of these channels in the form of repeated bout effects is proposed to be the tertiary injury phase. Notably, the use of proprioception is associated with motor learning and memory. The impairment of the monosynaptic static phase firing sensory encoding of the affected stretch reflex could be the immediate consequence of the proposed Piezo2 microdamage leading to impaired proprioception, exaggerated contractions and reduced range of motion. These transient Piezo2 channelopathies in the primary afferent terminals could constitute the critical gateway to the pathophysiology of delayed onset muscle soreness. Correspondingly, fatiguing eccentric contraction-based pathological hyperexcitation of the Type Ia afferents induces reactive oxygen species production-associated neuroinflammation and neuronal activation in the spinal cord of delayed onset muscle soreness.
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Sonkodi B, Hegedűs Á, Kopper B, Berkes I. Significantly Delayed Medium-Latency Response of the Stretch Reflex in Delayed-Onset Muscle Soreness of the Quadriceps Femoris Muscles Is Indicative of Sensory Neuronal Microdamage. J Funct Morphol Kinesiol 2022; 7:jfmk7020043. [PMID: 35736014 PMCID: PMC9224667 DOI: 10.3390/jfmk7020043] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Unaccustomed or strenuous eccentric exercise is known to cause delayed-onset muscle soreness. A recent hypothesis postulated that mechano-energetic microinjury of the primary afferent sensory neuron terminals in the muscle spindles, namely a transient Piezo2 channelopathy, could be the critical cause of delayed-onset muscle soreness in the form of a bi-phasic non-contact injury mechanism. This theory includes that this microlesion could delay the medium-latency response of the stretch reflex. Our aim with this study was to investigate this hypothesis. According to our knowledge, no study has examined the effect of delayed-onset muscle soreness on the medium-latency response of the stretch reflex. Our findings demonstrated that a significant delay in the medium-latency stretch reflex could be observed right after a multi-stage fitness test in the quadriceps femoris muscles of Hungarian professional handball players who consequently experienced delayed-onset muscle soreness. The long-latency stretch reflex and most likely short-latency stretch reflex were unaffected by delayed-onset muscle soreness in our study, which is in line with earlier findings. We translate these findings as indicative of proprioceptive Type Ia terminal microdamage in the muscle spindle in line with the aforementioned new acute non-contact compression axonopathy theory of delayed-onset muscles soreness.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, Hungarian University of Sport Science, 1123 Budapest, Hungary;
- Correspondence:
| | - Ádám Hegedűs
- Faculty of Kinesiology, Hungarian University of Sport Science, 1123 Budapest, Hungary; (Á.H.); (B.K.)
| | - Bence Kopper
- Faculty of Kinesiology, Hungarian University of Sport Science, 1123 Budapest, Hungary; (Á.H.); (B.K.)
| | - István Berkes
- Department of Health Sciences and Sport Medicine, Hungarian University of Sport Science, 1123 Budapest, Hungary;
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