Delayed Onset Muscle Soreness Neck Shoulder

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Delayed onset muscle soreness in neck/shoulder muscles

Hongling Nie, Adam Kawczynski, Pascal Madeleine *, Lars Arendt-Nielsen

Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction, Aalborg University,

Fredrik Bajers Vej 7D-3, DK-9220 Aalborg, Denmark

Available online 2 February 2005

Abstract

The aim of the present study is to: (1) induce delayed onset muscle soreness (DOMS) in the neck and shoulder muscles; (2) com-

pare the pressure pain sensitivity of muscle belly with that of musculotendinous tissue after DOMS; (3) examine the gender differ-

ences in the development of DOMS. An eccentric shoulder exercise was developed to induce DOMS on neck/shoulder muscles using

a specially designed dynamometer. Eccentric shoulder contraction consisted of 5 bouts, each bout lasted 3 min, with 3 min rest per-

iod between each bout. The right shoulder was elevating against a downward pressure force of 110% maximal voluntary contraction

force exerted by the dynamometer. Pressure pain thresholds (PPT) of 11 sites (seven sites measured were muscle belly and four sites

were myotendinous area) on neck/shoulder region were measured before, immediately after, 24 and 48 h after exercise. Pain inten-

sity, pain area and index of McGill pain questionnaire were assessed and all were increased after exercise. DOMS was induced in the

shoulder muscles. PPT was significantly decreased and reached lowest values at 24 h. The muscle belly sites are more sensitive to

pain than the musculotendinous sites. No gender differences were found in any of the parameters used to assess the development

of DOMS. DOMS did not distribute evenly in the neck/shoulder region. Soreness after exercise in the neck and shoulder seems

not to be among the conditions that produce predominant musculoskeletal pain in females.

2004 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All

rights reserved.

Keywords: Pressure pain threshold; Musculotendinous site; Muscle pain; Delayed onset muscle soreness; Gender differences

1. Introduction

Work related musculoskeletal disorders are a signifi-

cant problem in the working populations (Buckle and

Devereux, 2002). Musculoskeletal disorders commonly

affect the neck and shoulder region with sign of muscle

pain and soreness (Armstrong et al., 1993). Delayed on-

set muscle soreness (DOMS) which occurs after unac-customed exercise enables to study mechanisms related

to neck and shoulder pain. Previous studies show that

eccentric exercise, i.e. lengthening of the contracting

muscle, produces prominent soreness (Bajaj et al.,

2001; Jones et al., 1987; Newham et al., 1987). Although

the underlying mechanisms of DOMS are not clearly

understood, it has been suggested that soreness may

due to the damage of muscle structure during exercise;

furthermore, it may be exacerbated and maintained by

the subsequently acute inflammatory reaction in muscle

evoked by the release of biochemical substances after

disruption of the muscle fibres and connective tissue

(Armstrong, 1984; Newham et al., 1987). Delayed mus-cle soreness usually develops 2448 h following exercise

and is described as dull and tender (Armstrong, 1984;

Armstrong et al., 1983). The sensation usually subsides

within 57 days after exercise (Ebbeling and Clarkson,

1989). Biceps brachii (Dannecker et al., 2002; Jones

et al., 1987), quadriceps femoris (Baker et al., 1997;

Newham et al., 1983) and dorsal interosseous muscle

(Bajaj et al., 2001) are the most targeted muscles in the

1090-3801/$30 2004 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights

reserved.

doi:10.1016/j.ejpain.2004.12.009

* Corresponding author. Tel.: +45 96 35 88 33; fax: +45 98 15 40 08.

E-mail address: [email protected] (P. Madeleine).

www.EuropeanJournalPain.com

European Journal of Pain 9 (2005) 653660
mailto:[email protected]:[email protected]


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induction of DOMS because of convenience of exercise.

It has been suggested that DOMS may be a result of

muscle allodynia to pressure, hence indicating neural

plastic change and hyperexcitability develop and con-

tribute to DOMS (Barlas et al., 2000). An endogenous

model inducing pain in the neckshoulder region might

be helpful to gain knowledge about the transduction,transmission and processing of muscle pain and to test

the efficacy of interventional studies.

With respect to the localization of DOMS in muscle,

the area of the musculotendinous attachment of quadri-

ceps muscle are thought to be the main site of pain and

tenderness during the initial phase of DOMS (Newham

et al., 1983). The pain spreads to the centre of the muscle

by 48 h (Bobbert et al., 1986). It has been found that the

PPT of muscle belly in the forearm was more sensitive to

DOMS than adjacent musculotendinous sites (Slater

et al., 2003). It is therefore not known if the soreness

is distributed generally throughout the muscle or iso-

lated to specific areas.

Women are more likely to suffer more from musculo-

skeletal pain than men (Strazdins and Bammer, 2004). It

appears that women are more sensitive to pain and

incline to report greater pain to experimental muscle

pain conditions (Ge et al., 2004; Riley et al., 1998). Some

previous studies found no significant difference between

male and female in the sensation and development of

DOMS after high-force eccentric exercise of elbow flex-

or (High et al., 1989; Rinard et al., 2000). Others found

females tended to report less pain at 48 h after exercise

than males (Dannecker et al., 2003). It is not known if

there are gender differences in DOMS on the neck/shoul-der muscles.

With a newly designed shoulder dynamometer (Mad-

eleine et al., 2004), it is possible to perform eccentric exer-

cise in the shoulder muscles. The aim of the present

human quantitative experimental study was to: (1)

induce DOMS in the neck and shoulder muscles (i.e.

upper, middle and lower trapezius muscle; supraspinatus;

infraspinatus; levator scapulae; cervical muscle); (2) com-

pare the pressure pain sensitivity of muscle belly with that

of musculotendinous tissue after DOMS; (3) examine for

gender differences in development of DOMS.

2. Material and methods

2.1. Subjects

A total of 12 male and 12 female healthy volunteers

without musculoskeletal problems during the last 3

months participated in the study. The average age

(mean SD) was 24.6 3.4 years for the males and

24.1 3.6 years for the females; the average height

(mean SE) was 183.3 2.0 cm for the males and

169.3 2.0 cm for the females; the average weight

(mean SE) was 78.9 3.18 kg for the males and

61.4 3.18 kg for the females. Informed consent was

obtained from each subject. None had participated in

weight training in the past month. The study was ap-

proved by the local ethics committee and conducted in

accordance with the Declaration of Helsinki.

2.2. Protocol

A shoulder dynamometer (Aalborg University, Aal-

borg, Denmark) was used in the present experiment.

In addition, a plastic vest was worn by the subject toprotect the low back muscles (Fig. 1). The experiment

consisted of three sessions (i.e. in three sequential days).

The right shoulder was exercised and the left shoulder

acted as control side. In the first session, pressure pain

Fig. 1. The shoulder dynamometer (left) and the PPT test sites (site 111; description see method) on the right neck/shoulder region (right).

654 H. Nie et al. / European Journal of Pain 9 (2005) 653660


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the parameters used to assess the development of

DOMS.

6. DOMS in the neck/shoulder region

The PPT is an effective index in measuring the extendof muscle tenderness and validated as a diagnostic method

for the musculoskeletal disorders (Madeleine et al.,

1998; Nakata et al., 1993). An early subjective symptom

of a pathophysiologic alteration of a skeletal muscle is

increased tenderness (Mense, 1990). In the present study

the PPT decreased after exercise and reached its lowest

level at 24 h. Correspondingly, the PRI of MPQ, pain

area and pain intensity showed maximal response. All

of these data supported the conclusion that DOMS

was induced and located in the neck/shoulder region.

It is consistent with the previous observation that

DOMS develops usually in the first 2448 h after unac-

customed exercise (Ebbeling and Clarkson, 1989). The

significant decreases of PPTs were found in 8 of 11 test

sites situated on the upper and middle trapezius, levator

scapulae and supraspinatus muscles. There was no de-

crease in PPT on the scapula spine, infraspinatus and

lower trapezius, indicating that these muscles were prob-

ably not substantially involved under the current eccen-

tric shoulder exercise setting. The eccentric shoulder

exercise without raising arms resulted in elevation and

upward rotation of scapula. The main agonist in these

movements are levator scapulae and upper trapezius

(Brukner and Khan, 1993) although other muscles con-

tribute to a lower extent. The increased tenderness maydue to the acute damage to the muscle fibres during

exercise, causing mechanical disruption of the ultra-

structural elements within the muscle fibres such as the

Z-line and contractile filaments (Friden et al., 1983;

Waterman-Storer, 1991). Release of the inflammatory

mediators in the acute inflammation resulting from an

immune response to the initial injury may sensitize mus-

cle nociceptors and lower their threshold to mechanical

stimuli leading to increased pain sensation. (Mense,

1990; Smith, 1991). Barlas et al. (2000) suggested that

muscle allodynia observed in DOMS may relate to a

central mechanism besides sensitization of the peripheral

nociceptors. The pain following eccentric exercise was

only present when the muscles were stretched or con-

tract or palpated but not in rest. The most chosen words

in the MPQ were sore and tender which in the sen-

sory sub-group, showing the influence of DOMS was

mainly on the sensation aspect of pain. This is in agree-

ment with the observation of DOMS in the first interos-

seous muscle (Bajaj et al., 2001). It was found in the

present study that the relatively higher PRI and pain

intensity rating appeared immediately after exercise.

This phenomenon also occurred in elbow flexor after

eccentric contractions where most subjects reported that

the actual induction procedure produced more pain than

the delayed soreness (Barlas et al., 2000). This increased

pain may attribute to fatigue induced by the exercise

(Barlas et al., 2000). The relative low pain intensity

might due to the small range of shoulder motion and

small load during pain measurement. The range of the

shoulder eccentric exercise is not as large as that of thebiceps brachii or quadriceps femoris. The change of

muscle length was therefore small. It is believed that

the extent of muscle injury due to eccentric exercise is re-

lated more to the muscles change in length rather than

the amount of force generated by the muscle (Lieber and

Friden, 1993). Eccentric exercise performed at longer

muscle lengths causes more damage to the muscle than

at shorter muscle lengths (Child et al., 1998; Newham

et al., 1988). The pain intensity measured without load

on the shoulder may diminish the pain sensation because

pain after DOMS is obvious during muscle contraction.

The lack of changes in MVC may due to the synergetic

effect of shoulder muscles (Halder et al., 2000).

7. Different sensitivity of muscle and myotendinous site to

DOMS

It is, to date, not clear whether the eccentric exercise

produces muscle damage and soreness uniformly over

the muscle or in the specific area of the muscle, due per-

haps to susceptible weaker structural components (Ba-

ker et al., 1997). In the present study, it was found

that the PPTs for the muscle belly sites decreased more

than the myotendinous sites after exercise. The resultsare in contrast to those of Newham et al. (1983) where

the initial tenderness was primarily located at the distal,

medial and lateral parts of the quadriceps, but at peak

intensity of soreness the muscle-tendon region was not

more prone to soreness than others muscle sites. Cleak

and Eston (1992) reported that tenderness at the proxi-

mal myotendinous junction of the biceps was signifi-

cantly less than the distal myotendinous junction and

at the mid belly after strenuous eccentric exercise (Cleak

and Eston, 1992). Baker et al. (1997) reported that the

pressure pain tolerance of myotendinous sites was lower

than that of the muscle belly in the same quadriceps

femoris after eccentric down-hill running. Compared

to the pressure pain tolerance before the exercise, the

pressure pain tolerance decreased more in the muscle

belly site than in the myotendinous site when DOMS

reached the peak levels. The present results may due

to the discrete damage of eccentric exercise to the myo-

tendinous part and muscle belly. It has been found that

even in one muscle suffering from DOMS the decrease of

pain threshold was not distributed evenly (Weerakkody

et al., 2001), suggesting that the foci of damage underly-

ing the soreness were discrete and separated by regions

of the uninjured muscle.

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8. Sex difference in DOMS

In the present study, no gender differences was found

in change of PPT, pain intensity rating, PRI of McGill

pain questionnaire and pain area. Previous studies

showed equivocal results with respect to sex difference

in DOMS. There was no difference between genders inthe soreness rating for eccentric exercise of the leg (High

et al., 1989; MacIntyre et al., 2000) and the elbow flexors

(Poudevigne et al., 2002; Rinard et al., 2000). Another

study found that females reported less pain than males

at 48 h after eccentric resistance exercise (Dannecker

et al., 2003). The differences in the pain intensity rating

between men and women may be due to different depen-

dent variables (soreness or pain) and different time peri-

ods of data collection (Dannecker et al., 2003).

Although different methodologies were used in those

studies, most of them tailored the exercise intensity to

personal maximum contraction strength level as done

in the present study. Therefore the damage to the muscle

after the exercise was likely to be similar between men

and women in the present study. The lack of difference

in decrease of PPT reflected that the tenderness of mus-

cle after DOMS was induced similarly in men and

women. These results were in agreement with results

of previous studies (Dannecker et al., 2003). The present

study used a novel apparatus to induce DOMS in the

neck/shoulder region and the results indicated that

males and females were equally susceptible to the exer-

cise-induced muscle damage in the neck/shoulder mus-

cles. The mechanisms underlying DOMS might be

different from that of chronic musculoskeletal pain inthe neck/shoulder region where females have a higher

prevalence of chronic pain. Too low pain intensity

evolved by DOMS in the present study might be an

alternative reason for the lack of gender differences.

The present endogenous model might in the future pro-

vide quantitative data regarding the efficacy of interven-

tion studies.

Acknowledgement

This work was financially supported by Norma ogFrode S. Jacobsens Fond.

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Delayed Onset Muscle Soreness Neck Shoulder