|ORIGINAL RESEARCH REPORT
|Year : 2016 | Volume
| Issue : 2 | Page : 77-81
A comparative study of the effects of infrared radiation and warm-up exercises in the management of DOMS
Ayoola I Aiyegbusi1, Adebimpe J Aturu2, Adegoke M Akinfeleye1
1 Department of Physiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Anatomy, Lagos University Teaching Hospital, Lagos, Nigeria
|Date of Web Publication||4-Apr-2016|
Ayoola I Aiyegbusi
Department of Physiotherapy, College of Medicine, University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Introduction: Delayed onset muscle soreness (DOMS) is associated with temporary morbidity as a result of pain, soreness, and reduced muscular performance that affects the overall performance of the individual. Several interventional modalities have been studied without a conclusive evidence of efficacy. Objective: This study was carried out as part of a continuous attempt to find an effective and quick relief for DOMS. The study investigated the comparative effects of warm-up exercises and infrared radiation in ameliorating the symptoms associated with DOMS. Materials and Methods: Sixty volunteer subjects between the age of 16 years and 35 years had DOMS induced in the left biceps brachii muscle. They were randomized into three groups with 20 subjects in each group. The groups were allocated as follows: Group A as control that received no treatment, Group B had a bout of warm-up exercises consisting of 10 sets of maximal elbow flexion and extension after which DOMS was experimentally induced, and Group C had infrared radiation for 20 min after which DOMS was experimentally induced. Assessment for muscle soreness, pain, and joint range of motion (ROM) was carried out immediately after inducing DOMS and it was repeated 24 h and 48 h later using the Numerical Pain Rating Scale (NPRS), deep palpation (DP), and goniometry, respectively. Results: The infrared group (Group C) had significantly lower scores on NPRS and DP throughout the 3 days compared with the control while the significant effects of warm-up exercises were seen from day 2. There was, however, no significant difference (P > 0.05) in the range of movement (ROM) scores. Compared with warm-up exercises (Group B), infrared resulted in significantly lower NPRS and DP scores and greater ROM only on day 1. Conclusion: Infrared radiation (IRR) is effective in ameliorating the symptoms of DOMS immediately after treatment on day 1 while the effect of warm-up exercises is seen 24 h later. IRR, thus, has a better effect than warm-up exercises in ameliorating the symptoms associated with DOMS.
Keywords: Delayed onset muscle soreness, infrared radiation, warm-up exercises
|How to cite this article:|
Aiyegbusi AI, Aturu AJ, Akinfeleye AM. A comparative study of the effects of infrared radiation and warm-up exercises in the management of DOMS. J Clin Sci 2016;13:77-81
|How to cite this URL:|
Aiyegbusi AI, Aturu AJ, Akinfeleye AM. A comparative study of the effects of infrared radiation and warm-up exercises in the management of DOMS. J Clin Sci [serial online] 2016 [cited 2019 May 27];13:77-81. Available from: http://www.jcsjournal.org/text.asp?2016/13/2/77/179681
| Introduction|| |
Delayed onset muscle soreness (DOMS) is the perception of pain and discomfort in muscles following an exercise regime that involves increased intensity, longer duration, unfamiliar movements, or eccentric muscular work. It is commonly experienced by anyone who has undergone unaccustomed exercises and suffered from exercise-induced muscle damage (EIMD).  It is typically experienced by all individuals regardless of their fitness level and is a normal physiological response to increased exertion and introduction of unfamiliar physical activities.  DOMS, which occurs 48-72 h after activity, is more common following eccentric contraction due to the significantly greater force produced. ,, In addition to pain, DOMS is associated with loss of strength, loss of motion, and swelling of the involved musculature. , According to Clarkson and Sayers,  immediately after exercise, there is up to 60% loss in muscle strength that could persist for 10 days. The pain and discomfort associated with DOMS generally peaks 24-48 h following the activity and resolves itself within 3-7 days without any special treatment. , In the bid to find effective and quick relief for DOMS, many treatment modalities have been investigated without a conclusive result.  These include cryotherapy, repeat bout exercise, preventive training, anti-inflammatory medications, and electrotherapeutic modalities such as electrical stimulation and therapeutic ultrasound. , A prior study on the effects of ice massage on the signs and symptoms associated with EIMD showed that it had no effect on the symptoms of DOMS.  Also, a study by Brock et al., (2004)  on the effect of ultrasound-induced increase muscle temperature on the symptoms of DOMS failed to provide significant prophylactic effects. Warm-up exercises have been advocated to improve athletes' performance and reduce muscle injury.  These are gentle exercises preceding vigorous physical activity and are believed to reduce muscle strain injuries by increasing muscle temperature and hence, muscle compliance.  Warm-up could be either active or passive. Passive warm-up occurs when the muscles are warmed by means of external heating such as direct heat application (heat packs) or in the form of therapeutic ultrasound while active warm-up refers to a warm-up of the muscles by active contraction. This could be in the form of a jog or any other exercise where the muscles to be stretched are repeatedly contracted prior to stretching. 
Several studies have reported that concentric warm-up before eccentric exercises prepare the body for the stress caused by overloading the muscles with eccentric activity.  Stretching is generally the first activity in the warm-up whether it is static, ballistic, or proprioceptive neuromuscular facilitation (PNF).  However, previous studies have reported the ineffectiveness of stretching exercises in preventing DOMS and that these exercises could actually compromise performance and increase the rate of injury. ,, On the other hand, a number of studies have been carried out on the effect of warm-up exercises in the management of DOMS but there are conflicting reports of its efficacy in ameliorating the symptoms associated with it.
Infrared radiation has been shown to be effective in the treatment of muscle or joint pain including muscle spasm and stiffness. It has been reported to speed up the healing process in musculoskeletal injuries by increasing microcirculation through the release of nitrous oxide from hemoglobin.  However, its efficacy as a treatment modality in the management of symptoms associated with DOMS has not been thoroughly investigated; the few studies in this area have given conflicting results on the efficacy. Glasgow et al., (2001)  for instance, reported on the results of a randomized controlled clinical trial of low-level infrared therapy in 24 subjects with experimentally induced muscle soreness and found no significant differences between the treatment and placebo groups. In the study, infrared radiation (IRR) was administered for consecutive 5 days following the inducement of DOMS.
Though the effect of DOMS is associated with only temporary morbidity as a result of pain, soreness, and reduced muscular performance, it affects the overall performance of the person who is affected. It also increases the risk of injury,  thereby preventing or reducing the symptoms resulting from DOMS will be a welcome relief to all. This study aims to evaluate the comparative effectiveness of warm-up exercises and infrared in the relief of the associated symptoms.
| Materials and methods|| |
The subjects for this study were 60 nonathlete volunteers between the ages of 16 years and 35 years with no prior history of musculoskeletal injury that could interfere with the results. They were recruited from the students' population of the College of Medicine, University of Lagos, Lagos, Yoruba State, Nigeria.
A short oral interview was conducted to ascertain that the subjects were neither athletes nor participating in any sports activity or regular routine exercise at the time of study. The subjects who did not meet the criteria were excluded from the study.
The purpose and procedure of the study were explicitly communicated to the subjects and their consent was sought and obtained. The ethical approval was sought and obtained from the Research and Ethical Committee of the College of Medicine, University of Lagos.
A Phillips 150 W bulb infrared lamp (Delhi, India), made in India, a calibrated goniometer (baseline 12-inch plastic 360° ISOM/STFR goniometer made by Prohealthcare in Lehi, Utah, USA), a 5 kg dumbbell, and a calibrated line for Numerical Pain Rating Scale (NPRS) were used for this study.
A measurement of the muscle girth of both the right and left biceps was taken to ensure no appreciable difference between the two. The subjects were then instructed not to take any oral analgesic or use any topical analgesic, energy boosting drug, dietary supplement, or perform any sports or unusual exercise during the experimental period.
The subjects were randomly assigned to three groups by using computer-generated numbers with 20 subjects in each group. DOMS was experimentally induced in the left biceps of all 60 subjects by 100 maximal elbow flexion and extension while lifting the 5 kg dumbbell in 10 sets of 10 lifts each with 3 s rest interval after each set.
Group A (control) had DOMS that was experimentally induced on day 1. The subjects were immediately tested for muscle soreness and pain and the joint range of motion (ROM) in order to get the baseline readings. The assessment was repeated 24 h and 48 h later.
Group B had a bout of warm-up exercises consisting of 10 sets of maximal elbow flexion and extension after which DOMS was experimentally induced. Assessment for muscle soreness, pain, and joint ROM was carried out and repeated 24 h and 48 h later.
Group C had DOMS that was experimentally induced after which the subjects were tested for muscle soreness, pain, and joint ROM. This was followed immediately by the application of infrared radiation therapy for 20 min followed by a repetition of the assessments. The subjects had the biceps muscle irradiated for 20 min with the infrared lamp positioned at a distance of 45 cm (18 in) and well-focused on the muscle. The assessment was repeated 24 h and 48 h later. Muscle soreness was measured using NPRS and digital palpation.
Digital pressure was applied with the tip of the fingers against the deep tissues for 3 s. The subject was then asked to assess the discomfort felt and classify it as no pain, mild, moderate, or severe pain that were graded as 0, 1, 2, and 3, respectively.
The NPRS represented by a calibrated line from 0 (no pain) to 10 (greatest pain) was also shown to the subjects and they were asked to rate the pain they felt on maximum flexion and extension of the elbow joint and with activities of daily living (ADL). The subjects were given a standard description of ADL that included brushing of teeth, opening of a bottle, driving a car, or opening doors. 
Elbow ROM was measured using a standard plastic goniometer with the subjects in a standing position. The axis of the goniometer was placed over the lateral epicondyle of the elbow. The stationary arm of the goniometer was placed in line with the long axis of the humerus pointed at the acromion process. The movable arm of the goniometer was placed in line with the long axis of the forearm. The placement locations of the goniometer axis, movement arm, and stationary arm were marked with ink for consistency throughout the trials. The relaxed angle measurement on the goniometer was read before the subject was asked to flex the elbow fully in order to measure the range of movement.
The data were summarized in mean (rank) and standard deviation (SD). All the outcome measures in this study did not meet the assumptions for a parametric test and thus, nonparametric statistical test was employed. Friedman test was employed to test changes in the outcome measures between day 1 and day 3 in each of the groups. Kruskal-Wallis test was used to compare the differences in the means between the groups for all outcome measures. Wilcoxin signed-rank test and Tukey's honest significant differences (HSD) post hoc analysis was performed for significant difference tests to identify where the true differences lay. The level of significance was set at 0.05.
| Results|| |
In the control group, there was no significant difference (P > 0.05) in the numeric rating scale (NRS) and deep palpation (DP) scores though the ROM increased significantly (P < 0.05) over the 3 days [Table 1].
On [Table 2], subjects in the infrared group had a significant (P < 0.05) increase in the DP scores and ROM between day 1 and day 2 and day 1 and day 3 though the differences between day 2 and day 3 were quite marginal. The NRS increased significantly (P < 0.05) only between day 1 and day 2.
|Table 2: Days 1-3: Changes in NPRS, DP, and ROM means in the warm-up group|
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For the subjects who had warm-up exercises, DP decreased significantly on day 2 only to increase again significantly (P < 0.05) on day 3; NRS also decreased significantly on day 2 but marginally increased on day 3. There was also a significant (P < 0.05) increase in ROM between day 1 and the subsequent days [Table 3].
|Table 3: Day 1-3: Changes in NPRS, DP, and ROM means in the infrared group|
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[Table 4] showed a comparison of all the variables across the three groups over 3 days. It was observed that the infrared group had the lowest NRS and DP scores over the 3 days though on day 1, the differences were quite significant (P < 0.05) compared with the other two groups. The differences in the NRS and DP scores between the warm-up and infrared groups were only significant on day 1. The table also showed that compared with the control group, treatment with infrared and warm-up exercises had no significant effect on the ROM scores over the 3 days.
|Table 4: Comparison of means of VAS, DP, and ROM scores before and after infrared radiation|
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Administration of IRR immediately after the inducement of DOMS resulted in significant reduction in the NRS and DP scores [Table 5].
|Table 5: Comparison of means of NPRS, DP, and ROM scores between the control, warm-up, and infrared groups|
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| Discussion|| |
This study was carried out to address the issue of trauma to the muscles due to unaccustomed physical activity, especially as there is a potential for injury during participation in all types of sports.  In the bid to find effective and quick relief for DOMS, many treatment modalities including cryotherapy and therapeutic ultrasound have been investigated without a conclusive result.
This present study was carried out to investigate the effects of IRR in ameliorating the associated symptoms of DOMS when administered once immediately after the inducement of DOMS and compare the same with that of warm-up exercises. The results clearly show that warm-up exercises are especially effective in reducing the pain and muscle soreness associated with DOMS 24 h and 48 h after injury but had no significant effect on day 1 when compared with the control group [Table 1] and [Table 2]. These exercises also had no significant impact on the ROM scores. These results are in concordance with the study carried out by Law and Herbert (2007)  that showed that warm-up exercises reduced perceived muscle soreness 48 h after exercises but is contrary to the results of the study by Weltman et al. (1979)  that concluded that quadriceps stretches and warm-up prior to soreness-inducing step-up exercises did not result in a significant reduction in the symptoms of DOMS. The differences in their findings could be due to the inclusion of stretches that have been found to have no significant effect in relieving the symptoms of DOMS. ,,
Treatment with IRR immediately after the inducement of DOMS resulted in a significant reduction in pain and muscle soreness and a marginal increase in the ROM on day 1 [Table 3] and [Table 4]. The IRR group had the least pain and muscle soreness over the 3 days when compared with the control and warm-up groups [Table 5]. The significant reduction of pain and muscle soreness by IRR may be attributed to the analgesic effect of heat therapy since temperature elevation results in vasodilatation and an increase in blood flow. The increased blood flow facilitates tissue healing by supplying protein, nutrients, and oxygen at the site of injury that aids the healing process by increasing both catabolic and anabolic reactions needed to degrade and remove metabolic by-products of tissue damage. 
The significant decrease in muscle soreness immediately after treatment with IRR suggests that IRR aids in muscle repair, especially as prior studies have shown that it causes the release of nitric oxide (NO) from hemoglobin that causes vasodilatation with a resultant increase in blood flow that enhances healing.  Moreover, this is because red infrared has been found to have the deepest penetration among the infrared range and aids healing at any wavelength. , These results may also suggest a positive role for IRR in ameliorating the symptoms of DOMS, especially as treatment was given only on day 1 immediately after the inducement of DOMS. It will be pertinent to observe the effect of IRR on these symptoms if given consecutively for 3 days after the inducement of DOMS.
Comparative analysis of the NRS and DP scores between the warm-up and IRR groups shows that IRR had a significant effect over warm-up exercises in alleviating pain and muscle soreness only on day 1. On the subsequent 2 days, warm-up exercises were as effective as IRR in ameliorating these symptoms [Table 5]. It is seen on [Table 5] that though the IRR and warm-up groups experienced an increase in NPRS and DP scores on day 2 and day 3, the values were still significantly lower than the control groups. This indicates that both the protocols were able to significantly reduce the symptoms on day 2 and day 3 that are known to be the peak time for the symptoms of DOMS to appear.  Both the treatment protocols, however, had no significant effect on the ROM scores. The results of this study suggest that both warm-up exercises and IRR ameliorate the symptoms of pain and muscle soreness in DOMS. Since the effect of IRR is seen immediately after administration on day 1, it appears to have a better effect on the management of the symptoms associated with DOMS. Our findings are contrary to the results of the study by Glassgow et al. in which there was no appreciable difference in the symptoms of DOMS between the placebo group and those who had IRR. Further studies need to be conducted on the combined administration of IRR and warm-up exercises and also on the administration of IRR for consecutive 3 days following the inducement of DOMS.
| Conclusion|| |
IRR is effective in ameliorating the symptoms of DOMS immediately after administration on day 1 while the effect of warm-up exercises is seen 24 h later. IRR, thus, has a better effect than warm-up exercises in ameliorating the symptoms associated with DOMS.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]