Hvis du plages af muskelsmerter op til en uge efter træning eller anden fysisk aktivitet, har du sandsynligvis pådraget dig den såkaldte muskelfeber. I denne artikel gennemgår vi, hvordan muskelfeber opstår, hvor længe den varer, ser på dens årsager og symptomer, og især hvordan man kommer af med den hurtigst muligt og forebygger den i fremtiden.
Hvad er muskelfeber, og hvad er dens symptomer?
Muskelfeber, på engelsk kaldet forkortelsen DOMS (delayed onset muscle soreness), er en betydeligt smertefuld tilstand i kroppen, som kommer efter en krævende træning. Ud over at selve smerten er en meget ubehagelig oplevelse, kan muskelfeber begrænse sportsudøveren i sportslige aktiviteter og nogle gange endda i almindelige daglige aktiviteter. Ud over muskelsmerter ledsages muskelfeber af andre symptomer som nedsat fleksibilitet og en følelse af "forkortning" af de ømme muskler.1
Hvordan og hvorfor opstår muskelfeber?
Muskelsmerter efter sport opstår ved, at der under træningen sker en forstyrrelse i muskelfibrenes struktur (fibrene rives i stykker, så de kan regenerere til større og stærkere), og det forårsager smerten.
For at muskelfeber kan opstå, er det nødvendigt at skade muskelfibrene i overdrevent omfang. En sådan omfattende fiberrivning sker især ved udførelse af bevægelser, som kroppen ikke er vant til, eller ved intensiv træning, og det især i bevægelsens excentriske fase, altså når den belastede muskel strækkes (f.eks. ved squat, når man går ned med vægtstangen, ved chin-up er det den del, hvor man synker fra stangen til strakte arme, ved bicepscurl med håndvægt, når man sænker håndvægten ned).1
Betydelig skade på muskelfibrene burde i en ideel verden betyde regenerering til en markant stærkere tilstand og dermed markant muskelvækst, men sådan fungerer det desværre ikke. Overdreven skade på muskelfibrene forårsager nemlig elektrolytubalance, oxidativt stress og inddragelse af betændelsesceller i muskelhelingen. I dette miljø heler musklen langsommere, og der produceres samtidig stoffer, som påvirker nociceptorerne (smertereceptorerne), og derfor gør en sådan fiberrivning ondt i flere dage efter sport.1
Hvor længe varer muskelfeber?
Typisk begynder muskelfeber at vise sig efter 6-12 timer efter træning, smerten når sit maksimum den anden eller tredje dag og forsvinder derefter mellem den femte og syvende dag.1 Varighed, intensitet og tidspunktet for den højeste smerteintensitet afhænger af træningens intensitet, træningens varighed, den konkrete muskelgruppe og typen af muskelfibre i den trænede muskel. Et typisk eksempel er, når smerten efter en hård benøvelse er mest intens på anden hviledag.
Hvordan forebygger man muskelfeber, og hvordan kommer man af med den?
Forebyggelse og behandling af muskelsmerter kan delvist overlappe hinanden, fordi nogle behandlingstiltag kan bruges til at forebygge smerten.
Rent forebyggende for atleten er det at kende sin krop og lytte til den. Det er en meget nyttig evne, hvis sportsudøveren vil eliminere risikoen for skader, overtræning eller netop muskelfeber.
En vigtig forebyggelse er også gradvis opbygning af tolerance over for belastning. Det er ikke klogest at gå all-in i sporten med det samme, men i stedet er det fornuftigt at udvide kroppens muligheder og sine præstationer skridt for skridt.
Kulde
Både forebyggende og terapeutisk kan man bruge kulde og varme. Nedsænkning af musklerne i koldt vand hjælper med hurtigere restitution, fordi kulden hjælper med at flytte betændelsesfremmende og smertefremkaldende stoffer fra musklen til blodbanen, hvor de lettere elimineres. En metaanalyse af mange studier viser, at de bedste resultater opnås ved at nedsænke ømme muskler i 11-15 graders vand i 15 minutter. Lignende effekter opnås også med kryoterapi (2-5 minutter i et rum nedkølet til minus 100 grader).2
Brug af kølende salver med mentol er i forskningen stadig et uforklaret fænomen. Sportsudøvere bruger dem gerne, fordi de føles som en hjælp mod smerten. I en blindtest, hvor kølende salve blev sammenlignet med en salve uden virkestoffer, vurderede sportsudøverne placebo-salven som den, der hjalp bedst med at fjerne smerten. Det tyder på, at der snarere er tale om en placeboeffekt efter at have smurt en hvilken som helst salve på den smertende muskel. Samtidig bevarede springere og løbere med muskelsmerter efter at have brugt kølende salve dog deres styrke og præstationsevne i den efterfølgende træning bedre end sportsudøvere, der fik placebo. Disse resultater kan ikke forklares entydigt, men man ved, at kølende salve hjælper mod smerten (om end kun som placebo og ikke på grund af de indeholdte stoffer) og gør det lettere hurtigt at gentage en løbe- eller springpræstation efter muskelfeber.5
Anvendelse af varme
Anvendelse af varme i form af sauna, boblebad eller varme omslag anbefales først i de senere stadier af muskelfeber. Varme bør først anvendes, når smerterne begynder at aftage (ca. fra 4. til 7. dag efter smertens begyndelse), hvor det kan fremskynde restitutionen, og endda kan have en positiv effekt på muskelvolumen. I de første 3 dage, hvor smerterne stadig tiltager, kunne varme forværre betændelsesreaktionen.2
Kompression
Brug af kompression efter sport (ved at stramme den belastede muskel) kan enten forebygge smerter, eller lindre dem og forkorte deres varighed. Faktum er, at kompression af musklen under sport ikke giver nogen fordel, i modsætning til kompression efter sport.3
Mange kendte og i årevis anbefalede metoder til at fremskynde restitution og lindre smerte er ikke blevet påvist som beviseligt effektive i studier, hverken i forebyggelse eller behandling af muskelfeber. Nogle beskriver en effekt af dem, mens andre afviser den. Det drejer sig f.eks. om udstrækning af musklerne efter træning, aktiv hvile i form af let motion, vibrationsmassage af musklerne, brug af massagerulle eller elektrostimulering af musklerne, manuel massage eller akupunktur. Min beskedne holdning er, at hvis noget af dette føles som en hjælp for dig, er det værd at gøre det, og hvis du ikke mærker nogen forskel og det ikke giver dig noget, er det ikke umagen værd at fortsætte med det.2, 4
Smertestillende medicin
Brug af medicin til behandling af muskelfeber anbefales generelt ikke og bør kun være den sidste udvej. Betændelseshæmmende og smertestillende medicin (af typen ibuprofen) hjælper ganske vist mod den ubehagelige smerte, men fremskynder ikke musklernes restitution nævneværdigt og har derudover en række bivirkninger ved langvarig brug.
Fødevarer og kosttilskud
En positiv indvirkning på muskelfeber viser også nogle af kosttilskuddene. Der er ganske vist ikke tale om en revolutionerende behandling, men indtag af disse stoffer kan give en mild fordel i forebyggelsen og lindringen af muskelfebersymptomer. Muskelfeber lindres af indholdet af BCAA i en proteindrik efter træning, koffein efter træning, D-vitamin, gurkemejeekstrakt, juice af rødbede og omega 3-fedtsyrer.2, 3, 4
Sammenfatning til sidst
Muskelfeber er en smertefuld muskeltilstand, der opstår efter hård sport. Den kan vare op til en uge og er ret begrænsende. Det bedste er at forebygge den med fornuftig træning og samtidig bruge bade i koldt vand, kryoterapi og kompressionsbandager. Alt dette kan vi supplere med kosttilskud.
Kilder
- Hotfiel, Thilo et al. “Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics.” “Delayed Onset Muscle Soreness – Teil I: Pathogenese und Diagnostik.” Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin vol. 32,4 (2018): 243-250. doi:10.1055/a-0753-1884
- Heiss, Rafael et al. “Advances in Delayed-Onset Muscle Soreness (DOMS) - Part II: Treatment and Prevention.” “Delayed Onset Muscle Soreness – Teil II: Therapie und Prävention.” Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin vol. 33,1 (2019): 21-29. doi:10.1055/a-0810-3516
- Tanabe Y, Fujii N, Suzuki K. Dietary Supplementation for Attenuating Exercise-Induced Muscle Damage and Delayed-Onset Muscle Soreness in Humans. Nutrients. 2021 Dec 24;14(1):70. doi: 10.3390/nu14010070. PMID: 35010943; PMCID: PMC8746365.
- Afonso J, Clemente FM, Nakamura FY, Morouço P, Sarmento H, Inman RA, Ramirez-Campillo R. The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Physiol. 2021 May 5;12:677581. doi: 10.3389/fphys.2021.677581. PMID: 34025459; PMCID: PMC8133317.
- Gillis, D Jason et al. “Influence of Menthol on Recovery From Exercise-Induced Muscle Damage.” Journal of strength and conditioning research vol. 34,2 (2020): 451-462. doi:10.1519/JSC.0000000000002833
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This is a useful explanation of muscle soreness after exercise, especially the reminder that recovery takes time and that listening to your body is an important part of training. I also like the emphasis on gradually increasing training intensity rather than pushing too hard too quickly.
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