Exercise-induced muscle damage and the potential protective role of estrogen

Sports Med. 2002;32(2):103-23. doi: 10.2165/00007256-200232020-00003.


Exercise-induced muscle damage is a well documented phenomenon that often follows unaccustomed and sustained metabolically demanding activities. This is a well researched, but poorly understood area, including the actual mechanisms involved in the muscle damage and repair cycle. An integrated model of muscle damage has been proposed by Armstrong and is generally accepted. A more recent aspect of exercise-induced muscle damage to be investigated is the potential of estrogen to have a protective effect against skeletal muscle damage. Estrogen has been demonstrated to have a potent antioxidant capacity that plays a protective role in cardiac muscle, but whether this antioxidant capacity has the ability to protect skeletal muscle is not fully understood. In both human and rat studies, females have been shown to have lower creatine kinase (CK) activity following both eccentric and sustained exercise compared with males. As CK is often used as an indirect marker of muscle damage, it has been suggested that female muscle may sustain less damage. However, these findings may be more indicative of the membrane stabilising effect of estrogen as some studies have shown no histological differences in male and female muscle following a damaging protocol. More recently, investigations into the potential effect of estrogen on muscle damage have explored the possible role that estrogen may play in the inflammatory response following muscle damage. In light of these studies, it may be suggested that if estrogen inhibits the vital inflammatory response process associated with the muscle damage and repair cycle, it has a negative role in restoring normal muscle function after muscle damage has occurred. This review is presented in two sections: firstly, the processes involved in the muscle damage and repair cycle are reviewed; and secondly, the possible effects that estrogen has upon these processes and muscle damage in general is discussed. The muscle damage and repair cycle is presented within a model, with particular emphasis on areas that are important to understanding the potential effect that estrogen has upon these processes.

Publication types

  • Review

MeSH terms

  • Calcium / physiology
  • Calpain / physiology
  • Creatine Kinase / physiology
  • Cytokines / physiology
  • Estrogens / physiology*
  • Exercise / physiology*
  • Homeostasis
  • Humans
  • Muscle, Skeletal / injuries*
  • Muscle, Skeletal / physiology
  • Myositis / physiopathology
  • Pain / physiopathology
  • Perception


  • Cytokines
  • Estrogens
  • Creatine Kinase
  • Calpain
  • Calcium