Athletic expertise is not required for one to feel the aching and lasting effects of delayed-onset muscle soreness (DOMS). The aftermath of these effects can often exist along a spectrum ranging from significant muscle tenderness to debilitating pain.¹ In addition, the duration of these effects can exist along a spectrum ranging from 24 to 72 hours.¹ A common misconception correlates a good workout with the subsequent symptoms of DOMS, however, that is just not the case. With that being said, DOMS will often occur in accord with performing new exercises or increasing the intensity and/or duration of a current exercise.¹
The lingering soreness and stiffness as a result of DOMS can often cause individuals to seek methods that will ultimately reduce these symptoms and accelerate their return to the gym. Unfortunately, many of the treatment options on the market have mixed outcomes due to the individualized nature of exercise. Some may obtain adequate results through methods, such as massage or ibuprofen, while others may not; whereas, some methods prove to be completely ineffective, such as cryotherapy and stretching.¹ Furthermore, let’s give a look at a newly proposed treatment for DOMS and whether its results are promising.
Blood-flow restriction (BFR) training is often used at physical therapy as a passive way to regain strength without adding heavy weight. The venous blood supply is terminated at the area of injury, which in turn reduces the amount of oxygen at the site, activates anaerobic metabolism, and encourages muscle hypertrophy.² This proves to be an effective technique for restrengthening the muscle of patients who strictly lift lighter loads.² But, where is the crossover between BFR and DOMS?BFR is thought to provide an alternative training method that will achieve similar muscle gains to resistance training with heavy loads while also minimizing the effects of DOMS. It has been postulated that BFR training may attenuate DOMS by preventing calcium-mediated proteolysis³ and by recruiting fast-twitch motor units.⁴ However, it has also been hypothesized that BFR training may induce muscle damage through ischemia-reperfusion (lack of oxygen in the tissues) or through the reduction of neutrophils that aid in inflammatory response.⁵
A 2019 study wished to examine the effects of BFR training on DOMS by using 25 untrained females and submitting them to isokinetic forearm flexion training, where half performed a bicep curl with a BFR cuff at a load reflecting a 30% eccentric-peak torque and the other half at a load reflecting a 30% concentric-peak torque.⁶ The findings revealed neither eccentric or concentric movements with a BFR cuff resulted in DOMS after the 7 days of training.⁶ These results were inconsistent with other studies that showed an increase in DOMS with concentric exercises.⁶ Is this inconsistency due to the low number of participants, the lack of diversity, or the duration of the experiment being only 7 days?
In contrast, a 2017 study compared the effects of BFR training and resistance training on DOMS by using 17 male participants and assessing their elbow-flexor muscle strength for 7 days in one of four training techniques: heavy load, light load, intermittent high-pressure BFR, and continuous low-pressure BFR.⁷ From this, the researchers found DOMS was significantly greater in BFR training (both intermittent high-pressure and continuous low-pressure) than in resistance training (both in heavy and light load).⁷
Much like the other methods of muscle recovery, BFR training may not be the most effective way to minimize DOMS. Exercise can be highly variable and strongly impacted by genetics, which may be the reason a consistent and reliable technique for treating DOMS has yet to be discovered.
Watch this youtube video to learn more about DOMS.⁸
Questions to consider
- Based on the study mentioned in this article, do you think their findings are an accurate representation of the effects of BFR training on DOMS?
- How have your opinions regarding DOMS changed with this post?
- Did the video help you understand DOMS in an easily digestible way?
- Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003; 33(2):145-164. DOI: 10.2165/00007256-200333020-00005
- Blood-Flow Restriction Training. American Physical Therapy Association. Website.http://www.apta.org/PatientCare/BloodFlowRestrictionTraining/. Updated May 24, 2019. Accessed February 20, 2020.
- Sudo M, Ando S, Poole DC, Kano Y. Blood flow restriction prevents muscle damage but not protein synthesis signaling following eccentric contractions. Physiol Rep. 2015;3(7):e12449.
- Loenneke JP, Fahs CA, Wilson JM, Bemben MG. Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses. 2011;77(5):748-752.
- Curty VM, et al. Blood flow restriction attenuates eccentric exercise-induced muscle damage without perceptual and cardiovascular overload. Clin Physiol Funct Imaging. 2017;38(3):468-476.
- Hill EC, Housh TJ, Smith CM, Keller JL, Schmidt RJ, Johnson GO. Eccentric and concentric blood flow restriction resistance training on indices of delayed onset muscle soreness in untrained women. Eur J Appl Physiol. 2019;119(10):2363-2373.
- Brandner CR, Warmington SA. Delayed onset muscle soreness and perceived exertion after blood flow restriction exercise. Journal of strength and conditioning research. 2017;31(11):3101-3108. doi:10.1519/JSC.0000000000001779
- Should You Still Train Sore? Youtube. Website. https://www.youtube.com/watch?v=Ut_4C_5CNbg. Published November 18, 2018. Accessed February 20, 2020.
Personalized Blood Flow Restriction. Owens Recovery Science. ORS. 2020c.