Shin pain in athletes.

BACKGROUND: Both serious athletes and patients attempting to maintain or improve their health through exercise are at risk of a number of conditions that are not frequently mentioned during medical training. Most of these are related to overuse. OBJECTIVE: The aim of this article is to improve general practitioners' knowledge of a specific group of exercise-related conditions that occur in the anterior aspect of the lower limb below the knee, commonly referred to as the shin region. DISCUSSION: Many having been previously grouped under the relatively meaningless term 'shin splints', these conditions include, among others, bone stress reactions and fractures and chronic exertional compartment syndromes. Some resolve with rest and a gradual return to activity, whereas others are difficult to treat conservatively and might benefit from early referral.

Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT).

BACKGROUND AND AIMS: High quality clinical research that addresses important questions requires significant resources. In resource-constrained environments, projects will therefore need to be prioritized. The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network aimed to develop a stakeholder-based, transparent, easily implementable tool that provides a score for the 'importance' of a research question which could be used to rank research projects in order of importance. METHODS: Using a mixed-methods, multi-stage approach that included a Delphi survey, consensus workshop, inter-rater reliability testing, validity testing and calibration using a discrete-choice methodology, the Research Question Importance Tool (ANZMUSC-RQIT) was developed. The tool incorporated broad stakeholder opinion, including consumers, at each stage and is designed for scoring by committee consensus. RESULTS: The ANZMUSC-RQIT tool consists of 5 dimensions (compared to 6 dimensions for an earlier version of RQIT): (1) extent of stakeholder consensus, (2) social burden of health condition, (3) patient burden of health condition, (4) anticipated effectiveness of proposed intervention, and (5) extent to which health equity is addressed by the research. Each dimension is assessed by defining ordered levels of a relevant attribute and by assigning a score to each level. The scores for the dimensions are then summed to obtain an overall ANZMUSC-RQIT score, which represents the importance of the research question. The result is a score on an interval scale with an arbitrary unit, ranging from 0 (minimal importance) to 1000. The ANZMUSC-RQIT dimensions can be reliably ordered by committee consensus (ICC 0.73-0.93) and the overall score is positively associated with citation count (standardised regression coefficient 0.33, p<0.001) and journal impact factor group (OR 6.78, 95% CI 3.17 to 14.50 for 3rd tertile compared to 1st tertile of ANZMUSC-RQIT scores) for 200 published musculoskeletal clinical trials. CONCLUSION: We propose that the ANZMUSC-RQIT is a useful tool for prioritising the importance of a research question.

What Constitutes "Appropriate Care" for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project).

STUDY DESIGN: Multiround wiki-based Delphi expert panel survey. OBJECTIVE: To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The provision of inappropri ate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recom mendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care." METHODS: Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators. RESULTS: From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators compris ing screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided. CONCLUSION: These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/ funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.

The role of exercise in management of rheumatological disease.

BACKGROUND: Exercise was once viewed as having a deleterious effect on joint pain and function in those with rheumatic diseases. Positive evidence, both related to exercises at specific joints and for exercise in the management of comorbidities and for general illness prevention, is now well established. OBJECTIVE: The aim of this article is to provide an update on the role of therapeutic exercise at individual joints and the utility of general exercise programs in the management of comorbidities and prevention of chronic disease in those with rheumatic disease. DISCUSSION: Major international rheumatology bodies now recommend multiple forms of exercise as part of the non-pharmacological management of both osteoarthritis and the more classically inflammatory rheumatic disorders.

Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy.

Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.

Exercise in the time of COVID-19.

The COVID-19 pandemic has restricted the physical activity of the population, but maintaining exercise could reduce the risk of contracting the infection itself and mitigate the effects of quarantine.

A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency.

BACKGROUND: Health educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM). Clinical Practice Guidelines (CPGs) are tools for translating evidence into clinical practice for health professionals and educators who lack time to appraise the evidence. There have been CPGs published for lateral ankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Clinical decision rules have also been developed for LALS to increase the safety of practice. The Ottawa Ankle Rules (OAR) were developed to screen for the need for an x-ray following an ankle or foot injury. METHODS: Educators from the Australasian College of Sports and Exercise Physicians (ACSEP), St John Ambulance first aiders, pharmacy, nursing, and physiotherapy disciplines were participants in this study. Using purposeful sampling with semi-structured questions and a LALS case study, 19 Australian educators were interviewed. Curricula and textbooks were also collected and analysed. Two researchers independently analysed the data using a deductive method. RESULTS: Analysis found that no educator used a CPG to inform their teaching. There was no common LALS curriculum for the five groups studied. There were two approaches: a triage curriculum (St John Ambulance, pharmacy, nursing) and a reflective curriculum (ASCEP and physiotherapy). Textbooks influenced curriculum for physiotherapy, pharmacy and first aid educators. The triage curricula recommend rest, ice, compression and elevation (RICE) alone, while the reflective curricula uses OAR, RICE, immobilisation if the LALS is severe, functional support (brace), exercises and manual therapy. In addition, ACSEP and physiotherapy do not recommend electrotherapy. All five groups were cautious about the use of non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Physiotherapy and ACSEP educators teach OAR. Despite not using the CPGs to inform curriculum, physiotherapy and ACSEP have unintentionally aligned their curriculum with current LALS CPG recommendations. However, nursing, pharmacy and first aid trainers are not teaching OAR or aligned with LALS CPGs. Educators in pharmacy, nursing and first aid should re-examine their curricula and consider possibly teaching OAR and using CPG. Clinical practice guideline developers should consider pharmacists and first aiders as users of their LALS CPGs.

Overuse injuries in the athlete.

BACKGROUND: Most general practices will have patients who have more than a passing interest in fitness and exercise. These range from the elite athlete to the recreational enthusiast. These patients are highly motivated, but treating them can be challenging. OBJECTIVE: The aims of this article are to increase awareness of the management of a number of overuse injuries frequently seen in athletes, to assist in understanding the mindset of the athlete in relation to his or her injuries and to indicate the importance of a confident approach to these problems and a multidisciplinary management plan in facilitating a successful outcome. DISCUSSION: Athletes generally have dynamic personalities and high standards for themselves and others. Complete rest can be anathema to them. Fortunately, in cases of tendinopathy, a structured exercise program is an important component of management. A proactive approach, often with the assistance of a physiotherapist, is likely to improve outcomes.

What factors contribute to uncontrolled gout and hospital admission? A qualitative study of inpatients and their primary care practitioners.

OBJECTIVE: To provide deeper insight into why patients are admitted to hospital with gout and discover potential targets for better disease control. DESIGN: Data from semi-structured interviews were analysed using a thematic analysis approach. PARTICIPANTS AND SETTING: Eleven inpatients from a tertiary institution in the Australian Capital Territory of Australia and their respective general practitioners (GPs) were invited to participate in the semi-structured interviews. RESULTS: Despite significant pain and disability that accompanied acute flares, patients continue to experience shame in seeking treatment and regarded gout as being not particularly important. Other barriers included patients' poor continuity of care with and lack of confidence in GPs, suboptimal management in outpatient and inpatient settings, poor understanding of disease and treatment, and misconceptions held by both patients and physicians leading to uncontrolled disease activity. CONCLUSIONS: Barriers to optimal gout management including patient and health practitioner factors have produced a complex effect which has led to a cycle of treatment avoidance behaviours and recurrent hospitalisations for severe acute gout flares. These barriers could be addressed using a multipronged approach guided by the chronic care model which has been applied in a variety of other chronic diseases with improved patient and professional-level outcomes. Managing gout according to best practice for chronic disease is more likely to prevent recurrent hospitalisations and improve health outcomes in patients with gout.

What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review.

BACKGROUND: Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults. METHODS: Several medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers. RESULTS: This study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence. CONCLUSIONS: The overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation. SYSTEMATIC REVIEW: Systematic review registered with PROSPERO ( CRD42015025478 ).

Epidemiology of bone stress injuries in Australian high performance athletes: A retrospective cohort study.

OBJECTIVES: To examine the epidemiology of bone stress injuries in an elite sports institute. DESIGN: Retrospective cohort study at the Australian Institute of Sport. METHODS: A retrospective analysis of the clinical records contained within the Australian Institute of Sport Athlete Management System electronic database was performed. Records with Orchard Sports Injury Classification System codes relating to bone stress injuries and stress fractures were reviewed and descriptive statistics relating to sport, site of injury, athlete age, sex and activity were analysed. RESULTS: In the three-year period January 2014-2017, 11,942 injuries were recorded across 48 sports. 181 bone stress injuries (0.15% of all injuries) were recorded across 16 sports. BSIs in the foot and lumbar spine were the most common accounting for 30% and 23% of all the reported BSIs respectively. Gymnasts had a high frequency of lumbar spine stress injuries (n=24, 51%) and rowers had a high frequency of rib stress injuries (n=22, 88%). The most common location for stress injuries, equally distributed across a variety of sports, were in the foot (n=54, 30%). Female athletes recorded more BSIs than males. CONCLUSION: Across a three-year period, 0.15% of injuries were related to bone stress injuries. Almost double the cases were recorded in female athletes. Sport specific injury sites were observed in the dataset.

Patients' Attitudes and Experiences of Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis and Spondyloarthritis: A Qualitative Synthesis.

OBJECTIVE: Nonadherence to disease-modifying antirheumatic drugs (DMARDS) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) results in increased disease activity and symptoms and poorer quality of life. We aimed to describe patients' attitudes and experiences of DMARDs in RA and SpA to inform strategies to improve medication adherence. METHODS: Databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched to January 2016. Thematic synthesis was used to analyze the findings. RESULTS: From 56 studies involving 1,383 adult patients (RA [n = 1,149], SpA [n = 191], not specified [n = 43]), we identified 6 themes (with subthemes): intensifying disease identity (severity of sudden pharmacotherapy, signifying deteriorating health, daunting lifelong therapy), distressing uncertainties and consequences (poisoning the body, doubting efficacy, conflicting and confusing advice, prognostic uncertainty with changing treatment regimens), powerful social influences (swayed by others' experiences, partnering with physicians, maintaining roles, confidence in comprehensive and ongoing care, valuing peer support), privilege and right of access to biologic agents (expensive medications must be better, right to receive a biologic agent, fearing dispossession), maintaining control (complete ownership of decision, taking extreme risks, minimizing lifestyle intrusion), and negotiating treatment expectations (miraculous recovery, mediocre benefit, reaching the end of the line). CONCLUSION: Patients perceive DMARDs as strong medications with alarming side effects that intensify their disease identity. Trust and confidence in medical care, positive experiences with DMARDS among other patients, and an expectation that medications will help maintain participation in life can motivate patients to use DMARDs. Creating a supportive environment for patients to voice their concerns may improve treatment satisfaction, adherence, and health outcomes.

Comparison of frequency of significant electrocardiographic abnormalities in endurance versus nonendurance athletes.

Most data assessing the accuracy of electrocardiographic (ECG) screening in identifying cardiac pathology in athletes are derived from relatively unselected cohorts of subjects involved in competitive sports. We hypothesized that the prevalence of ECG abnormalities may be greater in athletes performing the greatest combination of exercise intensity and duration, namely professional endurance athletes. A total of 1,007 male and 254 female elite adult athletes underwent cardiovascular screening inclusive of an electrocardiogram, interpreted using the 2010 European Society of Cardiology guidelines. Training-related ECG changes (group 1) were more common in endurance athletes (EAs) than nonendurance athletes (NEAs; 90.8% vs 86.0%, p = 0.04), as were multiple (≥2) training-related changes (78.9% vs 53.5%, p <0.0001). Group 2 ECG changes (previously considered uncommon and training unrelated) were seen in 18.1% of subjects and were twice as prevalent in EAs compared with NEAs (29.9% vs 15.1%, p <0.0001). Right ventricular hypertrophy (4.4% EAs vs 1.5% NEAs, p <0.005) and deep right precordial T-wave inversion (14.3% EAs vs 4.7% NEAs, p <0.0001) were 3 times as common in EAs. Both group 1 and group 2 changes were similarly prevalent among elite male and female athletes and were more common in EAs regardless of gender. In conclusion, ECG abnormalities are very common in elite athletes and are more common in EAs than NEAs. Right ventricular hypertrophy and deep right precordial T-wave inversion are particularly common in EAs, possibly because of increased structural and/or electrical right ventricular remodeling in this subgroup. The predictive value of ECG screening and criteria for abnormal findings in elite EAs requires specific appraisal.

Sports Dietitians Australia position statement: sports nutrition for the adolescent athlete.

It is the position of Sports Dietitians Australia (SDA) that adolescent athletes have unique nutritional requirements as a consequence of undertaking daily training and competition in addition to the demands of growth and development. As such, SDA established an expert multidisciplinary panel to undertake an independent review of the relevant scientific evidence and consulted with its professional members to develop sports nutrition recommendations for active and competitive adolescent athletes. The position of SDA is that dietary education and recommendations for these adolescent athletes should reinforce eating for long term health. More specifically, the adolescent athlete should be encouraged to moderate eating patterns to reflect daily exercise demands and provide a regular spread of high quality carbohydrate and protein sources over the day, especially in the period immediately after training. SDA recommends that consideration also be given to the dietary calcium, Vitamin D and iron intake of adolescent athletes due to the elevated risk of deficiency of these nutrients. To maintain optimal hydration, adolescent athletes should have access to fluids that are clean, cool and supplied in sufficient quantities before, during and after participation in sport. Finally, it is the position of SDA that nutrient needs should be met by core foods rather than supplements, as the recommendation of dietary supplements to developing athletes over-emphasizes their ability to manipulate performance in comparison with other training and dietary strategies.

The effects of topical Arnica on performance, pain and muscle damage after intense eccentric exercise.

The aim of the study was to determine if topical Arnica is effective in reducing pain, indicators of inflammation and muscle damage, and in turn improve performance in well-trained males experiencing delayed onset muscle soreness (DOMS). Twenty well-trained males matched by maximal oxygen uptake (V̇O2 Max) completed a double-blind, randomised placebo-controlled trial. Topical Arnica was applied to the skin superficial to the quadriceps and gastrocnemius muscles immediately after a downhill running protocol designed to induce DOMS. Topical Arnica was reapplied every 4 waking hours for the duration of the study. Performance measures (peak torque, countermovement and squat jump), pain assessments (visual analogue scale (VAS) and muscle tenderness) and blood analysis (interleukin-1 beta, interleukin-6, tumour necrosis factor-alpha, C-reactive protein, myoglobin and creatine kinase) were assessed at seven time points over five days (pre-, post-, 4, 24, 48, 72 and 96 hours after the downhill run). Participants in the topical Arnica group reported less pain as assessed through muscle tenderness and VAS 72 hours post-exercise. The application of topical Arnica did not affect any performance assessments or markers of muscle damage or inflammation. Topical Arnica used immediately after intense eccentric exercise and for the following 96 hours did not have an effect on performance or blood markers. It did however demonstrate the possibility of providing pain relief three days post-eccentric exercise.

The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes.

BACKGROUND: In 2010, the European Society of Cardiology (ESC) released recommendations for the interpretation of the 12-lead ECG in athletes, dividing changes into group 1 (training related) and group 2 (training unrelated). Recently, the 'Seattle Criteria', a series of revisions to these recommendations, was published, with the aim of improving the specificity of ECG screening in athletes. OBJECTIVES: First, to assess the prevalence of ECG abnormalities in a cohort of elite Australian athletes using the 2010 ESC recommendations and determine how often group 2 ECG changes correlate with the evidence of significant cardiac pathology on further investigation. Second, to assess the impact of the 'Seattle Criteria' in reducing the number of athletes with ECG abnormalities in whom further cardiac testing is unremarkable ('false positives'). DESIGN: 1197 elite athletes underwent cardiovascular screening between 2011 and 2012, of whom 1078 aged 16-35 years volunteered and were eligible to participate. RESULTS: 186 (17.3%) had an abnormal ECG according to ESC recommendations and a further 30 (2.8)% had unclassified changes. Three athletes (0.3%) were found to have a cardiac abnormality on further investigation. Using the Seattle Criteria, the number of athletes classified as abnormal fell to 48 (4.5%, p<0.0001) and the three with an underlying cardiac abnormality were still identified. The improved specificity was due to reclassification of 71 athletes (6.6%) with an equivocal QTc interval, 42 (3.9%) with T wave inversion isolated to V1-2 and 22 (2%) with either isolated right axis deviation or right ventricular hypertrophy on voltage criteria. CONCLUSIONS: The 'Seattle Criteria' reduced the false-positive rate of ECG screening from 17% to 4.2%, while still identifying the 0.3% of athletes with a cardiac abnormality.

Intravenous iron supplementation in distance runners with low or suboptimal ferritin.

PURPOSE: Iron deficiency is prevalent in distance runners and may impair endurance performance. The current practice of oral supplementation is slow and often not well tolerated. The aim of this study was to assess the efficacy of intravenous (IV) iron supplementation (ferric carboxymaltose) compared with oral supplementation (ferrous sulfate) on iron status, hemoglobin mass (Hbmass), and physiological indices of running performance in distance runners. METHODS: Twenty-seven highly trained distance runners with low (LOW) (ferritin <35 µg·L(-1) and transferrin saturation <20%, or ferritin <15 µg·L(-1)) or suboptimal (SUB) iron status (ferritin <65 µg·L(-1)) were supplemented with either IV iron (Ferinject®) or oral (ORAL) supplements (Ferrogradumet) for 6 wk. Iron status and Hbmass were assessed before supplementation and at 1, 2, 4, 6, and 8 wk in the four groups (IV LOW, IV SUB, ORAL LOW, and ORAL SUB). In addition, athletes completed a treadmill running test for running economy, lactate threshold, and V˙O2max before and after supplementation. RESULTS: Both forms of supplementation substantially increased ferritin levels in all four groups. IV supplementation resulted in higher ferritin in both IV groups compared with both ORAL groups from week 1 onward. Hemoglobin concentration did not change substantially in any group. Hbmass increased in IV LOW (mean = +4.9%, 90% confidence interval [CI] = 1.1%-8.9%) and was accompanied by an increase in V˙O2max (mean = +3.3%, 90% CI = 0.4%-6.3%) and run time to exhaustion (mean = +9.3%, 90% CI = 0.9%-18.3%. CONCLUSIONS: IV supplementation can effectively increase iron stores in iron-deficient runners within 6 wk and, if Hbmass is compromised, may enhance endurance capacity by facilitating erythropoiesis. Hbmass appears a more sensitive tool for measuring changes in whole body hemoglobin than hemoglobin concentration and may be useful in the diagnosis and follow-up for iron deficiency.

The effects of Panax notoginseng on delayed onset muscle soreness and muscle damage in well-trained males: a double blind randomised controlled trial.

OBJECTIVES: The aim of the study was to determine if Panax notoginseng is effective in reducing pain, indicators of inflammation and muscle damage, and in turn improve performance in well trained males who underwent a bout of eccentric exercise designed to induce delayed onset muscle soreness (DOMS). DESIGN: A double blind randomised placebo controlled trial. SETTING: Twenty well trained male volunteers, matched by maximum aerobic capacity were randomly assigned to consume a regime of 4000 mg of P. notoginseng capsules or an indistinguishable placebo before and after a downhill treadmill running episode designed to induce DOMS. MAIN OUTCOME MEASURES: Performance measures (Kin-Com, counter movement and squat jump), pain assessments (visual analogue scale (VAS), algometer) and blood analyses (interleukin-1, interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), C-reactive protein, myoglobin, creatine kinase) were assessed at 7 time points over 5 days (pre, post, 4, 24, 48, 72 and 96 h after the downhill run). RESULTS: The placebo group demonstrated a significant decrease in squat jump performance immediately post the downhill run, with a mean change ± 95% confidence interval (CI) of 0.8 cm (-3.53 to 1.93). The placebo group also experienced increased pain in the quadriceps 96 h after the downhill run, with a mean VAS change ± 95% CI of -0.32 cm (-0.34 to 0.98).The serum concentration of IL-6 and TNF-α were significantly lower in the placebo group 24h after the downhill run. Mean IL-6 change ± 95% CI of 0.50 pg/mL (-1.59 to 0.59), and mean TNF-α change ± 95% CI was 0.98 pg/mL (-2.04 to 0.09). No other significant differences were identified between the groups for any other outcome measure. CONCLUSION: Considering all data from this study, P. notoginseng did not convincingly have an effect on performance, muscular pain or assessed blood markers in well-trained males after an intense bout of eccentric exercise that induced DOMS.

The effects of Lyprinol(®) on delayed onset muscle soreness and muscle damage in well trained athletes: a double-blind randomised controlled trial.

OBJECTIVES: The aim of the study was to determine if Lyprinol(®) is effective in reducing pain, indicators of inflammation and muscle damage, and in turn improving performance in well trained athletes suffering from delayed onset muscle soreness (DOMS). DESIGN: A double blind randomised placebo controlled trial. SETTING: Twenty well trained male volunteers, matched by VO(2max) were randomly assigned to consume 200mg of Lyprinol(®) or an indistinguishable placebo daily for 8 weeks prior to a downhill treadmill running episode designed to induce DOMS. MAIN OUTCOME MEASURES: Performance measures (Kin-Com, counter movement and squat jump), pain assessments (visual analogue scale, algometer) and blood analyses (Interleukin-1, Interleukin-6, Interleukin-10, tumour necrosis factor-α, C-reactive protein, myoglobin, creatine kinase) were assessed at 7 time points over 5 days (pre, post, 4, 24, 48, 72 and 96h after the downhill run). RESULTS: No statistically significant differences were identified in any parameters between the active and placebo groups at any time point. CONCLUSION: After 2 months ingestion of Lyprinol(®) at the currently recommended dosage (200mg/day) and a demanding eccentric exercise intervention, Lyprinol(®) did not convincingly affect DOMS and indicators of muscle damage.