Open Journal of Pharmacology and Pharmacotherapeutics
Review Article       Open Access      Peer-Reviewed

What is effective, may be effective, and is not effective for improvement of biochemical markers on muscle damage and inflammation, and muscle recovery? A Systematic Review of PubMed’s Database

Renato Carvalho Vilella1* and Camila Carvalho Vilella2

1IMAM, Independent Researcher, Minas Gerais, Brazil
2UNIBH, Medical Student, Minas Gerais, Brazil
*Corresponding author: Renato Carvalho Vilella, Idependent Researcher, IMAM, Belo Horizonte-Minas Gerais, Brazil, Tel: +55-31-98835-3246; E-mail: renatovilella@gmail.com
Received: 23 March, 2020 | Accepted: 22 April, 2020 | Published: 25 April, 2020
Keywords: Musculoskeletal; Exercise; Inflammation; Recovery

Cite this as

Vilella RC, Vilella CC (2020) What is effective, may be effective, and is not effective for improvement of biochemical markers on muscle damage and inflammation, and muscle recovery? A Systematic Review of PubMed’s Database. Open J Pharmacol Pharmacother 5(1): 009-023. DOI: 10.17352/ojpp.000012

Introduction: The Homo sapiens has one of the most amazing characteristic, adaptability. And when adaptability comes to mind, exercising is just by side. Exercising brings many benefits for our body and it is the greater stimulus to trigger musculoskeletal adaptation, starting at mitochondrial level (i.e. biogenesis) to muscular level (i.e. hypertrophy). Mainly when the exercise is of high performance or strenuous, the athlete need a time to recover from fatigue, muscular damage, over-increase of muscular inflammation series of muscle and to prevent overtraining syndrome. Following the concept of “Evidence Based Practice” that is use the best available evidence in clinical decisions, what should be the methods that really have efficacy to prevent or reduce muscle damage, muscle biochemical markers of inflammation and recover? The aim of this article is to search in the PubMed database about what can help our patients/athletes to recover faster, to avoid or to reduce muscle damage and inflammation.

Methods: A search in the PubMed database with the keywords Muscle Skeletal, Inflammation, and Exercise; the keywords had none language translation but results in any language were accepted. Only clinical trials were searched.

Results: 272 articles, 174 excluded (by exclusion criteria). The 98 selected articles were divided into subtopics to discuss their efficacy.

Conclusion: This article evidences the most effective treatments or prevention techniques for improvement of muscle damage, inflammation biochemical markers and muscle recovery.

In our knowledge it is the first in PubMed database that assemble diverse health care subjects, and it may serve as an easy guideline for clinical decision making.

Introduction

The Homo sapiens has one of the most amazing characteristic, adaptability. And when adaptability comes to mind, exercising is just by side. When we exercise we have changes for adaptation, from cellular to systemic, in our entire body. It has benefits on mitochondrial biogenesis and activity [1], weight loss [2], sleeping quality [3], depression and anxiety [4], and a lot more beneficial effects in our system [5].

In 2017, about 174.05 million people were members of a health/fitness club worldwide [6].

The number of amateur, professional/elite athletes is uncountable but statistics shows that UNI World Athletes is a global collective of 85,000 elite/professional athletes [7].

Exercise is also the greater stimulus to trigger musculoskeletal adaptation, this adaptation also starts at mitochondrial level (i.e. biogenesis) to muscular level (i.e. hypertrophy). Mainly when the exercise is of high performance or strenuous, the athlete need a time to recover from fatigue, muscular damage, over-increase of muscular inflammation series of muscle and to prevent overtraining syndrome [8].

Knowing this, athletes from all over the world seek for health care professionals, aiming to reduce the recovery time, muscle soreness, and loss of muscle strength, after exercise-induced muscle damage and overtraining.

Following the concept of “Evidence Based Practice” that is use the best available evidence in clinical decisions [64][9], what should be the methods that really have efficacy to prevent or reduce muscle damage, muscle biochemical markers of inflammation and recover?

The aim of this article is to search in the PubMed database about what can help our patients/athletes to recover faster, to avoid or to reduce muscle damage and inflammation.

Also, in a critical way, to highlight the most important findings.

Methods

A search in the PubMed database with the keywords Muscle Skeletal, Inflammation, and Exercise; the keywords had none language translation but results in any language were accepted. Only clinical trials were searched.

The exactly search was (((“muscles”[MeSH Terms] OR “muscles”[All Fields] OR “muscle”[All Fields]) AND skeletal[All Fields]) AND (“inflammation”[MeSH Terms] OR “inflammation”[All Fields]) AND (“exercise”[MeSH Terms] OR “exercise”[All Fields]) AND Clinical Trial[ptyp]).

The search returned 272 matches, dates from 1985 to 2020. First we read the abstract of all articles to remove those in the exclusion criteria.

The exclusion criteria were studies with animals, i.e. rats and horses; involving participants with any kind of previous or current injury, or any kind of disease or previous disease; involving sedentary or not healthy subjects; without DOI.

After reading the abstract of all articles and performing the exclusion criteria (174 excluded), 98 articles were selected.

Results

The following tables contains the article name, first author name, number of subjects (N), results and the DOI with a link to article’s page.

Table 1 contents the articles selected with effective results in reducing muscle inflammation and muscle damage, 17 articles.

Table 2 contents the articles selected with non-clear effective results (may be effective) in reducing muscle inflammation and muscle damage, 33 articles.

Table 3 contents the articles selected with not effective results in reducing muscle inflammation and muscle damage, 48 articles.

Discussion

As the objective of this article is to show what are effective, may be effective, and not effective means to reduce muscle damage and muscle inflammation and recover means, we set the discussion into result themes subtopics.

Antioxidants

Extenuating exercises often causes oxidative damage to proteins, nucleic acids, and lipids, leading to impaired cellular functionality [10]. Antioxidants have been widely used in the amateur and professional athlete’s daily supplementation, but are not well supported by literature.

Nine studies presented in this research, found non-significant/moderate results, in the use of antioxidants (beetroot juice, Vitamin C, N-acetyl-cysteine, Vitamin E, Grape consumption) for reducing biochemical markers of inflammation and muscle damage [11-20].

Clifford T, et al. 2016, show that in muscle damage by eccentric exercise, the beetroot juice is effective to reduce muscle soreness [21]. Toscano L. T, et al. 2015, article evidences that supplementation with purple grape juice promotes increased time-to-exhaustion and increased antioxidant activity [22].

Childs A, et al. 2001, findings suggest that supplementation with the antioxidants vitamin C and N-acetyl-cysteine immediately post-injury, may increase tissue damage and oxidative stress [13]. In contrast with the findings, Chou, et al. 2018, demonstrate the efficacy of a high dose of Vitamin C and E supplementation in short period (4 days) can attenuate tissue damage, and inflammatory response [23].

Studies with Panax ginseng, Avenanthramide, and Thiol-based antioxidant have also been carried. Panax ginseng may be effective in reduce exercise muscle damage and inflammatory responses [24]. Avenanthramide supplementation can attenuate inflammation markers, and increased antioxidant capacity during an eccentric exercise bout [25]. Thiol-based antioxidant may disrupts the skeletal muscle inflammatory response and repair capability [26].

Polyphenol-rich foods

The use of Montmorency Tart Cherry (polyphenol-rich foods) was found to be not effective or may be effective for accelerating recovery after strenuous exercises, and not effective to reduce muscle inflammatory response or inflammatory/muscle damage biomarkers [27-29].

Despite of the findings above, five studies from years 2010-2019, may present different results that in some corroborate and in some disagree. The Polyphenol-rich foods can be effective for combating post exercise oxidative and inflammatory cascades, be effective for accelerating recovery and reduce exercise inflammatory responses, attenuate muscle soreness and muscle catabolism [30-34].

In 2016, Levers, et al. had strong evidences, with short-term supplementation of Montmorency powdered tart cherries, as attenuated markers of muscle catabolism, reduced immune and inflammatory stress, better maintained redox balance, and increased performance in aerobically trained individuals [35].

Non-steroidal anti-inflammatory drugs (Nsaid’s)

NSAID’s type of drug is one of the most consumed in the world, mainly among athletes [37]. The use of NSAID’s by athletes is, mainly, to reduce the muscular soreness, muscle damage, and muscle inflammation.

The literature findings, do not support the use of Naproxen, Ibuprofen, COX-2 inhibitor, Acetaminophen, and Lyprinol(®) for the above cited parameters [36-42]. Also, the findings of Lija M, et. al. 2018, evidence that the excessive use of anti-inflammatory drugs may reduce and compromise muscle strength and muscle adaptation capacity in young adults [37].

O’Grady M, et al. 2000, findings demonstrate pre administration of diclofenac significantly reduces indices of exercise-induced skeletal muscle damage [43].

Cryotherapy

Most of all amateur and professional athletes use cooling (ice bags), cold water immersion, and/or whole body cryotherapy to reduce muscle pain, muscle soreness and muscle damages. It is an ancient practice that has been passed forward, but it really has efficacy or clinical significance?

Seven studies report non-significant results for cryotherapy (20 minutes; 30 minutes of cryotherapy; intermittent whole body (-110ºC) cryotherapy; cold water limb immersion; topical cooling) in reducing biochemical muscle damage markers, attenuating strength decrement, and soreness, showing that maybe the mechanism of cryotherapy recovery is not accurate and not supporting the use of cryotherapy on recovery [44-47]. Findings, also show that cryotherapy reduces arterial and cutaneous blood flow, and cerebral oxygenation, but not muscle temperature after resistance training [48-50].

In addition, topical cooling (icing) show to delay muscle recovery after muscle damage, therefore is not recommended as therapy intervention [51].

The protocol of multiple cold-water immersions attenuated muscle damage, but had no/small effects on muscle function recovery [52-54].

Massage therapy/soft tissue therapies

Instrument-Assisted Soft Tissue Mobilization of plantar fascia had no effects on biochemical markers of muscle damage or inflammation and had a negative result at perception of function (reduced) and pain (increased) [55].

The use of topical Arnica after exercise did not changed any of the markers of inflammation or tissue damage. Regardless of these findings, the use of topical Arnica showed to be effective as pain relief three days post exercise [56].

Vibration Therapy reduces muscle soreness and biochemical markers of muscle damage and inflammation. It may stimulate lymphocyte and neutrophil responses and may be a useful modality in treating muscle inflammation. Also, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis. When choosing between Vibration or Massage Therapy, the professional should take into account the patients preference, the experience with the technique and previous clinical outcomes, because both therapies promote muscle recovery after the performance of muscle-damaging exercise [57-59].

Supplementation

The evidence for Collagen Peptides; Omega-3; Taurine; Amino acids; Anatabine; Phosphatidylserine; Rhodiola/Cordyceps; Arachidonic acid; Creatine; Methylsulfonylmethane; 17beta-estradiol; Leucine Metabolites; Carbohydrate, Milk and Protein intake; supplementation has not or non-significant effect on muscle damage recovery and muscle inflammation biochemical markers [60-78].

The evidence for Protease; Phlebodium decumanum; Docosahexaenoic acid; Probiotic Streptococcus thermophilus FP4 and Bifidobacterium breve BR03; Protein-leucine; N-3 PUFA; Curcumin; Pomegranate Extract; Ellagitannin; supplementation is low/moderate on muscle damage recovery and muscle inflammation biochemical markers [79-86].

There was a moderate/strong evidence for Electrokinetically Modified Water; lemon verbena extract (Recoverben®); Iron; Black Currant Nectar; supplementation in recovering from muscle damage and reducing biochemical markers of muscle damage and inflammation [87-90].

Although the evidence above, there was moderate effect for Collagen Peptides on recovery [60], moderate to strong evidence that Rhodiola/Cordyceps improved endurance capacity and glycemic control [67], low (clinically) evidence for Methylsulfonylmethane in reduction of muscle and joint pain, low evidence for Taurine supplementation in improvement of performance and decrease of muscle damage [91].

Milk Protein concentrate supplementation is effective to reduce muscle strength loss after exercise-induced muscle damage [92].

Combined Bacillus coagulans GBI-30, 6086 and HMB, supplementation were effective to maintain muscle integrity and attenuate muscle inflammation biochemical markers in intense military training [93].

The increased consumption of carbohydrates in order to replenish the glycogen stores had no effect (positive or negative) in immune and muscular responses [69]. But increased consumption of carbohydrates and protein (as shake) and after exercise-induced damage seems to be effective to reduce muscle damage and increase recovery [94].

Compression garments

There is not a common sense for the compression garments. When we think about inflammation and tissue damage, should be used before, during or after physical activities?

In 2014, Hill JA, et al. carried a research with 24 marathon athletes and found that the use of compression garments for recovery (after physical activity) do no attenuate the biochemical markers of pain and muscle damage, but does improve the athlete perception of recovery [95].

The use of compression stockings after physical activity recovery may also be beneficial for reduce perceived muscle soreness, and had no benefits for biochemical markers [96,97].

If the athlete is already in delayed onset muscle soreness or at an inflammation phase of muscle damage, compression garments can be effective to reduce muscle stiffness [98].

Other means

,st >Not effective for improvement of muscle damage and inflammation biochemical markers

• Electrical Muscle Stimulation (Sensory Level) – but may be effective for improvement of range of motion and provide relief for muscle soreness [99].

• Short-Wave Diathermy [55].

• Supplemental Oxygen [100].

• Focused Extracorporeal Shock Wave – May be effective for delayed on set muscle soreness [101].

Effective for improvement of muscle damage and inflammation biochemical markers

• Infrared Low-Level Laser Therapy (810nm) – 50 J dose, pre exercise, may increase performance [102].

• Infrared Photobiomodulation Therapy (810nm) - 100 mW power output per diode, pre exercise, increased muscular performance and post exercise recovery [103].

• Exercise-induced histamine release may have a broad impact on protecting muscle from exercise-induced damage – Therefore the use of anti-histamine drugs before exercise may induce to increased perception of muscle pain and strength loss, also may impair muscle damage [104-107].

Conclusion

This article evidences the most effective treatments or prevention techniques for improvement of muscle damage, inflammation biochemical markers and muscle recovery.

In our knowledge it is the first in PubMed database that assemble diverse health care subjects, and it may serve as an easy guideline for clinical decision making.

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