Lower limb compression garment improves recovery from exercise-induced muscle damage in young, activ

Eur J Appl Physiol DOI 10.1007/s00421-010-1464-0

ORIGINAL ARTICLE

Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females John R. Jakeman • Chris Byrne • Roger G. Eston

Accepted: 26 March 2010 Ó Springer-Verlag 2010

Abstract This study aimed to investigate the efficacy of lower limb compression as a recovery strategy following exercise-induced muscle damage (EIMD). Seventeen female volunteers completed 10 9 10 plyometric drop jumps from a 0.6-m box to induce muscle damage. Participants were randomly allocated to a passive recovery (n = 9) or a compression treatment (n = 8) group. Treatment group volunteers wore full leg compression stockings for 12 h immediately following damaging exercise. Passive recovery group participants had no intervention. Indirect indices of muscle damage (muscle soreness, creatine kinase activity, knee extensor concentric strength, and vertical jump performance) were assessed prior to and 1, 24, 48, 72, and 96 h following plyometric exercise. Plyometric exercise had a significant effect (p B 0.05) on all indices of muscle damage. The compression treatment reduced decrements in countermovement jump performance (passive recovery 88.1 ± 2.8% vs. treatment 95.2 ± 2.9% of pre-exercise), squat jump performance (82.3 ± 1.9% vs.

94.5 ± 2%), and knee extensor strength loss (81.6 ± 3% vs. 93 ± 3.2%), and reduced muscle soreness (4.0 ± 0.23 vs. 2.4 ± 0.24), but had no significant effect on creatine kinase activity. The results indicate that compression clothing is an effective recovery strategy following exercise-induced muscle damage.

Keywords

Recovery DOMS Plyometric exercise

Communicated by William Kraemer.

J. R. Jakeman (&) C. Byrne R. G. Eston School of Sport and Health Sciences, University of Exeter, St. Luke’s Campus, Heavitree Road, Exeter, Devon EX1 2LU, UK e-mail: J.R.Jakeman@ex.ac.uk

Introduction Unaccustomed or eccentrically biased physical activity can lead to exercise-induced muscle damage (EIMD), which is characterised by impaired muscle function (Jakeman et al.

2009; Miyama and Nosaka 2004), delayed-onset muscle soreness (Eston et al. 2007; Impellizzeri et al. 2008), increases in circulating myoproteins (Byrne et al. 2001; Chapman et al. 2006), decreased self-paced exercise performance (Marcora and Bosio 2007), and increased perceived exertion during exercise (Davies et al. 2009; Twist and Eston 2009). Enhanced recovery following physical activity and EIMD has become a priority for individuals involved in a wide range of athletic disciplines. Consequently, a number of post-exercise recovery strategies have been implemented, though often based on anecdotal and equivocal evidence.

Several strategies to ameliorate the deleterious effects of EIMD focus on managing its symptoms following damaging exercise, with massage, cold water immersion therapy and active recovery all widely used methods in applied fields. Despite encouraging observations from such studies, their efficacy remains equivocal (Bailey et al. 2007; Farr et al. 2002; Gill et al. 2006; Jakeman et al. 2009; Mancinelli et al. 2006).

The use of clothing with specific compressive qualities is becoming increasingly widespread, and studies have shown improved performance and recovery after EIMD (Ali et al. 2007; Kraemer et al. 2001; Trenell et al. 2006).

The use of lower limb compression for athletes has been derived from research in clinical settings which has indicated positive effects of compression following trauma or some chronic diseases. Bringard et al. (2006a) observed positive effects of calf compression on calf muscle oxygenation and venous pooling in resting positions, whilst

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Hirai et al. (2002) reported reduced foot oedema in patients with varicose veins. These effects can be attributed to the alteration in haemodynamics resulting from the application of compression (Ibegbuna et al. 2003). Studies investigating whether these effects are transferable to athletic populations have indicated some encouraging results (Bringard et al. 2006b; Ali et al. 2007). The ability of compression to affect local haemodynamics may expedite the removal of cellular debris and moderate the formation of oedema associated with EIMD. Compression has also been suggested to offer mechanical support to the muscle, allowing faster recovery following damaging exercise (Kraemer et al. 2001. Kraemer et al. (2001) speculated that a ‘dynamic casting’ effect caused by compression may promote stable alignment of muscle fibres and attenuate the inflammatory response. This would, therefore, reduce both the magnitude of muscle damage and recovery time following injury.

The soreness caused by EIMD has been associated with a reduced neural drive affecting contractile ability (Westing et al. 1991). Kraemer et al. (2001) noted decreased muscle soreness following the use of compression clothing. The potential for compressive clothing to positively affect perceived soreness as reported by Kraemer et al. (2001) may have a subsequent effect on functional ability, further managing detrimental symptoms of EIMD. Trenell et al.

(2006) have suggested that compressive clothing can promote tissue regeneration and consequently positively benefit muscle function following damaging exercise. Very little research has considered the use of compressive clothing following eccentrically induced muscle damage (Duffield et al. 2009) and though previous research is encouraging, the paucity of data and lack of evidence related to compression and post-exercise recovery ensure that justification for its use is largely anecdotal.

The aim of this study was to investigate the efficacy of complete lower limb compression clothing on recovery from the symptoms of EIMD following strenuous plyometric activity.

Methods Participants and design Seventeen physically active (typically exercising at least three times per week) female volunteers with no history of musculoskeletal injury [mean (SD): height 1.68 (0.04) m; body mass 66.9 (5.9) kg; age 21.4 (1.7) years] volunteered to participate in this study, and were randomly allocated to a passive recovery (n = 9) or treatment group (n = 8).

Individuals were excluded if they had engaged in specific lower limb eccentric or plyometric training in the previous

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6 months. Participants provided written informed consent to be involved in the study which received ethical approval from the School of Sport and Health Sciences ethics committee. Following the collection of baseline data, participants completed an exercise protocol designed to induce muscle damage. Immediately following damaging exercise, volunteers in the treatment group were given a pair of lower limb compression tights (Skins, Sydney, Australia) to wear for 12 h (Gill et al. 2006). Participants were instructed to refrain from engaging in exercise or taking nutritional supplements during the testing period. A priori calculations of statistical power indicated that this sample size was appropriate to satisfy power at or above 80% (Faul et al. 2007).

Plyometric exercise Participants completed 10 9 10 repetitions of plyometric drop jumps from a 0.6-m box (10 s between jumps, 1 min between sets). Volunteers were asked to step from the box with one foot, land with both feet together and attempt to achieve approximately a 90° knee angle, before performing a maximal vertical jump, though jump height was not recorded (Marcora and Bosio 2007; Nosaka and Kuramata 1991). Plyometric exercise was monitored by an experienced strength and conditioning coach. Plyometric exercise makes up an important component of athletic training and performance, and is therefore an appropriate method of inducing muscle damage, which has been used previously by a number of other studies (Miyama and Nosaka 2004).

Assessment of EIMD Indicators of EIMD were collected in the same sequence on each occasion: perceived muscle soreness, plasma creatine kinase activity, squat jump height, countermovement jump height, and isokinetic muscle function. Data were obtained in this order, and with adequate time between exercises to allow full recovery. Data were collected prior to and 24, 48, 72, and 96 h following damaging exercise. Data were collected prior to and 24, 48, 72, and 96 h following damaging exercise. Data were also collected 1 h after damaging exercise in order to provide an indicator of the magnitude of immediate muscle damage, without the confounding factor of acute fatigue resultant from the plyometric exercise protocol.

Perceived muscle soreness Perceived soreness was assessed using a 10-cm visual analogue scale, with 0 (no pain) and 10 (worst pain ever) at the two extremes. Participants were instructed to assume an unweighted squat of approximately 90°, and mark their

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perceived soreness on a horizontal line between 0 and 10 (Hart et al. 2005; Twist and Eston 2005).

concentric contractions (Biodex 3 Medical Systems, New York, USA) of the knee extensors was taken as the criterion measure of muscle strength.

Creatine kinase activity Experimental treatment Plasma creatine kinase activity was assessed using fingertip capillary blood sampling. The finger was cleaned using a sterile alcohol swab, and a capillary puncture was made using a Haemocue lancet (Haemocue, Sheffield, UK).

30 ll of sampled blood was separated by centrifuge and refrigerated at 4°C until analysis. Spectrophotometry (Jenway, Dunmow, UK) was used to analyse creatine kinase activity in accordance with the manufacturer guidelines (Randox, Co. Antrim, UK). All samples were analysed in duplicate (coefficient of variance = 9%).

Vertical jump performance The average of 3 squat jumps was used to assess jump performance without contribution from the upper body or stretch-shortening cycle. Participants were instructed to adopt a squatting position, with hands on hips and knees flexed to approximately 90°. This position was held for 3 s before a maximal vertical jump was performed (Byrne and Eston 2002). Volunteers were instructed to keep their hands on their hips throughout the jump, and their legs straight whilst in the air.

The average of three countermovement jumps was used to assess jump capability. Participants stood fully erect, and following a verbal command, initiated a countermovement followed by a maximal vertical jump in one continuous motion. Volunteers were instructed to keep their legs straight whilst airborne, but were encouraged to use their arms during the jump (Byrne and Eston 2002). Squat jump and countermovement jump heights and flight times were recorded using the Optojump infrared jump system (Microgate, Italy). The average height of three jumps was used as an indicator of squat jump and countermovement jump performance.

Isokinetic muscle strength Dynamic muscle function was assessed using isokinetic dynamometry. Participants were seated upright with the upper body and experimental leg secured to reduce extraneous movement. The axis of rotation of the knee of the dominant leg was aligned with the dynamometer which was maintained throughout the testing period. Volunteer body position was recorded and replicated for subsequent tests. Volunteers completed five maximal voluntary isokinetic concentric contractions at 60° s-1 through approximately 80° range of movement from knee flexion on the dominant leg. The best of five maximal gravity-corrected

Immediately following damaging exercise, individuals in the treatment group were given a pair of commercially available lower limb (ankle to waist) compression tights (Skins, Sydney, Australia) to wear for 12 h. This duration of treatment was selected to increase ecological validity, as it is consistent with contemporary treatment methods and replicates previous work by French et al. (2008). These compression garments are 76% nylon tactel microfibre and 24% elastane, and are reported to have an average compression of 17.3 mmHg at the calf and 14.9 mmHg at the thigh (Scanlan et al. 2008). Compression garments were removed immediately prior to the 1-h test which took approximately 10 min, and replaced immediately following completion of the 1-h test. Participants in both groups were instructed to rest between damaging exercise and the 1-h test.

Statistical analysis A repeated-measures ANOVA (2 9 6, group 9 time) was used to analyse data (SPSS 15.0). Significance was set at p B 0.05 a priori. The Mauchly sphericity test was used to test assumptions of homogeneity of variance. Where this was violated, the Greenhouse–Geisser value was used to adjust degrees of freedom to increase the critical value of the F ratio. Bonferroni adjusted T tests were used to follow up any significant interactions.

Results No significant group differences for age height or weight were observed prior to testing. There were also no significant differences between groups in absolute terms at baseline for squat jump performance, countermovement jump performance or isokinetic muscle strength.

Perceived muscle soreness Perceived soreness increased significantly across time following the plyometric exercise protocol (F5,75 = 75.5, p \ 0.01). A significant group 9 time interaction (F5,75 = 3.0, p B 0.05) and group effect (F1,15 = 22.4, p \ 0.01) was observed following the plyometric exercise protocol.

The passive recovery group participants experienced significantly higher soreness 1, 24, 48, and 72 h following damaging exercise (Fig. 1).

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Fig. 1 Perceived muscle soreness following exercise-induced muscle damage. Asterisks represent significant difference from baseline; plus symbols represent significant difference between groups

Fig. 2 Squat jump height relative to baseline following exerciseinduced muscle damage. Asterisks represent significant difference to baseline in both groups; multiple symbols represent significant difference to baseline in passive recovery group; plus symbols represent significant difference between groups

Vertical jump performance Absolute vertical jump performance at baseline was not significantly different between groups for either squat or countermovement (0.22 vs. 0.22 for squat jump; 0.27 m vs. 0.26 m for countermovement jump height for the passive recovery and treatment groups respectively, p [ 0.05).

Squat jump A significant main effect of time was observed on squat jump height relative to baseline (F2.8,42 = 22.3, p \ 0.01).

A significant group 9 time interaction (F2.8,42 = 6.5, p \ 0.01) and group effect was also observed (F1,15 = 18.0, p \ 0.01) indicating that the decrement in squat jump was less severe in the treatment group. Followup analysis indicated that significant differences between groups occurred at 24, 48, 72, and 96 h following damaging exercise (Fig. 2).

Countermovement jump Countermovement jump height relative to baseline was significantly affected by the damaging protocol over time (F2.4,36, = 9.8, p \ 0.01). There was no significant group

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effect (F1,15, = 3.0, p [ 0.05) but a group 9 time interaction (F2.4,36 = 4.0, p \ 0.05) was observed following plyometric exercise. Follow-up analysis indicated that significant differences between groups occurred at 48 h following damaging exercise (Fig. 3).

Decrements in squat and countermovement jump performance were consistent with those expected following this type of exercise which have been reported previously (Miyama and Nosaka 2004).

Isokinetic muscle strength No significant baseline differences were observed between groups in terms of absolute peak muscle torque (152 n m-1 vs. 165 n m-1 for the passive recovery and treatment group respectively, p [ 0.05). Isokinetic muscle strength relative to baseline significantly decreased over time following plyometric exercise (F2.6,39.4 = 14.9, p \ 0.01). Significant group (F1,15 = 6.5, p \ 0.05) and group 9 time interactions (F2.6,39.4 = 5.5, p \ 0.01) were observed following the damaging protocol. Follow-up analysis indicated that significant differences between groups occurred at 24, 48, 72, and 96 h following damaging exercise (Fig. 4).

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Fig. 3 Countermovement jump height relative to baseline following exercise-induced muscle damage. Asterisks represent significant difference to baseline in both groups; multiple symbol represents significant difference to baseline in passive recovery group only; plus symbol represents significant difference between groups

Fig. 4 Isokinetic muscle strength relative to baseline following exercise-induced muscle damage. Asterisks represent significant difference to baseline in both groups; multiple symbols represent significant difference to baseline in passive recovery group only; plus symbols represent significant difference between groups

Creatine kinase activity Absolute measures of creatine kinase activity at baseline were not significantly different, and were within the normal resting range (104 and 170 U l-1 for the passive recovery and treatment groups, respectively) for female athletes (Mougios 2007). Creatine kinase activity was log-transformed to satisfy assumptions of sphericity associated with repeated-measures ANOVA. A significant main effect of time (F2.3,31.5 = 12.1, p \ 0.01) was observed. No group (F1,14 = 2.1, p [ 0.05) or group 9 time interaction (F2.3,31.5 = 2.9, p [ 0.05) was observed, indicating no differences between the passive recovery and treatment groups over time. Table 1 shows creatine kinase activity responses throughout the testing period.

the recovery of 17 physically active female participants for 96 h following plyometric exercise and assessed perceived muscle soreness, jump performance, functional muscle strength and creatine kinase activity to give an indication of recovery. Previous research has typically used male or mixed gender samples, with little attention focussing solely on female population samples. Some studies have suggested that gender differences may alter the magnitude of muscle damage and time-course of recovery in animal models (Komulainen et al. 1999; Enns and Tiidus 2008), and that these effects may also be observed in human studies. However, current research suggests that there is no difference in responses to EIMD in human (Clarkson and Hubal 2002; see Tiidus and Enns 2008 and Hubal and Clarkson 2008 for further discussion) though the potential effect of gender should be considered.

Discussion Muscle soreness The purpose of this study was to determine the efficacy of compressive clothing as a recovery strategy following damaging exercise. The use of compressive clothing in this way is increasingly widespread in applied fields, but has little supporting scientific evidence. This study monitored

Consistent with previous research, perceived soreness increased significantly following damaging exercise, peaking between 24 and 48 h, before returning towards baseline values after 48 h (Nosaka and Kuramata 1991;

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Eur J Appl Physiol Table 1 Creatine kinase activity (mean ± SD) following plyometric exercise Creatine kinase activity (U.I-1) Pre

1

24

48

72

96

PR

103.9 ± 21.2

148.1 ± 44.3*

304.1 ± 118.7*

148.7 ± 41.3*

101.2 ± 26.9

105.4 ± 53.7

Compression

170.1 ± 91.7

248.8 ± 110.6*

245.0 ± 100.9*

182.5 ± 104.8

202.2 ± 222.3

227.2 ± 255.2

* Significant difference from baseline (p \ 0.05)

Vaile et al. 2008). However, the extent of soreness of those individuals wearing lower limb compression was lower than those without compression. These results are consistent with previous research, indicating the potential benefits of lower limb compression (Ali et al. 2007; Duffield and Portus 2007; Kraemer et al. 2001), but contrast with other research (French et al. 2008; Trenell et al. 2006). It has been suggested that localised swelling may be one of the causes of soreness following damaging exercise (Cleak and Eston 1992; Friden et al. 1986). The compressive properties of the garments reduce oedema (French et al. 2008; Trenell et al. 2006) and may be the underlying cause of decreased perceptions of soreness, though further verification of this suggestion is required. The use of compression to manage oedema may also have a subsequent effect on secondary muscle damage resulting from the inflammatory process.

Vertical jump performance There was a significant drop in both squat jump, and countermovement jump height following damaging exercise (p \ 0.05) of a slightly greater but similar magnitude to the decrements observed by Byrne and Eston (2002). As previously observed by Byrne and Eston (2002), squat jump performance was affected to a greater extent by the plyometric exercise protocol. This is most likely due to the contribution of the stretch-shortening cycle (SSC), which is known to increase power output during this type of movement (Miyaguchi and Demura 2006). As it largely removes the contribution of the SSC to performance, the squat jump along with knee extension isokinetic dynamometry may be considered as more indicative of knee extensor performance than countermovement jump performance. The lack of group effect on countermovement jump performance is likely due to the large standard deviations notable within the groups, indicative of a greater individual SSC contribution. The significant group effect observed on squat jump performance here indicates that the compression treatment moderated the decline in performance. Similar declines in performance 1 h following plyometric exercise indicate that the treatment rather than a between subjects variance was responsible for the

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differences in performance. This indicates that the compression treatment was beneficial to the recovery of jump performance following damaging exercise.

Muscle strength Previous research has indicated that isokinetic muscle strength is adversely affected by EIMD, and that greater isokinetic strength losses are observed at slow angular velocities when compared with contractions at fast angular velocities (Highton et al. 2009). This study used a slow isokinetic muscle contraction (60° s-1) to reduce the incidence of artefact, but primarily to determine the occurrence of muscle damage and to provide the optimal opportunity for any effects of the treatment to become apparent. Muscle function, as assessed by isokinetic dynamometry, was significantly affected by the damaging protocol. However, the treatment group experienced a significantly reduced force decrement between 24 and 96 h. The difference between groups over these time-points was never less than 9%, with the greatest difference (&20%) occurring at 48 h. This temporal difference is important to individuals during competition, as athletes will often designate the day following competition a rest day, especially in team sports. A return to training is then expected the following day, approximately 48 h following competition. The ability to train consistently at high levels is important for athletes, and the potential advantage offered by compressive clothing at this time-point should not be understated.

Though the level of compression offered by compressive clothing is dependent on the body form of the individual, the average compression offered by lower limb compression using this type of garment has been reported as 17.3 mmHg at the calf, and 14.9 mmHg at the thigh (Scanlan et al. 2008). Though the mechanisms of functional recovery following damaging exercise are yet to be fully clarified, the mechanical support afforded by compressive clothing may enhance the functional recovery of the muscle by creating a dynamic cast (Kraemer et al.

2001), as well as reduce oscillatory muscle displacement, which may be a factor in performance and recovery (Doan et al. 2003). The mechanical properties of compressive

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clothing, and the subsequent effect on oedema may influence perceived soreness (Friden et al. 1986), and positively affect cellular repair following strenuous exercise (Trenell et al. 2006), though further research is required to further justify these suggestions. The disruption of normal neural function following muscle damage has been associated with subsequent inhibition of muscle function (Michaut et al. 2002) and it has previously been considered that perceptions of soreness may serve as a protective mechanism following damaging exercise to prevent full muscle activation exacerbating damage (Westing et al. 1991). Any mechanism that is effective in reducing the perceptions of soreness as indicated in this study may therefore be beneficial in terms of maintaining functional strength and performance.

Jones et al. (1997) used electron microscopy to assess sarcomere disruption following EIMD. They observed that areas of small and large disruption were present after damage, attributing the small areas of disruption to a failure of sarcomeres to re-interdigitate immediately following damaging exercise, whilst larger areas of disruption were attributed to membrane damage. Membrane damage can lead to a failure to contract as a result of damage to contractile components of the sarcomere, and disruptions in the excitation–contraction coupling relationship. The use of compression immediately following exercise may have been able to limit the detrimental consequences of EIMD, by stabilising muscle fibre alignment (Kraemer et al. 2001).

If this were the case, a better recovery of membrane structure may expedite the recovery of contractile components and excitation–contraction coupling processes, and be manifest by a reduced decrement in muscular performance as seen in the current study.

Creatine kinase activity Creatine kinase activity (CK) is a widely used marker of EIMD. However, its high inter- and intra-individual variability means its accuracy at gauging the magnitude of muscle damage is questionable (Clarkson et al. 1986; Friden and Lieber 2001). Therefore, this paper has used CK as an indicator to establish the occurrence of damage, rather than as a tool to determine its magnitude. The damaging protocol significantly increased creatine kinase activity, but the effects were not moderated by the treatment.

Perspective The aim of this study was to investigate the efficacy of lower limb compression as a recovery strategy following EIMD. These data indicate that lower limb compression can moderate strength loss and diminish perceptions of soreness following damaging exercise. Although further

research is required to determine the specific mechanisms by which this strategy is effective, this paper supports the use of lower limb compression following damaging exercise as a practical, non-invasive and non-restrictive method of post-exercise recovery, which is becoming increasingly supported by scientific research.

Conflict of interest statement no conflict of interest.

The authors declare that they have

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