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Topics: Exercise physiology, muscular function, stockings, engineering processes.
Abstract: Delayed onset muscle soreness (DOMS) is a common experience following unac-
customed eccentric exercise. DOMS and associated force deficits may limit optimal perfor-
mance in subsequent days. The cause of DOMS remains poorly understood, thus there is no
effective treatment. Graduated compression stockings (GCS) are a commonly used interven-
tion believed to diminish DOMS. The purpose of this study was to determine if GCS after
eccentric walking exercise minimizes DOMS and associated deficits (e.g. muscle force capa-
city). Eight healthy subjects (age 26±4 yrs, height 175±8 cm, weight 70±5 kg) volunteered to
perform a single bout of backward downhill walking exercise (duration 30 min, velocity
1 m.s-1, negative grade -25%, load 12% of body weight). Following walking exercise, subjects
were required to wear 5 hours per day for 3 consecutive days GSC (SupportivTM) on one
leg while the second was used as control. Muscle soreness and neuromuscular measures (M-
wave, peak twitch, maximal voluntary torque or MVT) were taken pre and postwalk, then 2,
24, 48 and 72 hours post-walking exercise for the two legs. There was a 28% reduction in
DOMS 72 h after exercise when wearing GCS (P<0.05) than in the control leg. Immediately
after exercise there was a 15% decrease in MVT of the plantar flexors in both legs partly attri-
butable to an alteration in contractile properties (-22% in electrically evoked mechanical
twitch).In leg wearing GCS, MVT starts to recover while the contractile properties had signi-
ficantly recovered within 24 h but not in the control leg. In the current study, GCS might
have had the effect of compressing the muscle tissue to such an extent that less structural
damage occurred relative to a control condition. GCS accelerated the recovery of the muscle
force capacity at 24 hours beyond that achieved by the control condition.
Keywords: stockings, tissue management, muscle damage, soreness, textile.
Graduated Compression Stockings and
Delayed Onset Muscle Soreness (P105)
Stéphane Perrey1, Aurélien Bringard1, Sébastien Racinais1, Kostia
Puchaux2, Nicolas Belluye2
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1- Introduction
Both recreational and serious athletes have experienced delayed onset muscle soreness
(DOMS), pain, and stiffness following unaccustomed exercise or increased training
workload. Although research on exerciseinduced muscle soreness dates back to 1902
(Hough), the exact mechanisms of soreness and pain, as well as the accompanying
responses remain unclear. These responses include a prolonged loss in range of motion
and strength, increases in muscle enzymes in the blood, swelling and structural damage.
Several studies have shown that eccentric muscle actions result in greater soreness,
fatigue and damage than isometric or concentric contractions. This explains why some
activities such as hiking that incorporates a large degree of eccentric contractions result
in considerable soreness while others, like cycling, that are not biased towards eccentric
contractions produce little soreness. Exercise models developed to study muscle damage
and soreness are those where eccentric contractions predominate such as downhill
running and backward downhill walking (Nottle and Nosaka 2005). The latter allows the
study of the effects of DOMS on alteration of muscle function of the triceps surae
region.
Compression stockings and tights are considered by many athletes to be beneficial
for recovery treatment and related exercise symptom relief and are now very popular.
One of the most recognized actions of compression tights during recovery relates to
DOMS prevention. The increased microcirculation provided by compressive garments
may prevent post-exercise damage and pain by reducing oedema and helping compen-
sate for impaired venous return (Jonker
e
t
a
l
.
2001). Two studies have shown that
compression garments maintained muscle function and reduced perceived muscle sore-
ness following eccentric exercise (Kraemer
e
t
a
l
.
2001a, Kraemer
e
t
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l
.
2001b). These
studies also showed that compression garments attenuate CK release from skeletal
muscle into the circulation following eccentric exercise. Although compression is advo-
cated in the recovery from exercise induced muscle damage (Noonan and Garrett 1999),
there is little information on the effect of compression on intracellular metabolic func-
tion. The most convincing evidence comes from magnetic resonance spectroscopy that
showed elevated skeletal muscle metabolites phosphodiester in the thigh 1-h following
eccentric injury caused by 30 minutes of downhill walking compared to the control
thigh (Trenell
e
t
a
l
.
2006) but without changing perceived muscle soreness. Overall,these
data suggest that wearing compression garments in the recovery from eccentric exercise
may alter the inflammatory response to damage and accelerate muscle repair processes.
Bringard
e
t
a
l
.
(2006) recently showed in sportsmen a significantly lower venous pooling
(smaller blood volume changes measured with near infrared spectroscopy) and a higher
calf oxygen saturation level with compression tight in comparison to elastic tight and
shorts when subjects were lying supine and during upright standing. It appears that in
comparison to elastic tights, compression tights have positive effects on muscle oxyge-
nation and venous function at rest, and could be useful to oxygenate damaged muscles
after exercise. In this context, wearing elastic compression stockings in 63-year-old
sportspeople during an 80 min recovery period between two maximal 5 min exercises
led to reduction in hematocrit and lactate concentrations. In this study, a 2.1% perfor-
mance enhancement was found during the second bout of exercise (Chatard
e
t
a
l
.
2004).
548 The Engineering of Sport 7 - Vol. 1
Therefore, the goal of this study was to determine whether the impaired muscle func-
tion and DOMS following a single 30-min bout of backward downhill walking exercise
is attenuated by wearing compression stockings 24 h, 48h and 72h after.
2- Materials and methods
2.1 Subjects
Eight healthy young men participated in this study. Their average age, height, and weight
(means ± SD) were 26 ± 4 years, 175 ± 8 cm, and 70 ± 5 kg, respectively. All subjects
were physically active and exercised 1 – 2 times a week, but they had not used an intense
workload for their own resistance-type exercise for the last 3 years. Subjects were not
allowed all forms of exercise throughout the period of the experiment. There is a well-
known repeated bout effect that performance of first bout of eccentric exercise will cause
an adaptation such that there is less damage in the second bout (for a review, see
McHugh 2003). Subjects gave informed, written consent to participate in this study. The
procedures complied with the Helsinki declaration for human experimentation and
were approved by the local Ethics Committee. None of the subjects suffered from muscle
soreness or ankle injuries. Subjects were asked to avoid caffeine intake within the 8-h
preceding the test and to avoid all vigorous activity during the 24-h preceding the test.
Subjects were also asked to refrain from analgesic intake all along the protocol, which
could have disturbed DOMS perception.
2.2 Experimental procedures
Subjects visited our laboratory on four consecutive days. The first day consisted of a
neuromuscular test session (described subsequently) on both legs followed by a back-
ward walking exercise (description below) followed by further neuromuscular testing.
On the second, third and fourth days, subjects returned to the laboratory at the same
hour of day that they had finished the walking exercise and performed the neuromus-
cular testing for both legs. Immediately following exercise and until the end of the expe-
riment, graduated compression stockings were worn 5 hours per day at 2 h, 24 h, 48h
and 72 h following backward walking exercise. Graduated compression stockings (GCS)
covered the calf on one leg (SupportivTM, France). The leg wearing GCS was randomly
assigned (dominant versus non-dominant as determined by the non-preferred leg to
kick a ball). Subjects exercised by walking on a motorized treadmill (S2500, HEF
Techmachine, France) for 30-min at a constant velocity of 1 m.s-1 with a negative grade
of -25%. To increase the eccentric loading on the plantar flexor muscles, the walk was
performed backwards (Nottle and Nosaka 2005) whilst wearing a vest loaded with an
additional weight equivalent to 12% of body weight.
All the neuromuscular tests began with the determination of the stimulation inten-
sity required to elicit a maximal M-wave amplitude (Mmax). Afterwards, three Mmax
interspaced by 8 s were elicited from the relaxed muscle.
The amplitude of the three twitches evoked at Mmax intensities were averaged for
subsequent analysis.
The Engineering of Sport 7 - Vol. 1 549
Thereafter, subjects were instructed to perform three maximal voluntary torque
(MVT) contractions of the plantar flexor muscles, each for 5-s. Subjects were verbally
encouraged to perform maximally. Finally, a doublet (two electrically evoked twitches,
10 ms apart, Mmax intensity) was evoked during each plateau (superimposed twitch)
and another doublet was evoked 4-s after each MVT (potentiated twitch). The ratio of
the amplitude of the superimposed twitch torque over the amplitude of a twitch evoked
at rest 4 s after the MVT was used to assess the level of voluntary activation (VA) where
VA (%) = (1- Superimposed Twitch/Potentiated Twitch) x 100.
A subjective evaluation of the extent of DOMS in the plantar flexor muscles was
performed before each neuromuscular test by completing two subjective scales for
evaluation of DOMS. The first was a visual scale of 9 cm without any graduation (hori-
zontal line ranging from no pain at the left to extreme pain at the right).
2.3 Measurement and calculations
The MVT of the plantar flexor muscles was recorded by a dynamometric pedal (Captels,
St Mathieu de Treviers, France). Subject position was standardized with hip, knee and
ankle angulations of 90°, and foot securely strapped on the pedal. The tibial nerve was
stimulated with a cathode electrode with a diameter of 9 mm placed in the popliteal
cavity (Contrôle Graphique Medical, Brie-Comte-Robert, France). Subjects were in a
standardized position with motionless head and a standardized environment (i.e., same
time-of-day, silent room, constant lighting). Furthermore, a constant pressure was
applied to the electrode with the use of a strap. This was controlled by an air pressure-
recorder (Kikuhime, TT MediTrade, Soro, Denmark). The anode (10 x 5 cm,
Medicompex, Ecublens, Switzerland) was positioned distal to the patella. Electrical
stimulations (400V, rectangular pulse of 0.2 ms) were delivered by a high-voltage stimu-
lator (Digitimer DS7AH, Digitimer, Hertfordshire, England). The amperage was
adjusted for each subject during the familiarization session. During this first session, the
amperage was increased progressively (10 mA increment) until a plateau in twitch
mechanical response (peak twitch, Pt) and Mmax were observed. Electrophysiological
responses to the evoked action potentials were recorded on the soleus and gastrocnemius
medialis muscles with bipolar Ag/AgCl electrodes (Contrôle Graphique Medical, Brie-
Comte-Robert, France) with a diameter of 9 mm and an interelectrode distance of 25
mm. The reference electrode was placed on the wrist. Low impedance between the two
electrodes (< 5 k!) was obtained by abrading and washing the skin with emery paper
and cleaning with alcohol.
Signals were amplified and filtered (band pass 30 Hz – 500 Hz, gain = 1000), and
recorded at high frequency (2000 Hz). The action potentials were recorded using MP30
hardware (Biopac Systems Inc., Santa Barbara, California, USA) and dedicated software
(BSL Pro Version 3.6.7, Biopac Systems Inc., Santa Barbara, California, USA). The same
equipment was also used to drive the stimulator. From the mechanical response
obtained, we calculated Pt considered as an index of the contractile properties while
Mmax amplitude represents an index of sarcolemmal excitability. Statistical analyses
were performed with Systat software (Systat, Evanston, IL, USA). Data are reported as
mean ± SEM and the level of statistical significance was set at P < 0.05.
550 The Engineering of Sport 7 - Vol. 1
3- Results
The MVT significantly changed across the 3 days following the walking test in both legs
(P < 0.02). Post hoc analysis showed a significant decrease in MVT after the walking
exercise and which persisted during the next two days (P < 0.01). A significant recovery
in MVT was observed on the third day (48-h versus 72-h after, P < 0.02). An enhanced
recovery of 6 % in MVT for the leg with GCS was observed early during the recovery
but failed to achieve statistical significance. In line with the evolution observed in MVT,
post hoc analysis showed a significant decrease in VA level after the walking exercise (pre
versus post-exercise: P < 0.02), which failed to recover by 48-h (post-exercise versus 24-
h and 48-h after exercise, NS). However there was a significant recovery by 72-h (post-
exercise versus after 72-h, P < 0.005). There was no difference between the two legs for
the VA level. The electrically evoked Pt also displayed a significant variation following
walking exercise (P < 0.001) and legs. Post hoc analysis revealed a significant decrease in
Pt after the exercise (P < 0.001) followed by a significant recovery thereafter (P < 0.001).
The recovery was better at 24 h for the leg wearing GCS. The walking exercise failed to
induce significant changes in the evoked potentials at rest (Mmax) for any experimental
conditions.
The subjects feeling of DOMS increased significantly in the days following the
walking exercise (P < 0.001). Post hoc analysis displayed significantly higher subjective
DOMS for the three days following exercise compared to the termination of exercise (P
< 0.001). Muscle soreness reached a maximum 48-h after exercise and began to recover
by 72-h (48-h versus 72-h after exercise, P < 0.01). At 72 h, DOMS were significantly
lower with the leg wearing GCS (P < 0.05, Figure 1).
Figure 1 - Mean ± SEM rating of perceived delayed onset muscle soreness following the exerci-
se protocol for graduated compression stockings (GCS) and control conditions. * P < 0.05
significantly different from control.
The Engineering of Sport 7 - Vol. 1 551
4- Discussion
The present experiment was designed to test the hypothesis that the triceps surae, which
acts both concentrically and eccentrically during everyday activities, can become
damaged after an eccentric exercise and that subsequently the muscle is able to show an
adaptation response differently while wearing GCS. Muscles exert an eccentric action
when they are lengthened while generating active tension. This occurred in our experi-
mental setup when plantar flexor muscles acted as brakes to slow the motion of the body
during backward walking (Nottle and Nosaka 2005). As expected the downhill walking
exercise induced a significant decrease in the maximal voluntary torque of the plantar
flexor muscles and of similar magnitude for both legs. Immediately after the walking
exercise, the torque decrement of -15% appeared to be caused partly by an alteration in
muscle contractile properties (i.e., -22% for Pt). Furthermore, this alteration was also
associated to a decrease in voluntary activation (i.e., -5% for both legs) suggesting the
concomitant existence of a “central modulation” (for a review, see Gandevia 2001). Drop
in torque due to damage to muscle fibres may be confounded by the effects of fatigue.
In the present study, muscle damage was produced by what subjects considered to be
low-intensity exercise. Subjects did not tire during the exercise and by implication
fatigue remained at very low levels.
Therefore, the post-eccentric changes could not simply be assigned to the effects of
fatigue.
The first relevant finding of this study is that the MVT failed to recover before the
third day, whereas the measure of the (peripheral) contractile properties had recovered
significantly within the first 24 hours after exercise (P < 0.01). This delayed recovery in
maximal voluntary torque appeared to be mainly associated to a decrease in VA. The
time course of change in VA presents similarities with the time course of torque changes.
Second, the previous findings on recovery patterns for MVT and Pt amplitudes were
“speeded-up” while wearing GCS. Although not significant, it is worthy to note that Pt
recovered fully with GCS while a 12% decline in Pt was still observed for the control leg
at 24 h. Meanwhile, MVT tended to be higher (+ 6%) for the leg wearing GCS. As in the
present study, several studies have reported a prolonged loss in the ability of eccentri-
cally exercised muscle to generate force (Nottle and Nosaka, 2005, Newham
e
t
a
l
.
1983).
This change may be due in part to alterations in excitation-contraction coupling and
crossbridge formation/function. In the present study, the contractile properties had
significantly recovered during the first day but not MVT (within the third day). Further,
ultrastructural damage worsens in the 2 to 3 days post-exercise as MVT is being restored,
thus ultrastructural damage is not the only factor explaining force loss. Thus, the delayed
recovery in MVT appeared to be mainly associated with a decrease in voluntary muscle
activation. The latter is presented in the literature as a central protection of the muscle
from further peripheral fatigue and damage (Gandevia 2001).
Overall, these results suggest that contractile properties recovered early during the
recovery but with temporal dissociation in the ability to generate force, and that GCS
was able to modulate positively contractile properties within 24 h.
Post-exercise muscle soreness is usually said to follow an inverted U-shaped curve
over time with soreness low immediately following exercise, highest at 24 and 48 h and
552 The Engineering of Sport 7 - Vol. 1
falling at 72 h (see Figure 1). Subjective reports of muscle soreness showed an increase
from baseline 2-h, 24-h and 48-h following eccentric exercise in both leg conditions (i.e.,
with and without GCS). Interestingly, there was a significant difference between both
legs at 72 h (Figure 1). It should be noted that the perceived muscle soreness was signi-
ficantly lower while wearing GCS, which is in line to previous observations (Kraemer
e
t
a
l
.
2001a, 2001b). Soreness itself is unlikely result in a reduced ability to generate force,
since MVT is already markedly reduced immediately following eccentric exercise before
DOMS is perceived. Bringard
e
t
a
l
.
(2006) demonstrated that compression tights were
effective in mediating a reduction in the amount of venous pooling and an increase in
muscle oxygenation in the lower body. Different constructions of garments may mediate
these overall effects via different physiological mechanisms related to fluid shifts and
muscle tissue damage (Jonker
e
t
a
l
.
2001). In the present study wearing GCS during 5 h
per day may minimize oedema and muscle tissue disruption, thereby increasing comfort
in the leg. Use of lightweight (low compression) gradient compression stockings is very
effective in improving symptoms of discomfort, swelling, aching, as well as leg tightness
when worn regularly (Weiss and Dufy 1999).
Wearing graduated compression stockings after eccentric exercise appears to reduce
delayed-onset muscle soreness but considerably later after exercise. This could have
important implications not only for cross-country runners and trailers, but also for indi-
viduals who wish to embark on exercise regimes with associated pain following exercise.
The ease of use, length of time and perceptual benefits of such a recovery aid may in
itself be of assistance to athletes; however, given minimal differences in neurophysiolo-
gical data, the likelihood of a placebo effect may be apparent. Whatever the explanation
for the significant effect reported here for DOMS with GCS 72 h post-exercise, the
current study has provided a small benefit for GCS in the management of the muscle
function impairment associated with DOMS.
5- Conclusion
In conclusion, GCS did affect differently some temporal measures of muscle function
and perceived muscle soreness during 3-days of passive recovery after an exercise-
induced muscle fatigue on calf. These results suggest that GCS may attenuate soreness
associated with delayed onset muscle soreness. However it may not be beneficial in the
treatment of strength and functional declines. Therefore, as significant benefits were
found when subjects wore GCS, it is recommended that active subjects use this addi-
tional recovery tool provided by a correctly fitted GCS after physical activity integrating
severe muscle damage. However, further research is recommended to investigate the
effects of GCS on other measures of muscle function, such as motor performance during
dynamic exercise, and to know the necessary application time of GCS after some specific
exercise. Such research is warranted to ensure that GCS provide an ergogenic aid so that
subjects can exercise more often and with less pain, without impeding performance
during successive training bouts.
The Engineering of Sport 7 - Vol. 1 553
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