Lindee Abe, APRN
Have you had a hard workout and several days later you are feeling the full effects? Is this just because you are getting older? What can help this? Is this an injury? Why am I so sore? High intensity training is the new trend in fitness and with it comes new concerns from those just starting and some that have been doing that type of training for a while. Every day it seems there are more and more Crossfit gyms, cardio classes, HIIT classes popping up everywhere. Then there is also all the new social media groups and posts promising amazing results in a short period of time.
Athletes should expect to be sore. However, some experience intense soreness that is worse than they have every experienced. It may begin several days after the activity. Of course they become worried if this is normal? Should they continue with their new program? All of these are normal questions that people have, leading them to seek medical care. Often times they seek medical care because they believe they have injured themselves.
What is muscle soreness?
During exercise, one can experience muscle soreness. This is due to the buildup of lactic acid. However, if there is muscle pain then keep in mind it is more likely an injury. This is a key differentiation to make with people just starting out with a new exercise program. The muscle soreness in this scenario is acute and resolves shortly after exercise is stopped.
The focus of this post is on the delayed onset muscle soreness (DOMS). So what exactly is DOMS? It is a delayed soreness that according to the American College of Sports Medicine, develops at least 12-24 hours after exercise and peaks one to three days later. There are several proposed theories as to why this happens. No universally accepted cause exists. There is one piece of the puzzle that the American College of Sports Medicine has noted to be true: DOMS is not caused by lactic acid build up. This is what makes it different than acute muscle soreness. Muscle soreness can occur as there are microscopic tears to the muscle during activity that as the body repairs these tears and the muscle grows strong, will cause a soreness in the muscle itself.
Eccentric Movement
It is frequently heard that specific activities or exercise programs cause DOMS, i.e. CrossFit. However, it is not the sport/exercise program that cause DOMS, but rather the specific type of exercise performed. There is one universal exercise that is known to cause DOMS and that is eccentric movement. Eccentric movement is more specifically a movement where the muscle is lengthened while under tension force. Examples would be slowly lowering from a pull up, “negatives”, pause squats, calf raises, slow bicep curls. DOMS is also caused by new exercises and high intensity training. DOMS is not specific to only new athletes, though. It can also affects seasoned athletes performing high repetition activities or increasing the load to the muscle substantially in a single exercise session.
It is important to note that DOMS is not rhabdomyolysis. Both can cause muscle soreness, but DOMS can be an expected outcome after a difficult workout, a normal variant. Rhabdomyolysis is an abnormal finding/result of a work out. Don’t worry, there will be further discussion on rhabdomyolysis in a subsequent post.
There are several other associated symptoms with DOMS aside from just the muscle soreness. These symptoms include swelling and stiffness of the muscles involved, sometimes with tenderness with palpation of the area. The picture that comes to mind is that of Popeye’s arm with athletes that perform high repetition bicep curls with a focus on the negative part of the movement. Athletes should know that affected muscles will suffer lower performance for several days.
How to Treat DOMS
The next question is always how to treat it. The fitness industry is great at marketing all sorts of products that are meant to help with recovery. There are hundreds of pieces of equipment, special drinks, creams, pills that are all advertised to significantly reduce recovery. There are some things that can help, but at the end of the day the body has to have sufficient time to heal. Rest is important in order for the body to health itself. Treatments such as cryotherapy, stretching, homeopathy, ultrasound and TENs units do not effectively reduce the soreness and pain associated with DOMS. There is some benefit with NSAIDs and massage for treatment modalities. Athletes should be informed that while these treatments may help to alleviate their pain, it does not mean that the muscle is recovered. These patients should be cautious to resume regular activities.
Massage and NSAIDs are most effective initially after activity (think that same day) in order to mitigate some of the inflammatory process. Manual massage with a foam roller is effective. Foam rollers are excellent tools that are not very expensive that can help with the manual massage of the muscle. Encouraging athletes to utilize this after a tough workout that involved a heavier than normal load or lots of eccentric movement may be
one way to help decreased DOMS.
Prevention
There are also ways to prevent DOMS. The primary way to prevent DOMS is to not overload the body with new activities. Developing a slow build up in intensity or working with a personal trainer will help to ensure that progress is made without being so sore it affects everyday life. The American College of Sports Medicine also stresses the importance of warming up the muscles for exercise. This is especially true using a combination of dynamic warm ups (skipping, shuffling, lunges) and mobility stretching. While arm up and stretches haven’t been shown to directly reduce DOMS symptoms, muscles will perform better and are less likely to be injured with a proper warm up. There was also a study that showed that compression garments may be helpful with preventing DOMS. The study reviewed the use of compression garments following eccentric movements for up to 24 hours after the activity.
The athlete should be instructed that the soreness from DOMS can last 3-5 days. They should be reducing their high intensity activities for 1-2 days following the exercise that cause DOMS. Athletes should limit the use of the affected muscles if possible. It is important to make sure the athlete understands that rest is essential for new muscle growth and without rest they will limit their body’s ability to build muscle. Athletes should be encouraged to continue with exercise. They should also be reassured that DOMS does get better as the body gets used to the exercise.
References:
Braun, W. & Storzo, G. (2011). ACSM Information on…..Delayed Onset Muscle Soreness (DOMS). Retrieved from https://www.acsm.org/docs/default-source/files-for resourcelibrary/delayed-onset-muscle-soreness-(doms).pdf?sfvrsn=8f430e18_2.
Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and
performance factors. Sports Med. 2003;33(2):145-64. doi: 10.2165/00007256-200333020-00005. PMID: 12617692.
Kim, J., Kim, J., & Lee, J. (2017). Effect of compression garments on delayed-onset muscle soreness and blood inflammatory markers after eccentric exercise: a randomized controlled trial. Journal of exercise rehabilitation, 13(5), 541–545. https://doi.org/10.12965/jer.1735088.554.