EIMD – How is it affecting you?

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What is EIMD??

EIMD stands for Exercise Induced Muscle Damage.

Exercise is typically followed by a muscle healing response (Danna, Brynan, Beutel,  Campell, & Joseph, 2014; Schoenfeld, 2012) =where the hypertrophy (the big gains!) happens.

Why is it not good for me?

There are two proposed mechanisms behind EIMD: the metabolic and the mechanical.

The Metabolic:

EIMD has been linked to cell damage as a result of ischaemia or hypoxia (Howatson & van Someren, 2008). Ischaemia can occur as a result of insufficient supply of blood to the muscles with hypoxia, lack of oxygen to the same cells, happening as a result (Tee, Bosch, & Lambert, 2007).

Earlier Smith (1991) also saw tissue damage causes an increase of neutrophils to migrate to injury site, followed by monocytes, numbers peaking at 48 hours following exercise, where maximum soreness is seen. The monocytes synthesise large numbers of prostaglandins which sensitise nerve endings, leading to the sensation of soreness. However Brown et al. (1997) could not find a clear link between EIMD and metabolic damage.

The Mechanical:

Howatson and van Someren (2008) also focused on a mechanical hypothesis to explain this EIMD, a theory used over the metabolic most frequently.

Following unaccustomed exercise with eccentric contractions there is evidence of injury to skeletal muscle a) disruption of the normal myofilament structures in sacromeres b) loss of intramuscular proteins into plasma, indicating damage to sarcolemma (Armstrong, 1990). Studies have also showed muscle glycogen synthesis to be impaired after eccentric exercise resultant EIMD (Tee et al., 2007). This pathology is what is responsible for the pain and loss of force; possibly due to loss of intracellular calcium homeostasis (Armstrong, 1990).

Well although you know what DOMS are – that the body hurts after exercise; sometimes though it’s not ‘just DOMS’ its actual damage, ‘exercise-induced muscle damage’ (EIMD)…

The table below shows the differences between DOMS and EIMD (Howatson & van Someren, 2008; Kuiper, 1994; Nosaka, Newton & Sacco, 2002; Tee et al., 2007).

DOMS        EIMD
Causes?                 Eccentric or Unaccustomed exercise    Eccentric or Unaccustomed exercise
Effects?                                                                Pain     Pain
Strength losses
Structural disruption
When it kicks in?                                  12 to 24 hours    12 to 24 hours
When does the pain peak?                             1-3 days    1-5 days
How long does it last?                                    3-7 days    as long as 30 days

If you have EIMD you experience strength losses, inflammation, stiffness AND pain, sure to reduce your performance lasting up to a month!


Train Clever!

Off-season is for NEW exercises, to potentially protect your muscles against EIMD.

Burt, Lamb, Nicholas, and Twist (2012) studied the effects of EIMD on sub-maximal running endurance (like in rugby!) They saw, when their 9 guys did 100 squats (10 x 10 – look familiar?) at 80% body mass, the effects of EIMD reduced when they did the same session two weeks later: the muscles had got used to the exercise!

Repeated Bout Effect?

Zainuddin, Sacco, Newton, and Nosaka  (2006) also saw that training a light concentric session after EIMD allowed temporary pain relief on the soreness but not on recovery of the actual muscle damage after exercise.

According to Howaston and van Someren (2008) it is the only intervention that consistently showed positive effects on limiting EIMD.


Howaston and van Someren (2008) looked at Vitamin C and E supplementation; after evaluating other studies, surmised that doses given for 14 days post-exercise could reduce EIMD symptoms (due to reducing oxidative stress put on the muscle cells).

McLeay et al. (2012) also looked at antioxidants, as New Zealand Blueberries after a leg workout and found a decrease in recovery time of muscle strength when in a smoothie before and after the session.


We love a protein shake – but is it helping symptoms of EIMD?

Well according to Howatson and van Someren (2008), yes! They found evidence to suggest that protein by itself, and carbohydrate-protein ingested together affords some protection against EIMD (carbohydrates alone didn’t). Roberts et al., (2011) however showed no differences in sprint ability after their same variable study after their ‘rugby-simulated’ session; however other markers returned to normal after 24 hours anyway, leading to question whether the session was intense enough in the first place?

Blomstrand, Hassmén,  Ekblom, and Newsholme (1991) also found that introducing BCAA’s to endurance athletes increased running performance with non-elite athletes, compared to a placebo group (the elite runners tested didn’t show increases- but that’s ok for you snails!).


Cockburn, Robson-Ansley, Hayes, and Stevenson (2012) showed drinking milk helped post-exercise effects; further research by Cockburn, Bell,  and Stevenson (2013) showed that 500ml of milk after exercise was optimal in limiting increases of 10m sprint times- great for us!


I know you guys loving ‘popping pinks’ from the doctors; BUT the evidence is fairly open to interpretation whether anti-inflammatories can prevent/reduce signs of EIMD. Given the lack of evidence Howaston and van Someren (2008) found after extensive analysis of current research let’s not recommend them for EIMD. Malm and Yu (2012) also found that our training structure doesn’t produce significant inflammation anyway!


Howaston and van Someren (2008) reported only minimal reduction of EIMD symptoms after meta-analysis, however Khamwong, Pirunsan, and Paungmali  (2012) showed 28 guys stretching before eccentric exercise helped reduce EIMD effects, which could positively affect performance, although they had no control group to compare!

So for now, let’s continue with our stretching and we’ll continue to research to find some definitive answers!


Jakeman, Byrne and Eston (2010) found massage plus compression reduced decrease in performance compared with a passive recovery group, although the study was women only,  they also found that perceived soreness was reduced at 48 and 72 hours after exercise when both treatments were used; great news for us and the sports massage team!

Howaston and van Someren (2008) however found in the evaluation of other research that it was only the perception of soreness decreased, not performance increases; but we’ll take reduced pain any day!


Goodall and Howatson (2008) found no positive effects on recovery after cryotherapy, quite strong results! Oakley, Pardeiro, Powell, and Millar (2013) established some positive results on reduction of pain using cryotherapy though; this was also possibly a better study being the study used a large sample size. Howatson and van Someren (2008) found in their meta-analysis that cryotherapy offers a quick intervention to aid recovery, so let’s get dunking!

Take Home Points:

The EXACT mechanisms behind EIMD are still under debate; however we know that it affects your muscles in a way which can lead to detriments in training. There are a number of ways to help reduce these effects; for now, let’s train consistently (for the RBE), maintain healthy diet and supplementation relevant personally, use ice, massage and stretching as appropriate and mainly, listen to the staff!



Armstrong, R. B. (1990). Initial events in exercise-induced muscular injury. Medicine Science in Sport Exercise. 22(4), pp. 429-435.

Blomstrand, E., Hassmén, P.,  Ekblom, B. & Newsholme, E. A. (1991). Administration of branched-chain amino acids during sustained exercise — effects on performance and on plasma concentration of some amino acids. European Journal of Applied Physiology and Occupational Physiology. 63(2), pp.83-88.

Brown , S. J., Child, R. B., Day, S. H. & Donnelly, A. E. (1997). Exercise-induced skeletal muscle damage and adaptation following repeated bouts of eccentric muscle contractions. Journal of Sports Sciences. 15(2), pp. 215-222.

Burt, D., Lamb, K., Nicholas, C. & Twist C. (2013). Effects of repeated bouts of squatting exercise on sub-maximal endurance running performance. European Journal of Applied Physiology. 113(2), pp.285-93.

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Cockburn, E., Bell, P. G. & Stevenson, E. (2013). Effect of Milk on Team Sport Performance after Exercise-Induced Muscle Damage. Medical Science Sports Exercise. 45(8), pp.1585–1592.

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Khamwong, P., Pirunsan, U. & Paungmali, A. (2011). A prophylactic effect of proprioceptive neuromuscular facilitation (PNF) stretching on symptoms of muscle damage induced by eccentric exercise of the wrist extensors. Journal of Bodywork & Movement Therapies. 15(4), pp. 507-516.

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McLeay, Y., Barnes, M. J., Mundel, T., Hurst, S., Hurst, R. & Stannard, S. (2012). Effect of New Zealand blueberry consumption on recovery from eccentric exercise-induced muscle damage. Journal of the International Society of Sports Nutrition. 9(1), pp. 1-12.

Nosaka, K., Newton, M. & Sacco, P. (2002). Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage. Scandinavian Journal Medical Science in Sports. 12(6), pp. 337-46.

Oakley, E. T., Pardeiro, R. B., Powell, J.W. & Millar, A. L. (2013). The effects of multiple daily applications of ice to the hamstrings on biochemical measures, signs, and symptoms associated with exercise-induced muscle damage. Journal of Strength and Conditioning Research. 27(10), pp. 2743-51.

Roberts, S. P., Stokes, K. A., Trewartha, G., Hogben, P., Doyle, J. & Thompson, D. (2011). Effect of combined carbohydrate–protein ingestion on markers of recovery after simulated rugby union match-play. Journal of Sports Science. 29(12), pp. 1253–62.

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Schoenfeld, B. J. (2012). The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage Implications for Skeletal Muscle Development. Sports Medicine . 42(12), pp. 1017-1028.

Schoenfeld, B.  J. (2012). Does exercise-induced muscle damage play a role in skeletal muscle hypertrophy? Strength and Conditioning Research. 26(5), pp.1441–1453.

Smith, L. L. (1991). Acute inflammation: the underlying mechanism in delayed onset of muscle soreness? Medical Science in Sports Exercise. 23, pp. 542-551.

Tee, J. C., Bosch, A. N. & Lambert, M. I. (2007). Metabolic Consequences of Exercise-Induced Muscle Damage. Sports Medicine. 37(10), pp. 827-836.

Zainuddin, Z., Sacco, P., Newton, M. & Nosaka, K. (2006). Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Applied Physiology Nutrition and Metabolism. 31, pp. 126–134.


Written by Kristina

I own 2 FITWORXS clinics (est'd '06), am Head Sports Rehabilitator down at Grasshoppers RFC, am a Pilates Instructor who now also teaches for the Physiotherapy and Pilates Institute (APPI), Netball Lover & Happy Woman! "Forever Pushing for a Fitworxs Future!"

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