A common issue for patients is finding they are sore after completing their home exercise program, especially after strengthening exercises.
The question is, what soreness is expected and is okay, and what soreness is unwanted. This summary should help to clarify the difference between how you might be feeling. If you still have any questions please post them up on our Facebook page (link below) or email us if you don’t feel comfortable asking the question in a public forum.
1. Muscle soreness
The most common pain people feel when they start a new exercise is called Delayed Onset Muscle Soreness or DOMS. This happens as a normal part of the strengthening process.
After doing exercise to strengthen a muscle, the collagen is broken down in a very similar way to having many tiny muscle tears. Over roughly 36-48 hours the collagen repairs to become stronger than it was before your last exercise bout. The pain associated with this is most often felt in the thick part of the muscle, the muscle belly, and peaks at roughly 48hours post workout.
This kind of soreness is harmless beyond causing a mild/moderate discomfort when you use the muscle. We generally recommend pushing on with your home program as long as the pain isn’t too severe.
It’s worth keeping in mind that DOMS is normally at its most severe after the first time you start new exercises. after a few days of training the pain generally becomes relatively insignificant.
2. Loss of Range of motion
If your DOMS is more severe you can often feel like your muscles have tightened up, for example if you work your bicep on the front of your upper arm, you will struggle to completely straighten your elbow. If you work your hamstrings, you might find it difficult to lift your leg straight up, or to touch your toes.
This is normal in more significant levels of muscle pain, and again is nothing to be worried about. Some gentle massage and stretching should help your muscles loosen back up to normal so that you can restart your strength exercises after a couple of days.
3. Rhabdomyolysis
This is the most serious side effect of strength training and is very rare. If you work a muscle to extreme levels of fatigue and muscle breakdown the body’s response can change significantly.
In the muscular cause of rhabdomyolysis we generally see large swelling around the entirety of the muscle, as well as muscle soreness and loss of significant amounts of movement. In smaller muscles this kind of symptom probably deserves to be seen by the doctor to make sure it isn’t adversely affecting the rest of your body.
When multiple large muscle groups are exhibiting the signs of rhabdo then admission to hospital may be necessary to help stop the side effects. Kidney and Liver failure, increased blood pressure, nausea and dizziness are just a few of the associated symptoms. If you ever believe you are experiencing these symptoms a day or so after a bout of extremely challenging exercise, please at least see your doctor.
I stress though that this kind of reaction is extremely rare, and not something you should ever be feeling from exercises your local physio gives you.
One common setting Rhabdomyolysis has become more common is with cross fitters, where they have even gone as far as to make their mascot the “Rhabdo Clown”!
4. Your Pain
The other common symptom that people feel is that an exercise will reproduce “their pain”, that is, the pain that they have presented to their physiotherapist with.
As a generally rule I would say that we rarely want anyone to feel like an exercise aggravates their pain. Or at worst we generally work to a severity of 2-3/10. If your pain is minorly aggravated, but returns to its baseline by the next morning this is often accepted as well.
Our advice within our clinic would be to always complete the exercises for the first time in the clinic. That way, if you have any questions about what you’re feeling you can ask us if it is okay to continue.
I hope this clears up a few of the different sorts of pain that you might feel from different exercises. Remember, a good exercise program is effective through persistence, not by going all out in one big session. Stay motivated and patient and you’ll improve your pain and function.
