Injury versus Soreness

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How do you know the difference between muscle soreness and an injury? Learn several techniques to alleviate muscle soreness after a hard workout.

By Troy Smurawa, MD
Member AMSSM

Post-exercise muscle soreness and discomfort are familiar occurrences in novice and elite athletes.  Muscle soreness and fatigue are the normal responses of muscle tissue to overload and exertion and is a part of the adaptation process that leads to greater stamina and strength as the muscles tissue recovers and builds stronger.

Athletes train by the principle of super-compensation.  The principle of OVERLOAD refers to imposing a demand onto the body’s systems and allowing them to adapt to that load.  Overload is the stimulation for the body to improve its ability to handle higher levels of training stress.  An appropriate level of stress leads to adaptation while non-adaptation occurs from too high of a stress load.  Non-adaptation leads to over-training and injuries.  The fundamental principle of training is to give the body a tough workout followed by the right amount of rest.  A gradual increase in workload, with appropriate rest, stimulates further improvement in conditioning.  Gradual increases in duration and intensity will improve endurance, power and strength.

The principle of ADAPTATION refers to the body’s ability to change and adjust to the new demands training imposes.  The goals of training adaptation are 1) to increase the workload that can be performed at the same intensity, and 2) to perform the same workload at an increased intensity.  Anaerobic adaptation is a result of increased muscle fiber strength and recruitment, increased lactic acid tolerance and increased glycogen utilization.  Muscles adapt by increasing the ability to utilize glycogen at a higher intensity and slow down the build-up of lactic acid.  Muscles increase the ability to tolerate lactic acid at a higher intensity. 

Training produces repetitive stress to muscles, tendons and tissues around joints and bones.  Ideally, an overload stimulus is applied to improve strength and endurance.  Following the overload the body is temporarily broken down and fatigued.  After recovery and regeneration, performance is enhanced.  Over-training occurs when the athlete’s training program exceeds the body’s ability to adapt.  The athlete pushes his or her body beyond the limits of recovery and adaptation.  The continuous stress produces repetitive microtrauma.  Overuse injuries result from the body’s inability to keep up with repair of the damage created from repetitive microtrauma to tendons and muscles.  The body’s tissue eventually breaks down resulting in pain, inflammation and weakness.  If an athlete ignores the pain and inflammation and continues to train regardless, it will lead to macrotrauma and disruption of the tendon or muscle.  Eccentric muscle exercises are more likely to cause muscle soreness and damage than concentric exercises.  Examples of eccentric muscle contractions include going down stairs, running downhill, lowering weights and the downward motion of squats and push-ups.

Muscle soreness presents with muscle stiffness, aching pain and muscle tenderness immediately after exercise and are transient lasting only hours. If this process is taken to extreme it may not adapt to the stress and lead to muscle strains and injuries. Muscle strains are injuries from small muscle tears there can be associated swelling and bruising in a muscle and contribute to soreness.   Delayed-onset muscle soreness (DOMS) is another condition that can occur and is unlike the acute, sudden and sharp pain of a muscle strain that often causes swelling or bruising. The delayed muscle soreness of DOMS is generally at its worst within the first two days following a new, intense activity and slowly subsides over the next few days.  Delayed onset muscle soreness is thought to be a result of microscopic tearing of the muscle fibers. The amount of tearing (and soreness) depends on how hard and how long you exercise and what type of exercise you do. Any movement you aren't used to can lead to DOMS, but eccentric muscle concentractions (movements that cause muscle to forcefully contract while it lengthens) seem to cause the most soreness.

Tips for Dealing with Muscle Soreness After Exercise

If you do find yourself sore after a tough workout or competition, try these methods to deal with your discomfort. Although not all are backed up with research, many athletes report success with some of the following methods:

1.    Use Active Recovery. This strategy does have support in the research. Performing easy low-impact aerobic exercise increasing blood flow and is linked with diminished muscle soreness. After an intense workout or competition, use this technique as a part of your cool down.

2.    Rest and Recover. If you simply wait it out, soreness will go away in 3 to 7 days with no special treatment.

3.    Sports Massage. Some research has found that sports massage may help reduce reported muscle soreness and reduce swelling, although it had no effects on muscle function.

4.    Ice Bath or Contrast Water Bath. Although no clear evidence proves they are effective, many pro athletes use them and claim they work to reduce soreness.

5.    Use R.I.C.E., the standard method of treating acute injuries, if your soreness is particularly painful.

6.    Perform Gentle Stretching. Although research doesn't find stretching alone reduces muscle pain of soreness, many people find it simply feels good.

7.    Try a Non-steroidal Anti-inflammatory. Aspirin, ibuprofen or naproxen sodium may help to temporarily reduce the muscle soreness, although they won't actually speed healing. Be careful, however, if you plan to take them before exercise. Studies reported that taking ibuprofen before endurance exercise is not recommended.

8.    Try Yoga. There is growing support that performing Yoga may reduce DOMS.

9.    Listen to Your Body. Avoid any vigorous activity or exercise that increases pain.

10.    Allow the soreness to subside thoroughly before performing any vigorous exercise.

11.    Warm Up completely before your next exercise session. There is some research that supports that a warm-up performed immediately prior to unaccustomed eccentric exercise produces small reductions in delayed-onset muscle soreness (but cool-down performed after exercise does not).

12.    If your pain persists longer than about 7 days or increases despite these measures, consult your physician.

Effective prevention of muscle soreness may be difficult because it is a normal physiological response to exercise.  While you may not be able to prevent muscle soreness entirely, you may reduce the intensity and duration of muscles soreness if you follow a few recommendations.

Tips to Help Prevent Muscle Soreness After Exercise

1.    Progress Slowly. The most important prevention method is to gradually increase your exercise time and intensity.

2.    Warm Up and stretch thoroughly before activity and cool down completely afterward.

3.    Cool Down with gentle stretching after exercise.

4.    Try an Ice Bath or Contrast Water Bath. Although no clear evidence proves they are effective, many pro athletes use them and claim they work to reduce soreness.

5.    Try a Sports Massage. Some research has found that sports massage may help reduce reported muscle soreness and reduce swelling, although it had no effects on muscle function.

6.    Try wearing compressive clothing or compression socks during and after exercise.

7.    Follow the Ten Percent Rule. When beginning a new activity start gradually and build up your time and intensity no more than ten percent per week.

8.    Start a new weight lifting routine with light weights and high reps (10-12) and gradually increase the amount you lift over several weeks.

9.    Avoid making sudden major changes in the type of exercise you do.

10.    Avoid making sudden major changes in the amount of time that you exercise. Certain muscle pain or soreness can be a sign of a serious injury.

11.    Carbohydrate and protein supplement drinks are beneficial when taken within 30 to 40 minutes after muscle damaging exercise.

12.    If your muscle soreness does not get better within a week consult your physician.

References

Quinn E, Tips for dealing with delayed muscle soreness after exercise About.com Guide November 17, 2011.

Herbert, R., Gabriel, M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review  BMJ 2002;325:468-470.

Szymanski, D. (2003). Recommendations for the avoidance of delayed-onset muscle soreness. Strength and Conditioning Journal 23(4): 7–13.

Lewis PB, Ruby D and Bush-Joseph CA Muscle soreness and delayed-onset muscle soreness Clinics in Sports Med;31(2):255-262.

Troy Smurawa, MD

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date: August 8, 2012