EFFICACY OF BUCHU IN TREATING SYMPTOMS OF PAIN AND SWELLING

 

The efficacy of Buchu (Agathosma Betulina) in treating symptoms of pain and

swelling from exercise-induced muscle damage

  

M.l. Lambert, T, Burgess and TO, Noakes

 

  

MRC/UCT Research Unit of Exercise Science and Sports Medicine,

Sports Science Institute-of South Africa,

P.O. Box115,

Newlands,

7925

mlambert@sports.uct.ac.za

02 1-65 0-4558

 

  

EXECUTIVE SUMMARY

 

 

Thirty male subjects (25—40 years) were randomly divided in two groups: Buchu group (treated with a cream containing Buchu) and Placebo group (treated with another inert cream which was indistinguishable from the active Buchu cream). Neither researchers nor subjects knew the identity of the treatment.

 

 

All subjects did a bout of exercise with the non-dominant arm involving the biceps muscle. This bout of exercise was designed to cause exercise-induced muscle damage. The dominant arm was not exposed to exercise and was the control arm for each subject. The clinical signs of damage using this research model included pain, increased serum creatine kinase activity, swelling and shortening of the exercised biceps, and an impairment in muscle function, The symptoms of swelling and impaired eccentric muscle function persisted for up to 7 days after the exercise.

 

 

The treatment with Buchu caused a reduction in swelling throughout the experiment. It was assumed that this was attributed to a reduced inflammatory response although this was not measured in the study. Treatment with Buchu also caused a greater impairment in concentric muscle function. The reason for this is not clear. No subjects reported any adverse affects from the Buchu or placebo cream.

 

 

   

INTRODUCTION

 

 

The herb Buchu, (Arathosama betulina) was introduced to the early Cape Colonists by the indigenous Khoi-San people in the 1700’s. The Khoi-San considered the herb a panacea for all ailments including rheumatism gout, cystitis, diarrhoea, nausea, asthma, colds and coughs. Anecdotal observations suggest that the herb relieves inflammation in the muscles and joints. A recent study has shown that the essential oils extracted from Buchu do indeed have anti-inflammatory properties in vitro and that these effects could account for its reported benefit to patients suffering from chronic inflammatory conditions.1 However, the scientific evidence to confirm that these in vitro findings manifest in v/ye are lacking. Accordingly, the aim of this study was to measure the effectiveness of a topical application of Buchu cream treatment on reducing the severity of muscle pain, inflammation and loss of muscle function arising from exercise-induced muscle damage.

 

 

METHODS

 

 

Study design

 

The study was a double-blind placebo-controlled trial, using healthy male volunteers. Muscle function and muscle recruitment were assessed in the biceps muscles of the male subjects before their non-dominant arms were exposed to an exercise protocol which caused muscle damage. Subjects were treated with either Buchu cream, or an indistinguishable placebo, before the experiment and three times a day for 96 (4 days) hours thereafter. Both the damaged and non-damaged biceps muscles in both groups were monitored up to 168 hours for;

 

  • muscle pain,

 

  • muscle function,

 

  • swelling and passive shortening of the muscle (as defined by elbow angle)

 

  • serum creatine kinase activity (as a marker of muscle damage)

 

 

 

The efficacy of the Buchu cream in reducing the symptoms of this acute soft tissue injury was measured as changes in muscle pain, muscle function, swelling and passive shortening between the damaged and non-damaged arm and between the experimental (Buchu) and control (Placebo) groups.

 

 

Subjects

 

Thirty males, aged between 25 to 40 years, with no known elbow joint disease, were recruited for the study. The subjects were only included in the study if they had not been involved in any eccentric training of the arms for the previous 12 weeks. The subjects completed a questionnaire to determine age, training history, medical and surgical history, and any past or present injuries to the upper limbs, After the nature, purpose, and testing procedures of the study were thoroughly explained, each subject signed an informed consent, The study was approved by the University of Cape Town Research and Ethics Committee.

 

 

The subjects were randomly divided into either a placebo or an experimental group. The decision on the group allocation for the first subject was done randomly (by flipping a coin). The next subject was assigned to the other group. This process of group allocation was repeated for each pair of subjects thereafter.

 

 

The subjects in the experimental group had Buchu cream applied to the biceps muscle before the exercise protocol which was designed to cause muscle damage, and the subjects in the placebo group received placebo treatment for the same duration. The identity of the Buchu cream or placebo treatment was not known to the researchers or the subjects until the study was completed. The subjects were asked to refrain from taking any other form of medication, including anti-inflammatory agents, during the study period. All subjects were also asked to avoid alcohol consumption for two days before testing and for the duration of the study. In addition, subjects were also asked to avoid any strenuous physical aOtivity for the duration of the study.

 

 

Body composition

 

On the first day the subjects’ body mass, stature, body composition (Durnin and Womersley, 1974), sum of seven skinfolds (triceps, biceps, subscapular, supra-iliac, abdominal, thigh, calf as described by Ross and Marfell-Jones, 1991) were measured.

 

 

Eccentric bout of exercise to induce muscle damage and pain

 

Muscle damage was induced in the non-dominant biceps muscle by a series of eccentric muscle actions (i.e. the muscle lengthens while producing force) on the Kin-Corn dynamometer (Chattanooga Group, Inc., Chattanooga, USA). The protocol consisted of 5 sets of eccentric actions with 25 reps each set at 80% of the subject’s maximum eccentric action. This protocol has been used previously (Lambert et al, 2002) and produces clinical symptoms which are associated with exercise-induced muscle damage. The Buchu cream (or placebo) was applied immediately after the exercise protocol and treatment continued three times a day for 96 hours.

 

 

Muscle function

 

Muscle function (peak concentric and eccentric force) of the exercised and non-exercised biceps muscles was assessed using a Kin-Corn sokinetic dynamometer (Chattanooga Group, Inc., Chattanooga, USA) at 24 hours before the muscle was damaged and again at 12, 24, 48, 72, 96, 120, 144 and 168 hours thereafter.

 

 

Blood sampling and analysis

 

Blood samples (5 ml) were collected from an antecubital vein prior to each test of muscle function. The blood samples was kept on ice until centrifugation (2000 rpm x g for 10 minutes at 4° C). Each sample was stored in an Eppendorf tube at -20° C until the analysis of serum creatine kinase activity. Serum creatine kinase (CK) activity was measured by a spectrophotometric (Beckman DU-62, Beckman Instruments, Fullerton, California, USA) enzymatic assay (CK- NAC- activated, Boehringer Mannheim Automated Analysis for 3M/Hitachi Systems 704, Meylan, France). Serum CK activity was assessed immediately prior to each test of muscle function.

 

 

Muscle soreness

 

Muscle soreness was measured at fixed sites on the biceps by measuring the farce required to elicit tenderness as previously described (Lambert et al, 2002). In brief, a round-ended probe (2 cm diameter), constructed by the Biomedical Engineering Department of University of Cape Town, was pressed into the muscle to elicit pain. The probe was calibrated so that a depression of 1 cm was equivalent to a force of 4 N. Muscle soreness was assessed immediately prior to each test of muscle function.

 

 

Muscle soreness was also measured subjectively according to a “rating of perceived pain” scale. The rating (on a scale from 0 to 10) determined the following categories in both arms: 1) general pain, 2) pressure pain, 3) stretch pain and 4) pain during the involvement of the arm in daily activity.

 

 

Girth measurements

 

A resting girth measurement of both biceps was measured 24 hours before the muscle was damaged, and again on each occasion when the muscle function were measured. The girth was measured between the acromion and radiale bony landmarks, with the arm relaxed and hanging by the side.

 

 

Resting angle of elbow joint

 

The resting angle of the elbow joint (humerus/arm) was measured to represent the shortening of the biceps muscle. The angle was measured with a goniometer 24 hours before the muscle was damaged, and again on each occasion when the muscle function was measured.

 

 

Assessment of the subjects’ tolerability of the Buchu cream

 

The subjects’ tolerability to the Buchu cream and any adverse events from the cream were assessed whenever the subjects visited the laboratory.

 

 

Statistical analyses

 

Statistical analyses were performed using Statistica software (StatSoft, Inc, Tulsa, OK, USA). All data are expressed as mean ± standard deviation. Statistical significance was assessed by an analysis of variance (ANOVA) with repeated measures. Post-hoc comparisons ‘were performed with a Tukey test. Statistical significance was accepted when P < 0.05.

 

 

RESULTS

 

 

General characteristics

 

The general characteristics of the subjects are shown in Table 1. There were no significant differences between groups for any of these variables. According to the subjective reports, all subjects were compliant with the requirements about avoiding medication and strenuous activity for the duration of the study.

 

 

Table 1: General characteristics of the Buchu (n = 15) and control (n 15) subjects). A~I values are expressed as means ± standard deviation.

Variables                             Buchu                                 Placebo

Age (years)                           26.3 ± 6.1                             25.0 ± 5.7

Mass (kg)                              73.1 ± 8.6                             75.8 ± 13.0

Stature (cm)                          174.7 ± 6.6                           178.7 ± 7.0

Sum of 7 skinfolds (mm)       70.5 ± 17.8                           71.2 ± 21.8

Body fat (%)                         16.6 ± 3.3                             16.7 ± 2.9

 

 

 

No adverse events related to the treatment with Buchu or placebo cream was reported for either group during the experiment.

 

 

Muscle function

 

The peak concentric torque for the rested and exercised arm in both groups is shown in Figure 1. Both groups had reduced muscle function from 12 to 120 hours in the exercised arm (P <0.0001). The concentric torque in the rested arm in both groups did not change over the experiment.

 

 

   

 

 

 

 

 

 

Figure 1:

The concentric torque in the rested and exercised arm in the placebo group (n = 15) and Buchu group (n = 15). The exercised arms had significantly lower concentric torque at 12, 24, 46 72, 96 and 120 hours (P <00001) than the rested arms in both groups.

 

 

 

 

When the concentric strength data were analysed as the difference between the rested and exercised arm for each group there was a group effect with the impairment in concentric strength being greater in Buchu vs. placebo group: P C 0.032). There was also a time effect (P <0.0001). There was a trend for the interaction between group X time, however this was not statistically different ( P C 0053). These data are shown in Figure 2.

   

 

 

 

 

 

 

 

  

 

Figure 2: The difference in concentric torque (Nm) between the rested and exercfsed arm in the placebo (ii = 15) and Buchu groups (n = 15).

 

# F c 0.032 group effect

*  P <0.0001 different to pre-triat values

 

 

The peak eccentric torque data are shown in Figure 3. Both groups had reduced eccentric muscle function from 12 to 120 hours (P <0.0001) in the exercised arm. The peak eccentric torque in the rested arm in both groups did not change over the experiment There was no interaction between group X time.

 

  

 

  

 

Figure 3: The eccentric torque in the rested and exercised arm n the placebo group (n = 15) and Buchu group (n = 15). The exercised arms had significantly lower eccentric torque at 12,24,48,72, 95 and 120 hours (P <0.0001) than the rested arms in both groups.

 

 

When the eccentric strength data were analysed as the difference between the rested and exercised arm for each group there was a time effect (P C 0.0001). There was no significant interaction between group X time ( P C 0.42). These data are shown in Figure 4.

 

 

 

 

 

 

 

Figure 4: The difference in eccentric torque (Nm) between the rested and exercised arm in the placebo (n = 15) and Buchu groups (n = 15).

 

*       P <0.0001 pre-trial values different Ia all other values

 

 

Serum creatine kinase activity

 

The serum creatine kinase activity was significantly increased in both groups (P < 0.001) at 48, 72, 96 and 120 hours compared the value before the exercise. There were no differences between groups (Figure 5).

 

 

 

 

 

 

Figure5:  Serum creatine kinase activ~ty (IU) in the placebo (n = 15) and Buchu groups (n = 15).

 

*            P <0.001 different to pre-trial values

 

 

 

Pain

 

The “general” pain scores are shown in Figure 6. The data are presented as the difference in pain between the exercised and rested arm. The pain was significantly higher (Pc 0.001) at 24, 48, 72, 96, 120 and 144 hours after the exercise. There were no differences between groups. The “stretch pain” and “pain during the involvement of the arm in daily activity” had a similar response.

 

 

  

 

 

 

 

 

 

Figure 6: General pain, expressed as the difference between the exercised and non-exercised arm for the placebo

(n = 15) and Buchu (n 15) groups.

 

 

*            pc 0.001 pre trial vs. 24, 48, 72, 96, 120 and 144 hours

 

 

 

The “pressure pain” scores are shown in Figure 7. The data are presented as the difference in pain between the exercised and non-exercised arm. The “pressure” pain was significantly higher (Pc 0.001) at 12, 24,48,72,96 and 120 hours after the exercise. There were no differences between groups.

 

 

  

 

 

 

 

 

Figure 7: General pain, expressed as the thfference between the exercised and rested arm for the placebo (n = 15) and Buchu (n = 15) groups.

 

 

P <0.001 pro trial vs. 12, 24, 46, 72, 96, 120 hours

 

 

 

Arm girth

 

The mid-girth measurement of the biceps is shown in Figure 8. There was a significant difference over time (P <0.0001) and there was also a significant interaction between groups (P C 0.038). Figure 8 shows there was marginally less swelling in the Buchu compared to the Placebo subjects.

 

 

 

 

 

 

 

Figure 8: The difference in mid-arm girth between the rested and exercise arm of the placebo (n = 15) and Buchu groups (n = 15).

*     P <0.0001 pre-trial values different to all values # P <0.038 interaction group X time

 

 

 

Elbow angle

The elbow angle decreased, and by implication the biceps muscle shortened, in both groups at 12, 24, 48, 72, 96 and 120 hours after the exercise (P <0.001) (Figure 9).

There were no differences between groups.

 

  

 

 

 

 

Figure 9: The difference in e!bow angle between the rested and exercise arm of the placebo (n = 15) and Buchu groups (n = 15).

 

Pc 0.001 pre-trial vs. 12, 24 48,72,96 and 120 hours

 

 

Discussion

 

 

The one-armed exercise model used in this study showed clearly that there were clinical symptoms of muscle damage. Examples of these symptoms were impaired muscle function, increased serum creatine kinase activity, swelling of the exercised arm and muscle shortening. The subjects were well matched, therefore it is safe to assume that any differences between groups (Buchu vs. Placebo) reflect the efficacy of the Buchu treatment.

 

 

The first finding of this study was that muscle function, measured as peak concentric torque was impaired in both groups. A more detailed analysis of the results suggest that the impairment was greater in the Buchu group. Although this was statistically different it is arguable that the magnitude of difference between groups (± 5 - 10 Nm) was not relevant from a practical perspective. The fact that peak eccentric torque was similar in both groups suggest that the changes observed in the peak concentric torque were quite specific. Further research will need to determine the practical relevance and mechanism of this finding in peak concentric torque.

 

The next finding was that the Buchu group had significantly less swelling of the exercised arm compared to the placebo group. This difference was pronounced and of clinical relevance. The reduction in swelling, and by impflcation the inflammatory response, did not manifest as a reduction in pain in the Buchu group. An interpretation of these data is that the pain was too severe and perhaps not tightly coupled to the magnitude of swelling.

 

 

In conclusion, this experiment showed that the exercise model induced clinical symptoms which suggested severe exercise-induced muscle damage of the biceps muscle. The treatment with Buchu reduced the swelling in the damaged muscle. This however seemed to be accompanied by a greater impairment in concentric muscle function in the Buchu group for which there is no immediate explanation.

 

 

 

References

 

 

Dumin, J.V.G.A. and J. Womersley. Body fat assessed from the total density and its estimation from skinfold thickness: Measurements on 481 men and women aged from l6to 71 years. British Journal of Nutrition. 32: 77-97, 1974.

 

Lambert MI.1 Marcus R Burgess T. and Noakes TD. Electro-membrane microcurrent therapy reduces signs and symptoms of muscle damage, Medicine and Science in Sports Exercise. 34(4): 602 —607, 2002.

 

Ross, W.D. and M.J. Marfell-Jones. Kinanthropometry. In: Physiological Testing of the High Performance Athlete, (edited by J.D. MacDougall, HA. Wenger and H.S. Green), Champaign, IL: Human Kinetics, 1991, pp. 223-308

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