Updated: May 22
Written by Anna Tong, AES, CSCS
Most of you would probably have experienced some level of body soreness after a hard workout. Some might rest for a few days and resume exercise after the soreness has subsided, while some might continue despite the body aches. What should we do if we have soreness then? Is there such thing as ‘good soreness’ and how much is too much? Does the level of soreness constitute the quality of the workout? Let’s dive into the basics to find out.
Why do we experience soreness?
When muscles are stressed beyond what it is used to experience, it causes micro-tears in the muscle fibers and this resulted in what we called muscle ache or soreness. This muscle ache is referred to as ‘delayed onset muscle soreness’ (DOMS). DOMS usually occurs when we perform an unfamiliar exercise (or resume an exercise that we have not done in a while) and spiking the workload of the muscle, especially when the exercise involves eccentric contraction (lengthening of the muscle). DOMS typically develops and increases in the intensity of discomfort within the first 24 hours after exercise, peaks between 24 – 72 hours, and eventually subsides by 5-7 days (3).
Muscle soreness tends to be associated with challenging workouts and is expected to bring improvement. Generally, muscle soreness is what we would call ‘good pain’, and it is the basis of the popular saying, “No pain, no gain”. Muscle has been shown to adapt quickly to damages caused by eccentric exercises. Following an initial session of eccentric workout, repeating the exercises between around 1 (17) and 6 weeks (2) after muscle soreness recovery seems to enhance muscle’s resilience to damage (2,4,5,13,17) and improve recovery rate (4).
The impact of DOMS on performance, injury, and health
DOMS is generally tolerable, and it is common for individuals to continue exercising even during periods of intense muscle soreness. However, it can potentially lead to more debilitating injury if it’s not properly managed. Studies have shown that DOMS can affect sports performance by causing a reduction in our range of motion (5,8), shock absorption ability (7) and strength and power production (5,16). Apart from the impact of DOMS on sports performance, it can alter muscle activation patterns that would cause changes in muscle coordination and segment motion (6). This alteration may increase the risk of injury due to unfamiliar loading stress to be placed on other muscles, joints, ligaments, and tendons (3). Typically, one might experience aches and/or pain in the joints (ligaments, cartilages) and tendons, and this is the type of soreness that you might need to be careful with. Our musculoskeletal system responds and adapts to exercise stress (workload) gradually. If the stress placed on the structures is too much and too sudden, our musculoskeletal system cannot respond effectively and may fail to adapt. Failure to adapt could result in pain which would typically lead to what we would refer to as ‘non-contact injury’. If this is something that you are experiencing, consider reducing the exercise intensity as it might be too much for your body to handle at the moment and/or re-assess your exercise technique.
Although DOMS is common and not necessarily a bad thing, a muscle that is stressed too much can become very sore to move and touch. In extreme cases, it can result in a condition called ‘rhabdomyolysis’. Rhabdomyolysis is a rare condition where there is extensive muscle damage. In this condition, large amounts of proteins from the muscle breakdown are released into the bloodstream. This situation can lead to life-threatening complications such as electrolyte imbalances, disseminated intravascular coagulation (small blood vessels blockage due to blood clots), and acute kidney failure (9). Patients diagnosed with rhabdomyolysis will have an elevated level of creatine kinase (CK), an enzyme, in the blood. Normal CK levels are 45-260 IU/ and it raises as the muscle is damaged, usually within 12 hours at the start of the injury, and peaks in 1-3 days (9). Handling a workload that your body is not prepared for (19), a sudden increase in intensity and/or duration (21), dehydration (18), heat stress and humidity (20) are some of the factors that can increase the risk of rhabdomyolysis.
I once had a patient who had never done a pull-up in her life, tried to do multiple unassisted eccentric pull-ups on top of other biceps exercises that she had already done. She developed extreme muscle soreness on her arms the next day, and she couldn’t move it as it was too painful. The patient thought it was just another muscle aches until she noticed that her urine was dark red/brown. Her blood test result revealed an elevated CK value of approximately 50,000 IU/L. This value was at least a few hundred times above the upper limit of normal levels. If left untreated, she could have gotten a kidney failure!
Management strategies for DOMS
Even though we can’t eliminate muscle soreness from occurring, we can optimize the recovery process to manage muscle breakdown from exercise. Some of the recovery strategies include the use of massage (10), foam rolling (14), compressive garments (12), cold water immersion (11,15) and active recovery/ exercise (1). Although the techniques are different, the method is the same; to reduce the interstitial space (space outside of the cell) available and improving the blood and lymph flow in the muscle. This process helps by decreasing the formation of edema (excessive accumulation of fluid that causes swelling) and increase the removal of metabolic waste from the breakdown of muscle cells, thereby reducing the soreness, fatigue, and risk of injury.
Exercise considerations and recommendations
Understanding the biomechanical and physiological changes associated with DOMS allows us to plan, and manage our exercise/ training accordingly. If you are experiencing severe muscle soreness, do allow sufficient time for recovery (at least 2 days) and making sure you are well-hydrated before starting another round of strenuous workouts. For those who exercise regularly and would like to continue with their exercise regime, consider reducing the exercise intensity and/or duration. Alternatively, do exercises that train different muscle groups. For athletes, it is inevitable to perform very high-intensity movements during the competitive season, and their muscles tend to get sore throughout this period. It is recommended to incorporate sessions of eccentrics training specific to their sport at least once every 4 weeks. This is to minimize the soreness and allowing the athletes to continue competing at the highest level possible. Last but not least, for those who are untrained or new to exercise, start easy by gradually increasing the intensity and duration (especially the eccentric phase of an exercise). If you are unsure of where to start, consider seeking the help of a qualified exercise professional for guidance on exercise techniques and training load.
We might occasionally experience DOMS, especially after a hard workout, and it is not always a bad thing, as long as it is not affecting your daily activities. Also, it is possible to continue to train, provided that you manage your training load and exercise program accordingly. To decrease the risk of injury and to maximize training adaptation, sometimes the easiest way is to listen to our body and pay attention to the signals that it’s giving us. At the end of the day, keep in mind that a hard workout is NOT the same as a good workout. As always, we should not only train hard but also train smart!
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