Hypermobility and Delayed-Onset Muscle Soreness (DOMS)
Do you or your clients experience hypermobility or Ehlers-Danlos syndromes? If so, new research suggests that you may experience increased pain and longer recovery times after exercise. A recent study conducted at the New York Institute of Technology found that hypermobile individuals experience significantly more delayed-onset muscle soreness (DOMS) than non-hypermobile individuals. This is important information for physical therapists, strength trainers, and anyone working with hypermobile individuals.
Background
Delayed-onset muscle soreness (DOMS) is intense muscle pain that lasts for days after a strenuous bout of resistance training, peaking 24 to 72 hours post-exercise. This phenomenon, often referred to as Hypermobility and Delayed-Onset Muscle Soreness, can significantly impact an individual’s exercise routine and overall well-being. While the relationship between hypermobility or Ehlers-Danlos syndromes and injuries has been well-studied and supported, less attention has been given to a potential correlation with exercise-induced muscle soreness.
A recent study conducted at the New York Institute of Technology sought to fill this gap, informing therapists of the potential for increased pain responses to exercise in hypermobile patients. The results are also promising for hypermobile athletes who aim to maximize the effects of resistance training while minimizing the impact of muscle soreness on their athletic performance.
Method
The study by Ostuni et al. (2024) used a quasi-experimental design to investigate the effect of hypermobility on DOMS and recovery time. The main hypothesis was that the hypermobile group would experience increased DOMS compared to the non-hypermobile group over the four days of post-exercise measurements. Participants were physically active students recruited from the New York Institute of Technology and were subsequently split into two groups based on the results of a hypermobility assessment (participants who scored >4 on the Beighton Scale were assigned to the hypermobile group).
Participants were measured across different domains of DOMS pre-exercise, as well as every day for four days post-exercise. The measurements included two pain scales (VAS and McGill), resting arm angle, girth, and pressure pain threshold. The exercise intervention consisted of eccentric bicep curls to failure. Participants were only measured on the VAS Numeric Pain Distress Scale and McGill Pain Questionnaire starting on day two, at 24 hours post-exercise, as there was no prior stimulation that required pain assessments.
Results
The exercise intervention caused DOMS in participants across both groups, as indicated by their scores on the five measurements. However, the hypermobile group experienced significantly more pain, as reported by the VAS scores, compared to the non-hypermobile group (F1,22 = 6.89, p-value = .015).
Implications and Future Directions
This study suggests that hypermobile individuals may experience increased pain following strenuous exercise and may take longer to recover than non-hypermobile individuals. Physical therapists and strength trainers should consider these data to inform their practice when working with hypermobile individuals, as pain can severely impact training outcomes and may have implications for mental health. This research has implications for athletic performance and could help design training programs that account for hypermobility and the longer recovery time required by hypermobile athletes.
In-season training, in particular, should be designed with this research in mind, as a one-size-fits-all training program might cause hypermobile athletes to experience peak pain during competition instead of being at their peak performance. Future research should address several issues present in this study. The gender distribution across the two groups was uneven, with significantly more women in the hypermobile group, leading to potential gender differences. Additionally, more measurements of exercise-induced muscle soreness markers are warranted, such as ultrasounds and measurements of athletic performance, to inform further implications for practice.
VAS Numeric Pain Distress
Resources: Ostuni, N. F., Marinello, C. A., Luzhnyy, T., Pawlikowski, A., Vlasaty, C., Thomatos, G., & Douris, P. C. (2024). The Effect of Joint Hypermobility Syndrome on DOMS and Recovery Time. International Journal of Sports Physical Therapy, 19(2), 159–165. https://doi.org/10.26603/001c.91644.
