Understanding Delayed Onset Muscle Soreness

DOMS Have you ever adopted a new workout regimen, then ended up kicking your ass so hard that you became discouraged from the pain you experienced after your workouts? If so, you were probably taken by surprise when delayed onset muscle soreness (DOMS) set in. What often occurs is that people adopting new exercise regimens may become quickly discouraged, usually because they don’t understand why they are so sore, and will back off from exercising without ever getting a chance to maintain consistency. However, DOMS may be a beneficial signal that your workouts are challenging enough to make a difference.

DOMS typically develops between 24 to 72 hours after physical activity, and is considered a relatively normal and common result of activity that challenges muscle tissue. One popular but flawed theory is that the microscopic tears which occur in the muscle fibers after exercise, coupled with the release of lactic acid and protons, are responsible for the muscle soreness which characterizes DOMS. Mizumura and Taguchi determined in an important study that neurotrophic factors are produced by muscle fibers and satellite cells, and are critical for the development of DOMS symptoms. They also determined that damage to muscle fibers was not a necessary component of DOMS, further suggesting that a neurological cascade is what results in the post-exercise soreness.

For the most part, the aches and pains which characterize DOMS are assumed to be a sign that your muscles are adapting to the activity which caused them to develop in the first place. Rather than shying away from physical activity in the long term, the general recommendation is to take it easy for a few days, while still exercising, until the pain subsides. However, those of us who are gym rats and fitness freaks will tend to adopt the “Suck it up, buttercup!” mentality, powering through workouts as best we can while our bodies scream out in general agony.

So what can you do if you have DOMS and you want to lessen the severity and duration of the soreness? The truth is, not much. However, here are some suggestions which you might want to try. Keep in mind that none of these suggestions is proven to ameliorate DOMS, but none will worsen the symptoms either.

• consumption of plenty of water both during and after exercise
• consumption of a protein-rich meal after exercise
• glutamine
• cherry juice
• vitamin D supplementation
• compression garments
• Epsom salts
• application of heat

One thing to bear in mind is that if you are consistently working out at the same intensity, your muscles will become familiar with that intensity, essentially adapting to it. This phenomenon is called the repeated bout effect (RBE), and basically means that you will most likely notice a drop-off in DOMS episodes. If you suddenly increase the intensity or duration of your workouts, the chance of developing DOMS will return.

Obviously if you believe you have a specific injury, and not DOMS, then get it evaluated and rest up.

REFERENCES
Mizumura K, Taguchi T. Delayed onset muscle soreness: Involvement of neurotrophic factors. J Physiol Sci. 2016 Jan;66(1):43-52.

Advertisements

Ham, Cheese and Pickles

During a recent urgent care shift, I encountered a man in his mid-50’s who had presented to the center with complaints of sinus pressure and cough. After I gathered more history and conducted a physical exam, the patient went on a tangent, asking me numerous questions about healthy foods. A commercial construction foreman, he was accustomed to being on site during the day, and insisted that his daily lunch was quite healthy and acceptable. As he prepared to tell me about this daily meal, he beamed with pride. What was it? Several slices of ham from the refrigerated section of the supermarket, a few slices of cheese, and a handful of pickles. He truly believed that the meal he consumed daily was incredibly healthy and nutritious. He even stated that he was consuming a high protein meal with produce (the pickle). The patient went on to tell me that when he was done with work, he often stopped at Arby’s to pick up a sandwich for dinner, and felt that the animal protein from these sandwiches wasn’t harmful in the least.

I shake my head in amazement when I encounter patients who have completely convinced themselves that somehow, their eating habits are completely clean and healthy, when they are actually abysmally deficient in nutritional value. What is more surprising is how insistent these people are on continuing their unhealthy habits, even when they ask for advice. The patient I mentioned above listened to me discuss the power of food as fuel, as sustenance, and nodded when I suggested he visit the fresh produce section of local grocery stores, select uncured meats, and avoid frequenting fast food establishments like Arby’s. I also mentioned that his blood pressure readings of 181/125, 179/127, and 185/122 (non-symptomatic) were rather alarming, especially since he stated that he had “forgotten” to take his blood pressure medications that morning. Was it fair to shake him out of his fog and inform him that with malignant hypertension, and a diet sure to compound the problem, he was on a short course to an unfavorable event like a stroke or heart attack? Did he even care if he was at high risk?

This is the kind of situation which I as a physician must often dance around. I have to determine how receptive a patient is to advice, and I also have to figure out the best way to speak to the patient without offending or discouraging him or her. It can be very tricky to reason with someone who has most likely gone through his entire life somehow believing that ham, cheese and pickles constitute an acceptable daily meal in anyone’s life!

Who Can Still Read A Map?

I am willing to bet that a fair portion of the millenial generation finds it difficult to read a plain map. Sure, they can look at a navigation screen which continues to re-center and process information to ensure that they will get to their desired destination, but what would happen if a paper map was unfolded in front of them, and they were put to task to find out how to go from point A to point B only by reading the map?

I remember using Thomas Guides, those large spiral bound collections of maps which yielded detailed geography within large metropolitan areas. I always had a Thomas Guide tucked away in my trunk at all times, so that I would be able to reference it in case I found myself in an unfamiliar part of town. However, without some sense of direction, some sense of where my home, or some recognizable geographic reference, was, a Thomas Guide would have just been a jumble of confusing roads. In stark contrast, with GPS navigation apps, all I have to do is select “HOME” on my trusty navigation system and allow it to guide me, without having any clue to where “home” is.

Don’t get me wrong. I’m grateful for the technology which GPS navigation affords, especially when it can factor in traffic flow and estimate time of arrival. But I think it’s tragic that an unavoidable dumbing down of our society has also occurred as a result of GPS technology. What should be an essential survival skill, namely, reading a map, has been largely lost. I still run into people who don’t have the slightest clue of north, south, east, west, and whose lack of spatial knowledge is being coddled by computer programs which do the thinking for them.

I do think that when it comes to short distances within an area, especially if one is walking from point A to point B versus driving, there is some spatial mapping and learning which occurs. However, longer distances with numerous circuitous navigation paths are best handled with forfeiting complete control to the navigation stream without really processing what turns have been made, etc. One prime example I have is a destination about 50 miles away from me which I must drive to each month, which also happens to be quite tricky to get to, because it is nestled deep in the next county, hidden from major highways. I rarely repeat a route to this destination, thanks to the fact that Waze factors in traffic flow, and puts me on the most complicated navigation paths. Waze wasn’t working on one of those days, and I honestly couldn’t think of how to get to my destination! I ended up plugging the address into my vehicle’s GPS, and was able to get to my destination. I had given in to Waze to show me the way, but hadn’t processed enough on my own to map out my route unassisted.

You Truly ARE What You Eat (Updated Post)

you-are-what-you-eatIt’s no secret that fast foods are unhealthy and artery-clogging, but there are impostors which sit on grocery shelves and have people believe they are healthy due to phrases like “Low Fat”, “Good for you”, “Fit ____”, and the list goes on. I encourage my patients to read EVERY label on food containers while perusing the grocery store shelves and aisles and to become aware of preservatives, sugar, hydrogenated oils, artificial flavors and artificial colorings.

A good general rule to follow is if there are more than five ingredients on a food label, or if there are a bunch of big terms which seem alien and strange to you, chances are that the item has questionable nutritional value and should be avoided. Over the last few years I have developed such an aversion to packaged foods that as soon as I see a food item in a bag, box or can, I tend to avoid it.

An interesting thing begins happening to people when they completely eliminate sugars and processed foods from their diets. They experience increased energy, clearer skin, fewer aches and pains, and lower body fat. If someone has been eating clean for a while and decides to have a sinful treat like pizza, a fast food burger, chips, cake or cookies, he or she will notice a detrimental effect on energy, aches and pains may return, and stubborn pockets of body fat will become more noticeable. I have seen this in myself and cannot stand it. What always occurs with me after I have had a couple of glasses of wine, a piece of cake, or greasy foods is that my digestion is completely thrown off whack and I feel sluggish and achy. In other words, these heavier foods make me feel heavy and tired, while clean, light, fresh foods make me feel energized.

I know some of you are thinking, “Wow, that would be so hard to stay away from processed food all the time!”, but in actuality, it isn’t difficult at all. The first thing you need to do is to clear out your pantry and refrigerator of any processed foods, thus wiping the slate clean. What do you replace those items with? You replace them with wholesome foods, fill up your crisper with fresh, organic vegetables and fruits, and favor single ingredients over packages which have ingredient lists which look like essays. Some of you might complain that you are so busy that it would be a waste to buy fresh fruits and vegetables because they would just rot. For you folks, I recommend purchasing frozen (NOT canned) produce which you can easily thaw out and cook whenever you need to.

And if you think it’s tough to cook clean meals, it really isn’t. A chicken breast can easily be marinated in simple marinades while you are at work (a favorite of mine has Bragg’s Amino Acids, apple cider vinegar, and sesame oil…yummy!), then placed in your broiler to cook. Add some steamed vegetables, and maybe a small serving of quinoa, and you have a healthy, nutritious meal which is a snap to make!

I understand that it can be challenging to find the time to eat whole foods each day, but I am telling you that it is well worth it if you intend to take control of poor eating habits and possibly even reverse disease processes in your body. Give it a try…you will probably love it.

Consistency (Updated Post)

As a physician, I am as much a therapist as I am a physical healer, and am well aware of the vital connection between mind, spirit and body. I have also seen how closely linked emotional stress is to development and exacerbation of physical ailments. What concerns me is when people abandon healthy habits during times of adversity, because it is at those times that some structure would provide balance to their lives.

A common question I hear from patients, clients, and strangers I meet is, “How can you maintain a regular exercise schedule and pack your food all the time with your busy careers?”, to which I respond, “I just do it.” Working out and eating right are as essential to me as sleeping and brushing my teeth. It never occurs to me to abandon healthy habits during stressful times. I recently went through a particularly difficult month during which I took a rigorous board certification exam, went through a residential move, and traveled to four destinations (two for my medical career, two for fitness and bodybuilding) over a two week period. Though I didn’t work out my usual six days per week, I did manage to train four to five days per week, every single week. The regular workouts gave me structure and balance which helped me to burn off some of the stress I was under, regulated my sleep cycle, and just plain felt good. In addition, I traveled with clean foods and lots of water, packing them and making sure I stayed on track.

Why would I push myself like this? Because I know that consistency is key to maintaining balance in one’s life. When I am consistent with my workouts and food, I maintain structure and focus and do not allow excuses of an insanely busy schedule to deter me from my mission to live an optimally healthy lifestyle. I know that if I were to deviate from a healthy lifestyle, I wouldn’t have the energy to push through my to-do list, and I certainly wouldn’t be very happy either. No matter whether I am traveling, working, or enjoying a rare free day for myself, I make sure to invest in myself every single day.

When I worked the Arnold Sports Festival Expo in Columbus, Ohio earlier this month, I made sure to drink plenty of water, filling up my one liter container 3 to 4 times each day. I also brought my Hot Logic Mini with me (https://youtu.be/GQltYTRLTC4) and had meals from Icon Meals with me, and I made sure to consume a meal every 3 hours to keep my energy levels up. If you are committed to living a healthy lifestyle, you will find ways to stay in line!

If you make an investment in yourself by being consistent with your exercise and meal habits, you will be rewarded with greater balance in your life and better health. Don’t you deserve that?