Muscle Soreness

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Muscle Soreness
You roll over in bed and everything seems to hurt. As you move to get up, the pain is now focused in both your quadriceps.  Sitting on the toilet is a slow, tortuous exercise.  You realize your gluteus muscles are also screaming. Damn those wall balls!   

No doubt as a CrossFitter—whether a new or seasoned member—you’ve experienced the burn of delayed onset muscle soreness (DOMS).  What is DOMS?  In simplest terms, it’s just what the name says.  Technically, it is defined as the sensation of discomfort or pain in the skeletal muscles following physical activity, usually eccentric, to which an individual is not accustomed.   Research demonstrates that the degree of soreness is related more to intensity of the muscle contractions than duration; however both can cause that familiar “I can’t move” feeling. Although extensively researched, there are still controversies regarding the origin, cause and treatment of DOMS.

A little about your muscles

Many in the exercise community believe that delayed soreness is a result of lactic acid accumulation in the muscles.  While lactic acid and other metabolic by-products do build up during intense muscle effort, blood to the area is very efficient at flushing these by-products away almost immediately.  Lactic acid is likely to account for the burn you feel while performing an exercise. It is hypothesized that other factors account for your delayed misery—mainly the actual structural damage and adaptive remodelling that occurs in the muscle, specifically the myofibril.  (see the Google Image illustration below).

For reasons to do with muscle fibre physiology, isometric and concentric exercises are less likely to cause DOMS than eccentric exercise. This may have to do with the fact that during concentric exercise the muscle fibres are able to overcome an opposing force and the muscle shortens as it contracts.  During isometric exercises, the muscle remains the same length as it contracts. However, during eccentric exercise, the muscle lengthens as it contracts.  It is hypothesized that it is this lengthening during contraction that causes microscopic injury or “damage” to the tiny muscle fibre units leading to inflammation and pain.  Eccentric exercises include a lot of what you do in CrossFit—including resistance training (think weights) and plyometric-type movements (think box jumps, split jumps, wall ball).  These exercises also include concentric contraction, but it’s the braking force—or eccentric force—in opposition to the concentric contraction that protects joints, keeps motion smooth and helps you maintain control. 

Pain duration and when to consider other causes for your discomfort

Typically, the pain and discomfort of DOMS appears 24 to 48 hours after an intense exercise session and resolves within 4-6 days.  Because of the associated inflammation in DOMS, you are likely to also feel increased muscle fatigue and stiffness.  And it’s not your imagination if you also detect a feeling of “slowness” in your muscles—like they just can’t contract as quickly as normal (technically called decreased contraction velocity). You actually have decreased “force” capacity during DOMS. But that doesn’t mean you shouldn’t continue exercising (more on this later).  Just do it with a bit of caution with increased attention to your form.  Because DOMS causes mild impairment in your power and strength, you may be more prone to injury. 

So, what is normal muscle soreness and when should you be concerned about something more serious? With DOMS, it’s normal for muscles to feel painfully sensitive to pressured touch or movement. In severe DOMS, actual swelling of the muscle can occur and pain is distributed over the entire muscle belly, not just at the muscle-tendon junction. If pain occurs immediately after exercise, is concentrated over a joint, continues beyond a week, or is accompanied by increased warmth, redness or bruising—something else may be causing your symptoms and a true injury may be present. This distinction is important since an injury requires a different treatment approach.  

Other possibilities for post-exercise pain include a strain, sprain or tear to the muscle or tendon, stress fracture, arthritis (joint inflammation), or a muscle cramp associated with electrolyte imbalance.

The important question: What can you DO about DOMS?

Just as there is some uncertainty over the cause of DOMS, there is also some uncertainty about how to prevent and treat it. Like pregnancy, you can avoid the activity that leads to the outcome.  But that’s not acceptable.  So, if you insist on continuing your commitment to being a fit human being, you will continue to be at risk of experiencing DOMS.  However, there may be some things you can do to ameliorate your pain before and after it begins.    

Cardio acceleration. A few well-designed studies have demonstrated that increasing your cardiovascular output before an intense workout will decrease muscle soreness. One study published in the Journal of Strength and Conditioning Research found that 20 minutes of aerobic exercise prior to the strength workout (HR about 65% above resting rate), along with aerobic movements incorporated throughout the workout, significantly reduced muscle soreness in both men and women performing heavy eccentric exercises. The theory behind this intervention is that increased blood flow to the exercised muscles more quickly “sweeps away” inflammatory factors and toxic by-products that cause pain.   

Omega-3 Fatty Acids.  A study published in the Clinical Journal of Sports Medicine found that ingestion of omega-3 could be effective in ameliorating DOMS induced by eccentric exercises. In this study, men assigned to the experimental group took 1.8 g of omega-3 supplement a day and reported significantly less pain 24-48 hours after exercise than men assigned to the placebo group or the control group.  The theory behind this intervention is that pain in DOMS is partially the result of free-radical formation. Omega-3 fatty acids are potent free radical scavengers.  

Contrast Water Therapy (CWT).  Treatment with alternating ice and hot water appears to do two things: first it prevents the reduction in muscle force that accompanies DOMS, and secondly it significantly reduces the intensity and duration of DOMS. A general CWT protocol would be to alternate ice water with hot water immersion every two to three minutes for a total of 15 minutes.  In one study, participants who had CWT every day for three days had better squat jump performance and isometric force recovery compared to study participants who had no specific post-exercise therapy.  Notably, one study that specifically followed a common sports protocol of three rounds alternating one minute of ice immersion and one minute out of water demonstrated no effect on DOMS.  

Physical Activity.  While it may seem counterintuitive, exercising sore muscles is one of the quickest methods of reducing the pain of DOMS; however, the relief may be brief and pain may return once your endorphin high ends.  The benefit is that you’ll continue to increase your physical fitness and be less prone to future DOMS in the same area.   

Massage.  Many studies published in the sports medicine literature demonstrate that massage can reduce DOMS by 30 to 50%, depending on factors such as timing and pressure.  Massage also reduces muscle swelling, but appears to have no effect on function.  In other words, massage may not prevent injury that could result from DOMS. But it sure feels good and many studies support the theory that massage increases blood flow to affected areas and stimulates “happy” hormones like serotonin and dopamine.   

Others. Additional therapies that may provide some relief from DOMS include ultrasound and electrical nerve stimulation.  However, these treatments would require a visit to a physical therapist and do not appear to be more effective than the ones listed above. 

Of course there are other treatments you can try, but science has not shown any consistent evidence that they work for decreasing DOMS. These include anti-inflammatory medicines like ibuprofen (Advil, Motrin) and naproxen (Aleve), and pain relievers such as aspirin and acetaminophen (Tylenol).  Pre- and post-exercise stretching also doesn’t seem to make a difference.  Neither does acupuncture arnica or vitamin C.  

So there you have it. As CrossFitters, DOMS is a just an unavoidable fact of life. The good news is that the more consistent you are with your workouts the less you’ll experience it. Don’t take too long a break or you’ll be experiencing DOMS like it was your first day at CrossFit. Good motivation, eh? The other good news it there are real things you can do to ameliorate your pain.  

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