ABSTRACT

Background: Delayed Onset of Muscle Soreness (DOMS) is a frequent problem after

unaccustomed exercise. No universally accepted treatment exists for this. Warm-up and
cool down is often recommended for this condition but uncertainty exists about its
effectiveness. Methods: Does the subject benefits more from a 10 minute warm-up and
cool down which reduces effect of delayed onset of muscle soreness over a 3 days
following eccentric exercise? To determine the effect of warm-up and cool down on
DOMS physically active male and female subjects (n=45) in age group 17-25 were
included after they met inclusion criteria.
Participants were randomly to one group warm-up, cool-down, both and control. The
soreness and pain measured in all groups. Result: of this study suggest that the warm up
has very good result on DOMS as compare to cool down.
Key words:-Soreness, pain, range of motion, warm-up, cool-down.

INTRODUCTION
Following unaccustomed physical activity, a sensation of discomfort, predominantly
within the skeletal muscle, may be experienced in the elite or novice athlete. Symptoms
can range from muscle tenderness to severe debilitating pain. The intensity of discomfort
increases within the first 24 hours following cessation of exercise, peaks between 24 and
72 hours, subsides and eventually disappears by 57 days post-exercise. 1-5 This exerciseinduced phenomenon is referred to as delayed onset muscle soreness (DOMS) and is
perhaps one of the most common and recurrent forms of sports injury.6 The mechanisms,
treatment strategies, and impact on athletic performance remain uncertain, despite the
high incidence of DOMS.6 DOMS is most prevalent at the beginning of the sporting
season when athletes are returning to training following a period of reduced activity.
DOMS is also common when athletes are first introduced to certain types of activities
regardless of the time of year.6
DOMS is usually associated with unfamiliar, high-force muscular work and is
precipitated by eccentric actions.7 Eccentric activity is characterised by an elongation of
the muscle during simultaneous contraction. Thus, if the external load exceeds the
muscles ability to actively resist the load, the muscle is forced to lengthen and active
tension is generated.8 Cross bridges formed during eccentric actions must also be
separated with greater force due to the disruption of the actin-myosin bonds prior to
relaxation.8 As a result, greater tension per active motor unit is developed and there is an
increased risk of injury to the vulnerable myotendinous junction. 6 The intensity and
duration of exercise are also important factors in DOMS onset.6
DOMS is classified as a type I muscle strain injury9,10 and presents with tenderness or
stiffness to palpation and/or movement.9 Although the pathology associated with DOMS
is usually sub-clinical, the sensations experienced with this injury can vary from slight
muscle stiffness, which rapidly disappears during daily routine activities, to severe
debilitating pain which restricts movement.7

Tenderness is concentrated in the distal portion of the muscle 2,7,11-14 and becomes
progressively diffuse by 2448 hours post exercise.7 This localisation of pain can be
attributed to a high concentration of muscle pain receptors in the connective tissue of the
2

myotendinous region.15 The myotendinous junction is characterised by a membrane which

is continuous, extensively folded and interdigitated with the muscle cells. 13 The oblique
arrangement of the muscle fibres just prior to the myotendinous junction reduces their
ability to withstand high tensile forces.13,16,17 As a result, the contractile element of the
muscle fibres in the myotendinous junction is vulnerable to microscopic damage.6
A number of theories have been proposed to explain the pain stimulus associated with
DOMS including: lactic acid, muscle spasm, connective tissue damage, muscle damage,
inflammation, enzyme efflux theories and other proposed models.5,9 The general
consensus amongst researchers is that a single theory cannot explain the onset of DOMS. 6
As a result, some researchers have proposed unique sequences of events in order to
explain the DOMS phenomenon.2,18 These models integrate aspects from the above
theories and start with the assumption that high tensile forces, associated with eccentric
exercise, damage muscle tissue and connective tissue initially. This is followed by an
acute inflammatory response consisting of oedema formation and inflammatory cell
infiltration.6
DOMS can affect athletic performance by causing a reduction in joint range of motion,
shock attenuation and peak torque. Alterations in muscle sequencing and recruitment
patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments
and tendons.6 These compensatory mechanisms may increase the risk of further injury if a
premature return to sport is attempted.6
The proposed mechanisms of DOMS have allowed researchers to investigate various
treatment strategies aimed at alleviating the symptoms of DOMS, restoring the maximal
function of the muscles as rapidly as possible and/or reducing the magnitude of the initial
injury.9 Treatment strategies have been administered either prophylactically as a
preventative measure and/or therapeutically as a treatment measure. Treatment strategies
have included cryotherapy, stretching, anti-inflammatory drugs, ultrasound, electrical
current techniques, homeopathy, massage, compression, hyperbaric oxygen and exercise.6
Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that
may also be influenced by the time of administration. 6 Similarly, massage has shown
varying results that may be attributed to the time of massage application and the type of
massage technique used.6 Cryotherapy, stretching, homeopathy, ultrasound and electrical
current modalities have demonstrated no effect on the alleviation of muscle soreness or
3

other DOMS symptoms.6 Exercise is the most effective means of alleviating pain during
DOMS, however the analgesic effect is also temporary.6
Although some studies have reported that there was no reduction in the risk 19 of injury
or total injuries,20 other studies reported positive effects and a reduction in
musculotendinous injuries from warm-up and stretching intervention programmes.
Warm-up is intended to perform the following two major functions: (i) improve a
muscles dynamics so that it is less inclined to injury; and (ii) prepare the athlete for the
demands of exercise. A 1C rise in muscle temperature has been shown to increase the
length to failure of rabbit hind-limb muscles. 21 In general, the warm-up should produce a
mild sweat without fatiguing the individual.22
Warm-up can be either passive or active.23 Active warm-up can further be classified as
either a general warm-up or a specific warm-up. A passive warm-up is one in which
muscle temperature or core body temperature is increased by external means. This can
include, for example, hot showers, saunas or heating pads.10,23 The active warm-up
involves some type of physical activity. The general active warm-up involves any nonspecific body movements such as jogging, cycling or callisthenics.10,23,24 The specific
warm-up utilises activities and stretches that are specific to the sport for which one is
preparing10,24. The most effective of the warm-up techniques appears to be the specific
warm-up, possibly due to the fact that it mimics the activity to be performed.24,25
It has been hypothesised that warm-up provides many physiological benefits. For
example, it may lead to an increase in the speed and force of muscle contractions by
speeding up metabolic processes and reducing internal viscosity, which results in
smoother contractions. Also, an increase in temperature leads to the dissociation of
oxygen from haemoglobin at higher plasma oxygen concentrations, providing more
oxygen to working muscles. The speed of nerve transmission may also increase with the
increase in temperature, which may, in turn, increase contraction speed and reduce
reaction time. In addition, the temperature increases that accompany warm-up lead to
vasodilation, which produces an increased blood flow through active tissues. 10,24,26,27
Finally, in research involving rabbit muscles, it has been reported that a warm-up provides
a protective mechanism to muscle by requiring a greater length of stretch and force to
produce a tear in the warmed muscle.21 Although much of the aforementioned research
4

highlights the effects of warm-up, Magnusson et al. concluded that passive energy
absorption of skeletal muscle is not dependent on increases in intramuscular
temperature.28
Cool-down (gentle exercise after vigorous physical activity; also called warm-down) has
been recommended because it has been observed that cool-down aids in the removal of
lactic acid.29,30,31,32 The relevance of this observation is questionable, as delayed-onset
muscle soreness is now known not to be due to an accumulation of lactic acid. 33 It has
been proposed that the temporary alleviation of pain during exercise may be due to the
break up of adhesions in the sore muscles, an increased removal of noxious waste
products via an increased blood flow or an increased endorphin release during activity. 34
The latter results in an analgesic effect that minimises the sensation of DOMS. Elevated
afferent input from large, low threshold sensory units (groups Ia, Ib and II fibres) may
also interfere with the pain sensation carried by group III and IV fibres, thus reducing
pain.35 However, pain relief is also temporary and rapidly resumes again following
exercise cessation.36 Nonetheless cool-down is still performed routinely by many people
in the belief that it may reduce delayed-onset muscle soreness.37
As the existing studies of the effects of warm-up and cool-down on delayed-onset muscle
soreness are inconclusive, further studies are necessary.

NEED OF STUDY:
To get the effect of dynamic and static warm up and cool down exercises in reducing
delayed onset muscle soreness in different subjects is different and physiotherapy
intervention for the patients.

Hypothesis
The effect of dynamic and static warm up and cool down exercises in reducing delayed
onset muscle soreness in different subjects is the same.
Null Hypothesis
The effect of dynamic and static warm up and cool down exercises in reducing delayed
onset muscle soreness in different subjects is different

OPETRATIONAL DEFINATION:
DOMS: It is a frequent problems after unaccustomed exercise .
ROM: It is the range available at the join.
WARM UP: It is done before exercise for 5-10 min in order to increase blood flow and
prepared muscles for exercise.
COOL DOWN: It is done end of exercise for 5-10 min in order to remove waste
materials

REVIEW OF LEATRATURE
Law and Herbert conducted a randomized controlled trial to determine the effects of
warm-up and cool-down in reducing delayed-onset muscle soreness in fifty-two healthy
adults. The subjects were randomly assigned to either warm-up and cool-down, warm-up
only, cool-down only, or neither warm-up nor cool-down groups. All participants
9999999performed exercise to induce delayed-onset muscle soreness. Muscle soreness
was measured on a 100-mm visual analogue scale as the outcome measurement. Results
showed that warm-up reduced perceived muscle soreness 48 hours after exercise on the
visual analogue scale while cool-down had no apparent effect. They concluded that
warm-up performed immediately prior to unaccustomed eccentric exercise produces
small reductions in delayed-onset muscle soreness but cool-down performed after
exercise does not.37
High et al conducted a study to determine the effects of static stretching and/or warm-up
on the level of pain associated with DOMS in the quadriceps muscle of sixty-two healthy
male and female volunteers randomly assigned to either a static stretching group, a
stepping warm-up group, both static stretching and stepping warm-up group or a control
group. The step test required subjects to do concentric work with their right leg and
eccentric work with their left leg to voluntary exhaustion. Subjects rated their muscle
soreness on a ratio scale from zero to six at 24-hour intervals for 5 days following the step
test. Results showed a significant peak muscle soreness in the eccentrically worked leg
but no difference in peak muscle soreness among the groups doing the step test. They
concluded that static stretching and/or warm-up does not prevent DOMS resulting from
exhaustive exercise.38
Rodenburg et al conducted a randomized a controlled study to determine the effect of a
combination of a warm-up, stretching exercises and massage on delayed onset muscle
soreness (DOMS) in fifty people, randomly divided to a treatment and a control group.
The subjects performed eccentric exercise with the forearm flexors for 30 min. The
treatment group additionally performed a warm-up and underwent a stretching protocol
before the eccentric exercise and massage afterwards.
Functional and biochemical measures were obtained before, and 1, 24, 48, 72 and 96h
after exercise. Results showed that the five post-exercise time points differed significantly
7

for DOMS measured when the arm was extended. Significant main effects for treatment
were found on the maximal force, the flexion angle of the elbow and the creatine kinase
activity in blood. DOMS on pressure, extension angle and myoglobin concentration in
blood did not differ between the groups. They concluded that the combination of a warmup, stretching and massage reduces some negative effects of eccentric exercise, but the
results are inconsistent.39
Rahnama et al conducted randomized controlled study to examine the physiological
effects of physical activity with or without ibuprofen on delayed onset muscle soreness.
Forty-four non-athletic male volunteers were randomly assigned to one of four groups:
physical activity, ibuprofen, physical activity and ibuprofen, or control. The physical
activity programme comprised of walking and jogging, static stretching, and concentric
movements with sub-maximal contractions. Delayed onset muscle soreness was induced
by performing 70 eccentric contractions of the biceps muscle. Perceived muscle soreness,
maximal eccentric contraction, creatine kinase enzyme activity and elbow range of
motion were assessed 1 h before and 1, 24 and 48 h after the eccentric actions. The results
indicated that, after the eccentric actions, soreness and creatine kinase increased across
time in all groups and greater soreness was observed in the control group than in the
physical activity and combination groups. There was also a reduction in elbow range of
motion and maximum eccentric contraction cross time and it was greater in the control
and ibuprofen groups than in the physical activity and combination groups. They
concluded that physical activity with or without ibuprofen helps to prevent delayed-onset
muscle soreness.40
Safran et al conducted a controlled study in an attempt to provide biomechanical support
for the athletic practice of warming up prior to an exercise task to reduce the incidence of
injury. Tears in isometrically preconditioned rabbit muscles were compared to tears in
control muscle by examining force, change of length required to tear the muscle, site of
failure, and length-tension deformation. Results showed that isometrically preconditioned
muscles required more force to fail than their contralateral controls. Preconditioned
muscles also stretched to a greater length from rest before failing than their
nonpreconditioned controls. The site of failure in all of the muscles was the
musculotendinous junction; thus, the site of failure was not altered by condition. The
length-tension deformation curves for muscles showed that in every case the
preconditioned muscles attained a lesser force at each given increase in length before
8

failure, showing a relative increase in elasticity. They concluded that physiologic

warming (isometric preconditioning) is of benefit in preventing muscular injury by
increasing the length to failure and elasticity of the muscle-tendon unit.21
Timothy et al in a study investigated the effects of passive warming on the biomechanical
properties of the musculotendinous unit by passively heating the rabbit hindlimb to
different temperatures and then subjected to controlled strain injury. They measured the
percent increase in length to failure, force to failure, energy absorbed by the
musculotendinous unit to failure, and site of failure. Warmed (39C) muscles achieved a
greater increase in length from rest before failing than did their contralateral controls at
35C. The force at failure was greater at 35C than at 39C. The energy absorbed was
greater at 39C, but these differences were not significant. All muscles failed at the distal
musculotendinous junction. They concluded that passive warming increases the
extensibility of the musculotendinous unit and may thereby reduce its susceptibility to
strain in jury.41
Bixler and Jones conducted a study to investigate the effects of a post-halftime warm-up
and stretching routine on the portion of injuries which occur during the third quarter of a
game in high-school football players. Intervention-group teams participated in a
prescribed three-minute warm-up and stretching routine following the halftime break. The
control group received no warm-up and stretching intervention. Results showed that in
the nonintervention group, injuries occurred most often in the third quarter. Intervention
teams sustained significantly fewer third-quarter sprains and strains per game, although
no significant difference in total third-quarter injuries was noted. They suggested that
there is an association between post-halftime warm-up and stretching and reduced thirdquarter sprain and strain injuries.20

Byrnes et al assessed pre- and 6, 18, and 42 h postexercise perceived muscle soreness
ratings, serum creatine kinase (CK) activity, and myoglobin levels in three groups of
subjects following two 30-min exercise bouts of downhill running separated by 3, 6, and 9
wk for groups 1, 2, and 3, respectively. On bout 1 the three groups reported maximal
soreness at 42 h postexercise, and relative increases in CK and myoglobin. When the
same exercise was repeated, significantly less soreness was reported and smaller increases
9

in CK and myoglobin were found for groups 1 and 2. Group 3 demonstrated no significant
difference in soreness ratings, CK activities, or myoglobin levels between bouts 1 and 2.
They concluded that performance of a single exercise bout had a prophylactic effect on
the generation of muscle soreness and serum protein responses that lasts up to 6 wk. 42
Weber conducted a study to test the impact of therapeutic massage, upper body
ergometry, or microcurrent electrical stimulation applied immediately following exercise
and again at 24 hours after exercise on muscle soreness and force deficits following a
high-intensity eccentric exercise bout in forty untrained, volunteer female subjects
randomly assigned to one of three treatment groups or to a control group. Soreness rating
was determined using a visual analog scale. Force deficits were determined by measures
of maximal voluntary isometric contraction on a isokinetic dynamometer. Maximal
voluntary isometric contraction and peak torque were determined at the before exercise
and again at 24 and 48 hours postexercise. Results showed significant increase in soreness
rating and significant decreases in force generated at 0 hour compared to 24- and 48-hour
measures and no statistically significant differences between all the groups.43
Gulick DT conducted a randomized controlled study to identify the effects of nonsteroidal
anti-inflammatory drug, high velocity concentric muscle contractions on an upper
extremity ergometer, ice massage, 10-minute static stretching, topical Amica montana
ointment, and sublingual A. montana pellets in the recovery of DOMS in 70 untrained
volunteers for a minimum of 9 weeks. Data were collected on active and passive range,
girth, limb volume, visual analogue pain scale, muscle soreness index, isometric strength,
concentric and eccentric total work, concentric and eccentric angle of peak torque preand post-induced DOMS, 20 minutes after treatment, and 24, 48, and 72 hours after
treatment. Significant main effects were found for all of the dependent variables on time
only and there were no significant differences between treatments. They concluded that
none of the treatments were effective in abating the signs and symptoms of DOMS.44
Saxton and Donnelly conducted a study to find out the effects of light concentric exercise
during recovery from exercise-induced muscle damage in eight subjects following two
eccentric exercise bouts separated by a period of three weeks. In one group, five sets of
10 sub-maximal concentric muscle actions were performed on the four days after the
eccentric bout while control group rested. Results showed an increase in serum creatine
kinase activity and decreases in joint angle and maximum voluntary contraction force
after both eccentric bouts. However, the serum creatine kinase response to eccentric
10

exercise was reduced in the experimental condition and recovery of maximum voluntary
force production at the most acute joint angle was accelerated. Although muscle soreness
increased after both eccentric bouts, further concentric exercise evoked temporary relief
of muscle soreness two days after the bout. However, light concentric work had no effect
on the other parameters monitored. They concluded that the therapeutic effects of light
concentric work on correlates of exercise-induced muscle damage are minimal.45
Zainuddin et al conducted a study to investigate the effect of light concentric exercise
(LCE) in delayed-onset muscle soreness (DOMS) in fourteen subjects who performed
two bouts of 60 maximal eccentric actions (Max-ECC) separated by 2-4 weeks. One arm
performed LCE 1, 2, 3, and 4 day after Max-ECC; the contralateral (control) arm
performed only Max-ECC. Changes in maximal strength, range of motion (ROM), upper
arm circumference, and muscle soreness and tenderness were assessed before and
immediately after LCE bouts. Significant decreases in muscle soreness and tenderness
were evident immediately after LCE, which also resulted in small but significant
decreases in strength and increases in ROM. They suggest that LCE has a temporary
analgesic effect on DOMS, but no effect on recovery from muscle damage.46
Donnelly et al studied the effects of light eccentric exercise (LB) during the period of
recovery from a heavy eccentric exercise bout (HB). An experimental and a control
group, performed two HB- HB1 and HB2- 14 days apart. The experimental group
performed an additional LB on the day following the first HB. HB1 resulted in muscle
soreness, muscle weakness, changes in elbow joint flexibility, and large delayed increases
in serum creatine kinase (CK) activity. The HB2 produced smaller changes in all
parameters, indicating that adaptation to the effects of eccentric exercise had occurred in
the muscle. They concluded that LB did not alter muscle soreness, strength or elbow
flexibility, but did reduce or delay CK activity increase after HB1 and had no apparent
effect on adaptation to HB2.47
Scrimshaw and Maher conducted a randomized controlled trial to compare the
responsiveness of the McGill Pain Questionnaire with the Visual Analogue Scale (VAS).
A repeated measures 2-group design was used, with seventy-five patients with low back
pain divided into "improved" and "non-improved" groups. The external criterion to
identify improved and non-improved patients was a 7-point global perceived effect scale.
All patients completed both a VAS and McGill pain scale to describe their pain over the
last 24 hours and a separate VAS to describe their current pain. Results showed that the
11

VAS was less responsive to clinical change when used to rate current pain in comparison
with pain over the last 24 hours. The study found that the VAS was more responsive than
the McGill Pain Questionnaire when both instruments were used to rate pain over the last
24 hours. They concluded that the VAS may be a better tool than the McGill Pain
Questionnaire for measuring pain in clinical trials and clinical practice.48

12

MATERIALS AND METHODS

3.1 Source of data
Data will be collected from the student population of College of Applied Education and
Health Science, Physiotherapy, Meerut, after obtaining informed consent.
3.2 Method of collection of data
Research Design
Single factor experimental design will be used for this study.
Sampling method
Random sampling method
Tools used
1. Treadmill
2. Measurement Tool
3. Assessment form
4. Questionnaire

13

METHODOLOGY
45 young and healthy adults within the age group of 17-25 years and answered No to all
questions on the Physical Activity Readiness Questionnaire49 will be recruited.
Physical Activity Readiness Questionnaire

Yes
No
Physical Activity Readiness Questionnaire

Has your doctor ever said that you have a heart condition and that you should only do
physical activity recommended by a doctor?

Do

you feel pain in your chest when you do physical activity?

In
the past month, have you had chest pain when you were not doing physical
activity?

Do

you lose your balance because of dizziness or do you ever lose consciousness?

Do
you have a bone or joint problem that could be made worse by a change in your
physical activity?

Is
your doctor currently prescribing drugs (for example, water pills) for your blood
pressure or heart condition?

14

Do you know of any other reason why you should not do physical activity?

After obtaining informed consent, and screening for the following inclusion and exclusion
criteria the subjects will be assigned randomly to one of three groups.
Inclusion Criteria
1. Non-athletes
2. Aged 17-25 years of both gender
Exclusion criteria
1. Active or chronic lung disease
2. Cardiac insufficiency and disorders
3. Neuromuscular disorders
4. Musculoskeletal problems

Study design
Each participant will be allocated to one of two groups: a static warm-up and cool down
exercise group (Group I), a dynamic cool-down group (Group II).
Group 1: This group will consist of 15 subjects (N=15) of both gender and they will do
static warm up and cool down exercise before undertaking eccentric exercises of
gastrocnemius muscle.
Group 2: This group will consist of 15 subjects (N=15) of both gender and they will do
dynamic warm up and cool down exercise before undertaking eccentric exercises of
gastrocnemius muscle.
Interventions

15

Initially, all participants will rest in a seated position for 10 minutes. Subsequently,
participants will perform the 10-minute dynamic or static warm-up. Then all participants
performed 30 minutes of eccentric exercise to induce muscle soreness. Then participants
will perform 10 minutes static or dynamic cool down.
Muscle soreness was induced using unaccustomed eccentric exercise. The exercise was
designed to induce muscle soreness in the gastrocnemius muscle of the right leg and
involved walking backwards downhill on a treadmill inclined at 13 degrees, for 30
minutes at 35 steps per minute, leading with the right leg. Participants were instructed to
take large backward steps with the right leg and to strike the treadmill with the toe of the
right foot and with the right knee extended. This protocol induces muscle soreness in
most people.50,51
Outcome measurement
Muscle soreness in the gastrocnemius muscle of the right leg was assessed 10 minutes
after the exercise, and then at 24-hour intervals over the three days following the exercise.
Soreness was rated on two scales: a 100-mm visual analogue scale anchored at no pain
and most severe pain, and a 10-point numerical rating scale anchored at no pain and
most severe pain. Tenderness was measured 10 minutes and 48 hours after exercise by
applying a force to the calf over the belly of the most tender part of the gastrocnemius
muscle with progressively increasing force.52,53 Participants will be asked to report when
they first feel discomfort. Low forces are associated with high levels of tenderness.
3.3 Statistical Analysis
The data collected will be analyzed using non-parametric tests as the data are ordinal in
nature. The intra group pre and post-test data will be analyzed using Wilcoxon sign rank
test, while the post-test inter group data will be analyzed with Mannwhitney U test.
3.4 The study requires non-invasive investigations and interventions to be conducted on
patients. The investigations to be conducted include general physical examination like
inspection, palpation, measurement of JROM, and MMT, and measurement of vital signs.
Treatment interventions include treadmill walking.

16

RESULTS
A group of 45 subjects were recruited for the study. Each subject completed the
measurements of soreness, pain, Dorsi flexion, planter flexion range of motion in warm
up, cool down, both warm up and cool down and control group. There were no missed
measurements in either group. Soreness measurements were measured by treadmill, pain
by Vas scale, range of motion by universal goniometer.
The soreness, pain, range of motion were compared between groups by using post Hoc
test and Mauchlys test used to compare values with in groups.
Within Group Analysis:
Soreness in Warm up group
The analyses revealed that the soreness compared with in warm up group at different time
intervals S0, S10, S24, S48 and S72 were statistically insignificant (P value >.005).

17

Graph 5.1 within group analysis of soreness in warm up group.

18

Soreness in cool down group

The analyses revealed that the some soreness values compared with in cool down group at
different time intervals S0, S10, S24, S48 and S72 were stastically insignificant (P value
>.005). Comparison of S0-S48, p value 0.01(P value<0.05) and S10-S48, p value 0.01(P
value<0.05) were statically significant.

Graph 5.2 within group analysis of soreness in cool down.

Within group analysis
In this present study soreness values at different time intervals S0, S10, S24, 48,
S72 in warm up and warm up and cool down group were statistically insignificant.(P
value>0.05). But in cool down group when soreness compared at S0-S48 and S10- S48
were statistically significant. (P value < 0.05). In control group comparison of soreness
were statistically significant. (P value < 0.05).
The analysis confirms the induction of DOMS in the selected muscle group. The
increased discomfort, decreased ROM of DF indicates that DOMS was successfully
induced. Eccentric exercise successfully produced the symptoms of delayed onset muscle
soreness. One of the possible causes the muscle damage may be due to disruption of the
z-band. Clarkson and Sayers in 1999 in their study stated that during the eccentric muscle
contractions there are fewer motor units, thus fewer muscle fibres, activated. This may
lead to an increase in tension taken through the cross bridges of the muscle fibre resulting
in disruption of the z-band causing streaming. Another previous study by Clarkson and
Kazunori37 reveals that soreness appears 24 hours after exercise and peaks at 2-3 days of

19

post exercise. Soreness slowly dissipates and does not fully subside until 8-10 days of
exercise. The probable reason could be this of my result.
In this present study pain values at different time intervals P0-24, P0-P48, P10P24,P24- P48,P24-P72 and P48-P72 in warm up, cool down, warm up and cool down and
control group were statistically significant.(P value<0.05).
Previous study by Newham30 stated that when subjects perform eccentric exercise
they are aware of muscle fatigue but are completely pain free for approximately 8h. The
first discomfort is usually a feeling on movement which increases over the following one
or two days. The affected muscle often feel swollen, are tender to palpation and, in severe
cases there may be an arching, pain at rest. All discomfort has usually disappeared by four
or five days. Our study results having significant difference only after 10min reading
because pain present at least after 8 hour.
Between group analysis

The analyses revealed that the soreness values compared with in warm up, cool down,
warm up and cool down and control group at different time intervals P0, P10, P24, P48
and P72 were statistically insignificant (P value >.005). Comparison of P24, P48 and P72
p value .01(P value<0.05) was statistically significant.
Comparison of pain between groups
In this present study pain compared in warm up, cool down, warm up and cool down and
control group, there were a significant difference between groups. As we compare warm
up group with cool down, both and control group, pain statically less significantly
produced in warm group that was most apparent at 24, 48 and 72 hours.

20

Graph 5.22 between group analysis of pain in all groups

Limitations
1. Due to lack of funds study cannot carried on large number of populations.
2. Blinding was not done during study.
3. Large sample size would have brought in more clarity in observed trends.
Suggestions
1. Generalized of results can be increased by compare with female subjects.
2. Study can be carried on a large sample size for better credibility of results.

21

CONCLUSION
To conclude our study that there is a strong significant difference between soreness, pain,
range of motion at all time intervals. The results of study have important implication of
using a warm up procedure to reduce pain and soreness. In conclusion, warm-up
performed immediately prior to unaccustomed eccentric exercise produces small
reductions in delayed-onset muscle soreness, but cool-down performed after intense
exercise does not. It opens up a board area for further studies.

22

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Consent from patient

I ........................................voluntary consent to participate in study. A

COMPARATIVE STUDY BETWEEN
THE EFFICACY OF DYNAMIC AND STATIC WARM UP AND COOL DOWN
EXERCISE IN PREVENTING
DELAYED ONSET MUSCLE SORENESS

The reasher has explained me the diagnostic and treatment approach in detail
along with the risk of
participation and answered all my question releated to research to my
satisfaction.

28

............................
Signature of participant
Residential address
Phone no
Date

29

ASSESSMENT

Demographic details-

Date-

Name:
Age:
Sex:
Occupation:
Address:
Dominance:
Chief complaint
History
Present history:
Past history:
Personal history:
Occupational history:
Family history:
Social history:
Pain history
Nature;
Onset:
Aggravating factor;
Relieving factor:
Intensity:

30

VAS SCALE

No pain

10

Mild pain

Worst pain

On observation
Built:
Posture:
Redness:
Swelling:
Skin color:
Deformity:
Gait:

On examination
Warmth:
Tenderness:
Edema:
Bony alignment:

On examination
1.

2.
3.
4.
5.
6.

Movement examination (range of motion )a. Flexion :

b. Extension :
c. Side flexion :
d. Rotation :
Accessory movement examination
Dermatomes
Myotomes
Deep tendon reflex
MMT

31

Special test

Posture examination
Muscle flexibility assessment
Provisional diagnosis
Investigation
X ray:
C.T scan:
MRI:
Diagnosis
Aim of treatment
Plan of treatment
Prognosis
Follow up

32