Effect of Blood Flow Restriction Technique on Delayed Onset Muscle Soreness: A Systematic Review

Physical Therapies for Delayed-Onset Muscle Soreness: An Umbrella and Mapping Systematic Review with Meta-meta-analysis

BACKGROUND

Delayed-onset muscle soreness commonly arises from intense and unaccustomed physical exercise, leading to reduced muscle strength, increased pain and inflammation. A number of systematic reviews evaluating physiotherapeutic treatments for delayed-onset muscle soreness have been published since the 1990s. However, these systematic reviews frequently yield conflicting findings, further impeding clinical practice.

OBJECTIVES

The primary aim of this study was to summarise the effectiveness of physiotherapy interventions in alleviating delayed-onset muscle soreness through an umbrella review. Additionally, we evaluated the risk of bias in systematic reviews, synthesised their findings, and categorised the evidence strength to provide practical insights for clinicians and researchers.

METHODS

An umbrella review with a meta-meta-analysis was conducted. MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro and Epistemonikos were searched from 1998 to February 2024. Systematic reviews of randomised controlled trials of any treatments used post-exercise by physiotherapists to reduce delayed-onset muscle soreness in healthy adults, regardless of their physical activity, were eligible. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to evaluate the methodological quality of the included systematic reviews. Corrected covered areas were calculated to address the overlap of primary trials in the included systematic reviews. An evidence map was created to categorise and visualise the effects of interventions using a multi-dimensional approach, based on the effect size and strength of evidence (Class I-V), i.e. the number of cases, Hedges' g, p-value, heterogeneity, Egger's test and excess of significance bias test.

RESULTS

Twenty-nine systematic reviews with 863 unique randomised controlled trials, addressing 24 distinct physiotherapeutic treatments, met the inclusion criteria. Seventeen systematic reviews were of critically low methodological quality, with only two rated as high quality. The evidence map suggests significant effects in pain reduction immediately post-exercise for contrast therapy (Class II), cooling therapy and cryostimulation (Class IV); 24 h: massage therapy (Class III) and cooling therapy, contrast therapy, electrical stimulation, cryostimulation, phototherapy, heat therapy (Class IV); 48 h: compression, contrast therapy, kinesiotaping and cryostimulation (Class III) and cooling therapy, massage, phototherapy, heat therapy (Class IV); 72 h: kinesiotaping (Class III) and contrast therapy, cooling therapy, massage, phototherapy, vibration (Class IV); 96 h: compression, phototherapy, and contrast therapy (Class IV). The effect sizes (Hedges' g) ranged from 0.36 (95% confidence interval 0.46, 3.18) for cooling therapy to 1.82 (95% confidence interval 0.46, 3.18) for heat therapy indicating small and large effects, respectively.

CONCLUSIONS

There is a large body of evidence from predominantly low-quality systematic reviews of randomised controlled trials evaluating the effectiveness of physiotherapeutic treatments for delayed-onset muscle soreness. There is some strong evidence to support the effectiveness of cooling therapy, cryostimulation, contrast therapy, massage, phototherapy and kinesiotaping at various follow-up intervals, whereas evidence for stretching, exercises and electrical stimulation is weak. Uncertainties, heterogeneity and weaknesses of the available evidence partially limit the applicability and generalisability of the findings.

CLINICAL TRIAL REGISTRATION

PROSPERO registration number CRD42024485501 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024485501 ).

Immediate Effects of High-Intensity Blood Flow Restriction Training on Muscle Performance and Muscle Soreness

Purpose: The aim was to investigate the immediate effects of high-intensity resistance training with blood flow restriction (HIRT-BFR) on rectus femoris (RF) muscle activity, reaction time, muscular performance, and delayed onset muscle soreness (DOMS) in healthy young adults. Methods: Twenty-four healthy young adults were randomized into the HIRT-BFR group or HIRT group. Both groups performed a single session of training with 80% of 1RM, 8 repetitions, 2 sets, and 3 minutes rest to RF muscle. The activity and reaction time of the dominant extremity RF muscle were evaluated by superficial electromyography (sEMG), muscular performance by single-leg squat test, and DOMS by the Visual Analog Scale. Results: Single-leg squat performance was significantly increased in HIRT-BFR (p = .001) and HIRT group (p = .04). Additionally, in HIRT group resting average (p = .03), resting maximal voluntary contraction % (p = .04), and relaxation minimum (p = .02) values of RF were significantly increased. DOMS level decreased significantly in HIRT-BFR (p < .001) and HIRT group (p = .019). The differences were similar in the groups for sEMG parameters, muscle performance, and DOMS level. Conclusion: We observed that HIRT-BFR and HIRT were similar in terms of muscle activation, reaction time, muscular performance of the RF, and DOMS level.Trial registration number: This study is registered at www.clinicaltrails.gov (NCT05274542).

Impact of blood flow restriction intensity on pain perception and muscle recovery post-eccentric exercise

BACKGROUND

Delayed onset muscle soreness (DOMS) is a well-established phenomenon characterized by ultrastructural muscle damage that typically develops following unfamiliar or high-intensity exercise. DOMS manifests with a constellation of symptoms, including muscle tenderness, stiffness, edema, mechanical hyperalgesia, and a reduced range of joint motion. In recent years, the application of blood flow restriction (BFR) has garnered attention for its potential impact on DOMS.

OBJECTIVE

This study aimed to investigate the effects of different BFR intensities on biomechanical alterations induced by DOMS in healthy individuals.

DESIGN AND METHODS

Thirty participants were split into two groups receiving either 80% or 20% BFR applied during low-intensity resistance exercise following DOMS induction. Pain perception, pressure pain threshold, muscle biometric characteristics, and strength were assessed before DOMS, after DOMS, and following BFR application at 24, 48, and 72 h.

RESULTS

The 80% BFR group experienced faster reductions in pain perception compared to the 20% BFR group. Muscle strength recovery was also statistically faster in the 80% BFR group. No significant differences were observed between groups in muscle stiffness, flexibility, or other mechanical properties.

CONCLUSIONS

These findings suggest that BFR, particularly at higher intensities, may alleviate DOMS symptoms and accelerate muscle strength recovery. However, the lack of a control group and limitations in muscle property assessment warrant further research to definitively determine BFR's efficacy in managing DOMS.

Acute physiological and perceptual responses to three blood flow restricted interval exercise protocols: a randomised controlled trial

Blood flow restriction (BFR) may enhance the acute training stimulus of exercise. This study examined acute physiological and perceptual responses to three lower-limb BFR + interval exercise protocols. Twenty-four club/university male athletes (age 25 ± 3.5, V̇O2max 47.0 ± 5.5 mL∙kg∙min- 1) completed four experimental conditions in a randomised crossover manner: (i) high-intensity control (HI) - 100% maximal aerobic power (Wmax); (ii) high-intensity recovery occlusion (HIRO) - 100% Wmax, 80% limb occlusion pressure (LOP) during rest; (iii) moderate-intensity low occlusion (MILO) - 70% Wmax, 50% LOP during exercise; and (iv) moderate-intensity high occlusion (MIHO) - 70% Wmax, 80% LOP during exercise. All interval exercise protocols were three sets of five × 30 s cycling, 30 s unloaded active recovery with 3 min seated rest between sets. During recovery, HIRO condition indicated lower tissue saturation index, higher deoxyhaemoglobin, oxyhaemoglobin and total haemoglobin levels than other conditions (all p < 0.05). HIRO exhibited significantly higher heart rate (HR) from set 2 and blood lactate (bLa) at 5 min post-exercise than other conditions (all p < 0.05). Higher vastus lateralis muscle activity was exhibited on the last exercise repetition of HIRO than HI (p < 0.05). MIHO elicited significantly higher deoxygenation, lower muscle activation but similar HR and bLa than HI during exercise; and higher perceived pain and exertion than other conditions (all p < 0.05). Applying BFR during rest between high-intensity interval exercise sets increases physiological stresses without affecting exercise intensity or perceptual responses; applying BFR during moderate-intensity exercise may increase both physiological and perceptual responses beyond those of high-intensity exercise. Study registration: Clinicaltrials.gov (NCT05835544).

Intensity and volume of physical exercise influence DOMS and skin temperature differently in healthy adults

It remains unclear whether exercises leading to different outcomes of delayed onset muscle soreness (DOMS) may also elicit different skin temperature responses. The aim of this study was to determine whether different intensities and volumes of a single-joint exercise influence the DOMS and skin temperature measurements differently in healthy adults. Thirty-nine men and women were randomly assigned to three groups performing different exercise of different intensities and volumes (Exhaustion, Fatigue, Submaximal) to induce DOMS in the biceps brachii. DOMS (numeric pain rate scale, NPRS), pressure pain threshold (PPT) and skin temperature (infrared thermography, IRT) were measured on exercise day and 48 h later. The different exercises resulted in lower PPT responses 48 h after exercise and different DOMS reported across the different groups. Skin temperature outcomes did not differ following the different protocols. We found an increased minimum skin temperature 48 h after exercise in groups performing more intense exercises, but such differences were found in both exercised and non-exercised arms. Differently of PPT outcomes, pain reported depended on exercise intensity, and skin temperature 48 h after exercise could not show acute exercise adaptations. Skin temperature responses are contingent upon the characteristics of the participants rather than exercise intensity.

The Effects of a Floss Band on Ankle Range of Motion, Balance, and Gait in Chronic Stroke: A Randomized Controlled Study

Background/Objectives: Stroke patients generally have balance and gait dysfunction due to decreased range of motion (ROM) and muscle strength of the ankle joint. A therapist can apply a floss band to enhance ROM, pain control, jump performance, strength, myofascial release, and recovery from fatigue. This study compared the immediate effects of floss band application on ankle ROM, balance, and gait ability in stroke patients. Methods: This study randomized 40 chronic stroke patients to either the floss (n = 20) or sham (n = 20) band group. The intervention consisted of wrapping the ankle with a band (floss and sham). Balance and gait ability were measured using APDM Mobility Lab system equipment. Outcome measures were assessed at baseline and immediately after applying the floss or sham band. Results: There were significant improvements in dorsiflexion (DF), WBLT, static balance, and foot strike in those who used the floss band compared to the sham group (all p < 0.05). Conclusions: The floss band improved ankle DF, balance, and gait, indicating that it is a feasible therapeutic method for improving ankle DF, balance, and gait in chronic stroke patients.

Tissue Flossing: A Commentary on Clinical Practice Recommendations

Tissue flossing is an emerging myofascial intervention used by sports medicine professionals with a growing body of research evidence. Sports medicine professionals may use tissue flossing to increase myofascial mobility, improve joint ROM, enhance athletic performance, and reduce pain. Despite the increasing use, there is no consensus on clinical practice recommendations for this intervention. The purpose of this commentary is to discuss proposed clinical practice recommendations for tissue flossing and to encourage sports medicine professionals and researchers to contribute their expertise to further develop best practices.

Level of Evidence

5.

Effect of Floss Band on Anaerobic Exercise and Muscle Tissue Oxygenation

CONTEXT

Flossing is still a relatively new technique that has yielded varied results in the research literature; therefore, it requires further investigation. Previous research has shown that thigh tissue flossing might improve performance in countermovement jump, sprint time, maximum voluntary contraction, and rate of force development.

DESIGN

The present study aims to investigate the effect of the floss band on performance during the Wingate test (30-WAT), muscle oxygen saturation (SpO2), and total hemoglobin in vastus lateralis.

METHODS

Twenty-two students of physical education and sport (11 men and 11 women) were randomly selected to complete either the Wingate test with the application of a floss band in warm-up or the Wingate test without the use of a floss band, followed by the alternative 24 hours apart.

RESULTS

Throughout the testing, the floss band did not affect performance values during the Wingate test (relative peak power, relative average power, and fatigue index). However, there was a medium to large effect difference during 1 minute prior to 30-WAT (PRE), during the 30-WAT, and 10-minute recovery (REC) in values of SpO2 and total hemoglobin. Use of floss band displayed a higher SpO2 during PRE, 30-WAT, and REC by ∼13.55%, d < 2; ∼19.06%, d = 0.89; and ∼8.55%, d = 0.59, respectively.

CONCLUSION

Collectively, these findings indicate that the application of thigh flossing during warm-up has no effect on 30-WAT performance; however, SpO2 was significantly increased in all stages of testing. This could lead to potential improvement in repeated anaerobic exercise due to increased blood flow. Increased muscle oxygen saturation can also lead to improved tissue healing as oxygen supply is essential for tissue repair, wound healing, and pain management.