Post-workout euphoria can leave you feeling pumped to conquer the world — until the next morning, when you can barely walk to the bathroom or lift an arm to brush your teeth.
Such are the painful rewards of delayed onset muscle soreness, or DOMS, a result of microscopic tears to muscle fibers that occur when you run faster, lunge deeper, crunch harder or lift more than usual. The damage ignites an inflammatory response as the muscle repairs itself, causing pain that peaks 24 to 48 hours after the activity and dissipates in five to seven days, said Carol Torgan, a health consultant and fellow with the American College of Sports Medicine.
Contrary to popular belief, next-day soreness is not caused by a build up of lactic acid, a normal byproduct of muscle metabolism responsible for the burn you feel during exercise, Torgan said. Lactic acid quickly leaves your muscles afterward, she said.
Enter the ache
DOMS is most common after a new activity or exercises involving "eccentric muscle contractions," which is when the muscle lengthens as it contracts, such as when you lower the weight in bicep curls or run downhill, Torgan said.
Next-day soreness is usually a good thing. The tear-and-repair process forces the muscle to adapt, so that the next time you do the same exercise there's less damage, less soreness and less recovery time — basically, you're stronger.
"If you don't get muscle damage, you don't get muscle growth," said Dr. Gabe Mirkin, a retired physician and former professor at Georgetown University Medical School who now runs a health news site at drmirkin.com. "If you want to grow and gain strength, you have to get sore."
How to handle it
Dial back exertion: When muscles are sore, they leak proteins from their cells into the bloodstream and can't generate their usual force, Mirkin said. So you have to put far less pressure on sore muscles, or you risk injuring them and delaying recovery.
Sore muscles heal faster if you just rest, but when you exert slight pressure on sore muscles, such as through light running, biking or very light weight lifting, you cause the muscle fibers to become more fibrous, so they can later withstand greater stress during your harder workouts, he said. It's a delicate balance.
No one knows for sure how much damage is necessary to get the muscle to adapt, said Priscilla Clarkson, distinguished professor of kinesiology at University of Massachusetts at Amherst, but she said that some soreness is probably optimal. Too much soreness can be counterproductive because the longer it takes for the muscles to rebuild, the longer you have to wait to resume your workouts. Extreme soreness can be dangerous.
In January, a heavy workout sent 13 University of Iowa football players to the hospital suffering from rhabdomyolysis, a condition in which the proteins from muscle breakdown flood the bloodstream and impair kidney function. Independent experts who reviewed the cases cited a squat exercise as the activity that likely pushed them into the danger zone.
Stay hydrated: It's important to stay hydrated while you're sore to flush the kidneys and prevent protein buildup in the blood, said Clarkson, a fellow with the American College of Sports Medicine. Watch your urine to make sure it's a light yellow, she said; if your urine turns brown, you're on your way to rhabdomyolysis and need to get to an emergency room.
Work up, cool down: There's little you can do to prevent DOMS. Cooling down helps remove lactic acid that gives you that muscle burn during exercise, and stretching can help prevent a pulled muscle, but neither stretching nor cooling down will do anything to prevent next-day soreness, Clarkson said.
Your best bet to mitigate soreness is to gradually build up to strenuous exercise with lighter versions of the activity over several days prior, Clarkson said.
Temporary relief: There's also little you can do to speed recovery from soreness. Massage, ice, stretching, a warm bath or taking anti-inflammatories can make your muscles feel better temporarily, but they won't make them heal faster, Clarkson said. High dosages of antioxidants like vitamins E, C and beta-carotene might also help, she said.
Diet: Mirkin said eating foods with protein and sugar within an hour of hard exercise speeds muscle recovery because the spike in insulin drives protein into the cells. He suggests getting that sugar from natural carbohydrates such as potatoes.
Be smart: In some cases, what you think is soreness could be injury. See a doctor if:
•You have acute, sharp pain as opposed to the dull burn of soreness.
•The pain is only on one side of your body (soreness is usually symmetrical).
•The pain gets worse during light exercise.
•The pain hasn't dissipated in seven days.
Dr. Lee Kaplan, head team physician for the University of Miami athletics department and medical director for the Florida Marlins, said his prescription for players feeling sore after a workout is a regimen of adequate sleep, plentiful hydration and a healthy diet of fruits, vegetables and high-value proteins. Ice baths, massage and stretching also can help, he said, and he tries not to push anti-inflammatory drugs, because in hot and humid environments they can put pressure on the kidneys.
Kaplan advocates active recovery for his players, with lighter workouts while muscles are sore, because just sitting back and resting can cause muscles to get stiff.
And for weekend warriors, he advises a reality check. Many high-level athletes are genetically blessed with bodies that repair and recover quickly, so people shouldn't try to emulate the pros who bounce back to the field or court so quickly.
"A patient will tell me that this player in the newspaper got better right away," Kaplan said. "But high-level athletes are just that. Some of them make their living with their ability to recover."
Rather than curse your inability to walk down the stairs, Dr. Gabe Mirkin, an avid bicycle racer, recommends using soreness as a guide to training.
On a day of high-intensity exercise, push yourself to the burn, then back off, push back up to the burn, back off again, repeating until your muscles start to feel stiff, then quit for the day.
Depending on how sore your muscles feel the next day, take it off or exercise at a very slow pace. Exercise at a reduced intensity, not attaining burn, for as many days as it takes for the soreness to go away completely.Copyright © 2014, The Baltimore Sun