No Pain, No Gain; Managing After Workout Soreness

Are you concerned about the level of pain your clients experience after a workout, athletic event and/or social recreation and games? The origin of athletic pain is threefold:

1. Delayed onset muscle soreness,(DOMS)
2. Soft tissue injury such as a sprain or strain
3. Contusions which result from direct blow or repeated blows to a part of the body which can crush underlying muscle fibers and connective tissue without breaking the skin, e.g. contact sports such as boxing, football and the like.

Admittedly, there are other forms of pain that result from disease, extensive tissue damage, a broken bone, dislocated joint, torn muscle, to name a few.  However, today’s focus is the pain that results from strengthening exercise.

Muscle growth occurs under the following techniques [Clark, R. J. (1996)] & [MedicineNet.com (June 2014). Muscle Soreness]:

1. Concentric (positive) reps in a set. A particular set will consist of 6 to 10 repetitions until failure, and then once a week lift heavier weight in the set with repetitions between the one to six range.
2. Eccentric contractions done slowly (lowering the portion of the lift, or negative contractions). In other words, complete the set to fatigue, then have a spotter help you with additional concentric movements, allowing you to do the prolonged eccentric contraction. This is known as cheat up with assisted negatives.
3. Forced negatives is when you complete the set to failure, allowing a spotter to help you with one more concentric movement to the point of flexion, then having the spotter pull back down while you resist.

The aforementioned three techniques will lead to acute and prolonged muscle sensations. Acute muscle sensations can be attributed to burning in the muscles during your workout. The burning sensation results in the accumulation of lactic acid in the muscles. Lactic acid is a normal byproduct of muscle metabolism. Lactic acid will irritate the muscles. Surprisingly, lactic acid is removed from the muscles in a few hours.  On the other hand, there is muscle soreness.

Depending on the intensity of exercise, swelling and inflammation can build up for days after a workout and can take up to five days for the muscles to heal completely (Lovering 2008). This swelling that occurs in the muscles will lead to an infiltration of white blood cells and prostaglandins (which are inflammatory). MedicineNet.com, Muscle Soreness (June 2014).

If proper rest is not taken between workouts, then muscle soreness continues to augment. To offset missing a workout, the first step an individual will take is to endure the pain. After all, no pain no gain, right? However, forcing continuous exercise when the body needs recovery will continue the influx of prostaglandins to the muscle fiber break, making the soreness/pain worse. Following the lack of recovery and continued pain the individual will seek pain relief, usually in the form of an over-the-counter pain reliever.

In the gym you will come across individuals that pre-treat their body’s prior to their work out with over-the-counter pain relievers.  A common pharmaceutical class of pain relievers is Non-Steroidal Anti-Inflammatory drugs (NSAIDs). How do NSAIDs relieve pain?

Muscle building through myofibril tearing down and rebuilding process will lead to inflammation. The myofibril injury causes the body to respond with cyclooxygenase-2 (COX-2), an enzyme related to cyclooxygenase-1 (COX-1).  COX-1 enzymes are responsible for maintaining balance in the stomach and kidneys, while COX-2 turns a type of fat (arachidonic acid) into prostaglandins which inflame the injured area, causing an increase in sensitivity to pain receptors.[Wellness Magazine, Jun 2014] [Biochemistry of Arachidonic Acid]

The literature purports that pre-workout use of NSAIDs will reduce soreness. However, continued use of NSAIDs will result in gastrointestinal upset, peptic ulcer, and intestinal bleeding.  Taken in large quantities NSAIDs may contribute to colon, kidney, or liver damage. [RxList. International Drug Index, June 2014]

The new generation of NSAIDs are designed to target only the COX-2 enzyme. They carry fewer gastrointestinal risks than the traditional NSAIDs. But, these new generation NSAIDs are not without their own side effects. Soon after their approval, physicians were reporting adverse drug reactions that occurred when taking the new generation NSAIDs; noting respiratory infections, dizziness and skin rashes. The medical journal Lancet reported new generation COX-2 inhibitors were associated with nonfatal heart attacks or strokes [Lancet 2005].

Further, the online journal BMJ Open (2014) contained reports that read NSAIDs heighten the risk of atrial fibrillation (an irregular heart beat) in older adults, which increases the chances of stroke, heart failure and possibly death. Clinicians hypothesize that the potential for stroke may be correlated to NSAIDs causing an increase in blood pressure due to fluid retention.

Are there alternatives in handling pain that results from exercise?  Health articles purport that nutrients, botanicals and proper eating will become your fortress against pain. I suggests you search the literature respective to the information below, which will allow you to be empowered to build your fortress against pain:

• Control your diet. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. [J Am Coll Cardiol. 2006 Aug 15;48(4):677-85]
• Ginger prior to your workout.  Ginger is a herb that is used as a spice and also for its therapeutic qualities. Gingerols are compounds that inhibit the COX-2 on stored arachidonic acid  (Journal of Pain 2009).
• The homeopathic preparation Arnica. Arnica provided runners with less muscle soreness than those that applied a placebo (Homeopathy 2003).
• Finally, when a strain, sprain or other pain occurs follow the RICE principle (rest, ice, compression and elevation) (NFPT, 1996).

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Article References:

1. Blacksmith CD. Ginger (Zingiber officinale ) Reduces Muscle Pain Caused by Eccentric Exercise. Journal of Pain –printed online ahead of print –doi:10.1016/j.jpain.2009.12.013]
2. Bouwe P Krijthe, Jan Heeringa, Albert Hofman, Oscar H Franco, Bruno H Stricker Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study.  BMJ Open 2014;4:4 e004059
3. Clark, R. J. (1996) NFPT Study and Reference Manual. Ch XI, p 37.
4. Clark, R. J. (1996) NFPT Study and Reference Manual. Ch XIII pp 46-51]
5. Clark, R. J. (1996) NFPT Study and Reference Manual. Ch XX, p 66.
6. Giugliano D, Ceriello A, Esposito K.   2006 Aug 15. The effects of Diet on Inflammation: Emphasis on the Metabolic Syndrome. J Am Coll Cardiol. 48(4):677-85.
7. Haag MD, Boss MJ, Hoffman A, et al. Cyclooxygenase selectivity of Non-Steroidal Anti-inflammatory Drugs and risk of stroke. Lancet 2005, 365:475]
8. Lovering, R.M. (2008) Physical Therapy and Related Interventions. In P.M. Tidus (Eds.), Skeletal Muscle Damage and Repair (pp. 219-230). United States of America: Human Kinetics.
9. Maroon JC, Bost JW, Maroon A.   2010. Natural Anti-inflammatory Agents for Pain Relief. Surgical Neurology International. 1:80 (Surg Neurol Int. 2010 Dec 13;1:80. doi: 10.4103/2152-7806.73804. PMID: 21206541 [PubMed])
10. D Tveiten, S Bruset,  Nov. 2003. Effect of Arnica D30 in marathon runners. Pooled results from two double-blind placebo controlled studies. Homeopathy 11/2003; 92(4):187-9.·0.84 Impact Factor.