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Delayed Onset Muscle Soreness (DOMS) is a familiar experience to most people who exercise. It effects affects people who weight train and run particularly, and DOMS can produce anything from mild muscle soreness to debilitating pain and weakness. = What is DOMS? =The soreness of DOMS generally occurs peaks between 24 and 72 hours after unusual or severe exercise, such as racing a marathonthough soreness may occur sooner after running<ref name="Vickers2001"/>. DOMS is particularly related to eccentric exercise, which is where the muscle works to resist becoming longer, rather than working to contract. When you muscles absorb the impact of running, this is eccentric. exercise, and [[Downhill Running]] is much more eccentric than flat or uphill running. The images below show the damage that occurs from eccentric exercise<ref name="FeassonStockholm2002"/> and marathon running<ref name="Warhol-1985"/>:
<gallery widths=300px heights=200px caption="Muscle damage from eccentric exercise (downhill running)">
File:EccentricA.JPG|Muscle before downhill running<ref name="images"/>File:EccentricC.JPG|Immediately after downhill running<ref name="images"/>. Notice the disruption to the dark bands (z-bands) that are part of the muscle structure showing there is immediate damage. File:EccentricD.JPG|One day later<ref name="images"/>, the damage and disruption is worse, indicated some continued breakdown. File:EccentricB.JPG|Muscle 14 days later<ref name="images"/>, structurally recovered (other metrics do not return to pre-exercise levels at 14 days).
</gallery>
<gallery widths=300px heights= What are the symptoms of DOMS? 200px caption="Muscle damage after running a marathon" >File:MarathonFiberDamage.jpg|The soreness selective pattern of DOMS is different damage, showing the normal upper fiber adjacent to a the 'pulledmoth eaten' muscleappearance of the damaged lower fiber. With DOMSFile:MarathonFiberDamage2.jpg|Here you can see extreme damage, large areas with only the Z band of the muscle fiber remaining (marked Z). Adjacent fibers show far less damage.</gallery>=What are very tender to the touch, and the pain symptoms of DOMS?=The soreness of DOMS is very unpleasantdifferent to other forms of muscle soreness. With a pulled DOMS, large areas of the muscle, are tender to the area of tenderness is usually more localized touch and painful when the pain muscle is used. With other forms of muscle soreness the area of tenderness is usually more localized and the pain of massage is sometimes described as a 'good pain'. The pain of DOMS will normally lessen with light exercise such as walking. This , which is often described as 'loosening' up. In addition, there are other symptoms, such as:* Reduction in strength<ref name= Why is DOMS important? "Saxton-1995"/><ref name="domsiso"/><ref name=DOMS can prevent continued running, due to weakness and soreness. However, the biggest issue for long distance runners is that although the pain occurs 24-72 hours after exercise, the weakness peaks after 30 minutes "Gulick-1996"/><ref name="Z1Paddon-Jones-1997"/>, typically 30-60%<ref name="Baldwin Lanier-2003"/>. If you've ever run a long, steep decent (Note that the latter part of Iron Mountain or Mount Mitchell Challenge spring to mind), you'll know reduction in strength starts immediately following the damaging exercise and increases over the strange feeling of weak numbness that pervades your quads as the effect of the downhill builds upnext 24-48 hours<ref name="Cheung-2003"/>. If you've felt a similar weakness The initial reduction in the latter stages of a marathon, this may not strength can be [[Glycogen]] depletion creating 'the wall', but eccentric as much as 40%<ref name="Baldwin Lanier-2003"/>.)* Increased passive muscle damage that will later manifest itself as DOMStension<ref name="Howatson-2008"/>. It is suggested that this is A muscle suffering from DOMS will often be hard to the reason the Boston Marathon course is relatively slowtouch, even though it is a net decentwhen relaxed as much as possible. * Swelling of the muscle<ref name= What does DOMS mean to you? =There is some good news "Howatson-2008"/>, which can be seen as a lack of muscle definition in all lean individuals. * The perceptions of this. While excessive eccentric exercise joint angle and force are impaired<ref name="Saxton-1995"/>, which can cause DOMS, doing some eccentric exercise causes result in reduced coordination and a sense of clumsiness. * A reduction in the muscles to adapt and to be able to handle eccentric exercise without DOMS Range of Motion<ref name="Y1Saxton-1995"/>. There are two ways then of protecting your muscles from DOMS <ref name="domsiso"/><ref name="Gulick-1996"/>.* Changes in running; running greater distancesbiomechanics, or running downhillpossibly as compensation for other changes<ref name="domsbio"/>. It is downhill running that is greatly underutilized For instance, the reduction in Range of Motion can result in a reduction in training regimesstride length. Most hill training workouts focus on the uphill segment, and relegate the downhill to recovery. While uphill can produce some benefits, it is the downhill that can provide the greatest advantage* Decreased [[Running Economy]]<ref name="Smith-1992"/><ref name="Braun-2003"/>. Adding hills into your workout can make you a much stronger runner* Impaired [[Glycogen]] repletion<ref name="Smith-1992"/><ref name="Braun-2003"/>, and have benefits even on flat race coursesthough higher carbohydrate intake partly offsets the reduction<ref name="Costill-1990"/>. Don't just use the downhill There is some evidence that Glycogen levels continue to recover from the uphill, but work on drop after DOMS inducing exercise<ref name="Zehnder-2004"/><ref name="Widrick-1992"/>, and the downhilldeficiency in glycogen lasts for over 72 hours<ref name="Widrick-1992"/>. * There are some studies that indicate there are possible changes in muscle fiber recruitment patterns<ref name= How to treat DOMS? "Miles-1997"/><ref name=Do if you do get DOMS, what can you do? * [[Caffeine]] has shown to be effective in reducing the pain of DOMS, as well as reducing the weakness"Zhou-1998"/><ref name="X1Zhou-1996"/>. * =Why is DOMS important?=Because running involves a lot of eccentric stress, DOMS is common in runners, especially after [[NSAIDs and Downhill Running|NSAIDS]] (Ibuprofen, Acetaminophen/Paracetamol, etc.) have been shown to increase The pain that occurs 24-72 hours after exercise can prevent continued training. However, the biggest issue for long distance runners is that although the pain of DOMS, though they may delay its onsetoccurs 24-72 hours after exercise, the weakness peaks after 30 minutes <ref name="DomsNsaids"/>, and NSAIDS may also impair healing<ref name="umMarginson-2005"/>/>.* The evidence for anti-oxidants is scantIf you've ever run a long, but Vitamin Csteep descent, D and E might help. * The evidenced for massage, stretching and ice is ambiguous<ref name="X2"/>you'll know the strange feeling of weak numbness that pervades your quads as the effect of the downhill builds up. In fact, short periods The Boston Marathon or the latter part of Mount Mitchell Challenge have descents that cause this type of weakness. If you've felt a similar weakness in the latter stages of a marathon, this may not be [[Cryotherapy| icingGlycogen]] can make depletion creating 'the wall', but eccentric muscle damage that will later manifest itself as DOMS worse<ref name="TsengLee2012"/>.* Light exercise has been shown to relieve It is suggested that this is the reason the Boston Marathon course is relatively slow, even though it is a net decent.=What does DOMS<ref namemean to you?="X3"/>There is some good news in all of this. * Performing a [[Warmup]] before While excessive eccentric exercise does not appear can cause DOMS, doing some eccentric exercise causes the muscles to adapt and to be able to reduce the resulting handle eccentric exercise without DOMS<ref name="Evans-2002Y1"/>.* Some<ref name="DaviesThompson2009"/><ref name="DaviesThompson2009"/><ref name="Kraemer-2001"/><ref name="DomsComp"/>There are two ways then of protecting your muscles from DOMS in running; running greater distances, or running downhill. I believe that downhill running that is greatly underutilized in training regimes. Most hill training workouts focus on the uphill segment, but not all<ref name="KraemerFlanagan2010"/><ref name="Viguier-2010"/> studies show and relegate the downhill to recovery. While uphill can produce some benefits, it is the downhill that [[Why compression clothes|Graduated Compression Clothing]] mitigates DOMScan provide the greatest advantage. A meta-analysis<ref name="MacRae-2011"/> Adding hills into your workout can make you a much stronger runner, and have benefits even on flat race courses. Don't just use the downhill to recover from the uphill, but work on the downhill.=How to prevent or treat DOMS?=There are various approaches to preventing or treating DOMS. The table below is a summary of 14 studies the approaches showing how likely the strategy is to prevent or treat DOMS combined with the possible downsides. At the top are those that are likely to help and have no downsides, then those that have no effects or downsides, then those with little benefit and significant downsides. {| class="wikitable"!Strategy!!Timing!!Soreness!!Weakness!!Downsides|-|Repeated Bout Effect|Before (days to months)|Strong evidence of reduced weakness|Some evidence of reduced weakness|None|-|Carbohydrate and/or protein|After|Some evidence of reduced soreness|Strong evidence of reduced weakness|None|-|Compression Clothing|After|Some evidence of reduced soreness|Some evidence of reduced weakness|None|-|Caffeine|After|Some evidence of reduced soreness |Some evidence of reduced weakness|None|-|Massage|After|Some evidence of reduced soreness|No benefit|None|-|Warmup|Immediately before|Some evidence of reduced soreness|No benefit|None|-|Light Exercise |After|Transient pain reduction |No benefit|None|-|TENS|After|Transient pain reduction |No benefit|None|-|Icing|After|No benefit|No benefit|None|-|Antioxidents|Before and/or After|Mixed evidence|Mixed evidence|Conflicting evidence of reduced endurance adaptations|-|Stretching|Before and/or After|No benefit|No benefit|* [[Stretching]] temporarily weakens muscles* Can induce DOMS* Can lead to injury|-|NSAIDs|Before and/or After|Most evidence indicates no benefit|Most evidence indicates no benefit|Can impair recovery|}==Repeated Bout Effect==The DOMS that follows an initial bout of eccentric exercise is much less on subsequent similar bouts. This is often called the Repeated Bout Effect (RBE)<ref name="Howatson-2008"/><ref name="Cheung-2003"/>. The initial bout does not have to cause significant soreness or damage<ref name="Clarkson-1987"/>. As few as 2-10 maximal eccentric repetitions can protect against a subsequent larger bout (24-50), but the initial bout must be close to maximal effort<ref name="Brown-1997"/>. By contrast, eight weeks of training with 50% of the maximal eccentric load did not provide protection against a subsequent maximal bout<ref name="Nosaka-2002"/>. There is some cross-over of protection between different forms of exercise. For instance, eccentric weight training protects against soreness and weakness in subsequent downhill running<ref name="Eston-1996"/>. The protection from the RBE is long lived. One study showed that while the initial weakness was not reduced by the RBE, the recovery of strength was much faster for up to 9 months, and soreness was less for up to 6 months<ref name="Nosaka-2001"/>. Another study showed that 30 minutes of downhill running provides protection for between 6 and 9 weeks<ref name="Byrnes-1985"/>. There is evidence that the RBE may rapidly start to provide protection from soreness and weakness<ref name="Mair-1995"/>, possibly as soon as 24 hours post exercise<ref name="Chen-2001"/>.==Carbohydrate and Protein=={{Main| Nutrient Timing}}The damage of DOMS requires repair, so it's not surprising that taking protein or amino acids, which are the building blocks of the muscle fibers, helps with recovery. * Most studies show that amino acids reduce muscle soreness<ref name="HowatsonHoad2012"/><ref name="Greer-2007"/> <ref name="Matsumoto-2009"/><ref name="Shimomura-2010"/>, and may<ref name="Shimomura-2010"/><ref name="Greer-2007"/> or may not reduce weakness<ref name="Jackman-2010"/><ref name="Nosaka-2006"/><ref name="Jackman-2010"/>. * Most studies have shown that protein will reduce muscle weakness after DOMS inducing exercise<ref name="CockburnHayes2008"/><ref name="Valentine-2008"/> <ref name="CookeRybalka2010"/><ref name="Cockburn-2010"/><ref name="Etheridge-2008"/>, with only two studies showing no improvement<span style='color:#FF0000'><ref name="Wojcik-2001"/><ref name="Green-2008"/></span>. * The effect of protein on soreness is more mixed with some studies showing improvement<ref name="Luden-2007"/> <ref name="Flakoll-2004"/><ref name="Etheridge-2008"/>, but others not<ref name="CockburnHayes2008"/><ref name="Samadi-2012"/><ref name="Green-2008"/>. * Not surprisingly [[Nutrient Timing| timing]] may be important, with CHO+PRO having an effect on muscle weakness directly after or 24 hours after, but not before DOMS inducing exercise<ref name="Cockburn-2010"/>, as shown below.* In addition to reducing muscle soreness, protein supplementation in military recruits also reduced illness and injury<ref name="Flakoll-2004"/>.* Taking carbohydrate alone after DOMS inducing exercise does not appear to help<ref name="Close2005"/><ref name="Nelson-2004"/>. [[File:Protein Timing.jpg|none|thumb|300px|The change in strength after DOMS inducing exercise. CON: control, PRE: protein before, POST: protein immediately after, TWENTY-FOUR: protein 24 horus after<ref name="Cockburn-2010"/>.]]Protein helps with recovery from DOMS<ref name="Etheridge-2008"/>. The graphs below show the impact of 100 grams of Protein taken immediately after 30 minutes of downhill running. Note that muscle soreness peaked at 72 hours, even though force and power had returned to baseline. {| class="wikitable" |- valign="top"|[[File:DOMS Protein Force.jpg|none|thumb|300px|Peak force generated after DOMS inducing eccentric exercise. (*is significant change from baseline, double S marker indicates significant change from treatment.)]]|[[File:DOMS Protein Power.jpg|none|thumb|300px|Peak power generated after DOMS inducing eccentric exercise.(*is significant change from baseline, double S marker indicates significant change from treatment.)]]|}==Caffeine=={{Main| Caffeine}}[[Caffeine]] has shown to be effective in reducing the pain of DOMS, as well as reducing the weakness<ref name="Maridakis-2007"/>. (The reduction in weakness did not reach statistical significance in regular caffeine users<ref name="Park-2008"/>.) While the evidence for caffeine reducing the weakness of DOMS, this is one of the few approaches that can help offset the weakness during the damaging exercise. ==Massage=={{Main| Massage}}Massage is widely used to prevent and treat injuries. Most meta-analysis suggest that post-exercise massage helps with the soreness of DOMS<ref name="Ernst-1998"/><ref name="Moraska-2005"/>, though the mechanisms are unclear<ref name="Tiidus-1997"/>. Studies that give massage 2-3 hours after DOMS inducing exercise showed reduced soreness<ref name="Smith-1994"/><ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>, but not weakness<ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>. One study that gave massage 2 days after exercise that resulted in reduced soreness and improved muscle function<ref name="MancinelliDavis2006"/>, but other studies that use massage 24 hours or more after exercise showed no benefit<ref name="Hart-"/><ref name="Dawson-2004"/>. Therefore it seems likely that the timing of the massage is important, though other factors, such as the style of massage and the extent of the DOMS may also change the outcome. ==Compression Clothing =={{Main| Why compression clothes}}Studies show that wearing [[Why compression clothes| Graduated Compression Clothing]] during the days after DOMS inducing exercise mitigates the soreness<ref name="DaviesThompson2009"/><ref name="Kraemer-2001"/><ref name="Kraemer-2001b"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/><ref name="Davies-2009"/><ref name="DuffieldPortus2007"/> and weakness<ref name="Kraemer-2001"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/> of DOMS. Relatively few studies showed no benefit from compression clothing<ref name="CarlingFrancis1995"/><ref name="Pearce-2009"/>. However, the results of compression clothing are likely to vary with the particular garment, how well it fits and therefore the pressure that is provided<ref name="MacRae-2011"/>. No studies were found that looked at post exercise at the effect of wearing compression clothing during DOMS inducing exercise on the subsequent recovery.==Warmup=={{Main| Warmup}}Performing a [[Warmup]] before exercise may help reduce DOMS pain<ref name="Law-2007"/><ref name="RahnamaRahmani-Nia2005"/>, but not all studies support this<ref name="Evans-2002"/>.==Light Exercise==Light training in the days following DOMS inducing exercise generally accepted to be one of the most effective ways of reducing muscle soreness, but unfortunately the reduction in pain is temporary<ref name="Armstrong-1984"/><ref name="Zainuddin-2006"/><ref name="Howatson-2008"/><ref name="Cheung-2003"/>.==TENS==TENS may reduce the soreness of DOMS<ref name="Denegar-1989"/>, but the effect seems to be transient<ref name="Denegar"/> and the effect is reduced if combined with icing<ref name="Denegar-1992"/>. Not all studies show any pain reduction<ref name="Bonacci-1997"/> and none show a reduction in the weakness. ==Icing=={{Main| Cryotherapy}}[[Cryotherapy| Icing]] does not help<ref name="Yackzan-"/><ref name="Shunsuke-2004"/><ref name="Gulick-17"/><ref name="Paddon-Jones-1997"/>, and can make DOMS worse<ref name="TsengLee2012"/><ref name="Isabell-1992"/>. Ice reduces pain slightly, but does not restore strength<ref name="Denegar-1992"/> ==Antioxidants - Vitamin C and E==The evidence for anti-oxidants is mixed, with some studies showing a benefit but not others. Note that one study below showed an impaired recovery with vitamin C supplementation. In addition, there is mixed evidence that vitamin C and/or vitamin E reduces endurance adaptations from exercise<ref name="Gomez-Cabrera-2008"/><ref name="RistowZarse2009"/><ref name="Strobel-2011"/> or they do not<ref name="Wadley-2010"/><ref name="Higashida-2011"/> <ref name="YfantiAkerstrom2009"/>.{| class="wikitable"|-!Vitamin C!!Vitamin E!!Dose Period!!Result|-|3,000mg/day||14 days prior and 4 days post-exercise|Vitamin C reduces soreness in first 24 hours<ref name="Bryer-2006"/>|-|3,000mg/day||3 days prior and 4 days post-exercise |reduced soreness<ref name="Kaminski-1992"/>|-|400mg/day||14 days prior to exercise|reduced soreness<ref name="Thompson-2001"/>|-|3,000mg/day||3 days prior and 5 days post-exercise |no effect<ref name="Connolly-2006"/>|-|1,000mg/day||2 hours prior and 4 days post-exercise|no soreness change, but impaired strength recovery 7 and 14 days after exercise<ref name="CloseAshton2006"/>|-|1,000mg||2 hours prior to exercise|no effect<ref name="Thompson-2001x"/>|-|400mg/day||12 days prior and 3 days post-exercise|no change in soreness<ref name="Thompson-2004"/>|-||1,200 IU/day|30 days prior to exercise|No effect<ref name="Beaton-2002"/>|-|500mg/day|1,200 IU/day|30 days prior and 7 days post-exercise |improved muscle function but no change in soreness<ref name="Shafat-2004"/>|-|1,000mg/day|300 mg/d|6 weeks prior to exercise|no change in function<ref name="Mastaloudis-2006"/>|}==Stretching=={{Main| Stretching}}Stretching before<ref name="High-1989"/><ref name="Johansson-1999"/> <ref name="Wessel-1994"/>, after <ref name="Johansson-1999"/><ref name="Buroker-1989"/><ref name="Herbert-2007"/>, or both before and after<ref name="Lund-1998"/> exercise does not help with DOMS. In fact, stretching alone can induce DOMS<ref name="Smith-1993"/>.==NSAIDs=={{Main|NSAIDs and Running}}The most common NSAIDs (Ibuprofen, Acetaminophen (Paracetamol), and Aspirin) are unlikely to help with DOMS, but Naproxen may reduce the pain and weakness. If an NSAID is taken, it should probably be immediately after the damaging exercise rather than waiting until the soreness develops. It seems likely that taking an NSAID for DOMS will reduce the muscular growth that would normally occur as part of the recovery. In one disturbing study, rabbits treated with an NSAID (flurbiprofen) after DOMS inducing exercise initially recovered their strength after 3-7 days, but between days 7 and 28 days the rabbits became weaker while the untreated controls became stronger<ref name="Mishra-1995"/>. I have not included other animal studies, but this is the only one that looks at how NSAIDs impact the longer term recovery from DOMS.{| class="wikitable"|-!NSAID!!Soreness!!Weakness|-|Ibuprofen|2xImproved<ref name="Hasson-1993"/><ref name="pmid12580656"/>7xNo Effect<ref name="Grossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="Stone-2002"/> |1xMaybe<ref name="Hasson-1993"/>8xNo Effect<ref name="Grossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="pmid12580656"/><ref name="Stone-2002"/> |-|Ibuprofen Gel|1xNo Effect<ref name="HyldahlKeadle2010"/>||-|Acetaminophen (Paracetamol)|2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>||-|Aspirin|2xImproved<ref name="Riasata-2010"/><ref name="Francis-1987"/>2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>|2xNo Effect<ref name="Riasata-2010"/><ref name="Francis-1987"/>|-|Naproxen |4xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>1xNo Effect<ref name="Bourgeois-1999"/>|3xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>1xNo Effect<ref name="Bourgeois-1999"/>|-|Diclofenac |Possible slight reduction<ref name="DonnellyMcCormick1988"/>||-|Codeine|1xNo Effect<ref name="Barlas-2000"/> ||-|Rofecoxib |1xNo Effect<ref name="LoramMitchell2005"/> ||-|Ketoprofen |1xImproved<ref name="Sayers-2001"/>|1xImproved<ref name="Sayers-2001"/>|-|Bromelain |1xNo Effect<ref name="Stone-2002"/>||}=Mechanisms of DOMS=The underlying mechanism of DOMS is thought to consist of phases; the initial damage that occurs during the exercise and then secondary damage that occurs subsequently<ref name="Cheung-2003"/><ref name="Howatson-2008"/>: * '''Primary damage'''. The initial damage is believed to be mechanical in nature, both on the contracting parts of the muscle (sarcomeres) and the supporting structures (primarily the z-bands). While there are some suggestions that the primary damage might be due to metabolic factors such as low blood flow, low oxygen saturation, impaired metabolite clearance, these causes are not well supported. The idea that DOMS is caused by lactic acid has been rejected<ref name="Schwane-1983"/>.* '''Secondary damage'''. The secondary damage appears to be initiated by the disruption of the intracellular Ca<sup>2</sup>+homeostatis, which leads to further myofibrillar damage including degradation of the cell membrane.===Mechanisms for the Repeated Bout Effect===For those interested in the details, there are several possible mechanisms that might be responsible for the Repeated Bout Effect (RBE)<ref name="McHugh-2003"/><ref name="McHugh-1999"/>:* '''Neural adaptation'''. The RBE may be due to changes in the way muscles are recruited. While there is some direct evidence that RBE occurs without neural adaptations, it is possible that this mechanism contributes to the protection. ** '''Increased recruitment of slow-twitch fibers'''. Fast-twitch fibers may be more susceptible to eccentric damage, so an adaptation to recruit more slow-twitch fibers might reduce DOMS. ** '''Activation of more muscle fibers'''. Recruiting a larger number of fibers may reduce the eccentric stress on each fiber, thus reducing the damage. * '''Mechanical adaptation'''. It is possible to consider muscle damage as similar to materials fatigue. These adaptations are in the non-contracting structures of the muscles. For instance, protection from damage could come from increased structural strength in the z-band of the muscles which get disturbed by eccentric exercise as seen above.** '''Increased dynamic muscle stiffness'''. Dynamic stiffness refers to how stiff the muscles are when contracted. ** '''Increased passive muscle stiffness'''. In contrast, passive stiffness is when the muscles are relaxed. It is unclear if increased passive stiffness protects against eccentric damage or actually exacerbates it. * '''Cellular adaptation. '''A number of changes at the cellular level may provide protection against eccentric damage. ** '''Increased sarcomeres. '''The sarcomeres are part of the contracting mechanism of the muscles. The contraction of a muscle comes from parts of the sarcomere sliding over each other. One adaptation to eccentric exercise may be that the overlap in these sliding areas becomes larger. ** '''Changed inflammation response. '''The delay in soreness is probably due to a delayed inflammatory response, so changes in that response could reduce the soreness. However, this would not reduce the immediate loss of strength.** '''Maintenance of Excitation-Contraction coupling'''. One reason for the loss of strength following eccentric exercise is that the nerve impulses (excitation) may result in less contraction. The decoupling could be due to lack of neural drive (perhaps due to pain), physical disruption of the contracting structures of the muscle soreness, 9 showed a reduction in soreness and 5 showed no change. Looking at the various studies, it appears that compression clothing may have the greatest benefit after 48-72 hours. My personal experience is that a small amount of easy running, while painful, can speed up recovery. I have found no benefit to ice, massage, or Ibuprofen.= Tangent - DOMS and Lactic acid =DOMS is not caused by lactic acid; a full discussion will have to wait until I write an entry on 'the lactic acid myth', but suffice failure to say, lactic acid is your friend, not your enemyactivate those contracting structures.
=See Also=
* [[Downhill Running]]
* [[Downhill Intervals]]
= References =
<references>
<ref name="Pearce-2009">Pearce, Alan J., et al. "Wearing a sports compression garment on the performance of visuomotor tracking following eccentric exercise: A pilot study." Journal of science and medicine in sport 12.4 (2009): 500-502.</ref>
<ref name="CarlingFrancis1995">{{cite journal|last1=Carling|first1=Jon|last2=Francis|first2=Kennon|last3=Lorish|first3=Christopher|title=The effects of continuous external compression on delayed-onset muscle soreness (DOMS)|journal=International Journal of Rehabilitation and Health|volume=1|issue=4|year=1995|pages=223–235|issn=1068-9591|doi=10.1007/BF02214641}}</ref>
<ref name="DuffieldPortus2007">{{cite journal|last1=Duffield|first1=R.|last2=Portus|first2=M.|last3=Edge|first3=J.|title=Comparison of three types of full-body compression garments on throwing and repeat-sprint performance in cricket players * COMMENTARY|journal=British Journal of Sports Medicine|volume=41|issue=7|year=2007|pages=409–414|issn=0306-3674|doi=10.1136/bjsm.2006.033753}}</ref>
<ref name="Davies-2009"> {{Cite journal | last1 = Davies | first1 = V. | last2 = Thompson | first2 = KG. | last3 = Cooper | first3 = SM. | title = The effects of compression garments on recovery. | journal = J Strength Cond Res | volume = 23 | issue = 6 | pages = 1786-94 | month = Sep | year = 2009 | doi = 10.1519/JSC.0b013e3181b42589 | PMID = 19675482 }}</ref>
<ref name="Jakeman-2010"> {{Cite journal | last1 = Jakeman | first1 = JR. | last2 = Byrne | first2 = C. | last3 = Eston | first3 = RG. | title = Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. | journal = Eur J Appl Physiol | volume = 109 | issue = 6 | pages = 1137-44 | month = Aug | year = 2010 | doi = 10.1007/s00421-010-1464-0 | PMID = 20376479 }}</ref>
<ref name="Mair-1995"> {{Cite journal | last1 = Mair | first1 = J. | last2 = Mayr | first2 = M. | last3 = Müller | first3 = E. | last4 = Koller | first4 = A. | last5 = Haid | first5 = C. | last6 = Artner-Dworzak | first6 = E. | last7 = Calzolari | first7 = C. | last8 = Larue | first8 = C. | last9 = Puschendorf | first9 = B. | title = Rapid adaptation to eccentric exercise-induced muscle damage. | journal = Int J Sports Med | volume = 16 | issue = 6 | pages = 352-6 | month = Aug | year = 1995 | doi = 10.1055/s-2007-973019 | PMID = 7591384 }}</ref>
<ref name="Dawson-2004"> {{Cite journal | last1 = Dawson | first1 = LG. | last2 = Dawson | first2 = PM. | last3 = Tiidus | first3 = PM. | title = Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon. | journal = J Sports Sci Med | pages = 37-43 | month = | year = 2004 | doi = | PMID = }}</ref>
<ref name="Hart-"> {{Cite journal | last1 = Hart | first1 = JM. | last2 = Swanik | first2 = CB. | last3 = Tierney | first3 = RT. | title = Effects of sport massage on limb girth and discomfort associated with eccentric exercise. | journal = J Athl Train | volume = 40 | issue = 3 | pages = 181-5 | month = | year = | doi = | PMID = 16284638 }}</ref>
<ref name="Moraska-2005"> {{Cite journal | last1 = Moraska | first1 = A. | title = Sports massage. A comprehensive review. | journal = J Sports Med Phys Fitness | volume = 45 | issue = 3 | pages = 370-80 | month = Sep | year = 2005 | doi = | PMID = 16230990 }}</ref>
<ref name="Ernst-1998"> {{Cite journal | last1 = Ernst | first1 = E. | title = Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. | journal = Br J Sports Med | volume = 32 | issue = 3 | pages = 212-4 | month = Sep | year = 1998 | doi = | PMID = 9773168 }}</ref>
<ref name="Hilbert2003">{{cite journal|last1=Hilbert|first1=J E|title=The effects of massage on delayed onset muscle soreness|journal=British Journal of Sports Medicine|volume=37|issue=1|year=2003|pages=72–75|issn=03063674|doi=10.1136/bjsm.37.1.72}}</ref> <ref name="MancinelliDavis2006">{{cite journal|last1=Mancinelli|first1=Corrie A.|last2=Davis|first2=D. Scott|last3=Aboulhosn|first3=Leila|last4=Brady|first4=Misty|last5=Eisenhofer|first5=Justin|last6=Foutty|first6=Stephanie|title=The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes|journal=Physical Therapy in Sport|volume=7|issue=1|year=2006|pages=5–13|issn=1466853X|doi=10.1016/j.ptsp.2005.10.004}}</ref>
<ref name="Zainuddin-2005"> {{Cite journal | last1 = Zainuddin | first1 = Z. | last2 = Newton | first2 = M. | last3 = Sacco | first3 = P. | last4 = Nosaka | first4 = K. | title = Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. | journal = J Athl Train | volume = 40 | issue = 3 | pages = 174-80 | month = | year = | doi = | PMID = 16284637 }}</ref>
<ref name="Smith-1994"> {{Cite journal | last1 = Smith | first1 = LL. | last2 = Keating | first2 = MN. | last3 = Holbert | first3 = D. | last4 = Spratt | first4 = DJ. | last5 = McCammon | first5 = MR. | last6 = Smith | first6 = SS. | last7 = Israel | first7 = RG. | title = The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: a preliminary report. | journal = J Orthop Sports Phys Ther | volume = 19 | issue = 2 | pages = 93-9 | month = Feb | year = 1994 | doi = | PMID = 8148868 }}</ref>
<ref name="McHugh-1999"> {{Cite journal | last1 = McHugh | first1 = MP. | last2 = Connolly | first2 = DA. | last3 = Eston | first3 = RG. | last4 = Gleim | first4 = GW. | title = Exercise-induced muscle damage and potential mechanisms for the repeated bout effect. | journal = Sports Med | volume = 27 | issue = 3 | pages = 157-70 | month = Mar | year = 1999 | doi = | PMID = 10222539 }}</ref>
<ref name="McHugh-2003"> {{Cite journal | last1 = McHugh | first1 = MP. | title = Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. | journal = Scand J Med Sci Sports | volume = 13 | issue = 2 | pages = 88-97 | month = Apr | year = 2003 | doi = | PMID = 12641640 }}</ref>
<ref name="Vickers2001">{{cite journal|last1=Vickers|first1=Andrew J|journal=BMC Musculoskeletal Disorders|volume=2|issue=1|year=2001|pages=5|issn=14712474|doi=10.1186/1471-2474-2-5}}</ref>
<ref name="Byrnes-1985"> {{Cite journal | last1 = Byrnes | first1 = WC. | last2 = Clarkson | first2 = PM. | last3 = White | first3 = JS. | last4 = Hsieh | first4 = SS. | last5 = Frykman | first5 = PN. | last6 = Maughan | first6 = RJ. | title = Delayed onset muscle soreness following repeated bouts of downhill running. | journal = J Appl Physiol | volume = 59 | issue = 3 | pages = 710-5 | month = Sep | year = 1985 | doi = | PMID = 4055561 }}</ref>
<ref name="Eston-1996"> {{Cite journal | last1 = Eston | first1 = RG. | last2 = Finney | first2 = S. | last3 = Baker | first3 = S. | last4 = Baltzopoulos | first4 = V. | title = Muscle tenderness and peak torque changes after downhill running following a prior bout of isokinetic eccentric exercise. | journal = J Sports Sci | volume = 14 | issue = 4 | pages = 291-9 | month = Aug | year = 1996 | doi = 10.1080/02640419608727714 | PMID = 8887208 }}</ref>
<ref name="Nosaka-2001"> {{Cite journal | last1 = Nosaka | first1 = K. | last2 = Sakamoto | first2 = K. | last3 = Newton | first3 = M. | last4 = Sacco | first4 = P. | title = How long does the protective effect on eccentric exercise-induced muscle damage last? | journal = Med Sci Sports Exerc | volume = 33 | issue = 9 | pages = 1490-5 | month = Sep | year = 2001 | doi = | PMID = 11528337 }}</ref>
<ref name="Nosaka-2002"> {{Cite journal | last1 = Nosaka | first1 = K. | last2 = Newton | first2 = M. | title = Concentric or eccentric training effect on eccentric exercise-induced muscle damage. | journal = Med Sci Sports Exerc | volume = 34 | issue = 1 | pages = 63-9 | month = Jan | year = 2002 | doi = | PMID = 11782649 }}</ref>
<ref name="Brown-1997"> {{Cite journal | last1 = Brown | first1 = SJ. | last2 = Child | first2 = RB. | last3 = Day | first3 = SH. | last4 = Donnelly | first4 = AE. | title = Exercise-induced skeletal muscle damage and adaptation following repeated bouts of eccentric muscle contractions. | journal = J Sports Sci | volume = 15 | issue = 2 | pages = 215-22 | month = Apr | year = 1997 | doi = 10.1080/026404197367498 | PMID = 9258852 }}</ref>
<ref name="Clarkson-1987"> {{Cite journal | last1 = Clarkson | first1 = PM. | last2 = Byrnes | first2 = WC. | last3 = Gillisson | first3 = E. | last4 = Harper | first4 = E. | title = Adaptation to exercise-induced muscle damage. | journal = Clin Sci (Lond) | volume = 73 | issue = 4 | pages = 383-6 | month = Oct | year = 1987 | doi = | PMID = 3665359 }}</ref>
<ref name="Schwane-1983"> {{Cite journal | last1 = Schwane | first1 = J | title = Is lactic acid related to delayed-onset muscle soreness. | journal = Physician & Sportsmedicin| volume = 11 | issue = 3 | pages = 124-127;130-131 | month = Mar| year = 1983 | doi = | PMID = }}</ref>
<ref name="Baldwin Lanier-2003"> {{Cite journal | last1 = Baldwin Lanier | first1 = A. | title = Use of nonsteroidal anti-inflammatory drugs following exercise-induced muscle injury. | journal = Sports Med | volume = 33 | issue = 3 | pages = 177-85 | month = | year = 2003 | doi = | PMID = 12656639 }}</ref>
<ref name="TsengLee2012">{{cite journal|last1=Tseng|first1=Ching-Yu|last2=Lee|first2=Jo-Ping|last3=Tsai|first3=Yung-Shen|last4=Lee|first4=Shin-Da|last5=Kao|first5=Chung-Lan|last6=Liu|first6=Te-Chih|last7=Lai|first7=Cheng-Shou|last8=Harris|first8=M. Brennan|last9=Kuo|first9=Chia-Hua|title=Topical Cooling (Icing) Delays Recovery from Eccentric Exercise-Induced Muscle Damage|journal=Journal of Strength and Conditioning Research|year=2012|pages=1|issn=1064-8011|doi=10.1519/JSC.0b013e318267a22c}}</ref>
<ref name="X1Maridakis-2007">{{Cite journal | last1 = Maridakis | first1 = V. | last2 = O'Connor | first2 = PJ. | last3 = Dudley | first3 = GA. | last4 = McCully | first4 = KK. | title = Caffeine Attenuates Delayedattenuates delayed-Onset Muscle Pain onset muscle pain and Force Loss Following Eccentric Exercisehttp://wwwforce loss following eccentric exercise.nowfoods| journal = J Pain | volume = 8 | issue = 3 | pages = 237-43 | month = Mar | year = 2007 | doi = 10.com/idc/groups/public/documents/digital_asset1016/074390j.pdf </ref> <ref name="X2">Delayed onset muscle soreness exerciseshttp://wwwjpain.sportsinjurybulletin2006.com/archive/1077-muscle-soreness08.htm 006 | PMID = 17161977 }}</ref> <ref name="X3Tiidus-1997">{{Cite journal | last1 = Tiidus | first1 = PM. | title = Manual massage and recovery of muscle function following exercise: a literature reviewhttp://www.ncbi.nlm.nih.gov/pubmed/| journal = J Orthop Sports Phys Ther | volume = 25 | issue = 2 | pages = 107-12 | month = Feb | year = 1997 | doi = | PMID = 9007768 }}</ref> <ref name="Z1Marginson-2005">{{Cite journal | last1 = Marginson | first1 = V. | last2 = Rowlands | first2 = AV. | last3 = Gleeson | first3 = NP. | last4 = Eston | first4 = RG. | title = Comparison of the symptoms of exercise-induced muscle damage after an initial and repeated bout of plyometric exercise in men and boyshttp://jap.physiology.org/cgi/content/full/| journal = J Appl Physiol | volume = 99/| issue = 3| pages = 1174-81 | month = Sep | year = 2005 | doi = 10.1152/1174 japplphysiol.01193.2004 | PMID = 15817716 }}</ref> <ref name="Y1">Skeletal muscle damage and repairhttp://books.google.com/books?id=ueMh1x7kFjsC&lpg=PA195&ots=wwIhuoi0Nt&dq=Tiidus%201997&pg=PA69#v=onepage&q=Tiidus%201997&f=true </ref><ref name="umFeassonStockholm2002">Ultrarunning magazine, May/June 2010, "Dealing with DOMS"</ref><ref name{{cite journal|last1=Feasson|first1=L|last2=Stockholm|first2=D|last3=Freyssenet|first3=D|last4=Richard|first4=I|last5=Duguez|first5=S|last6=Beckmann|first6=J S|last7=Denis|first7=C|title="images">Neuromuscular Molecular adaptations of neuromuscular disease-associated proteins and in response to eccentric exercise http://jp.physoc.org/content/in human skeletal muscle|journal=The Journal of Physiology|volume=543/|issue=1/297.full.pdf</ref> <ref name|year=2002|pages=297–306|issn="DomsNsaids">B0022-Com Web https:/3751|doi=10.1113/b-comjphysiol.mci-group2002.com/Abstract/Statistics/AbstractStatisticsViewPage.aspx?AbstractID=107621 018689}}</ref>
<ref name="Evans-2002"> {{Cite journal | last1 = Evans | first1 = RK. | last2 = Knight | first2 = KL. | last3 = Draper | first3 = DO. | last4 = Parcell | first4 = AC. | title = Effects of warm-up before eccentric exercise on indirect markers of muscle damage. | journal = Med Sci Sports Exerc | volume = 34 | issue = 12 | pages = 1892-9 | month = Dec | year = 2002 | doi = 10.1249/01.MSS.0000038895.14935.C8 | PMID = 12471293 }}</ref>
<ref name="DomsComp">Continuous Compression as an Effective Therapeutic Intervention in Treating Eccentric-Exercise-Induced Muscle Soreness http://journals.humankinetics.com/jsr-back-issues/jsrvolume10issue1february/continuouscompressionasaneffectivetherapeuticinterventionintreatingeccentricexerciseinducedmusclesoreness </ref><ref name="ViguierKraemer-20102001b"> {{Cite journal | last1 = Viguier Kraemer | first1 = MWJ. | last2 = Richette Bush | first2 = PJA. | last3 = Bachelez Wickham | first3 = H. | last4 = Wendling | first4 = D. | last5 = Aubin | first5 = FRB. | title = [Paradoxical cutaneous manifestations during antiContinuous Compression as an Effective Therapeutic Intervention in Treating Eccentric-TNFExercise-alpha therapy]. Induced Muscle Soreness | journal = Ann Dermatol Venereol J Sport Rehab| volume = 137 10 | issue = 1 | pages = 64-71; quiz 63, 7811-9 23 | month = Jan | year = 2010 | doi = 10.1016/j.annder.2009.10.003 | PMID = 20110075 2001 }}</ref>
<ref name="Kraemer-2001"> {{Cite journal | last1 = Kraemer | first1 = WJ. | last2 = Bush | first2 = JA. | last3 = Wickham | first3 = RB. | last4 = Denegar | first4 = CR. | last5 = Gómez | first5 = AL. | last6 = Gotshalk | first6 = LA. | last7 = Duncan | first7 = ND. | last8 = Volek | first8 = JS. | last9 = Putukian | first9 = M. | title = Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise. | journal = J Orthop Sports Phys Ther | volume = 31 | issue = 6 | pages = 282-90 | month = Jun | year = 2001 | doi = | PMID = 11411623 }}</ref>
<ref name="DaviesThompson2009">{{cite journal|last1=Davies|first1=Vanessa|last2=Thompson|first2=Kevin G|last3=Cooper|first3=Stephen-Mark|title=The Effects of Compression Garments on Recovery|journal=Journal of Strength and Conditioning Research|volume=23|issue=6|year=2009|pages=1786–1794|issn=1064-8011|doi=10.1519/JSC.0b013e3181b42589}}</ref>
<ref name="KraemerFlanagan2010">{{cite journal|last1=Kraemer|first1=William J|last2=Flanagan|first2=Shawn D|last3=Comstock|first3=Brett A|last4=Fragala|first4=Maren S|last5=Earp|first5=Jacob E|last6=Dunn-Lewis|first6=Courtenay|last7=Ho|first7=Jen-Yu|last8=Thomas|first8=Gwendolyn A|last9=Solomon-Hill|first9=Glenn|last10=Penwell|first10=Zachary R|last11=Powell|first11=Matthew D|last12=Wolf|first12=Megan R|last13=Volek|first13=Jeff S|last14=Denegar|first14=Craig R|last15=Maresh|first15=Carl M|title=Effects of a Whole Body Compression Garment on Markers of Recovery After a Heavy Resistance Workout in Men and Women|journal=Journal of Strength and Conditioning Research|volume=24|issue=3|year=2010|pages=804–814|issn=1064-8011|doi=10.1519/JSC.0b013e3181d33025}}</ref>
<ref name="MacRae-2011"> {{Cite journal | last1 = MacRae | first1 = BA. | last2 = Cotter | first2 = JD. | last3 = Laing | first3 = RM. | title = Compression garments and exercise: garment considerations, physiology and performance. | journal = Sports Med | volume = 41 | issue = 10 | pages = 815-43 | month = Oct | year = 2011 | doi = 10.2165/11591420-000000000-00000 | PMID = 21923201 }}</ref>
<ref name="Saxton-1995"> {{Cite journal | last1 = Saxton | first1 = JM. | last2 = Clarkson | first2 = PM. | last3 = James | first3 = R. | last4 = Miles | first4 = M. | last5 = Westerfer | first5 = M. | last6 = Clark | first6 = S. | last7 = Donnelly | first7 = AE. | title = Neuromuscular dysfunction following eccentric exercise. | journal = Med Sci Sports Exerc | volume = 27 | issue = 8 | pages = 1185-93 | month = Aug | year = 1995 | doi = | PMID = 7476064 }}</ref>
<ref name="domsbio">Muscle Soreness During Running: Biomechanical and Physiological Considerations http://journals.humankinetics.com/jab-back-issues/jabvolume7issue2may/musclesorenessduringrunningbiomechanicalandphysiologicalconsiderations </ref>
<ref name="domsiso">Delayed Onset Muscle Soreness and Decreased Isokinetic Stren... : The Journal of Strength & Conditioning Research http://journals.lww.com/nsca-jscr/abstract/1988/05000/delayed_onset_muscle_soreness_and_decreased.1.aspx </ref>
<ref name="Gulick-1996"> {{Cite journal | last1 = Gulick | first1 = DT. | last2 = Kimura | first2 = IF. | last3 = Sitler | first3 = M. | last4 = Paolone | first4 = A. | last5 = Kelly | first5 = JD. | title = Various treatment techniques on signs and symptoms of delayed onset muscle soreness. | journal = J Athl Train | volume = 31 | issue = 2 | pages = 145-52 | month = Apr | year = 1996 | doi = | PMID = 16558388 }}</ref>
<ref name="Paddon-Jones-1997"> {{Cite journal | last1 = Paddon-Jones | first1 = DJ. | last2 = Quigley | first2 = BM. | title = Effect of cryotherapy on muscle soreness and strength following eccentric exercise. | journal = Int J Sports Med | volume = 18 | issue = 8 | pages = 588-93 | month = Nov | year = 1997 | doi = 10.1055/s-2007-972686 | PMID = 9443590 }}</ref>
<ref name="Cheung-2003"> {{Cite journal | last1 = Cheung | first1 = K. | last2 = Hume | first2 = P. | last3 = Maxwell | first3 = L. | title = Delayed onset muscle soreness : treatment strategies and performance factors. | journal = Sports Med | volume = 33 | issue = 2 | pages = 145-64 | month = | year = 2003 | doi = | PMID = 12617692 }}</ref>
<ref name="Smith-1992"> Smith LL. Causes of delayed onset muscle soreness and the impact on athletic performance: a review. J Appl Sport Sci Res 1992; 6 (3): 135-41</ref>
<ref name="Miles-1997"> {{Cite journal | last1 = Miles | first1 = MP. | last2 = Ives | first2 = JC. | last3 = Vincent | first3 = KR. | title = Neuromuscular control following maximal eccentric exercise. | journal = Eur J Appl Physiol Occup Physiol | volume = 76 | issue = 4 | pages = 368-74 | month = | year = 1997 | doi = | PMID = 9349654 }}</ref>
<ref name="Zhou-1998"> {{Cite journal | last1 = Zhou | first1 = S. | last2 = Carey | first2 = MF. | last3 = Snow | first3 = RJ. | last4 = Lawson | first4 = DL. | last5 = Morrison | first5 = WE. | title = Effects of muscle fatigue and temperature on electromechanical delay. | journal = Electromyogr Clin Neurophysiol | volume = 38 | issue = 2 | pages = 67-73 | month = Mar | year = 1998 | doi = | PMID = 9553743 }}</ref>
<ref name="Zhou-1996"> {{Cite journal | last1 = Zhou | first1 = S. | title = Acute effect of repeated maximal isometric contraction on electromechanical delay of knee extensor muscle. | journal = J Electromyogr Kinesiol | volume = 6 | issue = 2 | pages = 117-27 | month = Jun | year = 1996 | doi = | PMID = 20719669 }}</ref>
<ref name="Gulick-17">Delayed Onset Muscle Soreness: What Is It and How Do We Treat It? http://journals.humankinetics.com/jsr-back-issues/jsrvolume5issue3august/delayedonsetmusclesorenesswhatisitandhowdowetreatit </ref>
<ref name="Isabell-1992"> {{Cite journal | last1 = Isabell | first1 = WK. | last2 = Durrant | first2 = E. | last3 = Myrer | first3 = W. | last4 = Anderson | first4 = S. | title = The effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness. | journal = J Athl Train | volume = 27 | issue = 3 | pages = 208-17 | month = | year = 1992 | doi = | PMID = 16558163 }}</ref>
<ref name="Braun-2003"> {{Cite journal | last1 = Braun | first1 = WA. | last2 = Dutto | first2 = DJ. | title = The effects of a single bout of downhill running and ensuing delayed onset of muscle soreness on running economy performed 48 h later. | journal = Eur J Appl Physiol | volume = 90 | issue = 1-2 | pages = 29-34 | month = Sep | year = 2003 | doi = 10.1007/s00421-003-0857-8 | PMID = 12783232 }}</ref>
<ref name="Denegar-1992"> {{Cite journal | last1 = Denegar | first1 = CR. | last2 = Perrin | first2 = DH. | title = Effect of transcutaneous electrical nerve stimulation, cold, and a combination treatment on pain, decreased range of motion, and strength loss associated with delayed onset muscle soreness. | journal = J Athl Train | volume = 27 | issue = 3 | pages = 200-6 | month = | year = 1992 | doi = | PMID = 16558162 }}</ref>
<ref name="Shunsuke-2004">CiNii Articles - EFFECTS OF ICE PACK ON MUSCLE INJURY INDUCED BY ECCENTRIC CONTRACTIONS http://ci.nii.ac.jp/naid/110004787806 </ref>
<ref name="Yackzan-"> {{Cite journal | last1 = Yackzan | first1 = L. | last2 = Adams | first2 = C. | last3 = Francis | first3 = KT. | title = The effects of ice massage on delayed muscle soreness. | journal = Am J Sports Med | volume = 12 | issue = 2 | pages = 159-65 | month = | year = | doi = | PMID = 6742292 }}</ref>
<ref name="High-1989"> {{Cite journal | last1 = High | first1 = DM. | last2 = Howley | first2 = ET. | last3 = Franks | first3 = BD. | title = The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. | journal = Res Q Exerc Sport | volume = 60 | issue = 4 | pages = 357-61 | month = Dec | year = 1989 | doi = | PMID = 2489863 }}</ref>
<ref name="Johansson-1999"> {{Cite journal | last1 = Johansson | first1 = PH. | last2 = Lindström | first2 = L. | last3 = Sundelin | first3 = G. | last4 = Lindström | first4 = B. | title = The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise. | journal = Scand J Med Sci Sports | volume = 9 | issue = 4 | pages = 219-25 | month = Aug | year = 1999 | doi = | PMID = 10407930 }}</ref>
<ref name="Wessel-1994">Wessel, Jean, and Aaron Wan. "Effect of stretching on the intensity of delayed-onset muscle soreness." Clinical Journal of Sport Medicine 4.2 (1994): 83-87.</ref>
<ref name="Smith-1993"> {{Cite journal | last1 = Smith | first1 = LL. | last2 = Brunetz | first2 = MH. | last3 = Chenier | first3 = TC. | last4 = McCammon | first4 = MR. | last5 = Houmard | first5 = JA. | last6 = Franklin | first6 = ME. | last7 = Israel | first7 = RG. | title = The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase. | journal = Res Q Exerc Sport | volume = 64 | issue = 1 | pages = 103-7 | month = Mar | year = 1993 | doi = | PMID = 8451526 }}</ref>
<ref name="Buroker-1989">Does Postexercise Static Stretching Alleviate Delayed Muscle Soreness? http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ414210&ERICExtSearch_SearchType_0=no&accno=EJ414210 </ref>
<ref name="Herbert-2007"> {{Cite journal | last1 = Herbert | first1 = RD. | last2 = de Noronha | first2 = M. | title = Stretching to prevent or reduce muscle soreness after exercise. | journal = Cochrane Database Syst Rev | volume = | issue = 4 | pages = CD004577 | month = | year = 2007 | doi = 10.1002/14651858.CD004577.pub2 | PMID = 17943822 }}</ref>
<ref name="Law-2007"> {{Cite journal | last1 = Law | first1 = RY. | last2 = Herbert | first2 = RD. | title = Warm-up reduces delayed onset muscle soreness but cool-down does not: a randomised controlled trial. | journal = Aust J Physiother | volume = 53 | issue = 2 | pages = 91-5 | month = | year = 2007 | doi = | PMID = 17535144 }}</ref>
<ref name="Etheridge-2008"> {{Cite journal | last1 = Etheridge | first1 = T. | last2 = Philp | first2 = A. | last3 = Watt | first3 = PW. | title = A single protein meal increases recovery of muscle function following an acute eccentric exercise bout. | journal = Appl Physiol Nutr Metab | volume = 33 | issue = 3 | pages = 483-8 | month = Jun | year = 2008 | doi = 10.1139/H08-028 | PMID = 18461101 }}</ref>
<ref name="Lund-1998"> {{Cite journal | last1 = Lund | first1 = H. | last2 = Vestergaard-Poulsen | first2 = P. | last3 = Kanstrup | first3 = IL. | last4 = Sejrsen | first4 = P. | title = The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. | journal = Scand J Med Sci Sports | volume = 8 | issue = 4 | pages = 216-21 | month = Aug | year = 1998 | doi = | PMID = 9764443 }}</ref>
<ref name="Riasata-2010">Riasati et al.: Aspirin and delayed onset muscle soreness ASPIRIN MAY BE AN EFFECTIVE TREATMENT FOR EXERCISE- INDUCED MUSCLE SORENESS | ResearchGate http://www.researchgate.net/publication/228091056_Riasati_et_al._Aspirin_and_delayed_onset_muscle_soreness_ASPIRIN_MAY_BE_AN_EFFECTIVE_TREATMENT_FOR_EXERCISE-_INDUCED_MUSCLE_SORENESS </ref>
<ref name="Francis-1987"> {{Cite journal | last1 = Francis | first1 = KT. | last2 = Hoobler | first2 = T. | title = Effects of aspirin on delayed muscle soreness. | journal = J Sports Med Phys Fitness | volume = 27 | issue = 3 | pages = 333-7 | month = Sep | year = 1987 | doi = | PMID = 3431117 }}</ref>
<ref name="Donnelly-1990"> {{Cite journal | last1 = Donnelly | first1 = AE. | last2 = Maughan | first2 = RJ. | last3 = Whiting | first3 = PH. | title = Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage. | journal = Br J Sports Med | volume = 24 | issue = 3 | pages = 191-5 | month = Sep | year = 1990 | doi = | PMID = 2078806 }}</ref>
<ref name="DonnellyMcCormick1988">{{cite journal|last1=Donnelly|first1=A E|last2=McCormick|first2=K|last3=Maughan|first3=R J|last4=Whiting|first4=P H|last5=Clarkson|first5=P M|title=Effects of a non-steroidal anti-inflammatory drug on delayed onset muscle soreness and indices of damage.|journal=British Journal of Sports Medicine|volume=22|issue=1|year=1988|pages=35–38|issn=0306-3674|doi=10.1136/bjsm.22.1.35}}</ref>
<ref name="Hasson-1993"> {{Cite journal | last1 = Hasson | first1 = SM. | last2 = Daniels | first2 = JC. | last3 = Divine | first3 = JG. | last4 = Niebuhr | first4 = BR. | last5 = Richmond | first5 = S. | last6 = Stein | first6 = PG. | last7 = Williams | first7 = JH. | title = Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. | journal = Med Sci Sports Exerc | volume = 25 | issue = 1 | pages = 9-17 | month = Jan | year = 1993 | doi = | PMID = 8423760 }}</ref>
<ref name="Grossman-1995">Effect of Ibuprofen Use on Delayed Onset Muscle Soreness of the Elbow Flexors http://journals.humankinetics.com/jsr-back-issues/jsrvolume4issue4november/effectofibuprofenuseondelayedonsetmusclesorenessoftheelbowflexors </ref>
<ref name="Dudley-1997"> {{Cite journal | last1 = Dudley | first1 = GA. | last2 = Czerkawski | first2 = J. | last3 = Meinrod | first3 = A. | last4 = Gillis | first4 = G. | last5 = Baldwin | first5 = A. | last6 = Scarpone | first6 = M. | title = Efficacy of naproxen sodium for exercise-induced dysfunction muscle injury and soreness. | journal = Clin J Sport Med | volume = 7 | issue = 1 | pages = 3-10 | month = Jan | year = 1997 | doi = | PMID = 9117523 }}</ref>
<ref name="Barlas-2000"> {{Cite journal | last1 = Barlas | first1 = P. | last2 = Craig | first2 = JA. | last3 = Robinson | first3 = J. | last4 = Walsh | first4 = DM. | last5 = Baxter | first5 = GD. | last6 = Allen | first6 = JM. | title = Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics. | journal = Arch Phys Med Rehabil | volume = 81 | issue = 7 | pages = 966-72 | month = Jul | year = 2000 | doi = 10.1053/apmr.2000.6277 | PMID = 10896014 }}</ref>
<ref name="Pizza-1999"> {{Cite journal | last1 = Pizza | first1 = FX. | last2 = Cavender | first2 = D. | last3 = Stockard | first3 = A. | last4 = Baylies | first4 = H. | last5 = Beighle | first5 = A. | title = Anti-inflammatory doses of ibuprofen: effect on neutrophils and exercise-induced muscle injury. | journal = Int J Sports Med | volume = 20 | issue = 2 | pages = 98-102 | month = Feb | year = 1999 | doi = 10.1055/s-2007-971100 | PMID = 10190769 }}</ref>
<ref name="SmithGeorge1995">{{cite journal|last1=Smith|first1=Lucille|last2=George|first2=Robert|last3=Chenier|first3=Thomas|last4=McCammon|first4=Michael|last5=Houmard|first5=Joseph|last6=Israel|first6=Richard|last7=Hoppmann|first7=R. A.|last8=Smith|first8=Susan|title=Do over-the-counter analgesics reduce delayed onset muscle soreness and serum creatine kinase values?|journal=Research in Sports Medicine|volume=6|issue=2|year=1995|pages=81–88|issn=1543-8627|doi=10.1080/15438629509512039}}</ref>
<ref name="Baldwin-2001"> {{Cite journal | last1 = Baldwin | first1 = AC. | last2 = Stevenson | first2 = SW. | last3 = Dudley | first3 = GA. | title = Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. | journal = J Gerontol A Biol Sci Med Sci | volume = 56 | issue = 8 | pages = M510-3 | month = Aug | year = 2001 | doi = | PMID = 11487604 }}</ref>
<ref name="pmid12580656">{{cite journal| author=Tokmakidis SP, Kokkinidis EA, Smilios I, Douda H| title=The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise. | journal=J Strength Cond Res | year= 2003 | volume= 17 | issue= 1 | pages= 53-9 | pmid=12580656 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12580656 }} </ref>
<ref name="Stone-2002"> {{Cite journal | last1 = Stone | first1 = MB. | last2 = Merrick | first2 = MA. | last3 = Ingersoll | first3 = CD. | last4 = Edwards | first4 = JE. | title = Preliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness management. | journal = Clin J Sport Med | volume = 12 | issue = 6 | pages = 373-8 | month = Nov | year = 2002 | doi = | PMID = 12466693 }}</ref>
<ref name="RahnamaRahmani-Nia2005">{{cite journal|last1=Rahnama|first1=N|last2=Rahmani-Nia|first2=F|last3=Ebrahim|first3=K|title=The isolated and combined effects of selected physical activity and ibuprofen on delayed-onset muscle soreness|journal=Journal of Sports Sciences|volume=23|issue=8|year=2005|pages=843–850|issn=0264-0414|doi=10.1080/02640410400021989}}</ref>
<ref name="KrentzQuest2008">{{cite journal|last1=Krentz|first1=Joel R.|last2=Quest|first2=Braden|last3=Farthing|first3=Jonathan P.|last4=Quest|first4=Dale W.|last5=Chilibeck|first5=Philip D.|title=The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training|journal=Applied Physiology, Nutrition, and Metabolism|volume=33|issue=3|year=2008|pages=470–475|issn=1715-5312|doi=10.1139/H08-019}}</ref>
<ref name="HyldahlKeadle2010">{{cite journal|last1=Hyldahl|first1=Robert D.|last2=Keadle|first2=Justin|last3=Rouzier|first3=Pierre A.|last4=Pearl|first4=Dennis|last5=Clarkson|first5=Priscilla M.|title=Effects of Ibuprofen Topical Gel on Muscle Soreness|journal=Medicine & Science in Sports & Exercise|volume=42|issue=3|year=2010|pages=614–621|issn=0195-9131|doi=10.1249/MSS.0b013e3181b95db2}}</ref>
<ref name="Arendt-NielsenWeidner2007">{{cite journal|last1=Arendt-Nielsen|first1=Lars|last2=Weidner|first2=Morten|last3=Bartholin|first3=Dorte|last4=Rosetzsky|first4=Allan|title=A Double-Blind Randomized Placebo Controlled Parallel Group Study Evaluating the Effects of Ibuprofen and Glucosamine Sulfate on Exercise Induced Muscle Soreness|journal=Journal Of Musculoskeletal Pain|volume=15|issue=1|year=2007|pages=21–28|issn=1058-2452|doi=10.1300/J094v15n01_04}}</ref>
<ref name="LoramMitchell2005">{{cite journal|last1=Loram|first1=L.C.|last2=Mitchell|first2=D.|last3=Fuller|first3=A.|title=Rofecoxib and tramadol do not attenuate delayed-onset muscle soreness or ischaemic pain in human volunteers|journal=Canadian Journal of Physiology and Pharmacology|volume=83|issue=12|year=2005|pages=1137–1145|issn=0008-4212|doi=10.1139/y05-113}}</ref>
<ref name="Howatson-2008"> {{Cite journal | last1 = Howatson | first1 = G. | last2 = van Someren | first2 = KA. | title = The prevention and treatment of exercise-induced muscle damage. | journal = Sports Med | volume = 38 | issue = 6 | pages = 483-503 | month = | year = 2008 | doi = | PMID = 18489195 }}</ref>
<ref name="Lecomte-1998"> {{Cite journal | last1 = Lecomte | first1 = JM. | last2 = Lacroix | first2 = VJ. | last3 = Montgomery | first3 = DL. | title = A randomized controlled trial of the effect of naproxen on delayed onset muscle soreness and muscle strength. | journal = Clin J Sport Med | volume = 8 | issue = 2 | pages = 82-7 | month = Apr | year = 1998 | doi = | PMID = 9641434 }}</ref>
<ref name="Mishra-1995"> {{Cite journal | last1 = Mishra | first1 = DK. | last2 = Fridén | first2 = J. | last3 = Schmitz | first3 = MC. | last4 = Lieber | first4 = RL. | title = Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function. | journal = J Bone Joint Surg Am | volume = 77 | issue = 10 | pages = 1510-9 | month = Oct | year = 1995 | doi = | PMID = 7593059 }}</ref>
<ref name="Sayers-2001"> {{Cite journal | last1 = Sayers | first1 = SP. | last2 = Knight | first2 = CA. | last3 = Clarkson | first3 = PM. | last4 = Van Wegen | first4 = EH. | last5 = Kamen | first5 = G. | title = Effect of ketoprofen on muscle function and sEMG activity after eccentric exercise. | journal = Med Sci Sports Exerc | volume = 33 | issue = 5 | pages = 702-10 | month = May | year = 2001 | doi = | PMID = 11323536 }}</ref>
<ref name="Park-2008"> {{Cite journal | last1 = Park | first1 = ND. | last2 = Maresca | first2 = RD. | last3 = McKibans | first3 = KI. | last4 = Morgan | first4 = DR. | last5 = Allen | first5 = TS. | last6 = Warren | first6 = GL. | title = Caffeines enhancement of maximal voluntary strength and activation in uninjured but not injured muscle. | journal = Int J Sport Nutr Exerc Metab | volume = 18 | issue = 6 | pages = 639-52 | month = Dec | year = 2008 | doi = | PMID = 19164833 }}</ref>
<ref name="Denegar-1989"> {{Cite journal | last1 = Denegar | first1 = CR. | last2 = Perrin | first2 = DH. | last3 = Rogol | first3 = AD. | last4 = Rutt | first4 = RA. | title = Influence of transcutaneous electrical nerve stimulation on pain, range of motion, and serum cortisol concentration in females experiencing delayed onset muscle soreness. | journal = J Orthop Sports Phys Ther | volume = 11 | issue = 3 | pages = 100-3 | month = | year = 1989 | doi = | PMID = 18796921 }}</ref>
<ref name="Denegar">The Effects of Low-Volt, Microamperage Stimulation on Delayed Onset Muscle Soreness http://journals.humankinetics.com/jsr-back-issues/jsrvolume1issue2may/theeffectsoflowvoltmicroamperagestimulationondelayedonsetmusclesoreness </ref>
<ref name="Bonacci-1997"> {{Cite journal | last1 = Bonacci | first1 = JA. | last2 = Higbie | first2 = EJ. | title = Effects of microcurrent treatment on perceived pain and muscle strength following eccentric exercise. | journal = J Athl Train | volume = 32 | issue = 2 | pages = 119-23 | month = Apr | year = 1997 | doi = | PMID = 16558440 }}</ref>
<ref name="Bryer-2006"> {{Cite journal | last1 = Bryer | first1 = SC. | last2 = Goldfarb | first2 = AH. | title = Effect of high dose vitamin C supplementation on muscle soreness, damage, function, and oxidative stress to eccentric exercise. | journal = Int J Sport Nutr Exerc Metab | volume = 16 | issue = 3 | pages = 270-80 | month = Jun | year = 2006 | doi = | PMID = 16948483 }}</ref>
<ref name="Kaminski-1992"> {{Cite journal | last1 = Kaminski | first1 = M. | last2 = Boal | first2 = R. | title = An effect of ascorbic acid on delayed-onset muscle soreness. | journal = Pain | volume = 50 | issue = 3 | pages = 317-21 | month = Sep | year = 1992 | doi = | PMID = 1280803 }}</ref>
<ref name="Thompson-2001"> {{Cite journal | last1 = Thompson | first1 = D. | last2 = Williams | first2 = C. | last3 = McGregor | first3 = SJ. | last4 = Nicholas | first4 = CW. | last5 = McArdle | first5 = F. | last6 = Jackson | first6 = MJ. | last7 = Powell | first7 = JR. | title = Prolonged vitamin C supplementation and recovery from demanding exercise. | journal = Int J Sport Nutr Exerc Metab | volume = 11 | issue = 4 | pages = 466-81 | month = Dec | year = 2001 | doi = | PMID = 11915781 }}</ref>
<ref name="Connolly-2006"> {{Cite journal | last1 = Connolly | first1 = DA. | last2 = Lauzon | first2 = C. | last3 = Agnew | first3 = J. | last4 = Dunn | first4 = M. | last5 = Reed | first5 = B. | title = The effects of vitamin C supplementation on symptoms of delayed onset muscle soreness. | journal = J Sports Med Phys Fitness | volume = 46 | issue = 3 | pages = 462-7 | month = Sep | year = 2006 | doi = | PMID = 16998453 }}</ref>
<ref name="CloseAshton2006">{{cite journal|last1=Close|first1=Graeme L.|last2=Ashton|first2=Tony|last3=Cable|first3=Tim|last4=Doran|first4=Dominic|last5=Holloway|first5=Chris|last6=McArdle|first6=Frank|last7=MacLaren|first7=Don P. M.|title=Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process|journal=British Journal of Nutrition|volume=95|issue=5|year=2006|pages=976–981|issn=00071145|doi=10.1079/BJN20061732}}</ref>
<ref name="Thompson-2001x"> {{Cite journal | last1 = Thompson | first1 = D. | last2 = Williams | first2 = C. | last3 = Kingsley | first3 = M. | last4 = Nicholas | first4 = CW. | last5 = Lakomy | first5 = HK. | last6 = McArdle | first6 = F. | last7 = Jackson | first7 = MJ. | title = Muscle soreness and damage parameters after prolonged intermittent shuttle-running following acute vitamin C supplementation. | journal = Int J Sports Med | volume = 22 | issue = 1 | pages = 68-75 | month = Jan | year = 2001 | doi = 10.1055/s-2001-11358 | PMID = 11258644 }}</ref>
<ref name="Thompson-2004"> {{Cite journal | last1 = Thompson | first1 = D. | last2 = Bailey | first2 = DM. | last3 = Hill | first3 = J. | last4 = Hurst | first4 = T. | last5 = Powell | first5 = JR. | last6 = Williams | first6 = C. | title = Prolonged vitamin C supplementation and recovery from eccentric exercise. | journal = Eur J Appl Physiol | volume = 92 | issue = 1-2 | pages = 133-8 | month = Jun | year = 2004 | doi = 10.1007/s00421-004-1064-y | PMID = 15024666 }}</ref>
<ref name="Gomez-Cabrera-2008"> {{Cite journal | last1 = Gomez-Cabrera | first1 = MC. | last2 = Domenech | first2 = E. | last3 = Romagnoli | first3 = M. | last4 = Arduini | first4 = A. | last5 = Borras | first5 = C. | last6 = Pallardo | first6 = FV. | last7 = Sastre | first7 = J. | last8 = Viña | first8 = J. | title = Oral administration of vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance. | journal = Am J Clin Nutr | volume = 87 | issue = 1 | pages = 142-9 | month = Jan | year = 2008 | doi = | PMID = 18175748 }}</ref>
<ref name="Wadley-2010"> {{Cite journal | last1 = Wadley | first1 = GD. | last2 = McConell | first2 = GK. | title = High-dose antioxidant vitamin C supplementation does not prevent acute exercise-induced increases in markers of skeletal muscle mitochondrial biogenesis in rats. | journal = J Appl Physiol | volume = 108 | issue = 6 | pages = 1719-26 | month = Jun | year = 2010 | doi = 10.1152/japplphysiol.00127.2010 | PMID = 20395544 }}</ref>
<ref name="Strobel-2011"> {{Cite journal | last1 = Strobel | first1 = NA. | last2 = Peake | first2 = JM. | last3 = Matsumoto | first3 = A. | last4 = Marsh | first4 = SA. | last5 = Coombes | first5 = JS. | last6 = Wadley | first6 = GD. | title = Antioxidant supplementation reduces skeletal muscle mitochondrial biogenesis. | journal = Med Sci Sports Exerc | volume = 43 | issue = 6 | pages = 1017-24 | month = Jun | year = 2011 | doi = 10.1249/MSS.0b013e318203afa3 | PMID = 21085043 }}</ref>
<ref name="Higashida-2011"> {{Cite journal | last1 = Higashida | first1 = K. | last2 = Kim | first2 = SH. | last3 = Higuchi | first3 = M. | last4 = Holloszy | first4 = JO. | last5 = Han | first5 = DH. | title = Normal adaptations to exercise despite protection against oxidative stress. | journal = Am J Physiol Endocrinol Metab | volume = 301 | issue = 5 | pages = E779-84 | month = Nov | year = 2011 | doi = 10.1152/ajpendo.00655.2010 | PMID = 21750271 }}</ref>
<ref name="YfantiAkerstrom2009">{{cite journal|last1=Yfanti|first1=Christina|last2=Åkerström|first2=Thorbjörn|last3=Nielsen|first3=Søren|last4=Nielsen|first4=Anders R|last5=Mounier|first5=Remi|last6=Mortensen|first6=Ole H|last7=Lykkesfeldt|first7=Jens|last8=Rose|first8=Adam J|last9=Fischer|first9=Christian P|last10=Pedersen|first10=Bente K|title=Antioxidant Supplementation Does Not Alter Endurance Training Adaptation|journal=Medicine & Science in Sports & Exercise|year=2009|pages=1|issn=0195-9131|doi=10.1249/MSS.0b013e3181cd76be}}</ref>
<ref name="RistowZarse2009">{{cite journal|last1=Ristow|first1=M.|last2=Zarse|first2=K.|last3=Oberbach|first3=A.|last4=Kloting|first4=N.|last5=Birringer|first5=M.|last6=Kiehntopf|first6=M.|last7=Stumvoll|first7=M.|last8=Kahn|first8=C. R.|last9=Bluher|first9=M.|title=Antioxidants prevent health-promoting effects of physical exercise in humans|journal=Proceedings of the National Academy of Sciences|volume=106|issue=21|year=2009|pages=8665–8670|issn=0027-8424|doi=10.1073/pnas.0903485106}}</ref>
<ref name="Beaton-2002"> {{Cite journal | last1 = Beaton | first1 = LJ. | last2 = Allan | first2 = DA. | last3 = Tarnopolsky | first3 = MA. | last4 = Tiidus | first4 = PM. | last5 = Phillips | first5 = SM. | title = Contraction-induced muscle damage is unaffected by vitamin E supplementation. | journal = Med Sci Sports Exerc | volume = 34 | issue = 5 | pages = 798-805 | month = May | year = 2002 | doi = | PMID = 11984298 }}</ref>
<ref name="Shafat-2004"> {{Cite journal | last1 = Shafat | first1 = A. | last2 = Butler | first2 = P. | last3 = Jensen | first3 = RL. | last4 = Donnelly | first4 = AE. | title = Effects of dietary supplementation with vitamins C and E on muscle function during and after eccentric contractions in humans. | journal = Eur J Appl Physiol | volume = 93 | issue = 1-2 | pages = 196-202 | month = Oct | year = 2004 | doi = 10.1007/s00421-004-1198-y | PMID = 15309547 }}</ref>
<ref name="Mastaloudis-2006"> {{Cite journal | last1 = Mastaloudis | first1 = A. | last2 = Traber | first2 = MG. | last3 = Carstensen | first3 = K. | last4 = Widrick | first4 = JJ. | title = Antioxidants did not prevent muscle damage in response to an ultramarathon run. | journal = Med Sci Sports Exerc | volume = 38 | issue = 1 | pages = 72-80 | month = Jan | year = 2006 | doi = | PMID = 16394956 }}</ref>
<ref name="Costill-1990"> {{Cite journal | last1 = Costill | first1 = DL. | last2 = Pascoe | first2 = DD. | last3 = Fink | first3 = WJ. | last4 = Robergs | first4 = RA. | last5 = Barr | first5 = SI. | last6 = Pearson | first6 = D. | title = Impaired muscle glycogen resynthesis after eccentric exercise. | journal = J Appl Physiol | volume = 69 | issue = 1 | pages = 46-50 | month = Jul | year = 1990 | doi = | PMID = 2394662 }}</ref>
<ref name="Zehnder-2004"> {{Cite journal | last1 = Zehnder | first1 = M. | last2 = Muelli | first2 = M. | last3 = Buchli | first3 = R. | last4 = Kuehne | first4 = G. | last5 = Boutellier | first5 = U. | title = Further glycogen decrease during early recovery after eccentric exercise despite a high carbohydrate intake. | journal = Eur J Nutr | volume = 43 | issue = 3 | pages = 148-59 | month = Jun | year = 2004 | doi = 10.1007/s00394-004-0453-7 | PMID = 15168037 }}</ref>
<ref name="Widrick-1992"> {{Cite journal | last1 = Widrick | first1 = JJ. | last2 = Costill | first2 = DL. | last3 = McConell | first3 = GK. | last4 = Anderson | first4 = DE. | last5 = Pearson | first5 = DR. | last6 = Zachwieja | first6 = JJ. | title = Time course of glycogen accumulation after eccentric exercise. | journal = J Appl Physiol | volume = 72 | issue = 5 | pages = 1999-2004 | month = May | year = 1992 | doi = | PMID = 1601811 }}</ref>
<ref name="Close2005">{{cite journal|last1=Close|first1=G L|title=Effects of dietary carbohydrate on delayed onset muscle soreness and reactive oxygen species after contraction induced muscle damage|journal=British Journal of Sports Medicine|volume=39|issue=12|year=2005|pages=948–953|issn=0306-3674|doi=10.1136/bjsm.2005.019844}}</ref>
<ref name="Nelson-2004"> {{Cite journal | last1 = Nelson | first1 = MR. | last2 = Conlee | first2 = RK. | last3 = Parcell | first3 = AC. | title = Inadequate carbohydrate intake following prolonged exercise does not increase muscle soreness after 15 minutes of downhill running. | journal = Int J Sport Nutr Exerc Metab | volume = 14 | issue = 2 | pages = 171-84 | month = Apr | year = 2004 | doi = | PMID = 15118191 }}</ref>
<ref name="Nosaka-2006"> {{Cite journal | last1 = Nosaka | first1 = K. | last2 = Sacco | first2 = P. | last3 = Mawatari | first3 = K. | title = Effects of amino acid supplementation on muscle soreness and damage. | journal = Int J Sport Nutr Exerc Metab | volume = 16 | issue = 6 | pages = 620-35 | month = Dec | year = 2006 | doi = | PMID = 17342883 }}</ref>
<ref name="Wojcik-2001"> {{Cite journal | last1 = Wojcik | first1 = JR. | last2 = Walber-Rankin | first2 = J. | last3 = Smith | first3 = LL. | last4 = Gwazdauskas | first4 = FC. | title = Comparison of carbohydrate and milk-based beverages on muscle damage and glycogen following exercise. | journal = Int J Sport Nutr Exerc Metab | volume = 11 | issue = 4 | pages = 406-19 | month = Dec | year = 2001 | doi = | PMID = 11915776 }}</ref>
<ref name="HowatsonHoad2012">{{cite journal|last1=Howatson|first1=Glyn|last2=Hoad|first2=Michael|last3=Goodall|first3=Stuart|last4=Tallent|first4=Jamie|last5=Bell|first5=Phillip G|last6=French|first6=Duncan N|title=Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study|journal=Journal of the International Society of Sports Nutrition|volume=9|issue=1|year=2012|pages=20|issn=1550-2783|doi=10.1186/1550-2783-9-20}}</ref>
<ref name="Matsumoto-2009"> {{Cite journal | last1 = Matsumoto | first1 = K. | last2 = Koba | first2 = T. | last3 = Hamada | first3 = K. | last4 = Sakurai | first4 = M. | last5 = Higuchi | first5 = T. | last6 = Miyata | first6 = H. | title = Branched-chain amino acid supplementation attenuates muscle soreness, muscle damage and inflammation during an intensive training program. | journal = J Sports Med Phys Fitness | volume = 49 | issue = 4 | pages = 424-31 | month = Dec | year = 2009 | doi = | PMID = 20087302 }}</ref>
<ref name="Greer-2007"> {{Cite journal | last1 = Greer | first1 = BK. | last2 = Woodard | first2 = JL. | last3 = White | first3 = JP. | last4 = Arguello | first4 = EM. | last5 = Haymes | first5 = EM. | title = Branched-chain amino acid supplementation and indicators of muscle damage after endurance exercise. | journal = Int J Sport Nutr Exerc Metab | volume = 17 | issue = 6 | pages = 595-607 | month = Dec | year = 2007 | doi = | PMID = 18156664 }}</ref>
<ref name="Jackman-2010"> {{Cite journal | last1 = Jackman | first1 = SR. | last2 = Witard | first2 = OC. | last3 = Jeukendrup | first3 = AE. | last4 = Tipton | first4 = KD. | title = Branched-chain amino acid ingestion can ameliorate soreness from eccentric exercise. | journal = Med Sci Sports Exerc | volume = 42 | issue = 5 | pages = 962-70 | month = May | year = 2010 | doi = 10.1249/MSS.0b013e3181c1b798 | PMID = 19997002 }}</ref>
<ref name="Shimomura-2010"> {{Cite journal | last1 = Shimomura | first1 = Y. | last2 = Inaguma | first2 = A. | last3 = Watanabe | first3 = S. | last4 = Yamamoto | first4 = Y. | last5 = Muramatsu | first5 = Y. | last6 = Bajotto | first6 = G. | last7 = Sato | first7 = J. | last8 = Shimomura | first8 = N. | last9 = Kobayashi | first9 = H. | title = Branched-chain amino acid supplementation before squat exercise and delayed-onset muscle soreness. | journal = Int J Sport Nutr Exerc Metab | volume = 20 | issue = 3 | pages = 236-44 | month = Jun | year = 2010 | doi = | PMID = 20601741 }}</ref>
<ref name="Samadi-2012"> {{Cite journal | last1 = Samadi | first1 = A. | last2 = Gaeini | first2 = AA. | last3 = Kordi | first3 = MR. | last4 = Rahimi | first4 = M. | last5 = Rahnama | first5 = N. | last6 = Bambaeichi | first6 = E. | title = Effect of various ratios of carbohydrate-protein supplementation on resistance exercise-induced muscle damage. | journal = J Sports Med Phys Fitness | volume = 52 | issue = 2 | pages = 151-7 | month = Apr | year = 2012 | doi = | PMID = 22525650 }}</ref>
<ref name="Flakoll-2004"> {{Cite journal | last1 = Flakoll | first1 = PJ. | last2 = Judy | first2 = T. | last3 = Flinn | first3 = K. | last4 = Carr | first4 = C. | last5 = Flinn | first5 = S. | title = Postexercise protein supplementation improves health and muscle soreness during basic military training in Marine recruits. | journal = J Appl Physiol | volume = 96 | issue = 3 | pages = 951-6 | month = Mar | year = 2004 | doi = 10.1152/japplphysiol.00811.2003 | PMID = 14657039 }}</ref>
<ref name="CockburnHayes2008">{{cite journal|last1=Cockburn|first1=Emma|last2=Hayes|first2=Philip R.|last3=French|first3=Duncan N.|last4=Stevenson|first4=Emma|last5=St Clair Gibson|first5=Alan|title=Acute milk-based protein–CHO supplementation attenuates exercise-induced muscle damage|journal=Applied Physiology, Nutrition, and Metabolism|volume=33|issue=4|year=2008|pages=775–783|issn=1715-5312|doi=10.1139/H08-057}}</ref>
<ref name="Luden-2007"> {{Cite journal | last1 = Luden | first1 = ND. | last2 = Saunders | first2 = MJ. | last3 = Todd | first3 = MK. | title = Postexercise carbohydrate-protein- antioxidant ingestion decreases plasma creatine kinase and muscle soreness. | journal = Int J Sport Nutr Exerc Metab | volume = 17 | issue = 1 | pages = 109-23 | month = Feb | year = 2007 | doi = | PMID = 17460336 }}</ref>
<ref name="Green-2008"> {{Cite journal | last1 = Green | first1 = MS. | last2 = Corona | first2 = BT. | last3 = Doyle | first3 = JA. | last4 = Ingalls | first4 = CP. | title = Carbohydrate-protein drinks do not enhance recovery from exercise-induced muscle injury. | journal = Int J Sport Nutr Exerc Metab | volume = 18 | issue = 1 | pages = 1-18 | month = Feb | year = 2008 | doi = | PMID = 18272930 }}</ref>
<ref name="Valentine-2008"> {{Cite journal | last1 = Valentine | first1 = RJ. | last2 = Saunders | first2 = MJ. | last3 = Todd | first3 = MK. | last4 = St Laurent | first4 = TG. | title = Influence of carbohydrate-protein beverage on cycling endurance and indices of muscle disruption. | journal = Int J Sport Nutr Exerc Metab | volume = 18 | issue = 4 | pages = 363-78 | month = Aug | year = 2008 | doi = | PMID = 18708686 }}</ref>
<ref name="Cockburn-2010"> {{Cite journal | last1 = Cockburn | first1 = E. | last2 = Stevenson | first2 = E. | last3 = Hayes | first3 = PR. | last4 = Robson-Ansley | first4 = P. | last5 = Howatson | first5 = G. | title = Effect of milk-based carbohydrate-protein supplement timing on the attenuation of exercise-induced muscle damage. | journal = Appl Physiol Nutr Metab | volume = 35 | issue = 3 | pages = 270-7 | month = Jun | year = 2010 | doi = 10.1139/H10-017 | PMID = 20555370 }}</ref>
<ref name="CookeRybalka2010">{{cite journal|last1=Cooke|first1=Matthew B|last2=Rybalka|first2=Emma|last3=Stathis|first3=Christos G|last4=Cribb|first4=Paul J|last5=Hayes|first5=Alan|title=Whey protein isolate attenuates strength decline after eccentrically-induced muscle damage in healthy individuals|journal=Journal of the International Society of Sports Nutrition|volume=7|issue=1|year=2010|pages=30|issn=1550-2783|doi=10.1186/1550-2783-7-30}}</ref>
<ref name="Armstrong-1984"> {{Cite journal | last1 = Armstrong | first1 = RB. | title = Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. | journal = Med Sci Sports Exerc | volume = 16 | issue = 6 | pages = 529-38 | month = Dec | year = 1984 | doi = | PMID = 6392811 }}</ref>
<ref name="Zainuddin-2006"> {{Cite journal | last1 = Zainuddin | first1 = Z. | last2 = Sacco | first2 = P. | last3 = Newton | first3 = M. | last4 = Nosaka | first4 = K. | title = Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. | journal = Appl Physiol Nutr Metab | volume = 31 | issue = 2 | pages = 126-34 | month = Apr | year = 2006 | doi = 10.1139/h05-010 | PMID = 16604130 }}</ref>
<ref name="Warhol-1985"> {{Cite journal | last1 = Warhol | first1 = MJ. | last2 = Siegel | first2 = AJ. | last3 = Evans | first3 = WJ. | last4 = Silverman | first4 = LM. | title = Skeletal muscle injury and repair in marathon runners after competition. | journal = Am J Pathol | volume = 118 | issue = 2 | pages = 331-9 | month = Feb | year = 1985 | doi = | PMID = 3970143 }}</ref>
<ref name="journals.ut.ac.ir"> {{Cite web | last = | first = | title = The Effect of Taking Naproxen Drug on the Level of Perceived Pain and Changes of CPK Serum after Eccentric Exercise - Harakat Volume: 37, Issue:| url = http://journals.ut.ac.ir/page/article-frame.html?langId=en&articleId=1003701| publisher = | date = | accessdate = 3 January 2013}}</ref>
<ref name="Bourgeois-1999"> {{Cite journal | last1 = Bourgeois | first1 = J. | last2 = MacDougall | first2 = D. | last3 = MacDonald | first3 = J. | last4 = Tarnopolsky | first4 = M. | title = Naproxen does not alter indices of muscle damage in resistance-exercise trained men. | journal = Med Sci Sports Exerc | volume = 31 | issue = 1 | pages = 4-9 | month = Jan | year = 1999 | doi = | PMID = 9927002 }}</ref>
<ref name="Chen-2001"> {{Cite journal | last1 = Chen | first1 = TC. | last2 = Hsieh | first2 = SS. | title = Effects of a 7-day eccentric training period on muscle damage and inflammation. | journal = Med Sci Sports Exerc | volume = 33 | issue = 10 | pages = 1732-8 | month = Oct | year = 2001 | doi = | PMID = 11581559 }}</ref>
</references>
