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Journal of Integrative Medicine ›› 2016, Vol. 14 ›› Issue (2): 114-120.doi: 10.1016/S2095-4964(16)60243-1

Special Issue: Natural Drug

• Research Article • Previous Articles     Next Articles

Effects of Zingiber cassumunar (Plai cream) in the treatment of delayed onset muscle soreness

NuttasetManimmanakorna , ApiwanManimmanakornb, DisaphonBoobphachartc, WorrawutThuwakumd, WiroonLaupattarakaseme, Michael Jhamlinf   

  1. a Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
    b Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
    c Department of Physical Education, Faculty of Education, Ubonratchathani Rajabhat University, Ubonratchathani, 34000, Thailand
    d Department of Sport Science, Faculty of Science, Uttaradit Rajabhat University, Uttaradit, 53000, Thailand 
    e Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand 
    f Department of Tourism, Sport and Society, Lincoln University, Lincoln, 7647, Christchurch, New Zealand
  • Received:2015-08-09 Accepted:2015-12-17 Online:2016-03-15 Published:2016-03-15
  • Contact: Nuttaset Manimmanakorn, MD, PhD; E-mail:


To evaluate the effects of Zingiber cassumunar (Plai cream) in either 7% or 14% concentration on delayed onset muscle soreness (DOMS).


Seventy-five untrained healthy volunteers (28 males and 47 females), performed 4 sets of 25 eccentric repetitions of the dominant quadriceps muscle on an isokinetic dynamometry machine. Participants were then randomized into 3 groups: 14% Plai cream, 7% Plai cream and placebo cream. Two grams of the cream (strips of 5-cm long) were gently rubbed into the quadriceps muscles for 5 min immediately following the exercise and every 8 h thereafter for 7 d in all groups. Muscle soreness, muscle strength, jump height, thigh circumference and creatine kinase were measured before and after eccentric exercise.


Compared to the placebo cream the 14% Plai cream substantially reduced muscle soreness over the 7 d by -82% (95% CI = -155% to -6%, P = 0.03), but had similar muscle soreness effects to 7% Plai cream (-34%, -96% to 27%, P = 0.2). Compared to the placebo cream the 7% Plai cream resulted in a small non-significant reduction in muscle soreness levels over the following 7 d (-40%, -116% to 36%, P = 0.3). Compared to placebo cream there was little effect of Plai cream (7% or 14%) on muscle strength, jump height, thigh circumference or creatine kinase concentration.


Using 14% Plai cream over a 7-day period substantially reduced muscle soreness symptoms compared to 7% Plai cream or a placebo cream. The authors suggest that the administration of 14% Plai cream is a useful alternative in the management of DOMS.

Key words: Plai cream, Muscle soreness, Muscle strength, Creatine kinase

1 Cheung K, Hume P, Maxwell L.Delayed onset muscle soreness: treatment strategies and performance factors.Sports Med. 2003; 33(2): 145-164.
2 Connolly DAJ, Sayers SE, Mchugh MP.Treatment and prevention of delayed onset muscle soreness.J Strength Cond Res. 2003; 17(1): 197-208.
3 Gleeson M, Almey J, Brooks S, Cave R, Lewis A, Griffiths H.Haematological and acute-phase responses associated with delayed-onset muscle soreness in humans.Eur J Appl Physiol Occup Physiol. 1995; 71(2): 137-142.
4 Warren GL, Hayes D, Lowe D, Prior B, Armstrong R.Materials fatigue initiates eccentric contraction-induced injury in rat soleus muscle.J Physiol. 1993; 464(1): 477-489.
5 Bovill JG.Mechanisms of actions of opioids and non-steroidal anti-inflammatory drugs.Eur J Anaesthesiol Suppl. 1997; 15: 9-15.
6 Baldwin AC, Stevenson SW, Dudley GA.Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals.J Gerontol A Biol Sci Med Sci. 2001; 56(8): M510-M513.
7 Rahnama N, Rahmani-Nia F, Ebrahim K.The isolated and combined effects of selected physical activity and ibuprofen on delayed-onset muscle soreness.J Sports Sci. 2005; 23(8): 843-850.
8 Cannavino CR, Abrams J, Palinkas LA, Saglimbeni A, Bracker MD.Efficacy of transdermal ketoprofen for delayed onset muscle soreness.Clin J Sport Med. 2003; 13(4): 200-208.
9 Jeenapongsa R, Yoovathaworn K, Sriwatanakul KM, Pongprayoon U, Sriwatanakul K.Anti-inflammatory activity of (E)-1-(3,4-dimethoxyphenyl) butadiene fromZingiber cassumunar Roxb. J Ethnopharmacol. 2003; 87(2): 143-148.
10 Masuda T, Jitoe A, Mabry TJ.Isolation and structure determination of cassumunarins A, B, and C: new anti-inflammatory antioxidants from a tropical ginger,Zingiber cassumunar. J Am Oil Chem Soc. 1995; 72(9): 1053-1057.
11 Panthong A, Kanjanapothi D, Niwatananant W, Tuntiwachwuttikul P, Reutrakul V.Anti-inflammatory activity of compound D {(E)-4-(3′,4′-dimethoxyphenyl) but-3-en-2-ol} isolated fromZingiber cassumunar Roxb. Phytomedicine. 1997; 4(3): 207-212.
12 Laupattarakasem W, Kowsuwon W, Laupattarakasem P, Eungpinitpong W.Efficacy ofZingiber cassumunar Roxb.(Plygesal) in the treatment of ankle sprain. Srinagarind Med J. 1993; 8(3): 159-164.
13 Srirochana S.Efficacy of Plai cream compared with diclofenac gel in osteoarthritis of knee. Mahasarakham Hosp J. 2010; 7(2): 53-60.
14 Summers S.Evidence-based practice part 2: reliability and validity of selected acute pain instruments.J Perianesth Nurs. 2001; 16(1): 35-40.
15 Jurenka JS.Anti-inflammatory properties of curcumin, a major constituent ofCurcuma longa: a review of preclinical and clinical research. Altern Med Rev. 2009; 14(2): 141-153.
16 Makris UE, Kohler MJ, Fraenkel L.Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review.J Rheumatol. 2010; 37(6): 1236-1243.
17 Davies NM.Clinical pharmacokinetics of ibuprofen. The first 30 years.Clin Pharmacokinet. 1998; 34(2): 101-154.
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