Skip to main content
NCBI home page
Journal of Athletic Training logoLink to Journal of Athletic Training
. 1995 Mar;30(1):29–34.

Pathophysiology of Acute Exercise-Induced Muscular Injury: Clinical Implications

Phillip Page 1
PMCID: PMC1317825  PMID: 16558305

Abstract

Acute muscular injury is the most common injury affecting athletes and those participating in exercise. Nearly everyone has experienced soreness after unaccustomed or intense exercise. Clinically, acute strains and delayed-onset muscle soreness are very similar. The purpose of this paper is to review the predisposing factors, mechanisms of injury, structural changes, and biochemical changes associated with these injuries. Laboratory and clinical findings are discussed to help athletic trainers differentiate between the two conditions and to provide a background knowledge for evaluation, prevention, and treatment of exercise-induced muscular injury.

Full text

PDF
29

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong R. B. Initial events in exercise-induced muscular injury. Med Sci Sports Exerc. 1990 Aug;22(4):429–435. [PubMed] [Google Scholar]
  2. Armstrong R. B. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529–538. [PubMed] [Google Scholar]
  3. Armstrong R. B., Ogilvie R. W., Schwane J. A. Eccentric exercise-induced injury to rat skeletal muscle. J Appl Physiol Respir Environ Exerc Physiol. 1983 Jan;54(1):80–93. doi: 10.1152/jappl.1983.54.1.80. [DOI] [PubMed] [Google Scholar]
  4. Bach B. R., Jr, Warren R. F., Wickiewicz T. L. Triceps rupture. A case report and literature review. Am J Sports Med. 1987 May-Jun;15(3):285–289. doi: 10.1177/036354658701500319. [DOI] [PubMed] [Google Scholar]
  5. Bennett J. G., Stauber W. T. Evaluation and treatment of anterior knee pain using eccentric exercise. Med Sci Sports Exerc. 1986 Oct;18(5):526–530. [PubMed] [Google Scholar]
  6. Bohannon R. W. Effect of repeated eight-minute muscle loading on the angle of straight-leg raising. Phys Ther. 1984 Apr;64(4):491–497. doi: 10.1093/ptj/64.4.491. [DOI] [PubMed] [Google Scholar]
  7. Byrd S. K. Alterations in the sarcoplasmic reticulum: a possible link to exercise-induced muscle damage. Med Sci Sports Exerc. 1992 May;24(5):531–536. [PubMed] [Google Scholar]
  8. Byrd S. K., McCutcheon L. J., Hodgson D. R., Gollnick P. D. Altered sarcoplasmic reticulum function after high-intensity exercise. J Appl Physiol (1985) 1989 Nov;67(5):2072–2077. doi: 10.1152/jappl.1989.67.5.2072. [DOI] [PubMed] [Google Scholar]
  9. Byrnes W. C., Clarkson P. M. Delayed onset muscle soreness and training. Clin Sports Med. 1986 Jul;5(3):605–614. [PubMed] [Google Scholar]
  10. Byrnes W. C., Clarkson P. M., White J. S., Hsieh S. S., Frykman P. N., Maughan R. J. Delayed onset muscle soreness following repeated bouts of downhill running. J Appl Physiol (1985) 1985 Sep;59(3):710–715. doi: 10.1152/jappl.1985.59.3.710. [DOI] [PubMed] [Google Scholar]
  11. Ciccone C. D., Leggin B. G., Callamaro J. J. Effects of ultrasound and trolamine salicylate phonophoresis on delayed-onset muscle soreness. Phys Ther. 1991 Sep;71(9):666–678. doi: 10.1093/ptj/71.9.666a. [DOI] [PubMed] [Google Scholar]
  12. Clarkson P. M., Byrnes W. C., McCormick K. M., Turcotte L. P., White J. S. Muscle soreness and serum creatine kinase activity following isometric, eccentric, and concentric exercise. Int J Sports Med. 1986 Jun;7(3):152–155. doi: 10.1055/s-2008-1025753. [DOI] [PubMed] [Google Scholar]
  13. Clarkson P. M., Nosaka K., Braun B. Muscle function after exercise-induced muscle damage and rapid adaptation. Med Sci Sports Exerc. 1992 May;24(5):512–520. [PubMed] [Google Scholar]
  14. Clarkson P. M., Tremblay I. Exercise-induced muscle damage, repair, and adaptation in humans. J Appl Physiol (1985) 1988 Jul;65(1):1–6. doi: 10.1152/jappl.1988.65.1.1. [DOI] [PubMed] [Google Scholar]
  15. Davies G. J., Wallace L. A., Malone T. Mechanisms of selected knee injuries. Phys Ther. 1980 Dec;60(12):1590–1595. doi: 10.1093/ptj/60.12.1590. [DOI] [PubMed] [Google Scholar]
  16. De Vries H. A. Quantitative electromyographic investigation of the spasm theory of muscle pain. Am J Phys Med. 1966 Jun;45(3):119–134. [PubMed] [Google Scholar]
  17. Ekstrand J., Gillquist J. The frequency of muscle tightness and injuries in soccer players. Am J Sports Med. 1982 Mar-Apr;10(2):75–78. doi: 10.1177/036354658201000202. [DOI] [PubMed] [Google Scholar]
  18. Evans W. J., Cannon J. G. The metabolic effects of exercise-induced muscle damage. Exerc Sport Sci Rev. 1991;19:99–125. [PubMed] [Google Scholar]
  19. Fridén J., Lieber R. L. Structural and mechanical basis of exercise-induced muscle injury. Med Sci Sports Exerc. 1992 May;24(5):521–530. [PubMed] [Google Scholar]
  20. Fridén J., Sjöström M., Ekblom B. Myofibrillar damage following intense eccentric exercise in man. Int J Sports Med. 1983 Aug;4(3):170–176. doi: 10.1055/s-2008-1026030. [DOI] [PubMed] [Google Scholar]
  21. Fritz V. K., Stauber W. T. Characterization of muscles injured by forced lengthening. II. Proteoglycans. Med Sci Sports Exerc. 1988 Aug;20(4):354–361. doi: 10.1249/00005768-198808000-00005. [DOI] [PubMed] [Google Scholar]
  22. Garrett W. E., Jr Injuries to the muscle-tendon unit. Instr Course Lect. 1988;37:275–282. [PubMed] [Google Scholar]
  23. Garrett W. E., Jr Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc. 1990 Aug;22(4):436–443. [PubMed] [Google Scholar]
  24. Garrett W. E., Jr, Rich F. R., Nikolaou P. K., Vogler J. B., 3rd Computed tomography of hamstring muscle strains. Med Sci Sports Exerc. 1989 Oct;21(5):506–514. [PubMed] [Google Scholar]
  25. Hasson S. M., Daniels J. C., Divine J. G., Niebuhr B. R., Richmond S., Stein P. G., Williams J. H. Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. Med Sci Sports Exerc. 1993 Jan;25(1):9–17. doi: 10.1249/00005768-199301000-00003. [DOI] [PubMed] [Google Scholar]
  26. Hasson S. M., Wible C. L., Reich M., Barnes W. S., Williams J. H. Dexamethasone iontophoresis: effect on delayed muscle soreness and muscle function. Can J Sport Sci. 1992 Mar;17(1):8–13. [PubMed] [Google Scholar]
  27. Heiser T. M., Weber J., Sullivan G., Clare P., Jacobs R. R. Prophylaxis and management of hamstring muscle injuries in intercollegiate football players. Am J Sports Med. 1984 Sep-Oct;12(5):368–370. doi: 10.1177/036354658401200506. [DOI] [PubMed] [Google Scholar]
  28. Jönhagen S., Németh G., Eriksson E. Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility. Am J Sports Med. 1994 Mar-Apr;22(2):262–266. doi: 10.1177/036354659402200218. [DOI] [PubMed] [Google Scholar]
  29. Knapik J. J., Bauman C. L., Jones B. H., Harris J. M., Vaughan L. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med. 1991 Jan-Feb;19(1):76–81. doi: 10.1177/036354659101900113. [DOI] [PubMed] [Google Scholar]
  30. McCully K. K., Faulkner J. A. Characteristics of lengthening contractions associated with injury to skeletal muscle fibers. J Appl Physiol (1985) 1986 Jul;61(1):293–299. doi: 10.1152/jappl.1986.61.1.293. [DOI] [PubMed] [Google Scholar]
  31. McGlynn G. H., Laughlin N. T., Rowe V. Effect of electromyographic feedback and static stretching on artificially induced muscle soreness. Am J Phys Med. 1979 Jun;58(3):139–148. [PubMed] [Google Scholar]
  32. Newham D. J., Jones D. A., Clarkson P. M. Repeated high-force eccentric exercise: effects on muscle pain and damage. J Appl Physiol (1985) 1987 Oct;63(4):1381–1386. doi: 10.1152/jappl.1987.63.4.1381. [DOI] [PubMed] [Google Scholar]
  33. Newham D. J., McPhail G., Mills K. R., Edwards R. H. Ultrastructural changes after concentric and eccentric contractions of human muscle. J Neurol Sci. 1983 Sep;61(1):109–122. doi: 10.1016/0022-510x(83)90058-8. [DOI] [PubMed] [Google Scholar]
  34. Nikolaou P. K., Macdonald B. L., Glisson R. R., Seaber A. V., Garrett W. E., Jr Biomechanical and histological evaluation of muscle after controlled strain injury. Am J Sports Med. 1987 Jan-Feb;15(1):9–14. doi: 10.1177/036354658701500102. [DOI] [PubMed] [Google Scholar]
  35. Noonan T. J., Best T. M., Seaber A. V., Garrett W. E., Jr Thermal effects on skeletal muscle tensile behavior. Am J Sports Med. 1993 Jul-Aug;21(4):517–522. doi: 10.1177/036354659302100407. [DOI] [PubMed] [Google Scholar]
  36. Safran M. R., Garrett W. E., Jr, Seaber A. V., Glisson R. R., Ribbeck B. M. The role of warmup in muscular injury prevention. Am J Sports Med. 1988 Mar-Apr;16(2):123–129. doi: 10.1177/036354658801600206. [DOI] [PubMed] [Google Scholar]
  37. Schwane J. A., Johnson S. R., Vandenakker C. B., Armstrong R. B. Delayed-onset muscular soreness and plasma CPK and LDH activities after downhill running. Med Sci Sports Exerc. 1983;15(1):51–56. [PubMed] [Google Scholar]
  38. Smith C. A. The warm-up procedure: to stretch or not to stretch. A brief review. J Orthop Sports Phys Ther. 1994 Jan;19(1):12–17. doi: 10.2519/jospt.1994.19.1.12. [DOI] [PubMed] [Google Scholar]
  39. Smith L. L. Acute inflammation: the underlying mechanism in delayed onset muscle soreness? Med Sci Sports Exerc. 1991 May;23(5):542–551. [PubMed] [Google Scholar]
  40. Stauber W. T., Clarkson P. M., Fritz V. K., Evans W. J. Extracellular matrix disruption and pain after eccentric muscle action. J Appl Physiol (1985) 1990 Sep;69(3):868–874. doi: 10.1152/jappl.1990.69.3.868. [DOI] [PubMed] [Google Scholar]
  41. Stauber W. T. Eccentric action of muscles: physiology, injury, and adaptation. Exerc Sport Sci Rev. 1989;17:157–185. [PubMed] [Google Scholar]
  42. Strickler T., Malone T., Garrett W. E. The effects of passive warming on muscle injury. Am J Sports Med. 1990 Mar-Apr;18(2):141–145. doi: 10.1177/036354659001800206. [DOI] [PubMed] [Google Scholar]
  43. Taylor D. C., Dalton J. D., Jr, Seaber A. V., Garrett W. E., Jr Experimental muscle strain injury. Early functional and structural deficits and the increased risk for reinjury. Am J Sports Med. 1993 Mar-Apr;21(2):190–194. doi: 10.1177/036354659302100205. [DOI] [PubMed] [Google Scholar]
  44. Taylor D. C., Dalton J. D., Jr, Seaber A. V., Garrett W. E., Jr Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. 1990 May-Jun;18(3):300–309. doi: 10.1177/036354659001800314. [DOI] [PubMed] [Google Scholar]
  45. Tiidus P. M., Ianuzzo C. D. Effects of intensity and duration of muscular exercise on delayed soreness and serum enzyme activities. Med Sci Sports Exerc. 1983;15(6):461–465. [PubMed] [Google Scholar]
  46. Wiktorsson-Möller M., Oberg B., Ekstrand J., Gillquist J. Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity. Am J Sports Med. 1983 Jul-Aug;11(4):249–252. doi: 10.1177/036354658301100412. [DOI] [PubMed] [Google Scholar]
  47. Yackzan L., Adams C., Francis K. T. The effects of ice massage on delayed muscle soreness. Am J Sports Med. 1984 Mar-Apr;12(2):159–165. doi: 10.1177/036354658401200214. [DOI] [PubMed] [Google Scholar]
  48. Zarins B., Ciullo J. V. ACute muscle and tendon injuries in athletes. Clin Sports Med. 1983 Mar;2(1):167–182. [PubMed] [Google Scholar]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association

RESOURCES