Unfortunately, what evidence there is to support this damns it with faint praise — it doesn’t work well enough to be impressive71 — and plenty of evidence goes the other way,72 including my own careful personal testing. If only. Ibuprofen failed to reduce muscle pain or soreness, and blood tests revealed that ibuprofen takers actually experienced greater levels of inflammation than those who eschewed the drug. Soreness spiked with the slightest contraction, making it easy to evaluate. I could barely lift my head off my pillow for 3 days. That is not really any kind of a surprise. The “interesting” ones are mostly dorky digressions, clarification, context, whatever’s needed to fully inform a keen reader. Nope. It was rarely (if ever) the main reason for the appointment, however. From the article: “An effective treatment has been sought for many years … to date, none of these approaches has been fully convincing.”. I make that case in a lot of detail in another article: Is there any hope? “We can put a man on the moon,” but we still don’t really know what non-steroidal anti-inflammatories do for injured/sore muscles other than relieve pain. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Interesting, short, and readable story of an elderly man who collapsed after an unusually strong massage. But there are undoubtedly other problems, like sleep disturbance (discussed below), that will aggravate DOMS specifically. Are you an ethical, progressive, science-loving massage therapist? “Its promoter claimed, ‘Some athletes are so fond of it that they rub it all over them.’” The more the merrier! Recovery science is a mess, most of the studies are just junk, and so most meta-analyses are too… and there’s a lot of them. It “exerts potent anti-inflammatory effects.” Although we’ve just discussed evidence that inflammation may not be a factor in DOMS, here’s some new evidence that it is: in a 2015 study, “curcumin caused moderate to large reductions in pain” in 17 men with very sore leg muscles.70 It also helped some aspects of strength loss. Nieman, director of the Human Performance Lab at Appalachian State University, eventually did recruit the subjects he needed for the study, comparing pain and inflammation in runners who took ibuprofen during the race with those who didn’t, and the results were unequivocal. But in 2011 I started the season in unusually good physical condition, thanks to months of sprint intervals and strength training. But how far outside your exercise comfort zone can you wander before DOMS strikes? And many take ibuprofen as prevention, but that doesn’t work either. While historically associated with severe crushing injuries, overexertion can also do it,3 usually manual labor, extreme endurance exercise, or lifting weights,4 and it can be dangerous.5, If you feel sick and your urine is brown, it’s a medical emergency, and you should take yourself to a hospital. Just as the burn only happens when certain molecules get mixed up, burn alone does not doom one to DOMS. Drugs will only take the edge off the pain. I’m in their roster of reserve guest myth busters. As of spring 2021, the only available scientific review of vibration for DOMS is junk science, completely useless.87 There’s a handful of scraps of evidence showing some signs of slightly reduced soreness.8889. Eccentric contraction is a bit mysterious, and is known to be a bit “harder” on muscle and a strong stimulus to adaptation. Finally, the failure to have any effect on muscle strength is consistent with all other studies of massage for DOMS, and it means that massage is only relieving a little pain at best — not actually “fixing” or promoting recovery. There have been many contenders over the last century, but nothing has ever been proven. Even a little head banging can be hard on neck muscles. more It may stimulate lymphocyte and neutrophil responses and may be a useful modality in treating muscle inflammation.”, PainScience.com is © 1999–2021 by Paul Ingraham778-968-0930 while(x=eval(x)); Branched-chain amino acids (BCAAs, or just “protein supplements”) are three of the six essential amino acids in human physiology, and they are widely believed to be more important to recovery than the others for more or less the same reasons: that is, they are allegedly better at promoting protein synthesis, and therefore may help muscle growth/repair after exercise, and that in turn might — in theory — also reduce DOMS. View this post on Instagram . For instance, another deficiency, iron, would cause fatigue and a variety of other symptoms — but it probably wouldn’t make DOMS worse. For instance, if one is generally inflamed or sensitized — two common broad explanations for widespread body pain — it stands to reason that it would either accelerate the timing, or at least obscure it. There are several common injuries that can mimic DOMS, such a mild. The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. Running Start provides academically motivated students an opportunity to take college courses as part of their high school education. Sometimes DOMS is so severe that it is mistaken for a muscle strain. When I returned to Vancouver and played ultimate again, I was really blasted sore. “Help, I’m sore from my workout!” is not really a common thing for people to say when they book massage appointments. I wonder what would happen if we took Occam’s razor to OCTriathlete’s anecdote. The most interesting example: a strong massage. And what was that drug? Degrees matter. Afterward, he asked whether his study results would change their habits. Fish oil has shown some potential to aid with recovery from exercise.69 The evidence is not compelling, but it’s noteworthy, especially the apparent effect on strength and ROM recovery. Exercise or other physical stresses outside your normal range of intensity — anything you aren’t used to. CrossFit and rhabdomyolysis: A case series of 11 patients presenting at a single academic institution. Another well-known source of rhabdo cases is military boot camp: “large numbers of [recruits] may have myoglobinemia … .”19 After a bit of browsing through the literature, I have the impression that you could be rhabdo-ized by an especially hard sneeze. For more information, see, The key indicator molecule is creatine phosphokinase (CPK, which is not myoglobin but a molecule that increases in concentration along with myoglobin). In a toasty steam room, I massaged the crap out of my left upper arm for several minutes, using strong deep palm stroking, which was super unpleasant. They don’t prevent DOMS either, not even a little bit. (You can go to the next section now, if you like.) And massage for DOMS has been tested. Excessive DOMS may also be a symptom of other health problems, some of which can be treated, most notably vitamin D deficiency and insomnia. Another very small test of ibuprofen, very similar to Hasson 1993 in design and results: “ibuprofen can decrease muscle soreness induced after eccentric exercise but cannot assist in restoring muscle function.”. Its typical sign is mechanical hyperalgesia (tenderness and movement related pain). From a wide range of programs for all ages and abilities, to a rewarding Volunteer Program and unmatched facilities and exhibition space, we invite you to experience our Mission to celebrate diversity of people, values, ideas and activities. But it depends. Don’t try to chalk up severe soreness to just moderately overdoing it — that is not a thing, and there is probably something else going on. Vancouver’s climate is classified as moderate oceanic. muscle fiber damage is not essential, although it is sufficient, for induction of DOMS, instead, NGF and GDNF produced by muscle fibers/satellite cells play crucial roles in DOMS. I went back to the gym, this time working the core, back and legs, but chest and arms were also involved in these exercises. I’m still updating it, well over a decade after I first published it. The rhabdo itself was undeniable, but Radu’s doctor was skeptical that it could have been caused by a workout. Radu Simion kindly granted permission to use his story and his real name. That’s never a good idea. Lots of athletes take them — but lots of athletes wear scammy Power Balance bracelets, too, and that’s blatant nonsense. The sensations are incredibly similar. Medical science can’t explain DOMS, let alone treat it. I have an example of sleep-deprivation induced DOMS from personal experience: The first ultimates games of the season have always been an ordeal. Pressure pain thresholds and sensitivities were measured a day later in the sore muscles, but also in other muscles that send their sensory information to the same part of the spinal cord — that’s unexercised and non-sore muscles on the sore side, that just happen to be connected to the same area of the spinal cord. Bakhtiary AH, Safavi-Farokhi Z, Aminian-Far A. However, exactly how they work is still mostly mysterious. Our tolerance for exercise drops while we are still recovering from the last dose. This time Scott Gavura (the Skeptical Pharmacist) recruited me early one morning for some short-notice debunkery of a sloppy Globe & Mail piece on delayed onset muscle soreness (DOMS). The variation between the results for individuals is undoubtedly greater than that. Vancouver, CANADA, “Boring” footnotes usually contain scientific citations from my giant, Since comprehensive update logging began in 2016. So there you have it—my own little scientific (however unintentional) experiment. We should especially be thinking more about neurology because of a series of Japanese studies since 2010 showing that the pain is related to neurotrophic factors: substances secreted by muscles cells that goose nerve growth.33343536 A simpler way to say this would just be nerve growing pains. The “suggested price” really is just a suggestion. Vancouver Film School is a post-secondary entertainment arts school training students in 13 immersive, production-oriented programs that deal with all aspects of Film + Television, Animation, Games, and Design. The fear of pain was assessed in 126 brave volunteers with a questionnaire before — yikes — “inducing muscle injury to the shoulder.” (Don’t worry, nothing too awful for the subjects: they just did a workout with a lot of eccentric contraction that made them super sore.) Added discussion of worst case scenarios, especially rhabdomyolysis, and DOMS that's out of proportion to overexertion. The major myths about massage therapy are: The complete list of dubious ideas in massage therapy is much larger. But we are impatient animals, and “working through it” is a popular way to try to get to the far side of DOMS quicker. Because manual massage does not appear to have a demonstrated effect on the above, its use in athletic settings for these purposes should be questioned. This state is driven by the mechanism of neuroinflammation, a very basic biology alarm system that suppresses activity in all sick and injured animals.37 It’s probably not the specific mechanism of DOMS, but there could be overlap. There are several completely unproven products that promise better absorption by various means, so caveat emptor. And its reputation got a big boost in early 2018 from a low-quality meta-analysis (more on Dupuy et al below). Arguably those studies should not have been included at all. Non-local muscle fatigue: effects and possible mechanisms. Half were given “once-daily sessions of vibration-therapy on the upper and lower legs,” and the other received no treatment. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. DOMS is just a part of a broader spectrum of challenges to “exercise recovery.” There are many possible reasons why people might struggle to recover from exercise. It’s only one study, but … yikes! Effects of ibuprofen topical gel on muscle soreness. Pain-related fear and catastrophizing predict pain intensity and disability independently using an induced muscle injury model. But how can you tell? Students may take just one class per quarter, or take all of their courses on the Clark College campus, earning both high school and college credit for all completed courses. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. I will tell that story later on. Yahtzee! Both are common, both can be helped, with a clear benefit to DOMS. That’s surprising when you consider the impact DOMS has on elite athletes — a group of people whose performance is collectively worth trillions of dollars, and obsessively optimized, seemingly sparing no expense. Researchers have spent decades identifying various obscure molecules produced by cells during exercise, but are any of these molecules necessarily a sign of painful metabolic wear and tear? Manson JE, Patsy M B, Rosen CJ, Taylor CL. This large review of eleven small scientific studies, and one huge one, wrapped up with a clear thumbs down: The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults. Playgrounds and Vancouver go hand in hand, there are ample parks and fun playscapes … Not surprisingly, pain thresholds were lower in the sore, exercised muscles. My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion. Acutely and chronically painful patches of soft tissue are a real phenomenon. 2003).” In other words, these researchers found evidence that what previously looked like microtearing of muscle tissue is actually probably just muscle tissue doing microscopic renovations — an adaptive process, not a repair process, and probably not painful in and of itself. For instance, “microtrauma” certainly gets said anyway, but it’s just another way of saying mechanical stress. we have observed mechanical hyperalgesia in rats 1-3 days after LC without any apparent microscopic damage of the muscle or signs of inflammation. Although it is a universal experience, the sensitivity to the effect, and its intensity, vary considerably from one person to the next. For a more detailed review — but no additional evidence, because there ain’t any — see Vibration Therapies, from Massage Guns to Jacuzzis: What are the medical benefits of vibrating massage and other kinds of tissue jiggling? Protected by Vancouver Island, the city experiences less rain than other coastal areas and has more sunshine. Everyone will be pleased to know that one study (predictably European) showed some benefits to hot tubbing, specifically “warm underwater jet massage”67 — aaaah. More severe DOMS than that is unlikely without obvious overexertion. So massage therapists were tripping over themselves sharing it on Facebook, retweeting it, and posting it on their clinic blogs. In other words, ibuprofen reduced the soreness only, but had no significant effect on other outcomes, like muscle function and inflammatory markers. It’s important to understand the myths, but there’s more to massage. Just keep on scrollin’ by! The things I do for science! Now it just needs to be replicated! I often have no symptoms at all on day one, and peak on day. Forty women were subjected to intense training of the biceps and brachilias muscles, until they were sore, and then treated with one of four treatments for DOMS: massage, TENS (electrical stimulation), and ergometry (basically light exercise, to stimulate metabolic activity), and rest. Perhaps a personal experiment like mine — an antimonial — is a just a little bit of an anecdote antidote. Can light exercise make DOMS tamer and briefer? The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. Every used car for sale comes with a free CARFAX Report. This article explores every DOMS sub-topic in substantial detail, with many references. There’s no direct evidence available on this topic (surprise surprise). Muscle knots — myofascial trigger points — are the name for unexplained sore spots associated with stiffness and aching, which almost everyone gets from time to time, like pimples. If you find this information useful, please support independent health science journalism by paying what you’d spend on a premium coffee. Ernst found only seven studies worth considering, and most of these had “serious methodological flaws” and “very small sample sizes.” Of the seven, three are inconclusive or show no effect on massage therapy on DOMS, and four “imply a positive symptomatic effect” or a “positive trend.” I was not particularly impressed by any of those positive effects or trends — they all seemed ambiguous to me, even if you ignore the “serious methodological flaws.” I could not come to the same optimistic-sounding conclusion that Mr. Ernst did. 2018 — New section about “That troublesome 2018 study that declared victory for massage therapy” (Dupuy et al). This means that muscle fiber damage is not essential, although it is sufficient, for induction of DOMS, instead, NGF and GDNF produced by muscle fibers/satellite cells play crucial roles in DOMS. DOMS can be made worse by some other health problems — possibly quite a few of them. I think it’s reasonably safe to assume that none of them alone are definitely effective. For instance, Ehlers–Danlos Syndrome, a connective tissue disorder, makes people get sore too easily. It wasn’t from a massage, so it might seem like a strange choice for this article, but the point of the story is that rhabdo can come from surprisingly minor physical stresses. At best, pushing through the pain is just probably harmless at lower intensities and severities. Refreshingly Local™ and utterly unique, Coast Coal Harbour Vancouver Hotel by APA puts a thoroughly modern spin on the standard hotel experience. Port Coquitlam. Fourteen updates have been logged for this article since publication (2007). Another (bad) reason people believe that massage might help DOMS is because of a misleading science story from 2012. “From the Department of the Obvious,” one MT quipped. This is a pre-print review, not yet peer-reviewed. This evidence is too weak to take to the bank. Happy heating! Catastrophic medical events with exhaustive exercise: "white collar rhabdomyolysis". This comment was provoked by a really awful mainstream article about muscle soreness in the, An eccentric contraction is an interesting type of muscular contraction while lengthening — an apparent contradiction! “They really, really think it’s helping,” Nieman says. This is a test of vibration therapy on sore muscles in runners. Not only does this account for the repeated bout effect, it might also explain the curious findings of Ayles et al. I felt like the Batman getting the bat signal, but instead of being a billionaire martial artist gadget freak called to fight crime, I’m a middle-class amateur athlete gadget freak called on to fight … bad science journalism. And massage is still awesome! The research clearly shows that exercise relieves soreness while you are doing it, but there is just no data at all on how it changes the next day or two of soreness. Despite all of these problems, the results were spun as an explanation for how massage works in general — in the paper itself, the abstract, the journal’s summary, the press release, and interviews. It’s weird, but $5 online purchases are rejected by credit card companies at an extraordinary rate, because that price point is strongly associated with fraud (specifically with the phenomenon of “card testing” — bad guys testing stolen card numbers with small purchases). Even while possibly causing some at the same time? Anti-Stiff was “a muscle rub intended to ward off aches & fatigue during a variety of sporting endeavours” (hat tip to TheQuackDoctor.com). About footnotes. If you overdid it enough to know that you overdid it, but not to a ridiculous degree, DOMS should be moderate at worst. Manual massage and recovery of muscle function following exercise: a literature review. It might just be more acute fatigue. If you’re entering first year at UBC Vancouver and coming directly from high school, you’ll want to register for Jump Start. Effect of pulsed ultrasound versus placebo on muscle soreness perception and muscular performance. The “delay” effect is strong in me. explains Alex Hutchinson for Runners’ World, Radu’s rhabdo: a story of intense exercise gone wrong, concise professional summary by Robergs in, prevalence of the lactate myth in the 2012 summer Olympics coverage, “Reconceptualising pain according to modern pain science”, fish are better for you than fish oil pills. Tsuchiya Y, Yanagimoto K, Nakazato K, Hayamizu K, Ochi E. Nicol LM, Rowlands DS, Fazakerly R, Kellett J. Cambron JA, Dexheimer J, Coe P, Swenson R. 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