***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Unaccustomed exercise is associated with an elevated plasma creatine kinase ( CK ) , myofibrillar inflammation , and delayed onset muscle soreness ( DOMS ) .  Nonsteroidal antiinflammatory drugs ( NSAID ) may attenuate DOMS and indirect indices of inflammation in humans . METHODS We studied the effects of an NSAID ( naproxen sodium ( 500 mg , 2 times a day for 48 h ) ) taken before and after resistance exercise in eight healthy , moderately trained men in a r and omized , double-blind trial . The exercise consisted of unilateral knee concentric/eccentric weight lifting with 6 sets x 10 repetitions at 80 - 85 % of the 1 repetition maximal contraction . Muscle biopsies of each vastus lateralis ( EX = exercised/REST = control ) were taken 24 h after exercise for immunohistochemical staining of inflammatory cells ( leukocyte common antigen ) . At 24 and 48 h postexercise , we also determined DOMS , plasma CK activity , and knee extensor muscle torque . RESULTS Exercise result ed in an increased CK activity at + 24 and + 48 h ( vs preexercise : P < 0.01 ) , with no treatment effect . There were no treatment effects for any of the measured variables except for a return of voluntary knee extension torque to baseline by + 48 h postexercise for NSAID treatment ( P < 0.05 ) . CONCLUSIONS NSAID administration did not alter CK rise , muscle force deficit at 24 h postexercise , nor perceived muscle pain . In addition , the increased CK at 24 h postexercise was not associated with an acute myofibrillar inflammatory cell infiltrate in moderately trained men after resistance exercise Objective :  Delayed-onset muscle soreness ( DOMS )  often occurs after unaccustomed eccentric exercise and reduces exercise performance . We aim ed to study the preventive effects of saffron and indomethacin on the biochemical and functional indicators of DOMS after 1-session eccentric exercise . Design : A 10-day , r and omized , double-blind , placebo-controlled , pretest – posttest design . Setting : Controlled research laboratory . Participants : Thirty-nine nonactive male university students r and omly divided into  saffron ( n = 12 ) , indomethacin ( n = 12 ) , and control ( n = 15 ) groups . Interventions : Saffron group received 1 capsule containing dried saffron powder ( n = 12 , 300 mg/d ) , indomethacin group received 75 mg indomethacin ( n = 12 , 25 mg thrice a day ) , and control group ( n = 15 ) received placebo capsules , 1 week before and 3 days after eccentric exercise . Ten days before and 24 , 48 , and 72 hours after muscle soreness protocol , the maximum isometric and isotonic forces , plasma creatine kinase ( CK ) , plasma lactate dehydrogenase ( LDH ) , perceived pain , knee range of movement , and thigh circumference were measured . Muscle soreness protocol was performed with a weight load equal to 80 % of the maximum isotonic force in 4 sessions with 20 repetitions and 3-minute rest in between . Main Outcome Measures : This study shows that 10-day supplementation with 300 mg saffron significantly decreased the CK and LDH concentrations ( P < 0.0001 ) . In the saffron group , there was no decline in maximum isometric and isotonic forces after eccentric exercise , but a significant decline in the isometric force was observed in the control group ( P < 0.0001 ) . No pain was reported in the saffron group , whereas the indomethacin group experienced pain before 72 hours ( P < 0.001 ) . Conclusions : Results obtained from the current novel research indicate a strong preventive effect of 10-day supplementation with saffron on the DOMS . Clinical Relevance : The saffron can be used to prevent DOMS and alleviate the DOMS symptoms The effects of two non-steroidal anti-inflammatory drugs ( NSAIDs ) , meclofenamate and diclofenac , in combination with physiotherapy modalities on the rate of healing of acute hamstring muscle tears were studied in a double-blind , placebo-controlled trial . Fourty-four of the 75 patients with this injury recruited were assessed and r and omly allocated to one of three treatment groups : meclofenamate ( 100 mg 3 times a day ) , diclofenac ( 50 mg 3 times a day ) and placebo . All patients received the same intensive physiotherapy treatment over the 7-day treatment period . Patient assessment s were performed on days 1 , 3 and 7 of the 7-day study period and included pain assessment ( visual analogue scale ) , swelling measurement ( thigh circumference measurement at the site of the muscle tear ) and isokinetic muscle performance testing . Treatment produced a significant improvement in all measurements in all groups , but there was no difference in any measurement between groups . However , when only the more severe injuries were analysed , the reported pain score at day 7 was significantly lower in the placebo group than in either the meclofenamate group or the diclofenac group ( P < 0.05 ) . Hence this study did not find any additive effect on the healing of acute muscle injuries when meclofenamate or diclofenac was added to st and ard physiotherapeutic modalities . The study therefore does not support the use of NSAIDs in the treatment of acute hamstring muscle injuries Objective To investigate the effect of epicutaneously applied Diractin ® ( ketoprofen in Transfersome ® gel ) on pain induced by eccentric muscle contractions . Methods Three pilot studies which were subsequently pooled for a meta- analysis compared the efficacy of a single application of 25 mg ketoprofen in Diractin ® to 25 mg oral ketoprofen and placebo for the treatment of pain induced by 50 eccentric contractions of the elbow flexor muscles . In addition , the effect of multiple usage of up to 100 mg ketoprofen in Diractin ® bid over seven days on pain induced by walking down stairs with a total altitude of 200 meters was investigated . Results A single dose of 25 mg ketoprofen in Diractin ® after the elbow flexion exercise was significantly superior to placebo from 5 to 12 hours after treatment and also to oral ketoprofen at some time points after treatment . In contrast , oral ketoprofen  was not different to placebo at any time after treatment . Multiple doses of up to 100 mg ketoprofen Diractin ® provided significant more pain relief than placebo on muscle pain induced by walking down stairs . Conclusions Eccentric exercise-induced muscle soreness was shown to be an appropriate acute pain model to evaluate the efficacy of nonsteroidal anti-inflammatory drugs applied epicutaneously with Transfersome ® carriers . Diractin ® proved to be efficacious in relieving pain from eccentric muscle contractions and muscle overexercise , respectively . The effect needs to be confirmed in a larger prospect i ve clinical trial Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Certain types of jaw-muscle pain may be managed with pharmacologic treatment . This study evaluated the effect of topical and systemic nonsteroidal anti-inflammatory drugs on  acute postexercise jaw-muscle soreness . Ten men without temporom and ibular disorders performed six 5-minute bouts of submaximal eccentric jaw exercise . The outcome variables were pressure pain thresholds and pain tolerance thresholds at the masseter muscles , and maximum voluntary occlusal force . Surface electromyography from the masseter muscles was used to assess the development of muscle fatigue during the exercise period . Three treatment modalities were tested in a placebo-controlled , double-blind approach : ( A ) placebo gel and placebo tablets ; ( B ) nonsteroidal anti-inflammatory drug gel ( 2 g , 5 % ibuprofen ) and placebo tablets ; and ( C ) placebo gel and nonsteroidal anti-inflammatory drug tablets ( 400 mg ibuprofen ) . The subjects used their medication 3 times a day for 3 days in the postexercise period . In the exercise period , the mean power frequency of the electromyography signal , pressure pain threshold , pain tolerance threshold , and maximum voluntary occlusal force decreased significantly ( analysis of variance , P < .01 ) . In the postexercise period , the effect of treatment on pressure pain thresholds was significant ( F[2,9 ] = 4.41 , P = .02 ) . On day 3 , treatment with topical nonsteroidal anti-inflammatory drugs was associated with significantly higher pressure pain thresholds as compared to treatment with systemic nonsteroidal anti-inflammatory drugs ( P < .05 ) and placebo ( P < .05 ) . Treatment effects on pain tolerance thresholds and on maximum voluntary occlusal force were nonsignificant . The results demonstrated that repeated eccentric jaw exercise caused muscle fatigue and low levels of postexercise pain and soreness .  Topical nonsteroidal anti-inflammatory drugs seem to have some advantages over systemic nonsteroidal anti-inflammatory drugs for management of exercise-induced jaw-muscle pain To test the hypothesis that delayed onset muscular soreness ( DOMS )  following intense eccentric muscle contraction could be due to increased production of prostagl and in E2 ( PGE2 ) , ten healthy male subjects were studied . Using a double-blind r and omized crossover design , each subject performed two isokinetic tests separated by a period of at least 6 weeks : once with placebo , and once with piroxicam ( Feldene ® ) . They were given one capsule containing either placebo or piroxicam ( 20 mg ) per day for 6 days with initial doses given starting 3 days prior to isokinetic testing . Exercise consisted of eight stages of five maximal contractions of the knee extensor and flexor muscle groups of both legs separated by 1 min rest phases , on a Kin Trex device at 60 ° /s angular velocity . The subjective presence and intensity of DOMS were evaluated using a visual analogue scale immediately after , and 24 and 48 h after each test . The mean plasma concentration of PGE2 measured at rest and after exercise was significantly lower in the group treated with piroxicam ( p < 0.05 ) . However , statistical analysis ( two-way ANOVA test ) revealed that exercise did not cause any significant change of mean plasma PGE2 over time in either of the two groups . Eccentric work was followed by severe muscle pain in extensor and flexor muscle groups . Maximal soreness was noted 48 h postexercise . Serum creatine kinase activity and the serum concentration of myoglobin increased significantly , and reached peak values 48 h after exercise in both experimental conditions ( p < 0.001 ) . By paired t-test , it appeared that there were no significant differences in the serum levels of these two markers of muscle damage between the two groups at any time point . We conclude that : ( 1 ) oral administration of piroxicam fails to reduce muscle damage and DOMS caused by strenuous eccentric exercise ; and ( 2 ) the hypothetical role of increased PGE2 production in eccentric exercise-induced muscle damage , DOMS , and reduced isokinetic performance is not substantiated by the present results Twenty untrained male volunteers were required to run downhill for 45 minutes on a motor driven treadmill to induce muscle soreness . The volunteers took diclofenac or placebo before and for 72 hours after two runs 10 weeks apart , in a r and omised double blind crossover design . Subjective soreness was assessed before and at intervals up to 72 hours after each run ; venous blood sample s , collected at the same time intervals , were used to estimate serum activities of creatine kinase , lactate dehydrogenase and aspartate aminotransferase and serum concentrations of creatinine and urea . Subjective soreness and the biochemical parameters increased after both runs , although the serum enzyme response to the second run was reduced . Diclofenac had no influence on the serum biochemical response to downhill running . Although overall soreness was not affected by diclofenac , individual soreness measurements were reduced by diclofenac at the first period of the study . These results suggest that diclofenac does not influence muscle damage , but may slightly reduce the associated soreness We examined the effect of two commonly consumed over-the-counter analgesics , ibuprofen and acetaminophen , on muscle protein synthesis and soreness after high-intensity eccentric resistance exercise . Twenty-four males ( 25 + /- 3 yr , 180 + /- 6 cm , 81 + /- 6 kg , and 17 + /- 8 % body fat ) were assigned to one of three groups that received either the maximal over-the-counter dose of ibuprofen ( IBU ; 1,200 mg/day ) , acetaminophen ( ACET ; 4,000 mg/day ) , or a placebo ( PLA ) after 10 - 14 sets of 10 eccentric repetitions at 120 % of concentric one-repetition maximum with the knee extensors . Postexercise ( 24 h ) skeletal muscle fractional synthesis rate ( FSR ) was increased 76 + /- 19 % ( P < 0.05 ) 
    Output:
    
Conclusion : Overall , our analysis supports NSAID use for reducing strength loss , soreness , and blood creatine kinase level after an acute muscle injury , at least for humans and in the short term .