The sun is shining! The sky is blue! The thermometer’s mercury is no longer hovering near the bottom of the glass. It’s finally time to get back outside and complete all those projects on your honey’s “to-do” list or at the very least, get a handle on your yard work.
If you’re anything like me, you tend to “go big or go home” and just charge through a project because you: A) really love doing it (and, at least during the activity, you feel good) or B) just want to get it over and done with. But then mysteriously approximately 12-48 hours later, your muscles are screaming at you in pain.
WHAT'S GOING ON HERE?
In short, you may have DOMS – which stands for Delayed Onset Muscle Soreness.
You may have DOMS if you have:
Pain that is “achey” or “dull” in quality
If it’s BURNING or SHARP = Please see your doctor or physiotherapist as this may indicate an injury
Tenderness when you gently poke your finger over the muscle/sore spot
Stiffness when moving your arm/leg/back (affected limb/body part)
It shows up approx. 12-48 hours after a “new” activity
Is worst approx. 24-48 hours post “new” activity
Then decreases in intensity after ~48 hours
(The good news is that DOMS generally fully recovers in approx. 3-5 days)
IS THIS NORMAL?
Yes, it’s very common. Anyone from the sedentary couch potato to the top Olympic-level athlete can get this. Essentially DOMS occurs when your muscles are exposed to higher amounts of physical stresses or exercise than your tissue is used to. This can occur whether you’re starting to shovel the dirt in your garden after your long months of winter hibernation OR whether you have significantly increased your training load (ie. doing 100 push-ups when you rarely do any) because you saw another “Exercise Challenge” on social media.
DOMS has also been linked to eccentric exercises (and no, that’s not referring to your crazy/weird/eccentric Auntie Suzie). Eccentric refers to the muscle fibres themselves lengthening while still under tension. For example, your bicep muscle (on the front of your upper arm) works eccentrically when you lower a bag of groceries carefully (so as to not break the eggs!) onto the ground – lengthening, while still controlling the load. Your quadriceps (on the front of your thigh) also work eccentrically – for example, when walking down stairs as well as during the lowering phase as you squat down (just like in gardening).
UNDER THE MICROSCOPE/What is ACTUALLY GOING ON?
Researchers are still looking into the detailed biochemistry of DOMS. Their current best hypothesis or model is a combination of several theories – which is summarized below:
Too much force, too soon, and/or for too long = results in micro damage to the structural proteins inside the muscle fibres
This then results in local inflammation and swelling (in addition to the release of histamine and monocytes (which are a type of white blood cell))
All of which lowers the sensitivity of and can stimulate the nerve endings – which relay the “Danger” signal up to the brain
What researchers do know for sure is that DOMS is NOT due to lactic acid build-up in the muscles. Intra-muscular lactic acid levels DO rise during exercise, but return to normal, pre-exercise levels within 1 hour of hard exercise. In addition, lactic acid levels do not correlate well with reported pain/soreness levels – ie. someone reporting 8/10 pain may have low lactic acid levels, whereas someone else may also report 8/10 pain but have high lactic acid levels…
Consequently, without a known specific mechanism or cause of DOMS, it’s challenging to have a “cure” or at least a treatment for this pain.
The best treatment is PREVENTION! Which means a graduated approach to exercise and activity levels.
Instead of mowing the entire lawn on the first sunny day of spring – try mowing only ½ of it one day, and finish the other half the next day (or at least take a few hours break and then come back to it later).
Or if you’re wanting to start a new fitness regimen, start small & slow and see how your body responds to it. Ideally you should give your muscle tissue at least 24-48hours (to recover and rebuild itself stronger) before returning to the same or higher level of activity/exercise.
By gradually exposing your muscles to increasing loads/forces, you will reduce the chance of getting a bad case of DOMS as well as prevent future injuries!
The good news is that according to the ACSM (American College of Sports Medicine), getting DOMS once actually reduces your risk of getting DOMS again for that specific activity for the next few months afterwards!
Long story short: While you may not ever completely eliminate post-exercise soreness, by gradually progressing your activity level, you’ll certainly reduce the intensity and duration of your soreness as well as prevent future injuries!
WHAT IS NORMAL to feel during/after exercise?
Any of the following either during or after exercise is NEVER okay and should get checked out by a doctor or physiotherapist:
Sharp pains
“Nerve-y”symptoms (ie. “tingling”, “buzzing”, “pins and needles”, “numbness”)
Joint swelling
However, some degree of a mild dull “ache” and fatigue in a muscle during or after exercise may be normal. On a scale of 0 to 10, where 0 = no pain and 10 = worst pain imaginable, the:
Green zone (or safe zone for this “achy” pain) = 0-3/10
Yellow zone (ie. you should consider slowing down/stopping if this activity soon) = 4-5/10
Red zone (ie. you should stop or risk injuring yourself) = 6-10/10
What can I do to help with this DOMS/pain?
As they say, “Hindsight is 20/20”… Prevention may be fine to plan for in the future, but you may be thinking “what can I do about my pain right now?”
Unfortunately, not much. Time and rest from that particular activity (for 1-3days afterwards) is truly the only “cure” for DOMS. (We just need to get a time machine!)
Over the counter Non-Steroidal Anti-Inflammatory Drugs (such as ibuprofen) and applying heat (either via a hot pack or soaking in a hot tub) may help reduce your pain, but sadly it won’t improve your muscle’s performance and function (ie. your arm will still feel weak to lift or your leg will fatigue when climbing up a hill).
How about getting a massage? The research behind the effect of massage on DOMS is variable at best and weak in quality (ie. studies only use 10-20 sets of limbs, not hundreds – which limits generalization to the entire population). You can certainly try it, but one study only reported a decrease of pain of approximately 20-40% which isn’t much (Zainuddin et al., 2005).
What can Physiotherapy do for you?
While we may not have time machines, magic wands, or a true “cure” for DOMS yet, we CAN help you prevent DOMS in the future by working WITH you to create an individualized and progressive exercise program.
We can help guide you from where you are…to where you want to be!
From getting out of breath after walking up a flight of stairs…
…to being able to hike up a hill!
From feeling back pain after lifting up your growing baby just once…
…to lifting your baby (for what seems like the thousandth time) without any nagging back pain.
From having knee, hip, or back pain when gardening…
to being able to squat down just to “smell the roses”.
If you have any further questions about DOMS or would like to discuss a prevention plan, feel free to book a Telehealth appointment with me at InReach Physiotherapy!
By: Susan Herdman, Registered Physiotherapist – Specializing in Upper Extremity and Hand Tele-rehabilitation
Susan provides online physio (aka telephysio, virtual physio, telerehab) to patients all over British Columbia including Haida Gwaii, Fort St James, Fraser Lake, Fort St John, Fort Nelson, Dease Lake, Dawson Creek, Hudson's Hope, Mackenzie and Stewart. She also collaborates with the First Nations Health Authority to provide service. Susan lives on beautiful Vancouver Island between Nanaimo and Victoria.
REFERENCES:
American College of Sports Medicine - Braun W & Sforzo G (2011). ACSM Information on...Delayed Onset Muscle Soreness. https://www.acsm.org/docs/default-source/files-for-resource-library/delayed-onset-muscle-soreness-(doms).pdf?sfvrsn=8f430e18_2
Brooks, GA, Fahey, TD, & Baldwin KM (2005). Exercise Physiology: Human Bioenergetics and Its Applications 4th Ed. McGraw Hill
Cheung K, Hume PA, & Maxwell L (2003). Delayed onset muscle soreness: Treatment strategies and performance factors. Sports Med 2003; 33 (2): 145-164
Henschke N, Lin CC (2011). Stretching before or after exercise does not reduce delayed-onset muscle soreness. British Journal of Sports Medicine 2011;45:1249-1250.
Hilbert JE, Sforzo GA, & Swensen T (2003) The effects of massage on delayed onset muscle soreness. Br J Sports Med 2003; 37:72–75 https://bjsm.bmj.com/content/bjsports/37/1/72.full.pdf
Ingraham P. (2021, Mar 19). A Deep Dive into Delayed-Onset Muscle Soreness: The biology & treatment of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar workout intensity. https://www.painscience.com/articles/delayed-onset-muscle-soreness.php
Silbernagel KG, Thomeé R, Eriksson BI, & Karlsson J (2007). Continued sports activity using a pain monitoring model during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med 35(6):897‐905
Zainuddin Z, Newton M, Sacco P, & Nosaka K (2005 July). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train: 40(3):174–180. https://pubmed.ncbi.nlm.nih.gov/16284637/