No Pain, No Gain?

You wake up the morning after a particularly strenuous workout. Your muscles have that familiar ache which brings back the words of your childhood coach, “No pain, no gain.” “Boy,” you think, “I have gained a lot.”

All of us have experienced the above scenario, but is the voice that echoes in your head speaking the truth? The answer is a resounding NO! Sore muscles are not the sign of a successful workout, but rather signify microscopic injury to the muscle, tendons, and ligaments.

What you are experiencing is known as delayed onset muscle soreness (DOMS). Even though DOMS has been investigated for decades, little is known about the actual cause and many theories exist. The more common theories include the torn tissue theory, which suggests that tears in the muscle fibers are the cause of the pain, whereas the connective tissue theory implicates damage to the tendons and ligaments attached to the muscles. The inflammation theory states that DOMS may be the result of the attempts by the body to repair the damage that has been caused by the workout.

What we do know about DOMS is that the skeletal muscle is the only muscle type affected and DOMS can occur in any skeletal muscle. The muscles do not sustain long-term damage and ultimately performance is not affected. However, performance may be affected in the short-term, primarily due to pain, but also from temporary loss of affected muscle to produce force. DOMS is not due to the accumulation of lactic acid in the exercising muscles as lactic acid is removed from the muscle within an hour or two after the exercise and DOMS usually occurs after 24 hours. Activities that require muscles to forcefully contract while they are lengthening such as running downhill, going downstairs, or lowering a weight (eccentric contraction) seem to result in the most pain.

Typically pain from DOMS occurs in the first 24-48 hours after exercise and peaks by 72 hours. The pain usually subsides by 5-7 days after the exercise.

Although most active adults have experienced DOMS, it is not a necessary part of your exercise program. Measures can be taken to avoid DOMS. Some of these measures include a thorough warm-up before exercise and with an adequate cool down at the end of the workout. The exercise program should be started with easy to moderate activity intensifying gradually over time. Don’t make abrupt changes in your exercise program and always allow your body time to adapt.

If you do experience DOMS, there are measures you can take to relieve it. The principal measure is time. Just wait. The pain will go away in 5-7 days without treatment. Performing easy aerobic activity will increase blood flow to the affected muscles and this may improve the soreness. As always, use the RICE principle (rest and ice to the affected area as well as compression and elevation) in addition to careful stretching and massage of the sore muscle. If the discomfort interferes with your usual activities, consider the use of non-steroidal anti-inflammatory medicines, such as aspirin or ibuprofen, but do not take more than is recommended on the bottle. Some recommend Vitamin C, as Vitamin C is needed to make connective tissue and has been reported to lessen the pain. If your pain persists longer than about seven days, or increases despite these measures, consult your physician.

Despite what your coach may say, pain after exercise is not an indication of a good workout and is not necessary for getting into shape. With a regular, carefully planned exercise program there can be gain without pain.

Jody Welborn is a cardiologist from Portland, Oregon. Her medical experience includes a B.A. from the University of Oregon, M.D. from Oregon Health Sciences University, internal medicine residency at University of Texas, San Antonio, and Cardiology fellowship at the University of Alabama, Birmingham. Jody is a member of three USMS national committees, including Sports Medicine, Fitness and Planning. She is also a Masters swimmer who swims with the Metro YMCA Masters in Portland.