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DOMS - a.k.a. "Why do I hurt?"

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Q. What is Delayed Onset Muscle Soreness and how does it relate to exercise? Is there any way to avoid it?

Heyla,

Since I've seen a bunch of references asking about this, I thought I'd do one of my research hunts and data dumps for y'all. :-)

Remember: This information is NOT intended as a substitute for medical treatment. Before starting an exercise program, consult a physician, and if you experience lasting PAIN, contact a physician.

What is DOMS?
Every athlete, regardless of his or her fitness level, has experienced sore and stiff muscles after moderate to strenuous exercise at the start of a new training programme. These symptoms usually occur after eccentric (downhill running, plyometrics, etc.) or unaccustomed exercise. During these activities your muscles become more susceptible to structural damage, resulting in muscle soreness, loss of strength, decreased range of motion and neuromuscular function. Ever get the feeling when the next day or two after a thigh workout you cannot walk up or down the stairs without grunting or it being extremely painful? Well that would be an example of DOMS. Some people enjoy the feeling and some find it extremely annoying. I take it as a sign of a great workout.

Aside from the pain of muscle injuries such as strains, there are two common kinds of exercise-related muscle soreness. One is acute soreness, which occurs during or immediately after exercise; the other kind is delayed-onset muscle soreness (DOMS), which develops 12 hours or longer after exercise.

Acute soreness. Muscle soreness during and immediately after exercise usually reflects simple fatigue, caused by a buildup of chemical waste products of exercise. If so, the discomfort will often subside after a minute or two of rest. Once the soreness goes away, you can usually continue exercising without any residual effects. If discomfort persists despite a rest period, you should stop your activity and rest the part of the body that is involved. You should not proceed with your workout until you're able to exercise that area without pain.

Delayed soreness. DOMS after a workout is common, particularly if you aren't used to the activity. If, for example, you haven't exercised for 6 months, and then you suddenly walk 3 miles and do some push-ups and sit-ups, you may feel soreness over much of your body the next morning. You may also notice muscle stiffness and weakness. Such symptoms are a normal response to unusual exertion and are part of an adaptation process that leads to greater strength once the muscles recover. The soreness is generally at its worst within the first 2 days following the activity and subsides over the next few days.

Delayed onset muscle soreness occurs hours after the exercise is over. This is much different than the acute pain of a pulled or strained muscle. A muscle tear, is felt as an abrupt, sudden, acute pain that occurs during activity, that is often accompanied by swelling or bruises.

Delayed onset muscle soreness (DOMS) is not a new phenomenon; research investigating the cause of delayed onset muscle soreness (DOMS) dates back to the early 1900s and several theories have been put forward to explain the underlying cause. Probably one of the most popular explanations is the accumulation of lactic acid in the muscles. Popular yes, correct, no. Blood and muscle lactate levels typically return to normal values after 30-60 minutes of recovery.

How did I get it?
DOMS is thought to be a result of microscopic tearing of the muscle fibers. The amount of tearing depends on how hard and how long you exercise and what type of exercise you do. For example, activities in which muscles forcefully contract while they are lengthening tend to cause the most soreness. These "eccentric" contractions, as they are called, provide a braking action; they occur in activities such as descending stairs, running downhill, lowering weights, and performing the downward movements of squats and push-ups.

In addition to microscopic tearing, swelling may take place in and around a muscle, which can also contribute to delayed soreness. Such swelling increases pressure on the neighboring structures, resulting in greater muscle pain and stiffness. Eccentric muscle contractions tend to cause both microtearing and swelling.

How do I deal with it now that I've got it?
Let's say you overdo it one weekend by hiking and playing flag football or pick-up basketball. What are your options? Most experts say the soreness will go away in 3 to 7 days with no special treatment. But there are some things you can do that may reduce the soreness and speed your recovery to some extent.

Initially, you should avoid any vigorous activity that increases pain, though you may work the unaffected areas of your body. By exercising unaffected areas or by performing low-impact aerobic activities such as biking or walking at a moderate pace, blood flow can be increased to the affected muscles, which may help diminish soreness. Do some easy low-impact aerobic exercise - this will increase blood flow to the affected muscles, which may help diminish soreness. Use the R.I.C.E. (Rest, Ice, Compression, Elevation) treatment plan.

Other measures include gently stretching, and massaging the affected muscles, which may be helpful for some people and poses little risk if done sensibly. Also, nonsteroidal anti-inflammatory medications like aspirin or ibuprofen may reduce the soreness temporarily, though they won't actually speed healing. These medications are available over the counter, and they can be prescribed by physicians in greater strengths. NOTE: No research supports the use if anti-inflammatory drugs, antioxidant supplements, ointments or creams in the prevention of delayed onset muscle soreness (DOMS). For those of you who are interested in alternative medicine approaches, there is some evidence that vitamin C may decrease soreness.

Finally, you should allow the soreness, weakness, and stiffness to subside thoroughly before vigorously exercising the affected muscles again, and don't forget to stretch and warm up before your targeted activity. Soreness should go away in 3 to 7 days with no special treatment. If your pain persists longer than about 7 days or increases despite these measures, consult your physician.

How can I NOT get it in the future?
Certain tactics may enable you to avoid delayed soreness altogether, or at least keep it to a minimum. The good news is that the best prevention is regular exercise. Studies have demonstrated that continued training acts in a preventative fashion to reduce muscle soreness. Regular endurance training, specifically, has been shown to be a method of preventing the onset of DOMS. The typical soreness experienced after training (DOMS), is part of the process of getting stronger and reaching your fitness goals. The best method to reduce this somewhat frustrating part of starting or modifying a fitness program is none other than consistent effort.

Standard preventative recommendations:
One step is to warm up thoroughly before activity and cool down completely afterward. This can be done by stretching the muscles that you will be using and by doing a few minutes of light, low-impact aerobic activity, such as walking or biking. Perform thorough flexibility exercises after exercise, while the muscles are warm
Perform specific dynamic mobility exercises for 15-20 minutes. Complete additional bouts of the exercise that originally caused delayed onset muscle soreness (DOMS) once the initial discomfort has subsided - for instance, if DOMS was sustained during downhill running, additional downhill running within one to six weeks will help alleviate the problem). Lastly, start with easy to moderate activity and build up your intensity over time.


Resources:
http://www.physsportsmed.com/issues/1999/01_99/muscle.htm
http://sportsmedicine.about.com/cs/injuries/a/doms.htm
http://www.sportsinjurybulletin.com/archive/1077-muscle-soreness.htm
http://www.runnersworld.com/home/0,1300,1-78-79-423,FF.html?site=RunnersWorld
http://www.jr2.ox.ac.uk/bandolier/booth/alternat/AT011.html
http://weightlifting.cowebz.com/delayed-onset-muscle-soreness.htm
http://www.fit-at-home.com/delayed-onset-muscle-soreness.htm

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