Regular exercise is vital for health and longevity, but often brings strains and sprains. Here are some tips on how to ease the pain.
After a good long walk or a full day of chores around the home or yard, that warm soreness in your muscles can feel almost pleasurable. No wonder: it means your muscles are going to get stronger and better.
“Soreness is the normal response to exercise stress, injury, and repair, but there is a good soreness and a bad soreness” says Dr. Aaron Baggish, assistant professor of medicine at Harvard Medical School and associate director of the Cardiovascular Performance Program at Massachusetts General Hospital Heart Center.
Dr. Baggish is familiar with sore muscles. He has served as the cardiologist for the Boston Marathon and is a marathoner himself. He recommends exercising and working only to a level of soreness that lasts a day or two. But also know when to see a doctor when you cross the line to the “bad soreness” of injury. The key trouble signs are persistent pain, black-and-blue bruising, and numbness or weakness.
Good or “healthy” soreness comes from working your muscles to their limits. On a microscopic level, some muscle fibers may tear, but not to the extent that you could see or feel the difference with your hand. Over the next few days, your body repairs the damage. “If the injury is mild, the muscle is broken down a bit and ends up stronger than before,” Dr. Baggish says.
For exercise like fast walking or workouts on a treadmill, expect the soreness to be bilateral (affecting both sides of your body). The goal should be to stay within limits that result in normal healthy soreness. When you experience mild to moderate muscle pain, ease the discomfort by following the RICE method. (See “RICE for sore muscles,” upper right.)
RICE for sore muscles
Rest: Get off your feet; take the weight off the affected limb.
Ice: Apply an ice bag or gel pack wrapped in a cloth to the affected area for 20 minutes every two hours. Don’t apply ice directly to the skin.
Compression: Wrap the area in an elastic bandage.
Elevation: Raise the affected limb to a level above your heart.
The typical sign of “bad” soreness is pain in one particular area of the body that lasts for more than 24 to 48 hours. Does one leg or arm hurt for a week or longer, or enough to keep you awake at night? Do you need to take daily doses of an over-the-counter pain medication? These signs suggest muscle damage exceeding a healthy low-grade injury.
See a doctor if you experience severe and persistent pain, black-and-blue bruising, or numbness and weakness. It may be an inflamed tendon (tendinitis) or even a tendon tear. Muscles can also tear severely enough that you can feel an imperfection in the muscle tissue.
The ‘good hurt’ that makes you stronger
Muscles consist of nested bundles of muscle fibers surrounded by connective tissue. Straining or even lightly damaging the fibers triggers repair processes that make muscles larger and more capable.
Responding to injury
Along with the RICE method, proper use of medication can ease pain and swelling. Over-the-counter products include the non-steroidal anti-inflammatory drugs (NSAIDs) aspirin, ibuprofen (Advil, Motrin, Nuprin, others), and naproxen (Aleve, Naprosyn, others). Acetaminophen (Tylenol, others) eases pain but does not help with inflammation. People commonly take it to avoid the stomach upset that NSAIDs can cause.
NSAIDs purchased over the counter are not necessarily “safe.” Make sure to talk to your doctor about proper use of these powerful medications, especially if you have a kidney or heart condition.
The dose suggested on the NSAID labeling is for ordinary pain. Inflammation-reducing doses are higher. An anti-inflammatory dose of ibuprofen, for example, is 600 milligrams three or four times daily. Ask your doctor if using NSAIDs this way is safe for you.
Therapy for injuries
To support recovery from an injury, physical therapists offer active stretching, therapeutic exercises, ultrasound, and electrical therapy. Massage, thought to increase blood flow to the injured area and speed healing, may also help. Massage therapists are widely available, although the cost is not always reimbursed by health insurance.
There are no definitive research-based guidelines to recommend one approach over another, but a physical therapist can lay out the options. “You should experiment with different things and see what works for your body,” Dr. Baggish says. “If you try it and it works for you, go with it.”
Key moves to prevent muscle strains
The importance of a warm-up
To prevent muscle strains and sprains, ease into activity gradually whether you are at work or at play. “No part of the body responds well to sudden unexpected stress,” Dr. Baggish says. “If you are going to hurt yourself, you are more likely to do so if you skip the warm-up phase of exercise.”
Warming up means gradually increasing the intensity of exercise. For example, before a brisk daily walk, spend five to 10 minutes taking a leisurely stroll and increase the pace gradually. When you begin exercising on a treadmill or other gym machine, start on a low setting to allow the blood to flow and your joints to loosen. “In my opinion, a warm-up is absolutely a mandatory part of any exercise,” Dr. Baggish says. “Allowing the body to build into the activity gradually is important for all organ systems and muscles.”
Does stretching help?
Many people wonder about the value of stretching before exercise to prevent injuries or soreness, but the answer isn’t clear. “There’s been lots of research and some studies disagree with others,” Dr. Baggish says. “Some stretching after exercise may be beneficial, but you could find lots of studies that say it makes absolutely no difference.”
However, Dr. Baggish recommends that you avoid vigorous, extreme stretching before exercise. “The muscles and tendons are not warmed up, so if you are stretching them you tend to stress the weakest point along the chain, which is usually the tendon,” Dr. Baggish says. “That’s how people can develop tendon injuries.”