Rebecca Nau & Lavon Williams, Ph.D. Guilford College The Effects of Epsom Salt Balneotherapy on Delayed Onset Muscle Soreness The results of this study support the hypothesis that Epsom salt balneotherapy will reduce the pain of DOMS compared to no treatment. Using that a 30% reduction in pain on the numeric ratings scale is clinically significant, we argue that the differences among the groups practically meaningful (Farrar et al., 2001). It is also interesting to note that the placebo was effective in relieving some pain compared to the control group. Although to counter to current rehabilitation practices (Sumida et al., 2003), hot packs have been shown to be more effective than cold packs in relieving pain of DOMS. Thus, the treatment of a hot bath alone may be therapeutic. This study relied upon a small, homogeneous sample with limited standardization of the treatment. Future researchers should consider using a larger sample from multiple colleges and developing methodologies to control for the administration of the treatment. Another significant symptom of DOMS that was not explored in this study is a decrease in muscle function. It would be interesting to include objective measures of testing muscle function in future research. In conclusion, the results of this study offer promising support to the traditional practice of Epsom salt balneotherapy for muscle soreness. The results of this study may renew the study of this for treatment for musculoskeletal injuries and rehabilitation. Main Analysis (see Figure 1) Mixed factorial ANOVA results revealed significant Time (F (2.48, 66) = 17.88, p <.05) and Group (F (2, 22) = 3.89, p <.05), and a Time x Group interaction (F (4.97, 66) =7.80, p <.05). Post hoc follow up revealed that none of the groups differed in perceived pain before ( F(2, 24) =.5, ns) or directly after (F (2, 22) = 1.84, ns) exercise. Twenty-four hours post treatment (F (2, 24) =.6.41, p <.05), the experimental group (M = 0.44, SD =.73) perceived less pain than the control group (M = 2.22, SD = 1.30). Forty-eight hours post treatment (F (2,24) =.6.19, p <.05), the experimental group (M =.22, SD =.44) perceived less pain than the control (M = 2.33, SD = 1.58) and the placebo (M = 1.56, SD = 1.51). Introduction One of the most common incidents of acute inflammation experienced by everyone from the elite marathon runner to the occasional weekend warrior is delayed onset muscle soreness (DOMS). DOMS develops a day or two after a heavy bout of exercise and can pose a restriction to maximizing training gains and the ability to perform normal activities of daily living. DOMS is caused by structural damage and acute inflammation within muscle tissue and is mostly initiated by eccentric muscle contractions (Armstrong, 1990). Research indicates that an immediate, even proactive attempt, to reduce inflammation, can significantly reduce pain associated with DOMS (Hasson et al., 1993). The current practices in the treatment of DOMS and related inflammation is with non-steroidal anti-inflammatory drugs (NSAIDs). Despite their effectiveness, continued use of NSAIDs can result in liver damage, stomach ulcers, kidney failures, and birth defects if taken during pregnancy (Adams et al., 1989). Given these negative side effects there is a need for effective treatments of this condition that can be used on a regular basis and not compromise the health of the body. A simple household remedy of Epsom salts (magnesium sulfate) could be such a treatment. The therapeutic administration of magnesium can potentially prevent DOMS by controlling the levels of calcium ions in muscle tissue. Armstrong (1990) contends that the structural damage and inflammation of DOMS is initiated by increased calcium ions. Magnesium is an inhibitory ion in the body that works as an antagonist to calcium, a stimulatory ion. Thus, introducing magnesium at times of elevated calcium ions may reestablish homeostasis and prevent further structural damage and inflammation. Magnesium is a mineral that occurs naturally in the body and in nature in the form of salts. One its most common forms is Epsom salt (MgSO 4 ). Epsom salts have been administered by baths and anecdotally used for a multitude of ailments for centuries. The therapeutic use of baths is known as balneotherapy and is one of the oldest healing modalities. Research indicates that chronic pain conditions associated with inflammation can be reduced via balneotherapy (Neumann et al., 2001; Sukenik et al., 1990). However, no studies have examined the effectiveness of these therapies on acute pain associated with inflammation. Given its magnesium content, Epsom salt balneotherapy may reduce pain associated with DOMS. This study examined the effectiveness of Epsom salt balenotherapies on perceived pain associated with DOMS. We hypothesized that Epsom salt balneotherapy within an hour after exercise reduces perceived pain experienced with DOMS within 48 hours after exercise. Participants N = 27 volunteer traditional students enrolled in Guilford college n = 10 Male; n = 17 Female Ages ranged from years (M= 20.41, SD = 1.15) 92.6% of the sample population was Caucasian Method Descriptive Statistics (see Table 1) The mean of the experimental group in both 24 and 48 hours post exercise were less than that of the placebo and control group. The standard deviation for the experimental group was also less than the other two groups, showing more consistency within this group and thus within the treatment. As expected, the control group showed the greatest mean of pain levels reported and showed the greatest variability in pain scores. Procedures Volunteer participants were randomly assigned (double blind) to one of three treatment groups, ten participants in each group. Control (n = 9): no treatment Placebo (n = 9): regular table salt (NaCl) Experimental (n = 9): Epsom salt (MgSO 4 ) Under the direction of the first author and following IRB protocol, participants completed an initial pre-exercise numeric ratings scale of pain and demographic questionnaire. They then completed a series of eccentric exercises of resisted elbow flexion of their non-dominant arm. All groups were asked to refrain from taking any pain medications, NSAIDs, or exercising or massaging their affected arm over the next two days. The experimental and placebo groups were instructed to bathe for 20 minutes in their given salts in their own homes within an hour of performing the exercises. Participants completed two more numeric ratings scale of pain at 24 and 48 hours and reported their results. Measures Numeric Ratings Scale. Participants self reported their pain symptoms using the numeric ratings scale (NRS). NRS is a widely used, reliable and valid tool to measure perceived pain (Lundeberg, 2001). Participants rated their pain experienced on a scale ranging from 0 (no pain) to 10 (worst pain possible). Results Pre-Exercise M (SD) Post-Exercise M (SD) 24 hours M (SD) 48 hours M (SD) Control Group0.00 (0.00)1.00 (0.82)2.45 (1.40)2.57 (1.52) Placebo Group0.11 (0.33)1.11 (0.33)1.33 (1.12)1.56 (1.51) Experimental Group0.11 (0.33)1.67 (1.00)0.44 (0.73)0.22 (0.44) Table 1: Mean Pain Scores of Treatment Groups Across Time Presented at the annual NCAAHPERD state convention, Greensboro, NC on November This study was conducted by Rebecca Nau under the direction of Lavon Williams in the spring of 2006 in partial fulfillment of the Sport Medicine major in the Department of Sport Studies at Guilford College. a a b a ab b ab different letters denote statistically significant difference between groups. Discussion