Why So Sore? The Curious Case of DOMS

For many avid exercisers, delayed onset muscle soreness, or DOMS, is used as an indicator of a successful workout; however, for those unfamiliar with its symptoms or who have an underlying injury or pain condition, DOMS can be a discouraging, unpleasant, and sometimes frightening experience. DOMS is defined as muscle pain, stiffness, swelling, and weakness beginning 12-24 hours after a workout, peaking around 48 hours, and persisting up to 7 days. It is typically a subclinical condition, meaning most cases resolve without the need for medical intervention. Most people have experienced such soreness at some point in their lives — whether due to starting a new exercise routine or from pulling weeds in the garden on the first day of spring. My goal is to demystify* DOMS and provide tips on reducing your chances of having your fitness or rehabilitation goals derailed by this temporary condition. By the end, you’ll feel confident to march on with exercise despite the soreness!

*Spoiler alert: there is currently no scientific consensus on the specific cause of DOMS.

 Break Down to Build Up

To provide some context for the discussion that follows, it will be helpful to take you through an abbreviated journey (think: The Magic School Bus) from the moment you perform an exercise, such as a biceps curl, through the first few days of recovery. When you lift a heavy weight for the first time in a while, you inflict exercise-induced damage, also known as microtrauma, to the muscle tissue. While this may sound scary it is a normal, typically healthy form of “injury” that leads to desirable adaptations including increases in muscle strength and size. (Curiously, the extent of microtrauma does not seem to correlate to the severity of DOMS1.)

In the hours/days that follow, like an episode of Extreme Makeover: Muscle Edition, your body gets to work not only repairing the affected tissue but making improvements to ensure that the next time you work out you’re prepared for the challenge. It accomplishes this through the action of immune cells, inflammatory enzymes, and genetic activity. The nerves and blood vessels that supply the muscle also become more active, increasing strength and power in as few as 1-2 weeks. Within 6-8 weeks of repeated exercise, visible changes such as increased muscle mass (AKA hypertrophy) become evident.

Getting Back to DOMS

Now let’s zoom back in to what’s going on the first 2-3 days following your biceps curl when you’re so sore that brushing your teeth is a struggle. I’d like to reiterate here that researchers are not in full agreement about the mechanism of DOMS. However, it’s still worth discussing a few of the more plausible hypotheses.

(Debunked) Theory #1: Soreness is the result of accumulated lactic acid in the exercised muscle. This is a popular one but is not accurate. While lactic acid plays a role in the burning sensation that occurs while you are lifting weights, it is not directly involved with the development of DOMS.

Theory #2: The aforementioned muscular microtrauma results in inflammation, sensitizing nerve endings and leading to pain. While this seems plausible, several studies have shown that the level of inflammation actually increases following subsequent workouts despite decreased levels of microtrauma and soreness2. It’s worth pointing out that while inflammation often gets a bad rap, it’s an essential part of recovery — it’s your body’s modus operandi for healing tissue and adapting to life’s stresses. Certain elements of the inflammatory process may be involved with DOMS, but inflammation alone does not seem to be an adequate explanation.

Theory #3: Physical and metabolic stresses during exercise cause microtrauma to the nerves that attach to the involved muscle fibers, which are then sensitized by a number of molecules spurred into action by the repair/rebuild process. This theory is hot off the press, having been published shortly before this post (September 2020)3. The idea is that, following exercise, nerves (depicted by the green and orange lines in the image below) are traumatized in a manner similar to muscles. Then, increased levels of nerve growth factor (NGF) and other restorative compounds sensitize the injured nerve endings. These compounds are distinct from inflammation, distinguishing this theory from the one above.

Theory #2 and #3 both have merit and the truth may be a combination of these factors. Nerve growth factor has been experimentally validated as a sensitizer of nerve endings and is produced in response to exercise, so this is likely to be a factor in DOMS. However, the extent to which muscle or nerve microtrauma and inflammation are involved is unclear.

If at first you’re sore, try, try again

Even though we don’t know exactly why DOMS happens, we do know that it’s a temporary condition as part of your body’s adaptive process. By executing these steps to recovery like a well-trained military unit, your body is able to adapt to new loads with remarkable efficiency. Within 1 week, a protective buffer allows you to repeat bouts of exercise with decreased soreness. This shield of DOMS protection can last as long as 4-12 weeks post-exercise and is referred to as the repeated bout effect4. The repeated bout effect is dose-dependent, meaning the greater the intensity or duration your first time exercising, the more protection you have for future efforts. However, even low loads (as few as 2 repetitions) can reduce the risk of DOMS the next time you work out. This should be encouraging to those who may be reluctant to start or continue exercising due to DOMS.

Can I work out when sore?

Yes. Exercising a sore muscle in moderation is not harmful to the muscle tissue nor the recovery process, though you may find you’re unable to exert as much force due to the strength deficits that accompany DOMS. Aerobic exercise is totally safe and will often help reduce the intensity of soreness in the affected areas5. While there is not much evidence to say that you shouldn’t work out a sore muscle, if you’re experiencing undue pain or fatigue while doing so it may be best to target another muscle group.

Chasing soreness

While the very first workout for an untrained individual is likely to result in DOMS, the repeated bout effect protects from perpetual soreness, and individual factors such as genetics also impact one’s susceptibility6. Furthermore, certain muscle groups are more likely to experience soreness than others. The fact is there isn’t much evidence that soreness is necessary for increasing strength or building muscle7. On the contrary, there is convincing evidence that strength and size can increase without muscle soreness8. So you don’t have to go searching for soreness to make gains.

Isn’t there a magic pill I can take?

Much time, effort, and money has been spent to reduce the incidence and severity of DOMS. However, many of these remedies have been deemed ineffective by science. For instance, stretching before and/or after exercise does not prevent DOMS9. Nor does massage10, ice11, Epsom salt12, or bee venom13 (yes, that’s a real study). This doesn’t mean that a good massage, stretch, ice bath, hot pack, (…or bee sting?) won’t curb symptoms once they set in. They just won’t reduce your chances of getting DOMS in the first place or decrease the duration of your misery.

If you really can’t stand DOMS, there are a few strategies to try. Some research has found that omega-3 fatty acid, caffeine, and taurine intake can potentially reduce symptom severity14 (disclaimer: discuss dietary supplementation with a medical provider). Light to moderate aerobic exercise such as riding a bike or jogging may help reduce DOMS when used as part of a warm up routine15. However, the best solution may be the most obvious: ease your way in. A 1- to 2-week preparatory exercise phase using lower volume and intensity reduces the soreness experienced with subsequent sessions16.

If you try all of the above and still get a case of the DOMS, do not fear. Father Time will take care of the soreness and your body will ensure that the next time you work out, the pain won’t be quite so bad. Trusting in your ability to repair and adapt will allow you to reap the numerous benefits that exercise has to offer.

Written by: Dr. Scott Newberry

Strain vs. Sprain- What is the Difference?

Strains and sprains are common musculoskeletal injuries that can develop from a variety of everyday activities. Although these injuries can be similar, they involve different types of soft tissue in the body.

A strain is an injury to a muscle or tendon that has been overstretched or torn. A tendon is a tough cord of fibrous tissue that connects muscles to bones. A strain can develop over time from repetitive use of a muscle or can develop acutely from a sudden overstretching of a muscle.

A sprain is an injury to a ligament that has been overstretched or torn. A ligament is a tough band of fibrous tissue that connects bones to other bones in your joints. The ankles and knees are common area of sprains due to abrupt pivoting and twisting motions.

Physical Therapists treat sprains and strains with exercise, manual treatment, and modalities. If you would like to learn more about your injury, contact Harbor Physical Therapy at 443-524-0442.

Written by Dr. David Reymann

Physical Therapy: Fact vs. Fiction

There are some common misconceptions out there about physical therapy. This list was created to help clear some of those up!

  1. I need a referral from a doctor before I can see a PT. FALSE

Because of direct access in the state of MD, you are able to schedule an appointment with a PT without a referral from your PCP.

  1. Any medical professional can perform PT. FALSE

Physical therapy services must be provided by a licensed physical therapist.

  1. Physical therapy is the same thing as massage therapy. FALSE

If you have been to PT before, you may have had some massage incorporated as part of your treatment. This is only one tool that some therapists may incorporate into your treatment. PTs are trained as movement experts and are focused on improving function. A lot of PT is exercised based and may incorporate strength training or balance training for example.

  1. PT is only for injuries. FALSE

PTs are trained to treat a myriad of different conditions and many PTs go on to specialize in specific fields. A few different areas that PTs can work in include pediatrics, geriatrics, sports rehab, chronic pain, vestibular, orthopedics, neurological, and cardiopulmonary to name a few.

  1. Surgery is my only option. FALSE

There are many studies that show that physical therapy can be as effective or more effective than surgery in many cases. Trying physical therapy first is a safe and smart approach to treatment for several different conditions.

Written by: Dr. David Reymann

The Rotator Cuff: What You Need to Know

The rotator cuff, an often neglected muscle group, is a group of four muscles and tendons that surround the shoulder joint.  The rotator cuff helps to keep the head of your upper arm bone firmly within the shallow socket of the shoulder joint. In addition to keeping your shoulder stable, these muscles help to lift and rotate your arm. Injury to this muscle group is common, particularly in those who perform repetitive overhead motions as you would in a sport like tennis or a profession like painting.

The key to preventing shoulder pain or injury to these muscles is maintaining good rotator cuff strength in addition to good posture to improve your shoulder mechanics. Here are four simple exercises that you can start performing at home to start building better shoulder strength and stability.

  1. Side-lying External Rotation with Weight

     2.  Shoulder Internal Rotation with Band

     3.  Scapular Rows

If you are currently suffering from shoulder pain, the physical therapists at Harbor Physical Therapy will help you to develop an exercise program that is specific to your injury.

 

Written by:

Dr. David Reymann

Staff Physical Therapist
Harbor Physical Therapy

Common Causes of Sciatica

What is sciatica?

Sciatica is a term commonly used to describe pain, weakness, numbness, or tingling that radiates down the back of the leg. These symptoms can be debilitating for some and contribute to difficulty performing daily activities.

Where does it come from?

There are 4 common causes of sciatica:

  1. Disc Herniation – Pressure on the sciatic nerve can occur from the protrusion of a disc in the lumbar spine. This pressure can cause pain to travel through the pathway of the sciatic nerve down the leg.
  2. Spinal Stenosis – Narrowing of the space where the nerve roots exit the spinal canal can also cause pressure on the nerve.
  3. Piriformis Syndrome – The piriformis is a muscle deep in your gluteal region that the sciatic nerve runs underneath and sometimes through. Tightness or spasm of this muscle can cause pressure on the nerve that sends pain down the leg.
  4. Referred Pain from Trigger Points – Trigger points are tight knots in muscles that can cause local or referred pain. Trigger points found in the gluteal muscles can cause referred pain that is felt down the leg and is similar to sciatic nerve pain.

How can PT help?

 A physical therapist is trained to evaluate your symptoms and do a thorough assessment to determine what may be causing them. The aim of treatment is to restore your range of motion, increase your flexibility, increase strength and stability, decrease trigger point formation, and improve your functional mobility. Treatment plans are individualized and are determined based on the causes of your symptoms and your specific presentation. If you are suffering from sciatica-related symptoms, call Harbor Physical Therapy to help eliminate your pain and prevent it from reoccurring.

Written by:

Dr, David Reymann
Staff Physical Therapist at Harbor Physical Therapy

What is the Difference between a Physical Therapist and Chiropractor?

 

Have you ever wondered whether you should see a Physical therapist or a Chiropractor for your symptoms? Check out the descriptions below to learn the differences and which type of provider you should see depending on your injury.

Physical Therapist

A physical therapist performs an exam of an individual’s impairment, disability or functional limitation by examining their movement, affected joints and tissue, neuromuscular imbalances and misalignment. They determine a diagnosis and intervention of treatment and set treatment goals.  Physical therapists work to alleviate pain, restore range of motion, regain any function lost, promote and maintain fitness and prevent further injury. The physical therapist may use heat/cold, electric stimulation, ultrasound, soft tissue mobilization, stretching, exercise and other manual techniques to reach treatment goals. There are many different specialties/settings in physical therapy.  Examples of this are outpatient, women’s health, acute care, sub-acute care, sport, and neurological.  An average physical therapy treatment program consists of the patient attending physical therapy 2 times a week for 4 to 6 weeks.  The end goal for a physical therapy treatment program is to decrease the patient’s symptoms and educate the patient on how to prevent their injury/symptoms from recurring through continued exercise.

Chiropractor

A chiropractor concentrates on musculoskeletal and systemic disorders through a controlled manipulation of the spine. Some chiropractors perform x-rays of the spine to check for misalignment. Chiropractors look to the physiological and biochemical aspects of the patient’s structural, spinal, musculoskeletal and neurological components. They also may use heat/cold electrical stimulation and ultrasound for pain control. Chiropractors practice in a private practice setting and occasionally you can find them staffed in a hospital setting.  In the state of Maryland, Chiropractors can take an exam to receive physical therapy privileges.  Therefore, you might see a facility advertising chiropractic and physical therapy services together. However, be mindful that most of these facilities only employ chiropractors.  A chiropractic treatment program on average is once a week and then tapers down to once a month for a long period of time.  Chiropractors typically see their patient consistently for sometimes years to continue to assess for misalignment of the spine to manipulate.

If you are wondering what practitioner you should see for your injury, it is always beneficial to see a physical therapist.  I typically educate my patients that you should always see a physical therapist first as we are more conservative than chiropractors.  Physical Therapists are able to increase strength/range of motion of a muscle/joint which in turn naturally corrects misalignment of the spine.  If you have not reached your goals with physical therapy, then try your local chiropractor.

Written by:

Amanda Macht, D.P.T.
Owner/Physical Therapist Harbor Physical Therapy

How to Decrease Arthritic Symptoms

One in four people suffer from arthritis. Arthritis causes stiffness, pain, deformity and decrease function of your joints. Physical therapy can help to decrease pain and restore mobility with the use of exercises and modalities.

Harbor Physical Therapy provides patients with arthritis instruction in exercises to help increase flexibility and improve muscle strength around the joint. A daily home exercise program will help to prevent loss of the use of your joints and preserve muscle strength.

If you are interested in learning more about how physical therapy can help with your arthritic symptoms, please contact us to schedule an appointment.

The Upper Trapezius and its Role in Neck Pain

If you find yourself suffering from neck and shoulder pain, it may be coming from one muscle in particular: the upper trapezius. The upper trapezius makes up one of three parts of the large trapezius muscle in the upper back and neck and runs from the base of the head to the clavicle. The upper trap works with the middle and lower trap to stabilize the scapula and assists in upward rotation of the scapula and shrugging of the shoulder.

Increased stress, poor posture, and weakness in the rotator cuff and scapular stabilizers can contribute to overcompensation from the upper traps. This can lead to increased tightness, neck/shoulder pain, and trigger point formation in the muscle. If pain and muscle tightness persists, it can affect daily activities such as sleeping, sitting, reaching, head turning and can also contribute to headaches.

If you suffer from this, here are some quick tips to help relieve pain:

1. Stretch the upper trap by placing one arm behind your back on the same side as your neck pain. Then, gently pull your ear to your shoulder with your other hand until a stretch is felt. Hold the stretch for 20-30 seconds. Repeat 3 times and perform throughout the day as needed.

2. Work on your posture. Squeeze your shoulder blades back and down towards each other and hold for 5-10 seconds while keeping your head in an upward position. Repeat multiple times throughout the day.

If your pain persists, the physical therapists at Harbor Physical Therapy can help by using a combination of manual therapy, strengthening and stretching exercises to decrease muscular tension and pain.

Written by:
Dr. David Reymann
Staff Physical Therapist
Harbor Physical Therapy

How Do I Lift Something Heavy Without Hurting My Back?

A lot of people end up having back pain from lifting heavy objects.  Most likely if they thought before they lifted the object, they would avoid causing themselves back pain. Listed below are steps to follow when lifting a heavy object to avoid straining your lower back muscles:

  1. Square your body to the object so it is right in front of you.
  2. Make sure the object is close to your body.
  3. Place your legs shoulder distance apart.
  4. Hinge forward slightly at the waist
  5. Squat down making sure your center of gravity is towards your heels not your toes.
  6. Pick up the object.
  7. If you need to place the object in a certain location, make sure to move your feet not twist your back.

If you continue to have back pain while lifting objects from the floor, call Harbor Physical Therapy to have one of our doctorate level physical therapists evaluate you to determine the source of the issue.