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The purpose of the study was to determine the effects of compression garments on recovery following damaging exercise. A systematic review and meta-analysis was conducted using studies that evaluated the efficacy of compression garments on measures of delayed onset muscle soreness (DOMS), muscular strength, muscular power and creatine kinase (CK). Studies were extracted from a literature search of online databases. Data were extracted from 12 studies, where variables were measured at baseline and at 24 or 48 or 72 h postexercise. Analysis of pooled data indicated that the use of compression garments had a moderate effect in reducing the severity of DOMS (Hedges' g=0.403, 95% CI 0.236 to 0.569, p<0.001), muscle strength (Hedges' g=0.462, 95% CI 0.221 to 0.703, p<0.001), muscle power (Hedges' g=0.487, 95% CI 0.267 to 0.707, p<0.001) and CK (Hedges' g=0.439, 95% CI 0.171 to 0.706, p<0.001). These results indicate that compression garments are effective in enhancing recovery from muscle damage.
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Compression garments and recovery from
exercise-induced muscle damage: a meta-analysis
Jessica Hill,
1
Glyn Howatson,
2,4
Ken van Someren,
3
Jonathan Leeder,
2,5
Charles Pedlar
1
1
School of Sport, Health and
Applied Science, St Marys
University College,
Twickenham, UK
2
Faculty of Health and Life of
Sciences, Northumbria
University, Newcastle Upon
Tyne, UK
3
GSK Human Performance Lab,
GlaxoSmithKline Consumer
Healthcare, London, UK
4
Water Research Group, School
of Biological Sciences, North
West University, Potchefstroom,
South Africa
5
English Institute of Sport,
Manchester, UK
Correspondence to
Jessica Hill,
School of Sport, Health and
Applied Science, St Marys
University College, Twickenham
TW1 4SX, UK;
jessica.hill@smuc.ac.uk.
Accepted 12 May 2013
To cite: Hill J, Howatson G,
van Someren K, et al.Br J
Sports Med Published Online
First: [please include Day
Month Year] doi:10.1136/
bjsports-2013-092456
ABSTRACT
The purpose of the study was to determine the effects of
compression garments on recovery following damaging
exercise. A systematic review and meta-analysis was
conducted using studies that evaluated the efcacy of
compression garments on measures of delayed onset
muscle soreness (DOMS), muscular strength, muscular
power and creatine kinase (CK). Studies were extracted
from a literature search of online databases. Data were
extracted from 12 studies, where variables were
measured at baseline and at 24 or 48 or 72 h
postexercise. Analysis of pooled data indicated that the
use of compression garments had a moderate effect in
reducing the severity of DOMS (Hedgesg=0.403, 95%
CI 0.236 to 0.569, p<0.001), muscle strength (Hedges
g=0.462, 95% CI 0.221 to 0.703, p<0.001), muscle
power (Hedgesg=0.487, 95% CI 0.267 to 0.707,
p<0.001) and CK (Hedgesg=0.439, 95% CI 0.171 to
0.706, p<0.001). These results indicate that
compression garments are effective in enhancing
recovery from muscle damage.
INTRODUCTION
Training and athletic competition frequently result
in exercise-induced muscle damage (EIMD). The
degree of muscle damage depends on several
factors including exercise type, duration, intensity
and habituation to the exercise.
12
Exercise with an
eccentric component results in a greater magnitude
of negative symptoms associated with EIMD.
3
During an eccentric contraction, the muscle length-
ens while under tension, resulting in mechanical
damage to the sarcomeres; this mechanical damage
leads to an inammatory response, proposed to
exacerbate the degree of damage.
3
EIMD is charac-
terised by a number of symptoms including tem-
porary reductions in muscle strength, decreased
rate of force development, reduced range of
motion, swelling, increased feelings of soreness and
the appearance of intracellular proteins in the
blood.
245
These symptoms can last for a number
of days and may affect the capacity to train at the
desired intensity in subsequent training sessions,
thus having an impact on long-term training pro-
grammes and competition performance; as a result,
methods to reduce the negative symptoms asso-
ciated with EIMD are widely sought.
A number of modalities have been investigated in
the search for a treatment that may reduce the
effects of EIMD and/or accelerate recovery;
6
these
include massage,
7
antioxidant supplementation,
8
cold water immersion
9
and recently the use of com-
pression garments.
10 11
Compression garments are
widely used to treat clinical pathologies such as
deep vein thrombosis and chronic-venous insuf-
ciency.
12 13
The use of compression garments in
sport is becoming increasingly popular due to
claims that they can improve recovery from strenu-
ous exercise
14
by creating an external pressure gra-
dient, thus reducing the space available for
swelling.
10
Other suggested benets include
enhanced blood ow that may aid the removal of
waste products and muscle metabolites.
10
Evidence for the efcacy of compression gar-
ments in alleviating symptoms associated with
muscle damage is equivocal with studies both sup-
porting
15 16
and refuting the use of garments.
17
MacRae et al
11
in their descriptive review on com-
pression garments indicated that discrepancies in
the ndings might be due to the differences between
studies in the populations, modality of exercise,
degree of compression, type of compression
garment and duration of treatment. Accordingly, in
order to clarify the role of compression garments in
recovery from EIMD, the aim of this investigation
was to conduct a systematic review and
meta-analysis on the efcacy of compression gar-
ments in recovery from damaging exercise.
METHODS
Literature search
A systematic review with meta-analysis was con-
ducted using established guidelines.
18
An electronic
search of the literature, ending in August 2012, was
conducted using combinations of the following
terms in three online databases (MEDLINE
(Pubmed), SportDiscus and ISI Web of Knowledge):
Compression garment, compression stocking, exer-
cise, EIMD, performance, recovery, sport. The refer-
ence lists of all obtained articles were examined in
order to identify any further studies.
Outcome variables
The literature was examined for the effects of com-
pression garments on recovery from damaging
exercise using the following outcome variables
which reect the most commonly assessed indices
in the EIMD literature: muscular power, muscular
strength, muscle soreness and creatine kinase (CK).
Measurements of muscular power included any
activity that measured the explosive power of the
muscle; examples include a counter-movement
jump and a 5 m sprint. Muscular strength included
measurements of isometric/isokinetic/isotonic
muscle contraction. Measurements of delayed onset
muscle soreness (DOMS) were obtained through
the use of visual analogue scales or Likert scales
and, nally, measurements of CK obtained from
capillary or venous sampling.
Hill J, et al.Br J Sports Med 2013;0:17. doi:10.1136/bjsports-2013-092456 1
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Inclusion and exclusion criteria
Studies were included on the basis of the following criteria: (1)
participants were randomised into a compression garment or
control group; (2) If they measured at least one of the outcome
variables and assessed at baseline and again at 24 and/or 48 and/
or 72 h after the exercise bout; (3) the study population could be
male or female participants from any training background; (4) if
the compression garment was worn after, or during and after the
damaging exercise. Studies were excluded if: (1) the compression
garment was not applied within 2 h of exercise completion; (2)
the experimental group received multiple treatments or the
control group undertook any practice which could be perceived
to improve recovery; (3) there was insufcient data.
Extraction of data
Mean, SD and sample size data were extracted from all included
studies. In some cases, the mean and SD data were extrapolated
from the gures. Where data were reported as the mean and SE,
data were converted to SE values. Risk of bias was calculated in
accordance with the Cochrane Collaboration Guidelines
19
(gure 1).
Statistical analysis
All analyses were conducted using comprehensive meta-analysis
software (V.2.2.057; Biostat Inc, Englewood, New Jersey, USA).
All data were analysed using a xed-effect model. Hedgesg
with 95% CI was used to indicate the standardised mean differ-
ences. Effect sizes were set at <0.40=small, 0.400.70=moder-
ate and >0.70=large.
20
Systematic differences (heterogeneity)
were assessed using an I
2
statistic, which indicates the percentage
of variability across studies due to heterogeneity.
20
A signicance
level of p0.05 was applied.
RESULTS
A total of 5292 records were identied through database searches
and a further seven studies were identied through reference list
searches. Of the total 5299 records screened, 5250 were not rele-
vant to this analysis and were excluded, leaving 49 studies to be
assessed for eligibility. Of the 49 potentially relevant studies, 37
were excluded due to: missing data; different outcome variables
from the inclusion criteria reported; outcome variables not mea-
sured in accordance with the inclusion criteria time points; appli-
cation timings of the compression garment were not in
accordance with the inclusion criteria (see gure 2). Twelve
studies that met the inclusion criteria had data extracted for
inclusion in the meta-analysis (see table 1). The training status of
the participants in the included studies ranged from untrained to
elite. The total number of participants in the data set was 205
(n=136 men and n=69 women) with a mean and SD age of 22.3
(2.3) years. Risk of bias is indicated in gure 1. The outcome of
the assessment revealed that sequence generation and allocation
concealment were largely unclear and that none of the studies
were able to blind participants from the treatment.
A total of 28 data points were extracted from original
research papers and included in the nal analysis. The use of
compression garments had a moderate benet in reducing the
experience of DOMS (Hedgesg=0.403, 95% CI 0.236 to
0.569, p<0.001; gure 3). The I
2
statistic indicated a minimal
heterogeneity (0.001%).
20
The use of compression garments appeared to have a moder-
ate effect on recovery of muscle strength postexercise (Hedges
g=0.462, 95% CI 0.221 to 0.703, p<0.001). Analysis was
conducted using a sample of 15 extracted data points (gure 4).
An I
2
statistic of 4.8% revealed minor heterogeneity.
Figure 5 demonstrates that the use of compression garments
has a moderate effect on the recovery of muscle power follow-
ing exercise (Hedgesg=0.487, 95% CI 0.267 to 0.707,
p<0.001). Seventeen extracted data points were included in the
analysis. An I
2
value of 0.001% suggests minor heterogeneity.
Analysis of 18 extracted data points (gure 6) revealed that
the use of compression garments had a moderate effect in redu-
cing concentrations of CK postexercise (Hedgesg=0.439, 95%
CI 0.171 to 0.706, p<0.001). An I
2
value of 37.4% indicates
moderate heterogeneity
20
DISCUSSION
There is a growing body of literature examining the use of com-
pression garments in performance and recovery; however, the
effectiveness of these garments is still in question. The wide
variation in methodological design, combined with the differ-
ences in timing and duration of application, exercise modality
and training status of the population investigated, has perhaps
contributed to the apparently inconsistent ndings. This study
used a meta-analysis approach to explore whether the use of
compression garments, as a recovery modality, are effective. The
results indicate that when compression garments are worn after,
or during and after, intense exercise, participants experience a
moderate reduction in severity of DOMS, reduced decrements
in strength and power and a reduced concentration of CK in the
serum.
The results suggest that using a compression garment allevi-
ates the perception of DOMS. The total Hedgesg of 0.40
(gure 3) indicates that, with the use of compression, 66% of
the population
21
is likely to experience reduced DOMS. The
underlying mechanism explaining the cause of DOMS currently
remains unclear.
22 23
Several theories have been proposed, with
some authors suggesting that DOMS arises as a result of disrup-
tion to the muscle bre and surrounding connective tissue,
24
others suggesting that it is associated with the inammatory
response
25
and yet others suggesting that it is a combination of
both.
1
The inammatory response, which follows tissue
damage, creates an increase in tissue osmotic pressure, which
sensitises nociceptors, resulting in sensations of pain and sore-
ness.
26
Although somewhat speculative, it is thought that apply-
ing compression generates an external pressure gradient that
attenuates changes in osmotic pressure and reduces the space
available for swelling and haematoma to occur.
26
A reduction in
osmotic pressure, occurring due to a decrease in exudates, may
lessen the degree of chemotaxis, thus attenuating the inamma-
tory response and experience of pain;
26
however, this remains
to be empirically demonstrated. Nonetheless, a reduction in
DOMS is benecial for athletes and may improve an individuals
readiness to participate in physical activity.
27
Principally, compression garments are worn during recovery
in order to improve subsequent performance.
11
The current
review demonstrates that the performance measures of strength
and power recover at a faster rate with the use of a compression
garment. The overall Hedgesg of 0.49 and 0.44 for strength
and power (gures 4 and 5) indicate that69% and 66%, respect-
ively, of the population
21
will experience accelerated recovery of
strength and power when using a compression garment.
Reductions in muscular function have been attributed to muscle
soreness,
28
ultrastructural damage
29
and reduced voluntary
muscle activation.
30
It is very likely that ultrastructural damage
is not the only factor that causes a temporary decrease in muscle
function. Previous research has indicated that ultrastructural
2 Hill J, et al.Br J Sports Med 2013;0:17. doi:10.1136/bjsports-2013-092456
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damage does not always occur following eccentric exercise that
leads to DOMS.
31
Therefore, it seems reasonable that reduced
voluntary muscle activation also contributed to a reduction in
muscular strength, which is consistent with previous research.
30
Considering this, the recovery of muscle function with the use
of compression garments either (1) reduces the inammatory
response, thus attenuating further ultrastructural damage occur-
ring 4872 h postexercise or (2) is able to accelerate restoration
of central factors that result in reduced voluntary activation.
Furthermore, the use of a compression garment may provide
dynamic immobilisation, which reduces muscle oscillation and,
in turn, enhances the neural input during the recovery
process.
28
CK has been used extensively as a marker of muscle
damage.
31032
This study indicated that the use of compression
garments is able to reduce concentrations of CK. A Hedgesg
value of 0.44 (gure 6) indicates that 66% of the population
21
will experience a reduced CK in blood. Reductions in CK con-
centrations observed with the use of compression garments have
been attributed to an attenuation in the release of CK into the
bloodstream, improved clearance of metabolites
26
and enhanced
repair of the muscle.
33
Compression garments may improve cir-
culation, probably via an enhanced-muscle pump function;
however, the exact mechanism remains speculative.
33
Nevertheless, an improved venous return may facilitate the clear-
ance of metabolites,
34
which may explain why reduced levels of
CK are evident following the application of compression.
A moderate risk of heterogeneity was revealed for CK across
the studies in this analysis; this is perhaps related to differences
in training status of the participants in each study and the type
of exercise modality used; for example, Montgomery et al
35
investigated recovery following a basketball tournament using
well-trained participants. In contrast to this, Kraemer et al
14 28
examined recovery following two sets of 50 arm curls using
non-strength-trained men and women. The CK response at 72 h
postexercise in Kraemer et al
14
appears inexplicably to be much
larger in magnitude in comparison with all other studies
included in the analysis, potentially skewing the overall CK ndings
Figure 1 Analysis of the risk of bias in accordance with the Cochrane Collaboration.
19
Figure 2 Process of study selection from initial identication to inclusion.
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Table 1 Summary of the literature included in the meta-analysis
Author(s)
Participant cohort (training status,
gender, number) Exercise intervention Type of compression garment
Timing and duration of
application
Outcome variables and
measurement times (h)
Carling et al
17
23 college students
n=7 males, n=16 females
70 eccentric contractions of non-dominant
elbow flexors
Compression sleeve extending from deltoid insertion
to wrist (Brecon Inc, Talladega, AL)
17 mm Hg
72 h postintervention DOMS (24, 48, 72)
Peak concentric torque (24, 48, 72)
Davies et al
10
Female University team netball players
n=7
Male University team basketball players
n=4
5×20 drop jumps Compression tights (Linebreak)
15 mm Hg
48 h postintervention DOMS (24, 48)
CMJ (48)
5 m sprint (48)
10 m sprint (48)
Duffield et al
38
Male club and regional standard rugby
players n=11
10 m x 20 m sprints and 100 SSC bounds Lower body (Bioslyx, Salzenger, Australia) During and 24 h
postintervention
Peak quadriceps extension force (24)
Peak flexion of hamstrings (24)
Knee extensor peak twitch force (24)
CK (24)
Duffield et al
27
Club standard rugby players n=14 Simulated team game Lower body (Skins, Sydney, Australia) During and 15 h
postintervention
DOMS (24)
Peak power (24)
CK (24)
Duffield and
Portus
36
Male club level cricket players n=10 30-min intermittent, repeated sprint test Whole body (3 different brands; Skins, Sydney,
Australia;
Under Armour, Baltimore, Maryland, USA; Adidas,
Herzogenaurach, Germany
During and 24 h
postintervention
CK (24)
French et al
32
Healthy young men n=26 Standardised whole body resistance
exercise protocol
Lower body, ankle to waist (Skins, Campbeltown,
Australia)
1210 mm Hg
12 h post DOMS (24, 48)
CK (24, 48)
Jakeman et al
16
Physically active females n=17 10×10 polymeric drop jumps Lower limb (Skins, Sydney, Australia) 12 h post DOMS (24, 48, 72)
Isokinetic muscle strength (24, 48,
72)
Squat jump (24, 48, 72)
CMJ (24, 48, 72)
CK (24, 48, 72)
Kraemer et al
14
Healthy non-strength trained men
n=15
2×50 arm curls Compression sleeve fitted from axillary line to
forearm
10 mm Hg
72 h post DOMS (movement) (24, 48, 72)
DOMS (global) (24, 48, 72)
Peak torque (24, 48, 72)
Peak elbow flexor power (24, 48, 72)
CK (24, 48, 72)
Kraemer et al
28
Non-strength trained women n=29 2×50 arm curls Compression Sleeve fitted from axillary line to
forearm
10 mm Hg
120 h post DOMS (movement) (24, 48, 72)
DOMS (global) (24, 48, 72)
Peak torque (24, 48, 72)
Peak elbow flexor power (24, 48, 72)
CK (24, 48, 72)
Montgomery
et al
35
Well-trained male basketball players
n=29
Basketball tournament Lower body (Linebreak, Sydney, Australia)
18 mm Hg
18 h post DOMS (24)
Jump Height (24)
Perrey et al
39
Healthy physically active men
n=8
30-min, backwards-downhill walking Calf length (SportivTM, France)
Single leg
5 h/day at 2, 24 and 48 h
post
DOMS (24, 48, 72)
Trenell et al
15
Recreational male athletes n=11 30-min downhill walking Lower Limb (Skins, Sydney, Australia) Single Leg 48 h post DOMS (48)
CMJ, counter-movement jump; CK, creatine kinase; DOMS, delayed-onset muscle soreness.
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and contributing to the increased risk of heterogeneity observed.
The CK response appears to be inconsistent following the applica-
tion of compression, with some studies indicating a reduction in
CK
14 28 36
and others indicating no change.
10 32
It is also import-
ant to consider that serum CK is a reection of both diffusion and
clearance from the circulatory system; as a result, changes in CK
concentration should be interpreted with some caution.
32
The role of compression garments as a recovery modality is
thought to be related to enhanced-tissue repair.
15 33
The results
from the meta-analysis provide evidence that the use of
Figure 3 Forest plot demonstrating a comparison between the use of a compression garment and a control for measures of delayed-onset muscle
soreness. The superscripted 24, 48 and 72 refer to the postexercise measurement times. Squared indicate the Hedgesg for each study and the lines
represent 95% CIs. The size of the square represents the weight of the study. The diamond indicates the overall Hedgesg, with its width
representing the 95% CIs. LL and UL represent the lower limit and upper limit of 95% CIs, respectively.
Figure 4 Forest plot demonstrating a comparison between the use of a compression garment and a control for measures of muscular strength.
The superscripted 24, 48 and 72 refer to the postexercise measurement times. Squared indicate the Hedgesg for each study and the lines represent
95% CIs. The size of the square represents the weight of the study. The diamond indicates the overall Hedgesg, with its width representing the
95% CIs. LL and UL represent the lower limit and upper limit of 95% CIs, respectively.
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compression may reduce the recovery time frame; however, any
meta-analysis is limited by the data available and there are
several limitations in the literature used in this analysis; (1)
Many of the studies included contain small sample sizes, which
results in reduced statistical power; (2) None of the included
studies blinded their patients to the treatment; as such, the
placebo effect cannot be eliminated; (3) Many of the studies do
not describe the method used to randomise subjects; nor do
they mention allocation concealment and (4) the garments used
within each of the studies also vary widely and include upper
body and lower body garments from a range of manufacturers,
which are likely to exert different degrees of pressure.
Figure 5 Forest plot demonstrating a comparison between the use of a compression garment and a control for measures of muscle power. The
superscripted 24, 48 and 72 refer to the postexercise measurement times. Squared indicate the Hedgesg for each study and the lines represent
95% CIs. The size of the square represents the weight of the study. The diamond indicates the overall Hedgesg, with its width representing the
95% CIs. LL and UL represent the lower limit and upper limit of 95% CIs, respectively.
Figure 6 Forest plot demonstrating a comparison between the use of a compression garment and a control for measures of CK. The superscripted
24, 48 and 72 refer to the postexercise measurement times. Squared indicate the Hedgesg for each study and the lines represent 95% CIs. The size
of the square represents the weight of the study. The diamond indicates the overall Hedgesg, with its width representing the 95% CIs. LL and UL
represent the lower limit and upper limit of 95% CIs, respectively.
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The majority of published studies do not measure the degree
of pressure exerted by the garments and simply report the esti-
mated levels indicated by the manufacturer. A potential problem
with this is that the garments are usually tted based on the
individuals height and weight. Owing to the differences in
body shape and variations in tissue structure, there may be large
ranges in the pressure exerted locally by a garment in one size
classication.
11
These differences may explain some of the vari-
ation in ndings within the literature and future research should
account for this by directly measuring the degree of compres-
sion achieved. Finally, trained participants are likely to experi-
ence fewer negative symptoms following intense exercise when
compared with their non-trained counterparts, due to the level
of habituation to exercise and the repeated bout phenomenon.
37
However, there is a lack of evidence to support this theory in
the context of compression garments.
CONCLUSION
A number of events are involved in the damage-inammation-
recovery process and they are initiated very quickly following the
damaging bout; therefore, rapid deployment of a treatment strat-
egy is important.
26
This is the rst systematic review with
meta-analysis to examine the efcacy of compression garments in
recovery from damaging exercise. These data provide new infor-
mation that the use of compression garments promotes a more
rapid recovery of muscle function, muscle soreness and systemic
CK activity when compared with a control group. Further
research is needed that investigates the relationship between
garment, t, the pressure exerted by the garment, the training
status of the athlete and the effect this has on markers of recov-
ery. This may address some of the inconsistent ndings within
the current literature. Although the physiological mechanisms
remain to be fully understood, this review highlights that the use
of a compression garment appears to facilitate enhanced recovery
of muscle function and reduce muscle soreness.
SUMMARY OF FINDINGS
The use of compression garments appears to reduce the severity
of DOMS, accelerate the recovery of muscle function and
attenuate the concentration of CK following strenuous exercise.
These ndings indicate that wearing a compression garment
may improve recovery following intense training and competi-
tion; this has implications for both elite athletes and recreational
populations.
Contributors JH participated in protocol design, data extraction, data analyses and
manuscript preparation. GH, KVS, JL and CP participated in protocol design, data analyses
and manuscript preparation. All authors have read and approved the nal manuscript.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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Hill J, et al.Br J Sports Med 2013;0:17. doi:10.1136/bjsports-2013-092456 7
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... The application of CGs after exercise reduced the decline in muscle power and strength [8,10,33], reduced the metabolites and concentrations of serum muscle damage markers [34,35], and improved perceptual measures of recovery, i.e., muscle soreness, vitality, and readiness to train [11,36]. Previous systematic reviews and meta-analyses suggest that CGs may aid faster recovery of exercise-induced muscle damage [5,37,38] by reducing inflammation [39]. However, whilst the use of CGs improved running economy, biomechanical variables (i.e., ground contact time, step frequency, step length, swing time), and perceived body temperature [40], garment wear was not associated with improved sports performance during high-intensity exercise [41]. ...
... The use of CGs to facilitate recovery of exercise-induced muscle damage is supported by encouraging scientific evidence (for reviews, see [5,37,38]); however, paralleling the inconsistencies in study designs, the results are also contradictory concerning how, if at all, CG-induced tissue compression would affect the recovery of muscle strength after physical exercise. Therefore, the purpose of this systematic review with meta-analyses was to determine if wearing a CG during or after physical exercise would reduce the deleterious effects of physical exercise on muscle strength-related outcomes. ...
... Contrary to this expectation, the meta-analytical comparisons between CG versus control revealed no muscle strengthsparing effects from physical exercise. This somewhat unexpected result is not in line with findings of previous reviews [5,37,39] that reported beneficial effects of CGs on muscle strength and recovery of muscle function after exercise. The inconsistencies might be due to differences in the applied meta-analytical methods between this current and previous meta-analyses. ...
Article
Full-text available
Background: The use of compression garments (CGs) during or after training and competition has gained popularity in the last few decades. However, the data concerning CGs’ beneficial effects on muscle strength-related outcomes after physical exercise remain inconclusive. Objective: The aim was to determine whether wearing CGs during or after physical exercise would facilitate the recovery of muscle strength-related outcomes. Methods: A systematic literature search was conducted across five databases (PubMed, SPORTDiscus, Web of Science, Scopus, and EBSCOhost). Data from 19 randomized controlled trials (RCTs) including 350 healthy participants were extracted and meta-analytically computed. Weighted between-study standardized mean differences (SMDs) with respect to their standard errors (SEs) were aggregated and corrected for sample size to compute overall SMDs. The type of physical exercise, the body area and timing of CG application, and the time interval between the end of the exercise and subsequent testing were assessed. Results: CGs produced no strength-sparing effects (SMD [95% confidence interval]) at the following time points (t) after physical exercise: immediately ≤ t < 24 h: − 0.02 (− 0.22 to 0.19), p = 0.87; 24 ≤ t < 48 h: − 0.00 (− 0.22 to 0.21), p = 0.98; 48 ≤ t < 72 h: − 0.03 (− 0.43 to 0.37), p = 0.87; 72 ≤ t < 96 h: 0.14 (− 0.21 to 0.49), p = 0.43; 96 h ≤ t: 0.26 (− 0.33 to 0.85), p = 0.38. The body area where the CG was applied had no strength-sparing effects. CGs revealed weak strength-sparing effects after plyometric exercise. Conclusion: Meta-analytical evidence suggests that wearing a CG during or after training does not seem to facilitate the recovery of muscle strength following physical exercise. Practitioners, athletes, coaches, and trainers should reconsider the use of CG as a tool to reduce the effects of physical exercise on muscle strength.
... Two common modalities, contrast therapy and compression therapy, reduce EAMD symptoms and improve the recovery of muscular strength after intense exercise. 4,14,18 However, the combined effects of contrast with compression (CwC) therapy on EAMD, inflammation, soreness and the recovery of muscular strength, power, and joint mobility after damaging exercise are unknown. Furthermore, although previous studies have observed that both EAMD and decreased tissue temperature can impair glycogen storage and synthesis rates, no studies have investigated the effects of any recovery modality on intramuscular glycogen storage after damaging exercise. ...
... 11,25 With recent advances in technology, this gap in knowledge can now be addressed because valid and reliable measures of intramuscular glycogen can now be obtained without the need for repeated muscle biopsies, which can interfere with the recovery process. 14,15,20 Given the need to validate CwC as a treatment for EAMD and the lack of understanding of how such treatments affect intramuscular glycogen stores, the purpose of the present study is 3-fold: (1) to determine the effects of CwC on the recovery of muscular strength, power, and joint mobility after a damaging bout of exercise; (2) to determine the effects of CwC on muscle soreness and EAMD after a damaging bout of exercise; and (3) to determine the effects of CwC on the recovery of intramuscular glycogen stores relating to EAMD. We hypothesized that CwC therapy will (1) enhance recovery of strength, power, and joint mobility, (2) reduce muscle soreness and measures of EAMD, and (3) enhance intramuscular glycogen recovery when compared with when no treatment is provided (CON). ...
... Changes in intramuscular glycogen could then be calculated based on the known association of changes in intramuscular water content and intramuscular glycogen. 14,20 This method has been validated previously to muscle biopsy determinations 14,20 and has sufficient test-retest reliability when performed on the biceps brachii for glycogen estimation. 16 Longitudinal ultrasound images that were obtained at the same location and using the same ultrasound settings described previously were used to measure changes in muscle thickness. ...
Article
Full-text available
Background: Exercise-associated muscle damage (EAMD) temporally impairs muscle function and intramuscular glycogen storage. Contrast with compression (CwC) therapy provides localized EAMD treatment with minimal changes in core/tissue temperature that can impair glycogen resynthesis. Hypothesis: CwC will enhance the recovery of strength, power, and joint mobility, reduce markers of EAMD, and attenuate the disruption of glycogen storage observed after damaging exercise. Study design: Randomized controlled trial with crossover design. Level of evidence: Level 2. Methods: Ten men completed 2 bouts of eccentric elbow flexor exercise, separated by 1 week, using contralateral arms. After each bout, participants received either CwC therapy (at 0, 24, and 48 h postexercise) or no therapy with intervention order and limb randomly assigned. Prior to (pre-exercise) and 1, 24, 48, and 72 h after each exercise bout, muscular strength, muscular power, intramuscular glycogen, creatine kinase, muscle thickness, muscle soreness, pressure pain threshold, active elbow flexion, passive elbow extension, and dietary intake were assessed. Comparisons were made between conditions over time (interaction effects) using separate repeated-measures analyses of variance/multivariate analyses of variance and effect sizes (Cohen d) to describe treatment effect at each time point. Results: Significant interaction effects were observed for muscular strength (d = 0.67-1.12), muscular power (d = 0.20-0.65), intramuscular glycogen (d = 0.29-0.81), creatine kinase (d = 0.01-0.96), muscle thickness (d = 0.35-0.70), muscle soreness (d = 0.18-0.85), and active elbow flexion (d = 0.65-1.17) indicating a beneficial effect of CwC over time (P ≤ 0.05). In contrast, no significant interaction effect was observed for pressure pain threshold or passive elbow extension (P > 0.05). Conclusion: These results support the use of CwC for the recovery of muscle function after damaging exercise in male patients and indicate that CwC attenuates, but does not remove, the disruption of intramuscular glycogen stores observed after intense eccentric exercise. Clinical relevance: Glycolysis-dependent athletes may benefit from CwC therapy after training/competition that causes EAMD.
... In addition to appropriate nutrition and rest/sleep, a multitude of physical recovery interventions have gained the attention of researchers and athletes (1,2,5). While evidence on many such interventions is equivocal (2,6), the volume and quality of evidence to support the use of compression garments (CG) has increased in recent years (7)(8)(9)(10). Compression appears to be particularly beneficial for recovery from exercise-induced muscle damage (EIMD) (7,8). ...
... While evidence on many such interventions is equivocal (2,6), the volume and quality of evidence to support the use of compression garments (CG) has increased in recent years (7)(8)(9)(10). Compression appears to be particularly beneficial for recovery from exercise-induced muscle damage (EIMD) (7,8). The term EIMD describes the cellular disruption of myocytes, and is functionally defined by severe and persistent declines in isometric strength (11). ...
... For example, a meta-analysis from 2015 failed to identify any effect of pressure on recovery (22); however, the analysis was limited by the small number of trials included (n = 6), and only three of these studies reported directly measured pressure data. Furthermore, only one of the studies reviewed focused specifically on damaging exercise, which seems to be the modality for which CG are most effective (7,8). In contrast, studies comparing the effects of different directly measured compression pressures for recovery have begun to emerge over the past 3 years (9,23-25), providing evidence to support a dose-response relationship between compression and recovery variables following EIMD. ...
Article
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The use of compression garments (CG) has been associated with improved recovery following exercise-induced muscle damage. The mechanisms responsible are not well established, and no consensus exists regarding the effects of compression pressure (i.e., the “dose”), which until recently was seldom reported. With the increasing prevalence of studies reporting directly measured pressures, the present review aims to consolidate current evidence on optimal pressures for recovery from exercise-induced muscle damage. In addition, recent findings suggesting that custom-fitted garments provide greater precision and experimental control are discussed. Finally, biochemical data from human trials are presented to support a theoretical mechanism by which CG enhance recovery, with recommendations for future research. The effects of compression on adaptation remain unexplored. More studies are required to investigate the relationship between compression pressure and the recovery of performance and physiological outcomes. Furthermore, improved mechanistic understanding may help elucidate the optimal conditions by which CG enhance recovery.
... These results are in disagreement with research highlighting a reduction of muscle damage markers with CG use post-exercise [77,82,83]. Furthermore, a series of meta-analyses found CG use post-exercise is useful for reducing creatine kinase concentration [75,84] and muscle swelling [75,85]. A likely explanation for the lack of benefit reported by Montgomery et al. [40] and other compression research [79,81,86] is the exercise protocols may not have been intense enough to induce a sufficient degree of muscle damage [49,79]. ...
... Similar results were observed in the study by Atkins et al. [72], where lower-body CG worn following exercise improved ratings of perceived muscle soreness. These findings are supported by reviews reporting moderate benefits of CG on reducing post-exercise muscle soreness [70,84,85]. The observed benefits on perceived muscle soreness may be due to increases in blood flow, decreases in inflammation, and reducing space for swelling to occur with CG use [72,79]. ...
... In summary, the use of CG after exercise appears to be beneficial for enhancing the recovery process [74,75,77,84], albeit there is limited research available in basketball players. Further research is needed to provide basketballspecific practical recommendations. ...
Article
Full-text available
Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players’ recovery for training and competition throughout the season.
... Compression garments are elastic clothing items that apply mechanical pressure at the surface of needed body zones, thereby improving venous return and stabilizing, compressing, and supporting the underlying tissues (Bochmann et al., 2005;MacRae et al., 2011;Xiong and Tao, 2018). The use of lower body and lower limb compression garments as a recovery tool has gained popularity both during and after exercise, and the beneficial effects of compression garments on recovery mechanisms are well investigated (MacRae et al., 2011;Hill et al., 2014;Marqués-Jiménez et al., 2016;Brown et al., 2017). ...
... A final potential reason for the lack of significant results, and therefore a limitation of the present study, could be that sports compression garments are supposedly more effective during periods of recovery than during actual exercise (Hill et al., 2014;Brown et al., 2017;Cullen et al., 2021). Sports climbing has been an Olympic discipline since 2020; therefore, the enhancement of athletic performance and recovery in climbing has become increasingly important (Engel et al., 2018). ...
Article
Full-text available
Purpose: Wearing compression garments is a commonly used intervention in sports to improve performance and facilitate recovery. Some evidence supports the use of forearm compression to improve muscle tissue oxygenation and enhance sports climbing performance. However, evidence is lacking for an effect of compression garments on hand grip strength and specific sports climbing performance. The purpose of this study was to evaluate the immediate effects of forearm compression sleeves on muscular strength and endurance of finger flexor muscles in sports climbers. Materials and Methods: This randomized crossover study included 24 sports climbers who performed one familiarization trial and three subsequent test trials while wearing compression forearm sleeves (COMP), non-compressive placebo forearm sleeves (PLAC), or no forearm sleeves (CON). Test trials consisted of three performance measurements (intermittent hand grip strength and endurance measurements, finger hang, and lap climbing) at intervals of at least 48 h in a randomized order. Muscle oxygenation during hand grip and finger hang measurements was assessed by near-infrared spectroscopy. The maximum blood lactate level, rate of perceived exertion, and forearm muscle pain were also determined directly after the lap climbing trials. Results: COMP resulted in higher changes in oxy[heme] and tissue oxygen saturation (StO 2 ) during the deoxygenation (oxy[heme]: COMP –10.7 ± 5.4, PLAC –6.7 ± 4.3, CON –6.9 ± 5.0 [μmol]; p = 0.014, η p ² = 0.263; StO 2 : COMP –4.0 ± 2.2, PLAC –3.0 ± 1.4, CON –2.8 ± 1.8 [%]; p = 0.049, η p ² = 0.194) and reoxygenation (oxy [heme]: COMP 10.2 ± 5.3, PLAC 6.0 ± 4.1, CON 6.3 ± 4.9 [μmol]; p = 0.011, η p ² = 0.274; StO 2 : COMP 3.5 ± 1.9, PLAC 2.4 ± 1.2, CON 2.3 ± 1.9 [%]; p = 0.028, η p ² = 0.225) phases of hand grip measurements, whereas total [heme] concentrations were not affected. No differences were detected between the conditions for the parameters of peak force and fatigue index in the hand grip, time to failure and hemodynamics in the finger hang, or performance-related parameters in the lap climbing measurements ( p ≤ 0.05). Conclusions: Forearm compression sleeves did not enhance hand grip strength and endurance, sports climbing performance parameters, physiological responses, or perceptual measures. However, they did result in slightly more pronounced changes of oxy [heme] and StO 2 in the deoxygenation and reoxygenation phases during the hand grip strength and endurance measurements.
... CGs aim to reduce space for swelling, enhance the blood flow and remove waste products post-exercise. However, the concrete mechanisms are not fully understood (Beliard et al., 2015;Hill et al., 2014). ...
... Positive, but non-significant effects of CGs on biomarkers were shown in semi-professional soccer players after friendly soccer matches (Marques-Jimenez et al., 2018). Two recent metaanalyses (Hill et al., 2014;Marques-Jimenez et al., 2016) demonstrated small to moderate effects on DOMS and muscle strength. Despite these findings, it should be noted that many of the included trials lack sufficient sample size and methodical strength. ...
Article
Full-text available
Strategies to improve recovery are widely used among soccer players at both amateur and professional levels. Sometimes, however, recovery strategies are ineffective, improperly timed or even harmful to players. This highlights the need to educate practitioners and athletes about the scientific evidence of recovery strategies as well as to provide practical approaches to address this issue. Therefore, recent surveys among soccer athletes and practitioners were reviewed to identify the recovery modalities currently in use. Each strategy was then outlined with its rationale, its physiological mechanisms and the scientific evidence followed by practical approaches to implement the modality. For each intervention, practical and particularly low-effort strategies are provided to ensure that practitioners at all levels are able to implement them. We identified numerous interventions regularly used in soccer, i.e., sleep, rehydration, nutrition, psychological recovery, active recovery, foam-rolling/massage, stretching, cold-water immersion, and compression garments. Nutrition and rehydration were classified with the best evidence, while cold-water immersion, compression garments, foam-rolling/massage and sleep were rated with moderate evidence to enhance recovery. The remaining strategies (active recovery, psychological recovery, stretching) should be applied on an individual basis due to weak evidence observed. Finally, a guide is provided, helping practitioners to decide which intervention to implement. Here, practitioners should rely on the evidence, but also on their own experience and preference of the players.
... [7,8]. 예 를 들면, 압축의복 착용의 회복 효과는 고강도 운동 후 지연성근통증(delayed onset muscle soreness)을 감 소시키고 [9], 근피로(muscle fatigue)를 줄이는 것으로 보고되었으며 [10], 근육 손상으로부터 회복을 증진하는 데 효과적이라고 밝혀졌다 [9]. 또한, 압축의복 착용의 운 동능력 향상 효과는 카운터 무브먼트(counter movement jump) 점프에서 수직 점프 높이를 증가시키고 [11], 사이 클 에르고미터 운동(cycle ergometer exercise) 중 무 산소성 파워를 높이는 것으로 보고되었으며 [12] ...
... [7,8]. 예 를 들면, 압축의복 착용의 회복 효과는 고강도 운동 후 지연성근통증(delayed onset muscle soreness)을 감 소시키고 [9], 근피로(muscle fatigue)를 줄이는 것으로 보고되었으며 [10], 근육 손상으로부터 회복을 증진하는 데 효과적이라고 밝혀졌다 [9]. 또한, 압축의복 착용의 운 동능력 향상 효과는 카운터 무브먼트(counter movement jump) 점프에서 수직 점프 높이를 증가시키고 [11], 사이 클 에르고미터 운동(cycle ergometer exercise) 중 무 산소성 파워를 높이는 것으로 보고되었으며 [12] ...
Article
Full-text available
The physical benefits of wearing compression garments vary, but the effect of compression garment fabrics on lower extremity muscle contraction properties is unknown. The purpose of this study was to determine this effect and to reveal the interaction effect between the compression garments fabrics and the lower extremity muscles. Sixteen young men took part in this experiment. Participants wore compression garments composed of four fabrics of the same size in random order. Six lower extremity muscles were measured using a tensiomyography (TMG), and five muscle contraction properties were collected. There was a significant difference in the muscle contraction properties of each of the lower extremity muscles (p < .05), but there was no significant difference in lower extremity muscle contraction properties based on variations in the compression garment fabrics (p > .05). In addition, there was no interaction between the compression garment fabrics and the lower extremity muscles (p > .05). In conclusion, a variation in the compression garment fabrics of the same compression intensity did not directly affect the muscle contraction properties. Therefore, it is necessary to consider various other settings, such as the design and intensity of compression garments in future studies.
... Practitioners should focus on the recovery and restitution of muscle damage and mechanical stress in the days post-strenuous training in preparation for performance. Utilising recovery methods that focus on the resolution of muscle function and soreness, such as cold water immersion, compression garments, and the application of garments fitted with cooled phase change material is advised, (Leeder et al., 2012;Hill et al., 2014;Clifford et al., 2018;Kwiecien et al., 2018;. Though further investigation is needed on the efficacy of various modalities in elite athletes (Barnett, 2006). ...
Article
Full-text available
Aim: To profile the etiology and recovery time-course of neuromuscular function in response to a mixed-content, standard training week in professional academy soccer players. We concurrently examined physical performance, cognitive function, and perceptual measures of mood and wellness states to identify a range of simple tests applied practitioners could use in the field as surrogate measures of neuromuscular function. Methods: Sixteen professional academy soccer players completed a range of neuromuscular, physical, perceptual, mood, and cognitive function tests at baseline and after a strenuous training day (pitch and gym), with retest at 24, 48, and 72 h, and further pitch and gym sessions after 48 h post-baseline. Maximal voluntary contraction force (MVC) and twitch responses to electrical stimulation (femoral nerve) during isometric knee-extensor contractions and at rest were measured to assess central nervous system (voluntary activation, VA) and muscle contractile (potentiated twitch force, Q tw,pot ) function. Results: Strenuous training elicited decrements in MVC force post-session (−11%, p = 0.001) that remained unresolved at 72 h (−6%, p = 0.03). Voluntary activation (motor nerve stimulation) was reduced immediately post-training only (−4%, p = 0.03). No change in muscle contractile function (Q tw,pot ) was observed post-training, though was reduced at 24 h (−13%, p = 0.01), and had not fully recovered 72 h after (−9%, p = 0.03). Perceptions of wellness were impaired post-training, and recovered by 24 h (sleepiness, energy) and 48 h (fatigue, muscle soreness, readiness to train). Countermovement jump performance declined at 24 h, while RSI (Reactive Strength Index) decrements persisted at 48 h. No changes were evident in adductor squeeze, mood, or cognitive function. Conclusion: Elite youth soccer training elicits substantial decrements in neuromuscular function, which are still present 72 h post-strenuous exercise. Though central processes contribute to post-exercise neuromuscular alterations, the magnitude and prolonged presence of impairments in contractile function indicates it is the restitution of muscular function (peripheral mechanisms) that explains recovery from strenuous training in academy soccer players.
... The increased focus on athlete recovery within professional sport has naturally been followed by many scientific investigations attempting to understand the efficacy of a range of commonly performed strategies (Howatson and van Someren, 2008;. However, few studies have been able to demonstrate the efficacy of strategies improving recovery in athletes following training or competition (Bieuzen et al., 2013;Hill et al., 2014;Davis et al., 2020). ...
... The increased focus on athlete recovery within professional sport has naturally been followed by many scientific investigations attempting to understand the efficacy of a range of commonly performed strategies (Howatson and van Someren, 2008;. However, few studies have been able to demonstrate the efficacy of strategies improving recovery in athletes following training or competition (Bieuzen et al., 2013;Hill et al., 2014;Davis et al., 2020). ...
Article
Full-text available
Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.
Article
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The low oxidative demand and muscular adaptations accompanying eccentric exercise hold benefits for both healthy and clinical populations. Compression garments have been suggested to reduce muscle damage and maintain muscle function. This study investigated whether compression garments could benefit metabolic recovery from eccentric exercise. Following 30-min of downhill walking participants wore compression garments on one leg (COMP), the other leg was used as an internal, untreated control (CONT). The muscle metabolites phosphomonoester (PME), phosphodiester (PDE), phosphocreatine (PCr), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were evaluated at baseline, 1-h and 48-h after eccentric exercise using 31P-magnetic resonance spectroscopy. Subjective reports of muscle soreness were recorded at all time points. The pressure of the garment against the thigh was assessed at 1-h and 48-h following exercise. There was a significant increase in perceived muscle soreness from baseline in both the control (CONT) and compression (COMP) leg at 1-h and 48-h following eccentric exercise (p < 0.05). Relative to baseline, both CONT and COMP showed reduced pH at 1-h (p < 0.05). There was no difference between CONT and COMP pH at 1-h. COMP legs exhibited significantly (p < 0.05) elevated skeletal muscle PDE 1-h following exercise. There was no significant change in PCr/Pi, Mg2+ or PME at any time point or between CONT and COMP legs. Eccentric exercise causes disruption of pH control in skeletal muscle but does not cause disruption to cellular control of free energy. Compression garments may alter potential indices of the repair processes accompanying structural damage to the skeletal muscle following eccentric exercise allowing a faster cellular repair.
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The aim of this investigation was to elucidate the efficacy of repeated cold water immersions (CWI) in the recovery of exercise induced muscle damage. A randomised group consisting of eighteen males, mean ± s age, height and body mass were 24 ± 5 years, 1.82 ± 0.06 m and 85.7 ± 16.6 kg respectively, completed a bout of 100 drop jumps. Following the bout of damaging exercise, participants were randomly but equally assigned to either a 12 min CWI (15 ± 1 °C; n = 9) group who experienced immersions immediately post-exercise and every 24 h thereafter for the following 3 days, or a control group (no treatment; n = 9). Maximal voluntary contraction (MVC) of the knee extensors, creatine kinase activity (CK), muscle soreness (DOMS), range of motion (ROM) and limb girth were measured pre-exercise and then for the following 96 h at 24 h increments. In addition MVC was also recorded immediately post-exercise. Significant time effects were seen for MVC, CK, DOMS and limb girth (p < 0.05) indicating muscle damage was evident, however there was no group effect or interaction observed showing that CWI did not attenuate any of the dependent variables (p > 0.05). These results suggest that repeated CWI do not enhance recovery from a bout of damaging eccentric contractions. Key pointsCryotherapy, particularly cold water immersions are one of the most common interventions used in order to enhance recovery post-exercise.There is little empirical evidence demonstrating benefits from cold water immersions. Research evidence is equivocal, probably due to methodological inconsistencies.Our results show that the cryotherapy administered did not attenuate any markers of EIMD or enhance the recovery of function.We conclude that repeated cold water immersions are ineffective in the recovery from heavy plyometric exercise and suggest athletes and coaches should use caution before using this intervention as a recovery strategy.
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Objectives: The purpose of this study was to investigate the physiological and psychological effects of massage on delayed onset muscle soreness (DOMS). Methods: Eighteen volunteers were randomly assigned to either a massage or control group. DOMS was induced with six sets of eight maximal eccentric contractions of the right hamstring, which were followed 2 h later by 20 min of massage or sham massage (control). Peak torque and mood were assessed at 2, 6, 24, and 48 h postexercise. Range of motion (ROM) and intensity and unpleasantness of soreness were assessed at 6, 24, and 48 h postexercise. Neutrophil count was assessed at 6 and 24 h postexercise. Results: A two factor ANOVA (treatment v time) with repeated measures on the second factor showed no significant treatment differences for peak torque, ROM, neutrophils, unpleasantness of soreness, and mood (p > 0.05). The intensity of soreness, however, was significantly lower in the massage group relative to the control group at 48 h postexercise (p < 0.05). Conclusions: Massage administered 2 h after exercise induced muscle injury did not improve hamstring function but did reduce the intensity of soreness 48 h after muscle insult.
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Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement-a reporting guideline published in 1999-there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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Delayed onset muscle soreness (DOMS) is a sensation of discomfort that occurs 1 to 2 days after exercise. The soreness has been reported to be most evident at the muscle/tendon junction initially, and then spreading throughout the muscle. The muscle activity which causes the most soreness and injury to the muscle is eccentric activity. The injury to the muscle has been well described but the mechanism underlying the injury is not fully understood. Some recent studies have focused on the role of the cytoskeleton and its contribution to the sarcomere injury. Although little has been confirmed regarding the mechanisms involved in the production of delayed muscle soreness, it has been suggested that the soreness may occur as a result of mechanical factors or it may be biochemical in nature. To date, there appears to be no relationship between the development of soreness and the loss of muscle strength, in that the timing of the two events is different. Loss of muscle force has been observed immediately after the exercise. However, by collecting data at more frequent intervals a second loss of force has been reported in mice 1 to 3 days post-exercise. Future studies with humans may find this second loss of force to be related to DOMS. The role of inflammation during exercise-induced muscle injury has not been clearly defined. It is possible that the inflammatory response may be responsible for initiating, amplifying, and/or resolving skeletal muscle injury. Evidence from the literature of the involvement of cytokines, complement, neutrophils, monocytes and macrophages in the acute phase response are presented in this review. Clinically, DOMS is a common but self-limiting condition that usually requires no treatment. Most exercise enthusiasts are familiar with its symptoms. However, where a muscle has been immobilised or debilitated, it is not known how that muscle will respond to exercise, especially eccentric activity.