By: Tahani Dakkak
BSc, MMASc, PharmD ‘23
You hit the gym motivated to start a new workout program, or decided to push your boundaries and run for 90 minutes instead of your typical 60 minutes. It felt great until the next morning when you woke up sore, struggling to get out of bed. Now you are asking yourself “What happened? Did I injure myself? How long will the pain last?”
Here’s what you need to know about what causes post-workout muscle pain, how to speed up recovery, and prevent soreness from disrupting your workout schedule.
What causes post-workout muscle pain?
When you start exercising for the first time in months or increase your workout intensity or duration, you apply more stress on your muscles forcing them to work harder, which will cause microscopic tears in your muscle fibers. Those tears are believed to cause mild swelling which stimulates pain receptors known as nociceptors within the muscle’s connective tissue and result in muscle pain. Exercise Physiologists refer to this pain as Delayed Onset Muscle Soreness (DOMS), which typically occurs 24-72 hours after exercising. Thankfully, this damage is temporary and can be repaired by satellite cells also known as “muscle stem cells”. Satellite cells are located between the basement membrane and the sarcolemma of muscle fibers. When muscle cells are damaged, satellite cells activate and fuse with damaged muscle fibers to initiate repair. Satellite cells are also able to divide and differentiate to form new muscle fibers resulting in bigger and stronger muscles able to endure higher levels of stress. As our body repairs the damage, swelling will go down and pain will diminish in a few days.
So yes, if there is no pain, there is no gain but how much pain is too much pain? And how do you know if your pain is due to overworking your muscles or due to a muscle injury? Here are a few indicators that can help you identify if your soreness is more serious and requires medical attention:
If you felt sharp or localized pain during or immediately after exercising, you should pay attention to the exercise you’ve done and stop the activity before serious joint or muscle damage occurs.
If you notice redness, severe swelling, skin discoloration, or severe pain, you should seek medical attention immediately. It may indicate severe damage to your muscle tissues.
If the pain does not diminish in 72 hours, that may indicate it's something more serious than DOMS.
If you heard a pop while working out and started to feel pain, the pop accompanied with pain or swelling may indicate a dislocation of a joint or a major tear of a ligament or a tendon, which requires medical attention.
How to treat DOMS and speed up recovery?
Now that you know if you indeed have DOMS, you may be wondering if there is a treatment or a way to speed up recovery. There is no single treatment for DOMS that is 100% effective, however, there are few pharmacological and nonpharmacological therapies that can help ease the pain.
Many studies have shown strong evidence that foam rolling can effectively reduce pain and improve muscle tenderness associated with DOMS. To speed up recovery and diminish pain, it is recommended to do a 20-minute session of foam rolling on a high-density roller immediately after working out as well as 24 hours thereafter. Foam rolling can help increase blood circulation and improve the delivery of oxygen and nutrients to your muscles, which aid in the healing and growth of new tissues. Foam rollers are affordable, easy to use and time-efficient, however, you can also massage the area yourself or visit a massage therapist.
It may sound counter-intuitive, but light exercises such as walking, swimming or light yoga may help alleviate pain and speed up recovery. This is commonly referred to as active recovery which involves non-strenuous aerobic or physical activity that will reduce soreness, improve flexibility, and aid in recovery through enhancing blood flow to your muscles.
Although cold therapy is effective for pain relief, studies have shown that heat therapy provides significantly greater pain relief for DOMS than cold therapy when applied 18 and 32 hours post-exercise. Heat therapy relieves pain through once again increasing blood circulation and supplying your muscles with nutrients and oxygen to promote healing. Therefore, it’s recommended to apply heat therapy such as hot towels, hot water bottles or heating pads
for 20 minutes three times daily. However, it's important to note that heat should not be applied on an open wound, inflamed skin or if you have dermatitis. It is also important to avoid using heat for an extended period of time or sleeping with a heating treatment to prevent burns and skin irritation.
Pain relief medications
There are many analgesics (painkillers) available in the market to alleviate muscle pain, however, they differ in terms of safety, efficacy, and onset of action. Many people don’t know the difference between acetaminophen (eg. Tylenol
) and ibuprofen (eg. Advil
), as well as what each medication is indicated for, so let’s break it down: Acetaminophen is not the most effective painkiller, however, it’s considered relatively safe and has minimal risk of causing side effects, when used appropriately. It is indicated for pain relief and fever in children, women who are pregnant or breast-feeding, as well as patients taking certain anticoagulants or at risk of GI bleedings. However, acetaminophen is not effective at reducing pain caused by inflammation. On the other hand, ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) known to be effective for musculoskeletal pain due to its anti-inflammatory properties that help in reducing swelling and thus pain.
With that being said, NSAIDs are a better option for muscle pain than acetaminophen. In terms of effectiveness, all NSAIDs share the same level of efficacy, however, the choice of drug depends on the individual’s risk factors where some medications are safer than others. Oral NSAIDs such as ibuprofen (eg. Advil) and naproxen (eg. Aleve
) are not considered safe for pregnant or breastfeeding women as well as patients with active stomach ulcers. However, topical medications are known to be safer than oral medications due to the lower levels of medication that enter your bloodstream, which minimizes systemic exposure and reduces the risk of side effects.
Voltaren Emulgel is an example of a topical NSAID that penetrates into the skin to reach the inflamed area in the muscle. It will inhibit the production of prostaglandins, a chemical in the body that promotes inflammation, pain and fever. By reducing the levels of prostaglandins, Voltaren will reduce acute pain and swelling within one hour of application, therefore, it is recommended for muscle pain as well as muscle sprains and strains. However, it’s important to stress that each person is different and there is no treatment that fits all - so I highly recommend that you speak to one of our pharmacists at The Health Depot to determine the safest most efficacious medication for you.
How to prevent future episodes of DOMS?
So now you may be wondering if there is a way to prevent future episodes of DOMS. Although DOMS is a natural process that indicates your muscles are getting stronger and able to endure heavier loads, there are few things that can be done to prevent it. As previously mentioned, DOMS occurs as a result of increasing your typical workout intensity, duration or frequency. If you plan on trying a new exercise, it’s recommended to start gently and ramp up your intensity gradually giving your muscles time to adapt. Exercise Physiologists also recommend scheduling a warm-up session for 10-15 minutes pre-workout to prepare your muscles for the exercise. In addition to warming up and starting gently, it’s important to mix up your workout routine and avoid focusing on the same muscle groups constantly in order to give each muscle group time to recover. If you are still unsure how to continue exercising while avoiding muscle pain, it’s highly recommended to consult a trainer to help guide your workout and provide you with tips to help you meet your personal fitness goals.
This information is for educational purposes only and is not intended as a substitute for medical advice from a healthcare professional. Please consult your physician or pharmacist for medical advice about your condition or medications.
In the meantime,
Stay Healthy, Stay Home.
BSc, MMASc, PharmD ‘23