international journal of physiotherapy and research, int j physiother res 2014… · 2019. 12....

Int J Physiother Res 2014;2(6):799-05. ISSN 2321-1822 799

Original Article

Warin Krityakiarana *, Jariya Budworn, Chatchawan Khajohnanan, NutchanadSuramas, Watcharaporn Puritasang.Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Ongkharak,Thailand.

Objective: To investigate the effects of ice bag, dynamic stretching, combined ice and dynamic stretching, andcontrol (non-treated) on the prevention and treatment of delayed onset muscle soreness (DOMS) in bicepsmuscle.Subjects: Fifty-five participants (aged 18 to 25 years) were engaged in this study and randomly assigned intofour groups (control group (non-treated) (CG), n = 13; ice bag, n = 14; dynamic stretching, n = 14; and combinedtreatment, n = 14).Method: Before inducing DOMS, the range of motion (ROM) and maximum voluntary contraction (MVC) weremeasured. The dynamic stretching was performed before inducing DOMS. Subjects performed biceps eccentricexercise at 110% of the predicted one-repetition maximum (1-RM), for each subject, to induce muscle soreness.Pain, ROM and MVC were assessed at 0, 24, 48, 72, and 96 hours after induction of DOMS.Results: These non-significant results for mode of treatment and time interaction showed that combinedtreatment, ice bag, or dynamic stretching alone is not effective at significantly reducing the symptoms of DOMS.Conclusion: These results are non-significant, the pattern of the data showed that the combined treatment maybe contraindicated in the prevention of DOMS and ice bag or dynamic stretching might be the best choice oftreatment. Further investigation is strongly recommended.KEYWORDS: Physical therapy, Exercise, Pain, Muscle Soreness, Range of Motion.

ABSTRACT

INTRODUCTION

Address for correspondence: Dr. Warin Krityakiarana, PhD, PT. Division of Physical Therapy, Facultyof Health Science, Srinakharinwirot University, Ongkharak, Nakhon-Nayok, 26120. Thailand. Phone:(+66) 02649 5447-9 ext 234, Fax: (+66) 02649 5450 E-Mail: [email protected]

International Journal of Physiotherapy and Research,Int J Physiother Res 2014, Vol 2(6):799-05. ISSN 2321-1822

DOI: 10.16965/ijpr.2014.696

EFFECT OF ICE BAG, DYNAMIC STRETCHING AND COMBINEDTREATMENTS ON THE PREVENTION AND TREATMENT OF DELAYONSET MUSCLE SORENESS

Delayed onset muscle soreness (DOMS) is aphenomenon that arises from physical exertionand described as unpleasant sensation or painafter unaccustomed strenuous exercise. Sportsmedicine professionals use various forms of coldapplication and stretching on a daily basis toprevent and treat DOMS. The onset of DOMSoccurs 8 to 24 hours post-exercise. It is essen-

tial that these clinicians know about thephysiologic effects of cold and stretching inorder to provide the most appropriateapplication protocols for athletes. Thephysiologic effects of cryotherapy are decreasesin metabolism, inflammation, pain, and musclespasm1. Cold decreases the responsiveness ofthe neuromuscular system, including nerveconduction velocity and specific reflex activity2.

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International Journal of Physiotherapy and ResearchISSN 2321- 1822

www.ijmhr.org/ijpr.htmlAccepted : 17-11-2014Published (O): 11-12-2014Published (P): 11-12-2014

Received: 04-11-2014Peer Review: 04-11-2014Revised: NoneDOI: 10.16965/ijpr.2014.696

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Warin Krityakiarana. et al. EFFECT OF ICE BAG, DYNAMIC STRETCHING AND COMBINED TREATMENTS ON THE PREVENTION ANDTREATMENT OF DELAY ONSET MUSCLE SORENESS.

Bags of crushed ice are commonly used in thefield of sports because they are inexpensive andreadily available. Moreover, ice can cool moreeffectively than other cold modalities, such aschemical cold packs. Ice bag application provideslonger decreases in muscle temperature thanice massage3,4. The depth of cold penetrationincreases when compression is applied togetherwith the cold modality. Stretching exercises areregularly included in warm –up and cooling-downexercises. Several authors have suggested thatstretching has a beneficial effects on injuryprevention, improve muscle flexibility andenhance physical performance5. Dynamicstretching involves moving the limb from itsneutral position to its end range, where themuscles are at their greatest length, and thenmoving the limb back to its original position. Thisdynamic action is carried out in a smooth,controlled manner and is repeated for aspecified time period. Dynamic stretching hasbeen recommended as an alternative to staticstretching post-warm-up, as evidence suggeststhat dynamic stretching positively impacts onimmediate physical performance5, 6. The purposeof this study was to compare the effects of icebags, dynamic stretching, and combined ice bagand dynamic stretching on the prevention andtreatment of DOMS.

METHODS

Fifty-five participants aged between 18 to 25years were engaged in this study and wererandomly assigned into four groups (controlgroup (non-treated) (CG), n = 13; ice bag,n = 14; dynamic stretching, n = 14; andcombined treatment, n = 14). The subjects werehealthy female students (right handed), with-out musculoskeletal problems, from Srinakharinwirot University. General data of the subjectsare presented in Table 1. All subjects wereinformed about the purpose of the study, test-ing procedure, and instructions and signed theconsent form. We instructed all subjects not tostretch, massage, or engage in any other treat-ment or therapy and to abstain from taking anymedication during the study. Ethical approval forthe protocol was obtained from SrinakharinwirotUniversity Ethics Committee prior to the study.

Table 1: Means and standard deviations of weight,height, body mass index (BMI), age, biceps skin fold,triceps skin fold, and arm circumference (p = 0.200).

We randomly assigned subjects to each of thetreatment groups and control. The dependentvariables measured were pain (detected byvisual analogue scale, VAS), range of motion(ROM), and strength (maximum voluntarycontraction, MVC). Our 5x4 factorial designallowed the statistical analysis of time(5 periods), the main effect of intervention(4 groups), and the interaction between timesand treatments. (Figure 1)

Fig. 1: Study procedure. Dependent variables weremeasured for subjects and they were randomly

divided into four groups (control non-treated, ice bag,dynamic stretching, and combined treatments).

Pre-DOMS-induction measurementsThe predicted one-repetition maximum (1-RM)was presented by ACSM in 20007, 8. We evaluatedthe predicted 1-RM for left biceps muscles for



each subject using dumbbells to determine theappropriate weight. The predicted 1-RM valuewas used to determine the amount of weight tolift to induce DOMS. We measured the MVC andactive ROM by standard goniometer. For ROMmeasurement, the pivot of the equipment wasover the lateral epicondyle. The stationary armwas aligned with the lateral midline of thehumerus, and the movable arm was aligned withthe radius. The neutral position was set at 180o

(arm straight). The total difference in ROM wascalculated from the degrees of full flexion andextension.A handheld dynamometer was used to detectthe MVC of biceps muscle. Each subject sat withthe forearm on the arm supported in a supineposition (elbow flexion at 90o). The dynamometerwas placed perpendicular to the wrist. The MVCwas detected twice and the best amount wasused. Pain or soreness was determined by thestandard VAS method (by 10 cm line).Induction of DOMSThe induction was adapted from Paddon-Jonesand Quigley (1997)9 (1). The non-dominant armwas selected for this study. The biceps muscleexercise (eccentric exercise) was performed byusing 110% of predicted 1-RM weight. Thesubject held the 110% of predicted 1-RM weightin the full flexion position and let the weightdrop slowly until full extension within 3 seconds(using a metronome). We helped the subject tohold the weight while moving back to full flexion(passive full support), and then the eccentricexercise was repeated eight times per set. Atotal of eight sets were used in this inductionprotocol (with 30 seconds’ rest between thesets).Dynamic stretchingDynamic stretching was achieved before theinduction of DOMS in the dynamic stretchinggroup and combined treatment group. Thismethod was modified from Brandy et al. (1998)8.Each subject was instructed to actively swingthe forearm to be stretched backward while theshoulder was moved to extension until a stretchwas felt in the biceps muscle. The forearm wasthen allowed to swing back into shoulder flexion.This was repeated six times per set. A total ofthree sets were performed in this study (with

one minute’s rest between the sets).Ice bagThe ice bag comprised crushed ice in a plasticbag and was applied with polyethylene wrap ontop of the biceps muscle. It was applied in theice bag group and combined treatments groupfor 20 minutes immediately after DOMSinduction.Post-DOMS-induction measurementsAfter inducing DOMS, measurements ofstrength, ROM, and perceived pain were acquiredfollowing the same protocol as for pre-DOMS-induction. Post-DOMS-induction measurementsfor all variables were performed at 0(immediately after inducing DOMS), 24, 48, 72and 96 hours after inducing DOMS. Moreover,the strength was measured at two time points(before inducing DOMS and 96 hours afterinducing DOMS).Data analysisTwo-way mix model ANOVA was used to studyand compare different among treatment groups.Statisical significance was considered at the pd”0.05 level. Where applicable, Tukey post hocprocedures were utilized to identify significantdifferences for these data.

RESULTSThe subjects in this study were femaleundergraduate students aged 18–25 years(22.07 ± 1.13) (p = 0.2). The purpose of this studywas to investigate the effects of ice bag,dynamic stretching, and combined treatments(ice bag and dynamic stretching) for preventionand treatment of DOMS. We found that thetreatment or time interactions showed nosignificant differences (p > 0.05). Interestinglyenough, the ice bag and combined treatmentgroups showed a tendency towards decreasedROM when compared to the control and dynamicstretching groups, respectively (Figure 2). Thegreatest decrease in ROM was presented at 48hours after inducing DOMS in every group (Table2). The pain perception results showed that thedynamic stretching group had the lowestperceived pain and the ice bag treatment grouphad the highest perceived pain in the bicepsmuscle (at 0 hours after inducing DOMS)(Figure 3A). Perceived pain was highest at 24



and 48 hours after induced DOMS in every group(Table 3). Fascinatingly, the dynamic stretchinggroup presented the smallest percentagedifference (102.80%) at 96 hours after inducingDOMS compared to 0 hours after inducing DOMS(Figure 3B). This percentage difference from themeasurement at 0 hours after inducing DOMSwas also used for comparing the effects oftreatment. We found that the control groupshowed the best recovery with regard to painperception.Fig. 2: Change in active range of motion (ROM) with re-spect to treatment groups (control non-treated, ice bag,dynamic stretching, and combined treatments) at differ-ent time points (0, 24, 48, 72, and 96 hours) after induc-ing DOMS.

Fig. 3: Change in visual analogue scale (VAS) withrespect to treatment groups (control non-treated, ice bag,dynamic stretching, and combined treatments) atdifferent time points (0, 24, 48, 72, and 96 hours) afterinducing DOMS (A). Percentage difference in VAS betweenpre-DOMS-induction and post-DOMS-induction at 96hours; the dynamic stretching group showed thesmallest percentage difference in pain perception whencompared to the other groups (B).

Table 3: Means and standard deviations of visual ana-logue scale (VAS) of biceps muscle at 5 different timepoints (immediately after induced DOMS, 0; 24 hoursafter induced DOMS, 24; 48 hours after induced DOMS,48; 72 hours after induced DOMS, 72 and 96 hours afterinduced DOMS, 96). The results showed non-significantdifferent among all groups (p > 0.05).

The strength of the biceps muscle was detectedby maximum voluntary contraction (MVC) andcompared between pre-induction of DOMS and96 hours after inducing DOMS (Table 4). We

Table 2: Means and standard deviations of active rangeof motion (ROM) of elbow movement at 6 different timepoints (pre-inducing DOMS, pre; immediately afterinduced DOMS, 0; 24 hours after induced DOMS, 24; 48hours after induced DOMS, 48; 72 hours after inducedDOMS, 72 and 96 hours after induced DOMS, 96. Theresults showed non-significant different among allgroups (p > 0.05).

(A)

(B)


found that the MVC was not significantly differ-ent between each group (Figure 4A). We alsoused the percentage difference in strength forcomparison between pre-induction of DOMS and96 hours after inducing DOMS in each group toshow the effects (Figure 4B). The control groupshowed the best recovery of strength when com-pared to the other groups and the dynamicstretching group showed the worst.Fig. 4: Shows the maximum voluntary contraction (MVC)between pre-DOMS-induction and post-DOMS-inductionat 96 hours (A). The percentage difference in MVCbetween pre-DOMS-induction and post-DOMS-inductionat 96 hours. There were no significant differences amongtreatment groups (combined treatments, dynamicstretching, ice bag, and control-DOMS) (B).

Table 4: Means and standard deviations of maximalvoluntary contraction (MVC) of biceps muscle at 2 timepoints (pre-inducing DOMS, pre and 96 hours afterinduced DOMS, 96). The results showed non-significantdifferent among all groups (p > 0.05).

DISCUSSION

The mechanisms of DOMS after exercise arecontroversial, making information aboutprevention and treatment scarce. Then the studyof mechanisms, treatments, and preventionswas presented in literature resources10-12. Weattempted to present the effects of preventionand treatment of DOMS through the use of icebag, dynamic stretching, and combinedtreatments. We found that there were nosignificant differences in mode of treatment andprevention and time parameters. These findingsare similar to those of previous studies9, 13, 14.Interestingly, the peak in pain perception wasfound to occur between 24 and 48 hours afterinducing DOMS in all groups4-7. The maximumpain perception in the same period showed theconsequences and the effectiveness of theDOMS-inducing programme.Putting the previous information together withour knowledge, it can be stated that cryotherapymust be useful for soft tissue injury. It has beenreported that the mechanisms responsible formuscle adaptation and repair and subsequentrelief from DOMS symptoms may centre onphysiological responses that are adverselyaffected by cold application; however, there isstill controversy concerning the previousresearch results12, 19. In our study, we applied theice bag immediately after inducing DOMS (inboth ice bag and combined treatment groups).Despite these changes, no significantdifferences were found compared to othertechniques and time interactions. Since therewere no significant differences between themodes of treatment, we cannot conclude whichtechnique prevents and treats the DOMS.However, a possible mechanism is theaccumulation of waste products in soft tissueafter induction of DOMS. The effect of immediatevasoconstriction due to cold after inducing DOMSmight interrupt the draining of waste productsin the soft tissue20, 21. Noxious substances arealso released after inducing DOMS, which alsodisrupts the vasoconstriction effect. The noxiousreceptor is stimulated by these substances,which can cause an increase in painperception22.


(B)

(A)


The ROM in each group also showed nosignificant differences in relation to time.Fascinatingly, ice bag and combined treatmentsgroups showed faster recovery (compared to theROM at 0 hours after inducing DOMS) thanothers at 48 hours after DOMS-induction (datanot shown). It might be possible that thecryotherapy affects soft tissue healing duringthe acute phase. Our results correspond withthose of McLean (1989), who found thatimmediate treatment by cryotherapy promotessoft tissue healing better than late treatment23.Maximum voluntary contraction (MVC) wasdetected in each group pre-DOMS-induction and96 hours after inducing DOMS. We found thatthe ice bag group showed higher MVC at 96hours, which is equivalent to the results of painperception. It might be possible that the effectof facilitating the healing process by cryotherapycan assist better recovery of muscle functionafter injury. Interestingly, the combinedtreatments group showed similar effects to theice bag group. Dynamic stretching has beenrecommended as an alternative to staticstretching post-warm-up because of the impacton physical performance5. Our observations fromthe subjects of the dynamic stretching andcombined treatments groups informed us aboutfatigue after finishing the dynamic stretching.An effect of fatigue on force absorption duringmuscle contraction has been reported. Thedecrease in force absorption might increase therisk of injury after exercise and slow down theprocess of healing of soft tissue after injury24.Although these results are not significant, somelimitations are evident. The VAS in this study wasthe data from resting position or non-activity.These may not be the precise data for VAS inthe DOMS condition22. The consistency ofpressure from wrapping in an ice bag in bothice bag and combined treatments groups mighthave affected the results. Moreover, our studywas investigated only one time treatment foreach group after induced DOMS, which differentto the clinical treatments. The repetitivetreatment with cold water has been proved thatdecreased pain after DOMS21, 25. Therefore, theeffects of number of treatment are recommen-ded for further study.

CONCLUSIONThis study provides additional support for theproposition that repeated eccentric exerciseproduces DOMS. The increase in pain percep-tion and decrease in ROM correspondedsimilarly to the aetiology of DOMS. Nosignificant differences were found between thetherapeutic use of ice bag, dynamic stretching,or combined treatments or in relation to timeparameters. The combined treatment may becontraindicated for the prevention of DOMS andice bag or dynamic stretching might be the bestchoice for treatment and prevention.

ACKNOWLEDGMENT(S)

REFERENCES

Conflicts of interest: None

We are deep appreciated to Saitida Lapanantasinfor her suggestion.

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How to cite this article:Warin Krityakiarana, Jariya Budworn, Chatchawan Khajohnanan, NutchanadSuramas, Watcharaporn Puritasang. EFFECT OF ICE BAG, DYNAMICSTRETCHING AND COMBINED TREATMENTS ON THE PREVENTION ANDTREATMENT OF DELAY ONSET MUSCLE SORENESS. Int J Physiother Res2014;2(6):799-805. DOI: 10.16965/ijpr.2014.696

international journal of physiotherapy and research, int j physiother res 2014… · 2019. 12....

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