Aim: To investigate the effects of pulsed Ultrasound (US) in recovery from Delayed Onset Muscle Soreness (DOMS).
Methods: Twelve healthy male athletes (mean age 23.83±1.697 year) performed an eccentric exercise protocol of non-dominant elbow flexors to induce muscle soreness on 2 occasions separated by 3 weeks. Subjects in experimental group received pulsed US (1 MHz, intensity 0.8 W/cm2, mark space ratio 1:10), whereas control group received sham US after 24 h, 48 h and 72 h. Perception of muscle soreness, active ROM and muscle strength were the parameters measured at 0 h, 24 h, 48 h and 72 h with the help of VAS, manual goniometer and JONEX muscles master instrument respectively.
Results: Post hoc t test analysis revealed significant differences (p <0.05) between 0 h and 72 h in the parameter of ROM (t = 6.18) and muscle power (t = 2.54) as well as between 24 h and 48 h in the parameter of muscle soreness (t = 3.13) in control group. Similar differences were also observed in the experimental group. No significant inter-group differences at α level  of 0.05 was observed in any parameter at any level.
Conclusion: The pattern of recovery from DOMS was not influenced by the application of pulsed Ultrasound at the parameters discussed here

A G, Sinha

J S, Sandhu

Shankar, Gauri

English

CogPrints Cognitive Sciences Eprint Archive

Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness

Cognitive Sciences ePrint Archive

Published Quarterly
Mangalore, South India
ISSN 0972-5997
Volume 5, Issue 1; Jan-Mar 2006
Pulsed Ultrasound Does Not Affect Recovery From Delayed 
Onset Muscle Soreness
Authors
Gauri Shankar, Student
Sinha AG, Senior Lecturer
Sandhu JS, Professor, Dean and Head
Dept. of Sports Medicine and Physiotherapy,
Guru Nanak Dev University (GNDU),
Amritsar, Punjab-143005, India.
Address For Correspondence
Gauri Shankar
Dept. of Sports Medicine and Physiotherapy,
Guru Nanak Dev University (GNDU),
Amritsar, Punjab-143005, India.
E-mail: gshank006@yahoo.com
Citation
Gauri Shankar, Sinha AG, Sandhu JS. Pulsed Ultrasound does not affect recovery from 
Delayed Onset Muscle Soreness. Online J Health Allied Scs.2006;1:5
URL
http://www.ojhas.org/issue17/2006-1-5.htm
Open Access Archives
http://cogprints.ecs.soton.ac.uk/view/subjects/OJHAS.html
http://openmed.nic.in
1
Short Communication
Submitted: Mar 10,  2006;  Revised: June 17,  2006; Accepted: June 18,  2006; Published: Jul 08,  2006
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm
Abstract:
Aim:  To  investigate  the  effects  of 
pulsed  Ultrasound  (US)  in  recovery 
from Delayed  Onset  Muscle  Soreness 
(DOMS).
Methods:  Twelve  healthy  male 
athletes (mean age 23.83±1.697 year) 
performed  an  eccentric  exercise 
protocol of non-dominant elbow flexors 
to  induce  muscle  soreness  on  2 
occasions  separated  by  3  weeks. 
Subjects  in  experimental  group 
received  pulsed  US (1  MHz,  intensity 
0.8  W/cm2,  mark  space  ratio  1:10), 
whereas control group received sham 
US  after  24  h,  48  h  and  72  h. 
Perception of muscle soreness,  active 
ROM  and  muscle  strength  were  the 
parameters measured at 0 h, 24 h, 48 
h  and  72  h  with  the  help  of  VAS, 
manual  goniometer  and  JONEX 
muscles  master  instrument 
respectively.
Results: Post  hoc  t  test  analysis 
revealed  significant  differences  (p 
<0.05) between 0 h and 72 h in the 
parameter  of  ROM  (t  =  6.18)  and 
muscle  power  (t  =  2.54)  as  well  as 
between  24  h  and  48  h  in  the 
parameter  of  muscle  soreness  (t  = 
3.13)  in  control  group.  Similar 
differences were also observed in the 
experimental  group.  No  significant 
inter-group  differences  at  α level  of 
0.05 was observed in any parameter at 
any  level.
Conclusion: The  pattern  of  recovery 
from DOMS was not influenced by the 
application of pulsed Ultrasound at the 
parameters  discussed  here.
Key  Words:  Ultrasound,  Delayed 
Onset Muscle Soreness 
Introduction:
Delayed  Onset  Muscle  Soreness 
(DOMS) is defined as the sensation of 
pain  or  discomfort  in  the  skeletal 
muscles  following  unaccustomed 
physical  activity,  usually  eccentric 
muscular contraction.1
Several hypotheses have been offered 
with regard to the cause of DOMS like 
torn  tissue  theory,  connective  tissue 
theory, muscle spasm theory etc.
DOMS  is  an  annoying  condition  that 
may interrupt performance of athletes. 
Thus, an effective treatment has been 
sought for many years by athletes and 
sports  medicine  professionals  con­
stantly to accelerate recovery. To date, 
a sound and consistent treatment for 
DOMS  has  not  been  established.  Al­
though multiple practices exist for the 
treatment of DOMS such as stretching, 
massage, ultrasound, and many more. 
Pulsed ultrasound (US) could be used 
in the treatment of DOMS. The aim of 
present study is to investigate the ef­
fects  of pulsed  US  in  recovery  from 
DOMS. 
Materials  and  Methods:
This  study,  a  same-subject  repeated 
measure clinical trial, was confined to 
12 male athletes from Guru Nanak Dev 
University,  Amritsar.  Only  male  sub­
jects were selected in  order  to  elimi­
nate any potential gender related dif­
ferences  in  the  perception  of  muscle 
soreness.  Subjects  included  in  this 
study were in between 21 to 26 years 
(Mean age = 23.83±1.697 year)  and 
not  engaged  in  any  weight  training 
program  of  the  upper  extremity  4 
weeks prior to and at the time of data 
collection. Subjects with recent muscu­
loskeletal  injuries to tested upper ex­
tremity  and  taken  medications  24 
hours prior to DOMS induction until the 
last day of data collection were exclud­
ed from the study.
Prior  to  participation  in  this  experi­
ment, all subjects were informed of the 
procedures of the study and completed 
a  pre-test  health  screening  question­
naire and all subjects signed a written 
informed consent.
Subjects were randomly assigned to ei­
ther  a  treatment  or  control  group;  in 
the cross-over design with 12 subject 
in each group undertaken treatments 
after exercise at day 1, day 2 and day 
3.  Subjects  in  treatment  group  re­
2
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm
ceived pulsed US (1 MHz, intensity 0.8 
W/cm2,  Mark  space  ratio  1:10)  for  8 
minute , while control  group received 
sham US with the power output set to 
0 for 8 minute.
Induction  of  DOMS:
Subjects performed an exercise proto­
col designed to induce DOMS on 2 sep­
arate occasions, separated by 3 weeks 
on  non-dominant  elbow  flexors.  The 
subject  was  required  to  lift  a  fixed 
weight of 20 pound in his hand from a 
fully extended to a fully flexed position 
in  standing  position.  The  weight  was 
reduced to 15 pound in those subjects 
who could not lift 20 pound. Amount of 
weight  was  determined  by  subject’s 
perception.  Repetitions  were  per­
formed  with  a  concentric  contraction 
followed  by  an  eccentric  contraction 
lasting 7 seconds.  For this  purpose a 
stop watch  was  used.  During the ec­
centric contraction subjects were ver­
bally encouraged to maintain the force 
level. Assistance was provided if sub­
jects were unable to complete the con­
centric  phase of  the  repetition;  while 
during  the  eccentric  phase  no  assis­
tance was provided. Each subject was 
required to perform at least 4 sets of 
10 repetitions with a 3 minute rest be­
tween  each  of  the  sets.  Repetitions 
were  determined  by  subject’s  feeling 
of exhaustion. Sets of repetitions were 
increased for those subjects who could 
lift it till exhaustion.
Dependent variables of this study are 
the  following:
1.  Measurement  of  Muscle  Soreness 
(DOMS)  
Visual  Analogue  Scale  (VAS)  ranging 
from 0 to 10 cm was used to measure 
soreness. The subject had to mark the 
line at the point corresponding to the 
intensity of pain perceived. It was used 
after  treatment  on  day  1  to  day  3.  
2. Measurement of Active Joint Range 
of  Motion  of  Elbow  
Subjects had to lie in supine comfort­
ably. Goniometer was placed with it’s 
axis on lateral epicondyle, stable arm 
was  kept  parallel  with  the  humerus 
while  movable  arm was  kept  parallel 
with the long axis of forearm. Subjects 
had instructed to bend the elbow ac­
tively  from  full  extension  position  to 
fully  flexed  position.  The  score  was 
taken on goniometer ranging from 0-
180°  before  and  after  treatment  on 
day  0  to  day  3.
3. Measurement of Jonex Muscle Mas­
ter  Score  (JMMS)
Subjects by sitting in half squatting po­
sition had to pull the wire of Jonex Mus­
cle  Master  by  keeping  the  elbow  at 
right angle. Scale after pulling indicat­
ed the strength of the elbow flexors. It 
was  used before  and after  treatment 
on day 0 to day 3.
Statistical Analysis: Data were sta­
tistically  analysed  using  ANOVA  with 
repeated  measures.  Post  hoc  t  tests 
were  performed  to  investigate  the 
source of statistical significance for all 
main effects. Significance was accept­
ed at p < 0.05.
Results:
Fig.  1  presents  the  graphical 
representation of Range of Motion (in 
degree)  of  experimental  and  control 
group at different stages of treatment.
Fig. 1: Comparison of mean Range of 
Motion  between  experimental  and 
control  group  at  different  stages  of 
treatment.
ROM is decreasing rapidly immediately 
post  exercise  in  both  group  upto  2nd 
day (i.e. 48 hr). This value decreased 
to  lowest  of  119.42±9.307  in 
treatment  group  and  115.5±7.562  in 
control  group  at  day  2  (48  h).  ROM 
starts  increasing in  both groups from 
3
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm
day 2 to day 3 post exercise, though 
remained  lower  than  pre-treatment 
level.
Fig. 2: Comparison of mean Jonex Muscle 
Master Score (JMMS) between experimental 
and  control  group  at  different  stages  of 
treatment.
Fig.  2  shows  graphical  representation  of 
Jonex Muscle Master Score (JMSS) between 
experimental and control group at different 
stages  of  treatment.  JMMS  decreased  in 
both  groups  from  day  0  to  day  2  post 
exercise  reaching  the  lowest  value  of 
61.67±18.505  in  treatment  group  and 
55.83±9.252  in  control  group,  on  day  2 
post  exercise.  JMMS  started  increasing 
after day 2 but it did not reach the baseline 
value on day 3.
Fig.  3: Comparison  of  mean  Visual 
Analogue  Score  (VAS)  between 
experimental and control group at different 
stages of treatment.
Fig.  3  presents  the  graphical 
representation  of  Visual  Analogue 
Score  (VAS)  of  experimental  and 
control  group  at  different  stages  of 
treatment. VAS starts increasing from 
day 1 and reached its maximal value 
on day 2 in both group. On day 3 the 
VAS is less than day 2 but more than 
day 1.
Discussion:
Many modalities have been advocated 
for enhancing the recovery of pain and 
range  of  motion  in  the  treatment  of 
Delayed  Onset  Muscle  Soreness 
(DOMS),  however  there  is  lack  of 
concrete  information  regarding  the 
efficacy of those modalities.  Evidence 
with  regard  to  the  efficacy  of 
ultrasound  (US)  on  DOMS  are 
conflicting.  Some  study2 showed  that 
US helps relieve DOMS while the other 
have  observed  contradictory  findings 
of  no  effects3,4 and  also  adverse 
effects.5  The  present  study  was 
designed  to  evaluate  the  possible 
contribution  of  pulsed  ultrasound  for 
recovery of the active Range of Motion 
(ROM),  pain  and  muscle  power 
following DOMS.
Although  the  pathophysiologic  pro­
cesses of  DOMS remain occult,  many 
forms of treatment have been investi­
gated in an attempt to establish an ef­
fective  and  appropriate  treatment. 
Pulsed  US  is  an  electrotherapeutic 
modality that has been used typically 
to  decrease  the  symptoms of  inflam­
mation  (pain  and  edema)  and  to  in­
crease the rate of healing in many con­
ditions e.g. soft tissue injuries, muscu­
loskeletal pain and chronic edema.6
The absorption of ultrasonic waves in 
tissues is suggested to cause an “oscil­
lation” within those tissues. This vibra­
tion is believed to produce both ther­
mal  and  non-thermal  effects.  It  has 
been accepted that continuous US may 
cause  a  greater  heating  effect  than 
pulsed  US.7 Moreover,  continuous 
mode of US was studied by Ciccone et 
al.5 who concluded that US enhanced 
the development of DOMS. They used 
4
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm
continuous mode of US with 1 MHz, in­
tensity 1.5 W/cm2 for 5 minute.
According to Young7 the criteria for the 
use of pulsed US versus continuous US 
remain in a grey area, with the practi­
tioner having to decide whether ther­
mal  or  non-thermal  effects  are  re­
quired. Young7  suggests that non-ther­
mal effects may be preferable for tis­
sue  repair  and  stimulation  of  blood 
flow,  therefore,  pulsed  US  should  be 
selected  for  conditions  of  this  type. 
Given such putative effects,  it  is  rea­
sonable  to  postulate  that  pulsed  US 
might  be  expected  to  accelerate  the 
inflammation  and  healing  processes 
while  reducing  the  pain  associated 
with DOMS. Pulsed US would therefore 
appear  to  be  a  useful  modality  for 
treating DOMS, where its reported anti-
inflammatory effects would be benefi­
cial.
In  the  current  study  analysis  of  the 
ROM, muscle power and muscle sore­
ness data showed no significant differ­
ence  between experimental  and con­
trol group. ROM data indicated that the 
subjects  who  received  sham  US, 
showed as similar a pattern those who 
received  pulsed  US  suggests  that 
pulsed  US  has  same  effects  on  that 
sham US as far as ROM is concerned.
Delayed onset muscle soreness is typi­
cally associated with pain and stiffness 
that  leads  to  a  transient  decrease  in 
joint  ROM in  affected  areas.(8)  In  the 
present  study  among  control  group, 
ROM decreased significantly (p<0.001) 
from day 0 and day 1 and from day 1 
to day 2 (p<0.01).
Similarly,  ROM in  experimental  group 
decreased  significantly  (p<0.001)  be­
tween the intervals of day 0 Vs day 1 
and  non-significantly  between  the  in­
tervals of day 1 Vs day 2.
The possible explanation of the restric­
tion of motion lies in the study of How­
ell  et  al.8 which  clearly  indicate  that 
neuromuscular activity is not the cause 
of restriction of motion in post-exercise 
muscle soreness.
The present study shows that muscle 
soreness  peaked  at  48  h  after  exer­
cise. The similar observations had also 
been made by Mekjavic  et al.9  In  the 
present  study,  muscle  power  de­
creased in both groups from day 0 to 
day 2 post exercise, reaching the low­
est  value  of  61.67±18.505  in  treat­
ment group and 55.83±9.252 in con­
trol group, on day 2 post-exercise, and 
started increasing after day 2, though 
remained  lower  than  pre-treatment 
levels, it is clear that muscle power did 
not recover in 3 days. This is in accor­
dance with  the findings of  Cleak and 
Eston10  which show maximum strength 
loss  (46% of  pre-exercise  values)  oc­
curred 24 h later.
In this study significant loss of range of 
motion and increased pain level during 
first 24 h indicates that DOMS was suc­
cessfully induced. This is in accordance 
with the study of Craig et al3 
Conclusions:
In the present study efficacy of pulsed 
ultrasound  has  been  investigated  on 
the  recovery  pattern  of  pain  percep­
tion,  range  of  motion  and  muscle 
strength following delayed onset mus­
cle  soreness  (DOMS).  In  the  present 
study no significant benefits of pulsed 
ultrasound on DOMS in terms of pain 
relief,  range  of  movement  or  muscle 
strength was observed. No intergroup 
differences were observed in  any pa­
rameter  at  any  level.  These  results, 
therefore, do not provide any evidence 
of the putative benefits of pulsed ultra­
sound in DOMS treatment.
Recommendations  and  Limita­
tions:
The  present  study  was  delimited  by 
the  application  of  US  dosage  of  0.8 
W/cm2, mark space ratio of 1:10 to the 
DOMS  of  elbow  flexor  muscle  for  3 
days.  Further  studies  are  required  to 
explore the efficacy of various doses of 
pulsed US on the other muscle group. 
5
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm
Current study was conducted with fre­
quency of 1 MHz, further study may be 
done with 3 MHz. The US was applied 
once daily, it may be increased to 2-3 
times a day. The duration of treatment 
was 8 minute which may be increased 
or decreased in further study. The fol­
low-up  treatment  was  given  upto  3 
days that may be increased upto 4-5 
days. The site of application of US was 
only one on the anterior aspect of el­
bow flexors muscle which may be in­
creased  to  multiple  sites  in  future 
study.  The  sample  of  present  study 
was 12, that may be increased in fu­
ture study. The more effective and reli­
able measurement of variation of mus­
cle power by the use of isokinetic ma­
chine would throw more light. Psycho­
logical status of the subjects should be 
monitored  properly.  Dietary  control 
should be properly monitored in future 
study,  which  could  affect  the  result. 
Dose measurement of the machine in 
present study could not be controlled, 
which  should  be  clearly  calibrated  in 
future study by proper dosimetry. The 
parameters for DOMS induction should 
be clearly clarified.
References:
1. Newham DJ, McPhail G, Mills KR, et 
al.  Ultrastructural  changes  after 
concentric  and  eccentric  contrac­
tions  of  human  muscle.  J  Neurol 
Sci. 1983;61:109-22. 
2. Hasson S, Mundorf R, Barnes W, et 
al. Effect of pulsed ultrasound ver­
sus  placebo  on  muscle  soreness 
perception  and  muscular  perfor­
mance.  Scand  J  Rehabil  Med. 
1990;22(4):199-205.
3. Craig JA, Bradley J, Walsh DM, et al. 
Delayed  onset  muscle  soreness  : 
Lack of effect of therapeutic ultra­
sound  in  humans.  Arch Phys  Med 
Rehabil. 1999;80(3):318-23.
4. Plaskett  C,  Tiidus  P,  Livingston  L. 
Ultrasound treatment does not af­
fect  postexercise  muscle  strength 
recovery or soreness.  J  Sports Re­
hab. 1999;8:1-9.
5. Ciccone CD, Leggin BE,  Callamaro 
JJ.  Effects  of  ultrasound  and  tro­
lamine salicylate phonophoresis on 
delayed  onset  muscle  soreness. 
Phys Ther. 1991;71(9):666-75, dis­
cussion 675-78.
6. Holmes  MAM,  Rudland  JR.  Clinical 
trials  of  ultrasound  treatment  in 
soft tissue injury : a review critique. 
Physiother  Theory  Pract. 
1991;7:163-75. 
7. Young  S.  Ultrasound  therapy.  In: 
Kitchen  S.  Bazin  S.  editors.  Clay­
ton’s  electrotherapy.  10th ed.  Lon­
don : WB Saunders. 1996. p.  243-
67.
8. Howell JN, Chila AG, Ford G, et al. 
An electromyographic  study of  el­
bow  motion  during  post  exercise 
muscle  soreness.  J  Appl  Physiol.  
1985;58:1713-18.
9. Mekjavic IB, Exner JA, Tesch PA, et 
al. Hyperbaric oxygen therapy does 
not  affect  recovery  from  delayed 
onset  muscle  soreness.  Med  Sci 
Sports Exerc. 2000;32(3):558-63.
10. Cleak  MJ,  Eston  RE.  Muscle  sore­
ness,  swelling,  stiffness  and 
strength  loss  after  intense  eccen­
tric  exercise.  Br  J  Sp  Med. 
1992;26(4):267-72.
 
6
OJHAS  Vol 5 Issue 1, 2006-1-5:  Short Communication. Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness.  www.ojhas.org/issue17/2006-1-5..htm


An electromyographic study of el bow motion during post exercise muscle soreness.

Clinical trials of ultrasound treatment in soft tissue injury : a review critique. Physiother Theory Pract.

Delayed onset muscle soreness : Lack of effect of therapeutic ultra sound in humans. Arch Phys Med Rehabil.

Effect of pulsed ultrasound ver sus placebo on muscle soreness perception and muscular perfor mance.

Effects of ultrasound and tro lamine salicylate phonophoresis on delayed onset muscle soreness. Phys Ther. 1991;71(9):666-75, dis cussion

Hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness. Med Sci Sports Exerc.

Muscle sore ness, swelling, stiffness and strength loss after intense eccen tric exercise.

Ultrasound therapy. In:

Ultrasound treatment does not af fect postexercise muscle strength recovery or soreness.

Ultrastructural changes after concentric and eccentric contrac tions of human muscle.

Aim: To investigate the effects of pulsed Ultrasound (US) in recovery from Delayed Onset Muscle Soreness (DOMS).  Methods: Twelve healthy male athletes (mean age 23.83±1.697 year) performed an eccentric exercise protocol of non-dominant elbow flexors to induce muscle soreness on 2 occasions separated by 3 weeks. Subjects in experimental group received pulsed US (1 MHz, intensity 0.8 W/cm2, mark space ratio 1:10), whereas control group received sham US after 24 h, 48 h and 72 h. Perception of muscle soreness, active ROM and muscle strength were the parameters measured at 0 h, 24 h, 48 h and 72 h with the help of VAS, manual goniometer and JONEX muscles master instrument respectively.  Results: Post hoc t test analysis revealed significant differences (p <0.05) between 0 h and 72 h in the parameter of ROM (t = 6.18) and muscle power (t = 2.54) as well as between 24 h and 48 h in the parameter of muscle soreness (t = 3.13) in control group. Similar differences were also observed in the experimental group. No significant inter-group differences at α level  of 0.05 was observed in any parameter at any level.  Conclusion: The pattern of recovery from DOMS was not influenced by the application of pulsed Ultrasound at the parameters discussed here

Gauri Shankar

Sinha AG

Sandhu JS

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Pulsed Ultrasound Does Not Affect Recovery From Delayed Onset Muscle Soreness

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