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.

Of Orifices and Zero Freedom

As a physician, I have had the incredible honor and privilege of studying every part of the human body, to the most minute detail. I have hovered over cadavers which were fileted and displayed for they eyes of inquisitive medical students, and scrubbed in on colon resections, open heart surgery, neurosurgery, cataract removal, etc. During my first month of internship as a newly minted physician, I massaged a dying heart with my gloved hands (no, the patient didn’t survive). I have also delivered over 40 infants via vaginal and Cesarean methods, and have pronounced the demise of patients in the wards. In fact, there are many stories I have collected over the years, some incredibly sad, some disgusting, some frightening, and some infuriating, but all true, and all part of my experience as a doctor.

I knew full well that by signing up for an education in medicine, I would be subjected to disgusting, morbid, frightening things, and that I would face mortality on a regular basis. However, after several years of working in family practice, I began to notice that I wasn’t thrilled with the fact that I examined orifices of every kind on a very regular basis. Whether it was a nostril, a mouth, an ear canal, an anus, a urethral meatus (layman’s term pee-hole), or vagina I had to examine, I was never thrilled about it, and the orifices below the belt were certainly much more bothersome to address. My intense dislike of such examinations, combined with the tedium of primary care and the low insurance reimbursement for services and procedures provided, caused me to retreat from primary care and focus more on the areas I had more interest in, namely, physical medicine, cosmetic dermatology, and anti-aging medicine, all of which are much cleaner and which do not require me to conduct examinations on private parts.

Another feature of primary care which made me cringe was the intense demand on a practitioner’s time. The only time it ever seemed reasonable for me to literally lose sleep night after night as a physician was when I was in training. At this point, there is no way you could convince me that such a thing is healthy, and I refuse to sign up for that. I won’t give up weekends to take on three stacked 12-hour work shifts, and I will not give up the few holidays I celebrate (Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day) in order to work. As it is, I give up other major holidays to work, but since the work I perform on those holidays is in bodybuilding and fitness, I don’t mind it at all.

I love being a physician, and I find it incredibly rewarding to make a positive impact on my patients. However, I will not sacrifice balance in my life, or the freedom to pursue my other interests, in order to prove to society what a good physician I am. I don’t believe for a second that running oneself into the ground working as a physician ever sends a positive message to others. I don’t ever want to be the kind of doctor who is saddled with so many chart notes to write that an entire weekend is devoted to completing them. Not for me.

Lasty, I think it’s so strange that society still assumes that doctors are supposed to give their time and knowledge at a moment’s notice, on demand, yet I don’t see those same demands placed on people in other industries. I can’t tell you how many times I have been in a brief conversation with a complete stranger, who dares to ask me a medical question as soon as my profession is revealed. I swear, one of these days I am going to get a t-shirt made that says, “THE DOCTOR IS OFF-DUTY RIGHT NOW…NO MEDICAL QUESTIONS PLEASE”!

How To Be As Prepared As You Can Be for Your Big Run

I am posting this a second time with links embedded in the article. What a great contribution by Jason Lewis!

– Written by Jason Lewis

Mike Tyson once said, “everyone has a plan until they get punched in the mouth.” For those about to compete in a major race, the logic still applies. Everyone has a plan for their run until they come face to face with some of the harsh realities of the race running. It can be hard, and you may face what feels like insurmountable obstacles. But if you prepare yourself properly, you can make sure you have the best chance possible to beat whatever punch – metaphorically speaking of course – comes your way. Here are some tips.

Know how to properly hydrate

If there’s one thing that any runner must know, it’s proper hydration. Dehydration lowers your blood volume and when you have lower blood volume your heart has to work extra hard to get blood (oxygen) to your muscles. Long story short, you can’t run your best when dehydrated. So, drink as much water as you can before, during, and after your runs?

Not exactly. Overconsumption can be an issue. For the most part, you should drink when you’re thirsty – no more, no less. Don’t overcomplicate things. Here’s a good resource on how to properly hydrate for certain types of runs.  

One big question is whether water is good enough, or should you hydrate with sports drinks. Both are true, actually. Water is fine, but there are some benefits to Gatorade. Sports drinks contain carbs (in the form of sugars) and electrolytes (which you lose when you sweat) – two things your body needs when participating in demanding physical activity.

Find a routine and stick to it

You should develop a routine surrounding your runs and keep it the same through training and through race day. Eat the same thing before, during, and after runs. Wear the same shoes and clothing. Get the same amount of sleep the night before. Listen to the same music. This routine, if you keep to it, will help your body and mind stay strong through the tough stretches.

Know how to treat common running injuries

Running puts a good amount of stress on your body – whether it’s trail running, city running, or even practicing in a gym or on a treadmill. If you run a lot, you’re going to get hurt at some point. There’s no getting around it. It’s vital that you know how to deal with sprains, scrapes, blisters, and more. The shorthand guide is to always ice a sprain, stretch a cramp, pressure a wound, and leave a blister intact. For more on this, check here.

Know why you’re running

Sure, you’re running for the exercise and the feelings of personal accomplishment. The runner’s high isn’t an unwelcome byproduct. But in the end, running is about a mentality – even a spirituality for some. Focus on how running gives you a mental boost and makes you a stronger person: push your self to achieve goals you never thought possible; give yourself a chance to find a stronger you through self-discovery; heal from a broken past; overcome seemingly impossible obstacles. As Jim Friedrich says in the article The Spirituality of Running, “What we do with our bodies manifests and expresses inner states, the sacred ground of our being. But bodily practices can also induce inner states.”

Whether you’re running for fun, a charity 5K or a marathon – the principles of proper running preparation are pretty much the same. If you know how to hydrate, deal with inevitable injuries, and stick to what you know works, you will have a good chance at succeeding in whatever you do. “Success” is whatever you want it to be – only you can decide your own criteria.
Photo Credit: Pixabay.com

ABOUT THE AUTHOR
Jason Lewis is passionate about helping seniors stay healthy and injury-free. He created StrongWell.org to share his tips on senior fitness.

When Your Joints Rebel: How To Modify Your Lifting Regimen So You Can Train With Joint Issues

You are a beast in the gym…that is, until a joint injury or flare-up from arthritis, bursitis or sprain threatens to deflate your motivation as a result of the pain. While it is always important to take preventative measures to protect the joints, such as warming up the surrounding soft tissues properly, using proper form during exercises, and taking supplements which promote joint health, there may be times when joint discomfort is so significant that a little TLC needs to be added to the regimen. The recommendation of complete rest usually falls on deaf ears when a fitness fanatic is the one suffering from joint woes, because the general mindset for such an individual is to push through the pain and continue training. However, in most cases, the pain and inflammation will throw a wrench in the works by adversely affecting range of motion and strength. As long as the joint pain isn’t severe, and is not caused by direct, acute injury to the joint, exercises can usually be modified to alleviate load stress on the affected area.

There are a number of exercise modifications which can be made to weightlifting exercises to minimize the loading on affected joints while still effectively training surrounding muscle groups. Bear in mind that you might not be able to perform certain exercises at all, even with a modified grip or stance. The most important thing is to pay attention to your body and stop doing anything which exacerbates the joint discomfort.

SAVE YOUR SHOULDERS AND ARMS

Since shoulder joint issues are relatively common, most of the suggestions made in this article for exercise modifications for the upper body will take this into account. Depending on the degree and location of shoulder pain, you might still be able to perform shoulder presses, but do not perform them behind the neck as they can cause impingement. Incidentally, you will also need to avoid pulling the bar behind your head when doing lat pulldowns. To perform overhead presses, use a straight bar with a grip slightly wider than shoulder width apart, or use dumbbells, and use a light weight. Another exercise which should be modified when shoulder pain is an issue is the bench press. Chest presses should be avoided on an incline bench due to increased abduction and a corresponding increased shear stress and strain on the glenohumeral joint.

Shoulder joint pain can also interfere with lower body barbell exercises like the back squat and lunges. Since the barbell must be stabilized across the back, the shoulder must remain in an externally rotated and abducted position. Even barbell deadlifts force the shoulder into a gravitational load in extension which can be enough to aggravate shoulder joint issues if a heavy weight is used. Modifications to these exercises include performing front squats while holding onto a kettlebell or dumbbell, and switching to dumbbells when performing lunges and deadlifts.

Most cases of shoulder pain from joint instability or arthritis can make it impossible to perform a plank for an extended period of time due to the superior-posterior stress across the shoulder joint complex, but this is easily remedied by modifying the plank so that you rest on your forearms instead of your hands, thus shortening the lever arm and decreasing the stress load.

If you have issues with your elbows, it is wise to avoid pullups, pushups, mountain climbers, overhead tricep extensions and planks, but bicep curls may also be difficult to do, especially as you supinate and flex the elbow. The elbow joint is a tricky one to train around, and the best approach is to completely avoid any direct movements which involve the elbow flexors if the pain is severe. If the pain is minimal, regular dumbbell bicep curls, hammer curls and cable tricep extensions can be performed with light weights. Using a false grip on dumbbells (in which the thumb is not engaged in opposition around the bar), using a cuff around the arm with a cable assembly, or switching to weight plates with a neutral (palms in) grip can also be helpful in minimizing the strain on the elbow stabilizers during delt training routines.

Wrist pain can often be eradicated by using lifting gloves which have wrist support to counteract some of the stress. Since bench dips can aggravate sore wrists, they should be avoided and replaced with cable tricep extensions, which can be performed without extending the wrist. Traditional pushups also force the wrists into a hyperextended position, but a simple switch in hand position, in which the fingers point out to the sides, with hands at least shoulder width apart, will minimize joint stress during the down phase of the movement.

WEIGHT BEARING JOINTS

If you have issues with the joints in your lower extremities (hips, knees, ankles, feet), ballistic movements, such as the ones performed in plyometrics and calisthenics, should be avoided. Unfortunately, exercises which are considered staples in a weightlifter’s regimen, such as squats, lunges and leg presses, can also wreak havoc on achy hips and creaky knees, especially if poor form and heavy weights are used. It’s best to trade these in, at least for a while, and instead turn to leg lifts on all fours, wall sits, front leg raises against a wall, and single leg deadlifts, all of which decrease the load on the hips and knees while still providing good isolation.

Since ankles and feet take the brunt of weight bearing, they should be babied when flare-ups occur, which means that calf raises, leg presses, and squats should be avoided and replaced with moves which do not require excessive joint motion under a loading force. Foot stance should be maintained at shoulder width to maintain the ankle position in a neutral plane and avoid any inversion or eversion. Mat exercises are also an excellent alternative to hardcore standard weight machines when dealing with joint flare-ups in the ankle or foot.

OHHHHH MY BACK

The incidence of low back pain is extremely high, especially among fitness devotees. Since it is usually triggered by extreme positions of flexion or extension, something as simple as standing with your heels on two weight plates and dropping the amount of weight lifted can be enough to maintain a more upright position and avoid the excessive lumbar flexion often seen with back squats. Another modification which spares the low back as well as the knee is performing Bulgarian squats, which keep the upper body in a vertical plane.

If you experience joint pain in your neck or upper back, you should avoid exercises mentioned earlier such as behind the head lat pulldowns and military presses, both of which cause excessive flexion in the cervical spine. In some cases, you will need to omit exercises which involve the use of a barbell behind the neck since this type of load increases flexion stress. You can modify these movements by using dumbbells or by switching to a machine, for example, switching from barbell squats to hack squats.

The most important thing to remember is to listen to your body and stop any movement if you feel sudden pain. By training wisely and making necessary modifications while your joints are inflamed, you will be able to bypass injury and continue to make gains at the gym.

Anti-Inflammatory Meds and Muscle Growth

NOTE: This was originally written for Oxygen Mag digital version.

There has been a heated debate over many years within the bodybuilding community about whether anti-inflammatory medications like ibuprofen (Advil, Motrin) and naproxen sodium hinder muscle growth. These medications inhibit the synthesis of prostaglandins, which also play a role in muscle synthesis. All it took was one clinical study published in the Journal of Clinical Endocrinology and Metabolism to put bodybuilders into a panic about reduced protein synthesis, and it didn’t matter that such results were found in laboratory rats. While there is some evidence to suggest that the anabolic signal is shut off when anti-inflammatories circulate in the bloodstream, nothing is absolutely conclusive, and what might be seen in the rat model might not necessarily be the case for humans.

While I will never advocate chronic use of painkillers and anti-inflammatory agents, I think they definitely serve a purpose when acute injury is present. When I find myself in the middle of disputes with bodybuilders who INSIST that a few days on such medications will completely destroy all their efforts in the gym, I simply shake my head in frustration. If you are injured and your lifting is adversely affected by the injury, whether it be a muscle strain, a ligament tear, or a minor disc herniation, you need to be aware that training through that injury, especially when it deranges your form and causes other body parts to compensate for the injury, will end up really messing you up over time. I honestly think that a minimal decrease in muscle mass over the course of a few days is preferable to the imbalance and asymmetry which usually occur when a bodybuilder foolishly pushes through heavy workouts despite an injury which has a domino effect on the body.

Common sense, and medical expertise, dictate that the inflammation must be removed from the area, most commonly through short term administration of anti-inflammatory agents, ice, and rest. Trust me, if you follow a regimen like this, you won’t lose all the muscle you have built over the years. Be sure to take these medications with food, and if you have any history of gastric ulcers. bleeding disorders, or kidney dysfunction, avoid taking them.

Remember that I am talking about DAYS, not weeks or months. This is one time when eating constantly has its benefits, since bodybuilders and fitness people can pretty easily fit in their medication administration with one of their meals. I know it’s difficult to back off from training, but if you truly want to HEAL, you must give the injured area time to repair itself. If you insist on continuing to train through the injury, especially, without any medications or other interventions on board, you can count on the injury either lingering or worsening over time.

How To Be As Prepared As You Can Be for Your Big Run

Those of you who enjoy running should definitely read this article!

I am delighted to share the following article which was written by Jason Lewis. Jason Lewis is passionate about helping seniors stay healthy and injury-free. He created StrongWell.org to share his tips on senior fitness.

Mike Tyson once said “everyone has a plan until they get punched in mouth.” For those about to compete in a major race, the logic still applies. Everyone has a plan for their run until they come face to face with some of the harsh realities of race running. It can be hard, and you may face what feels like insurmountable obstacles. But if you prepare yourself properly, you can make sure you have the best chance possible to beat whatever punch – metaphorically speaking of course – comes your way. Here are some tips.

Know how to properly hydrate

If there’s one thing that any runner must know, it’s proper hydration. Dehydration lowers your blood volume and when you have lower blood volume your heart has to work extra hard to get blood (oxygen) to your muscles. Long story short, you can’t run your best when dehydrated. So, drink as much water as you can before, during, and after your runs?

Not exactly. Overconsumption can be an issue. For the most part, you should drink when you’re thirsty – no more, no less. Don’t overcomplicate things. Here’s a good resource on how to properly hydrate for certain types of runs.

One big question is whether water is good enough, or should you hydrate with sports drinks. Both are true, actually. Water is fine, but there are some benefits to Gatorade. Sports drinks contain carbs (in the form of sugars) and electrolytes (which you lose when you sweat) – two things your body needs when participating in demanding physical activity.

Find a routine and stick to it

You should develop a routine surrounding your runs and keep it the same through training and through race day. Eat the same thing before, during, and after runs. Wear the same shoes and clothing. Get the same amount of sleep the night before. Listen to the same music. This routine, if you keep to it, will help your body and mind stay strong through the tough stretches.

Know how to treat common running injuries

Running puts a good amount of stress on your body – whether it’s trail running, city running, or even practicing in a gym or on a treadmill. If you run a lot, you’re going to get hurt at some point. There’s no getting around it. It’s vital that you know how to deal with sprains, scrapes, blisters, and more. The shorthand guide is to always ice a sprain, stretch a cramp, pressure a wound, and leave a blister intact. For more on this, check here.

Know why you’re running

Sure, you’re running for the exercise and the feelings of personal accomplishment. The runner’s high isn’t an unwelcome byproduct. But in the end, running is about a mentality – even a spirituality for some. Focus on how running gives you a mental boost and makes you a stronger person: push yourself to achieve goals you never thought possible; give yourself a chance to find a stronger you through self-discovery; heal from a broken past; overcome seemingly impossible obstacles. As Jim Friedrich says in the article The Spirituality of Running, “What we do with our bodies manifests and expresses inner states, the sacred ground of our being. But bodily practices can also induce inner states.”

Whether you’re running for fun, a charity 5K, or a marathon – the principles of proper running preparation are pretty much the same. If you know how to hydrate, deal with inevitable injuries, and stick to what you know works, you will have a good chance at succeeding in whatever you do. “Success” is whatever you want it to be – only you can decide your own criteria.

Photo Credit: Pixabay.com