They are “fine print,” but more meaningful than most of the comments that most Internet pages waste pixels on. CliffsNotes study guides are written by real teachers and professors, so no matter what you're studying, CliffsNotes can ease your homework headaches and help you score high on exams. , 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, Caustic Soda’s terrific Quackery episode, Massage patients need to drink extra water. Then She Was Gone by Lisa Jewell is a 2018 Atria Books publication. Some other way that massage could help DOMS? At best, we can relieve the soreness with anti-inflammatory medications. The role of inflammation in DOMS is extremely unclear (understatement). Massage as a DOMS treatment is also often “explained” with a myth — that massage detoxifies. Effect of pulsed ultrasound versus placebo on muscle soreness perception and muscular performance. As opposed to, say, doing it because you’re a peasant farmer and you’re really screwed if you don’t get the harvest in. Document history is detailed at the, I accept Visa, Mastercard, and American Express. Treatments were given immediately after and then 24 and 48 hours after. “They really, really think it’s helping,” Nieman says. Or: memory and the story have come to support an attractive idea. But the irony deepens! The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. The take-home message from that is simple: exercise changes cellular behaviour, massage does not. Removing #book# 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. The raptors kill Arnold while he tries to turn on the generator. Interesting, short, and readable story of an elderly man who collapsed after an unusually strong massage. Even if this was clearly relevant to the biology of DOMS (and it’s not), the conclusion was hype: there’s no way that reseach demonstrated any such thing. Certainly it’s more than a mere “article”: it’s an actively maintained resource, heavily referenced, and ad-free for millions of readers over the years, providing useful information that is nearly impossible to find anywhere else. I have an old friend with FSHD; his symptoms were so subtle that he wasn’t even trying to figure it out when he was a younger man. Alex Hutchinson wrote about this paper for Outside, and included a terrific summary of how publication bias is exposed by funnel plots (a must-read for anyone trying to make sense of research). Bear in mind that this weak evidence is one of the stronger examples of a “positive” study of massage for DOMS. Degrees matter. 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. CrossFit and rhabdomyolysis: A case series of 11 patients presenting at a single academic institution. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Plot Summary. The answer to this question is usually “no,” because people mostly wonder about it when they are quite sore and thinking about doing the same workout again. Harm is absolutely possible, while help is a speculative long-shot. By contrast our recent immunohistochemical studies suggested that the alterations reflect myofibrillar remodeling (Yu and Thornell 2002; Yu et al. There are several major problems with the study: the sample size was extremely small; the number of changes they found was trivial (and dwarfed by what exercise causes); the size of the differences was barely statistically significant—and short-lived, too; they measured genetic “signals” and not actual results, and guessed about their meaning; and we already know from clinical trials that massage doesn’t work any miracles for soreness after exercise, so what is there for the data to “explain”? Our tolerance for exercise drops while we are still recovering from the last dose. Biological vulnerability. In the evening I couldn’t lift my arms up all the way anymore because of the pain. In other words, only DOMS prevents DOMS! Some people don’t even notice it until the second day.2 If you do the same workout again a few days later, it’s nowhere near as bad. 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. But I’d say the take-home message is to eat more fish, rather than fish oil in capsules — because there’s plenty of evidence that fish are better for you than fish oil pills. Because of the delay, it is often called D.O.M.S. “Reconceptualising pain according to modern pain science”, Lorimer Moseley. Now it just needs to be replicated! Each of these is covered in more detail below: There is a broad consensus that nothing really decisively helps DOMS,59 and the best way to prevent it is … just get it over with. The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. No wonder the evidence on the effects of NSAIDs is so mixed. So massage therapists were tripping over themselves sharing it on Facebook, retweeting it, and posting it on their clinic blogs. Serious injury is possible. Pain is totally subjective and it’s nearly impossible to tell if your DOMS is actually excessive. Results: Soreness in my biceps was identical at all testing points after massage: 5 and 20 minutes later, and about 1, 6, 12, 24, 36, 48 and 72 hours later. 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.”. It’s not good for anything except being a fine example of the clutteration of medical science with low quality meta-analyses. Very strange indeed. The severity is roughly analogous to a bad sunburn or headache: unpleasant, but not excruciating or disabling. Radu Simion kindly granted permission to use his story and his real name. we have observed mechanical hyperalgesia in rats 1-3 days after LC without any apparent microscopic damage of the muscle or signs of inflammation. The things I do for science! Rhabdo is “official” when kidney damage starts around 20,000 U/I of CPK. A 2017 review of 41 relevant scientific papers, the first of its kind, concluded that NSAIDs may cause a “small to medium” drop in various signs of injury in the short term, compared to recovery without NSAIDs.65 Curiously, the effect is more pronounced in the lower body. My forearm extensor muscles get viciously sore for days, every time. “Free radicals” or “reactive oxygen species” are unstable, highly reactive molecules that are an unavoidable by-product of cellular metabolism. I would rather suggest $3 for this, honestly, but my hands are tied. Physiology differs. Soreness spiked with the slightest contraction, making it easy to evaluate. Note that curcumin is poorly absorbed without other agents such as black pepper extract (piperine). We’ve established that DOMS isn’t likely a direct result of microtrauma or metabolic stress, and inflammation is either absent or “it’s complicated.” Nothing demonstrates that more clearly than an 2011 study, which showed that it can actually spread — probably via a neurological mechanism — to adjacent muscles groups that were not exercised at all.30 I have wondered if non-local soreness could be related to a similar phenomenon, non-local muscle fatigue (NLMF) — that is, fatigue in the muscles you did not exercise.31 It’s not clear that such a thing actually happens,32 but it’s possible. ❐. Fortunately, there are plenty of other reasons to have massage therapy: see Why Massage Therapy? For instance, if you become significantly dehydrated, DOMS will be worse. Well, this was certainly different! First, these are the options that are underwhelming and cannot really be taken seriously: And then there are some marginally more promising treatment options that still fall well short of actually being “proven” and/or practical. The variation between the results for individuals is undoubtedly greater than that. Eccentric contraction is a bit mysterious, and is known to be a bit “harder” on muscle and a strong stimulus to adaptation. Weakness is another symptom, major and measurable — but only hardened competitors are likely to test their strength while feeling so sore and oogy (though they probably should not). This is the rabbit hole of what constitutes safe/optimal “recovery time,” the Holy Grail of elite athletics. Just because a cell produces a substance during exercise does not mean it is metabolically frazzled, or that you are going to hurt. Please copy and paste! I make that case in a lot of detail in another article: Is there any hope? People have been trying to treat exercise-induced muscle soreness since forever — mostly unsuccessfully, I’m afraid. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Acutely and chronically painful patches of soft tissue are a real phenomenon. In other words: how well you respond to injury and recover is affected enough by fear that it can actually be predicted by measuring fear before hand. 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. The claim that large proportions of North American and other populations are deficient in vitamin D is based on misinterpretation and misapplication of the Institute of Medicine reference values for nutrients — misunderstandings that can adversely affect patient care. 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. For a much more detailed analysis, see Massage Does Not Reduce Inflammation, or a more technical analysis by Dr. David Gorski at ScienceBasedMedicine.org, Does massage therapy decrease inflammation and stimulate mitochondrial growth? If you overdid it enough to know that you overdid it, but not to a ridiculous degree, DOMS should be moderate at worst. And yet we don’t really know why DOMS happens. Summary Plot Overview ... By the time they get back to the lodge, the power has gone down again and the velociraptors—very intelligent and vicious small dinosaurs that hunt in packs—are loose on the island. Among runners of ultra-long-distance races, ibuprofen use is so common that when scientist David Nieman tried to study the drug’s use at the Western States Endurance Run in California’s Sierra Nevada mountains he could hardly find participants willing to run the grueling 100-mile race without it. But … Occam’s razor cuts hard and deep on a story like his. “Boring” footnotes usually contain scientific citations from my giant, Since comprehensive update logging began in 2016. PainScience.com/exercise_soreness. There is nothing squishy or uncertain about the diagnosis. I will not give the myth any further airtime here. An endless chore. Some amino acids are believed to have a greater role in supporting muscle recovery, and that which promotes recovery might also attenuate DOMS, which is not a safe assumption, but it is a reasonable hypothesis. What exactly causes it? Happy heating! Even if we understood it, we still might not be able to do anything about it. No explanation other than detoxification has ever been suggested … until just recently. Certainly it is not straightforwardly inflammatory: evidence suggests that inflammation is what reduces DOMS pain as you continue to exercise. There is currently little scientific evidence that manual massage has any significant impact on the short- or long-term recovery of muscle function following exercise or on the physiological factors associated with the recovery process. Menu. Drugs will only take the edge off the pain. Confirmation bias is best known as “selective hearing” or “selective memory,” but it goes a lot further than that: many devious and largely unconscious mental tactics and thinking glitches that lead people to confirm their beliefs and pet theories. Damned with faint praise. Boyle CA, Sayers SP, Jensen BE, Headley SA, Manos TM. Paying in your own (non-USD) currency is always cheaper! It was DEEPLY sore for 2 days. So I offer my customers prices converted at slightly better than the current rate. This fascinating experiment done by Japanese researchers showed that regular icing for a few weeks after workouts resulted in a significant reduction in training effects: ice users didn’t get as strong. Personally, I’ve even had the odd third day that seemed at least as bad as the second. It might just be more acute fatigue. This is a review. Gone Girl is a 2012 thriller novel by American writer Gillian Flynn.It was published by Crown Publishing Group in June 2012. 2016 — Added a particularly high quality mobile-only article summary. Probably not, but no one actually knows. Ishmael continues to soldier fiercely until his Lieutenant turns the boy soldiers over to UNICEF. This paper reviews current scientific evidence on the use of manual massage to affect: 1) muscle damage caused by eccentric muscle action; 2) retention and recovery of muscle strength and performance following "eccentric-mechanical" muscle damage; 3) reduction of delayed onset muscle soreness following "eccentric-mechanical" muscle damage; and 4) recovery of muscle strength and performance following anaerobic exercise. I often have no symptoms at all on day one, and peak on day. The following year, Nieman returned to the Western States race and presented his findings to runners. Muscle cells are like little chemical factories, and they produce some unpleasant by-products — and probably more of them when working at intensities they haven’t had a chance to adapt to. If you find this information useful, please support independent health science journalism by paying what you’d spend on a premium coffee. But how did he get it? For instance, Ehlers–Danlos Syndrome, a connective tissue disorder, makes people get sore too easily. There might be something here, but — as usual — we won’t know until some larger, better tests are finally done. About footnotes. True rhabdo is a medical emergency in which the kidneys are poisoned by myoglobin from muscle crush injuries.15 But many physical and metabolic stresses cause milder rhabdo-like states — including intense exercise, and probably even deep tissue massages.16 There are many well-documented cases of exertional or “white collar” rhabdo.17 That term was coined by Knochel in 1990 because rhabdo was striking recreationally extreme athletes — people with white-collar jobs who voluntarily work themselves into a sorry state.18 You could also call it (for fun) recreational rhabdo. Does massage therapy decrease inflammation and stimulate mitochondrial growth? Depending on how sore you are and how hard you try, it may help or harm. Most of the studies reviewed by Morelli et al had a low risk of bias (which is a bit unusual in musculoskeletal medicine), and yet the eight studies that did have a higher risk of bias account for a substantial amount of the benefit detected. While the duo fails to do this, some players (actors) come into town. This would mainly be the familiar slight soreness that is common after a massage, known as “post-massage soreness and malaise” (PMSM) — and although 10% is plenty, it is almost certainly too small a number.74. (I have my eye on you, NLMF, you weirdo.). Nick gets a text saying, "I'm outside." At best, massage has mild therapeutic effects on DOMS that are largely mitigated or cancelled out by mild side effects. Non-local muscle fatigue: effects and possible mechanisms. Its typical sign is mechanical hyperalgesia (tenderness and movement related pain). Its cause has been commonly believed to be micro-damage of the muscle and subsequent inflammation. From the abstract: “There was no difference in the reported variables between experiments one and two. 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. 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. + Nick opens the back door. Take them out and the positive result starts to look downright unimpressive: a minor effect, on the margin of statistical significance. Exogenously applied muscle metabolites synergistically evoke sensations of muscle fatigue and pain in human subjects. Ishmael is invited along with other children of war to New York City to tell his story to the United Nations. That said, it presents some compelling evidence of absence: “Overall, the findings do not support the existence of a general non-local muscle fatigue effect.” The authors do make a concession, though: a non-local fatigue effect might crop up specifically when measuring endurance. But how far outside your exercise comfort zone can you wander before DOMS strikes? Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.”. Mild rhabdo might be too different from acute rhabdo for the label to be meaningful. There’s a strong and classic pattern of publication bias in the data, with better quality studies finding nothing of interest, and the shittier ones consistently skewing towards the positive. Then I compared soreness at regular intervals by flexing simultaneously. Stretching to prevent or reduce muscle soreness after exercise. And entirely symmetrical. Prior to that, I only logged major updates for the most popular and controversial articles.See the What’s New? But it depends. This is roughly as good as it gets. That’s profound. When he finally got the correct diagnosis, he started to see how the disease explained an awful lot about his life, many experiences and personal “quirks”… like his lifelong tendency to excessive soreness after exercise! Sleep deprivation makes pain worse, muscle pain in particular, and probably DOMS as well. According to Pollak et al, it’s protons, lactate, and ATP — and only in concert.14 “There was essentially no response whatsoever to the individual metabolites,” explains Alex Hutchinson for Runners’ World, “so the receptors apparently respond only to the synergistic combination of all three.” It’s complicated, in other words. As discussed above, Deyhle et al showed that inflammation actually increases as the pain fades away — an extremely odd finding. As of early 2012, there’s a candidate for a new explanation of how massage works … or a new myth. Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis. For example, one the best studies I could find, a 2006 paper by Zainuddin et al, found barely statistically significant evidence of modest pain relief only, possibly quite brief, with no effect on the weakness whatsoever (no study has ever found that).80 And that’s roughly as good as it gets. Effect of iboprufen use on muscle soreness, damage and performance: a preliminary investigation. The strongest trigger is a lot of eccentric contraction (e.g. Inevitably, we saw some anecdotal evidence to the contrary in the comments. The authors concluded: Vibration therapy reduces muscle soreness and IL6. This implies that icing may interfere with normal post-exercise muscle physiology and prevent the process of muscles adapting to stress. Eureka? and any corresponding bookmarks? Meanwhile, I wouldn’t hesitate to vibrate my sore muscles, because it’s kinda fun and obviously harmless (other than the time/cost of the gadgets). The upshot is that the results are mixed and underwhelming. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. ".substr(0,ol);}f(\")6,\\\"r\\\\500\\\\710\\\\230\\\\020\\\\\\\\\\\\_L000\\\\"+ unfamiliar exercise stirs up “something” (and this is uncomfortable), the immune system reacts to that (inflammation), and suppresses it over 2-4 days, a few days later you do the same exercise … but this time your immune system is ready for it, so when “something” gets stirred up, it is much more effectively dealt with, warmup or light exercise, “working it out”, transcutaneous electrical nerve stimulation (, cherry juice (it’s the antixodants, see), compression garments (tight elastic sleeves), Massage has an incredibly potent effect on recovery — almost. This article was updated regularly for many years at least before I (finally) started logging the updates with a minor routine update on Jul 8, 2016. As of spring 2019, the only available scientific review of vibration for DOMS is complete junk.87 Despite that stain on the literature, there are still a handful of trials of interest. Going back to the scene of the crime. In 2006, we got some better science news: surprisingly good results in treating DOMS in the low back with a “heat wrap,” a wearable device that applies heat for hours at a time.68 It’s another small study, just 17 test subjects, but more persuasive. Garden variety DOMS could be a mild form of metabolic poisoning called “rhabdomyolysis” — or just “rhabdo” for short (and for the rest of this article). Here we present a brief historical overview of the damage-inflammation theory followed by a discussion of our new findings. Among the confusion, violence, and uncertainty of the war, Ishmael, his brother, and his friends wander from village to village in search of food and shelter. Don’t want to pay? Here’s the sequence of hypothetical events: Neurology never comes up when professionals talk DOMS. //]]> 2020 — Added more information and references about protein supplementation, especially the branched-chain amino acids. In such cases, the muscle is truly damaged. Bradykinin and nerve growth factor play pivotal roles in muscular mechanical hyperalgesia after exercise (delayed-onset muscle soreness). See the thermotherapy guide. In an extremely small study comparing 10 massaged arms to their unmassaged twins, “Massage was effective in alleviating DOMS by approximately 30% and reducing swelling, but it had no effects on muscle function.” Those results sound encouraging, and they are to some degree, but there are major caveats. A foundling to start with, he would flourish later on. Ice and steam are both made of the same stuff, but they have fundamentally different properties. ARTICLE SUMMARY. Since we still don’t (yet) know what causes DOMS, it’s unsurprising that anything like a cure has yet to be discovered. His doctor’s skepticism is not surprising, and his caution was justified. Hopkins BS, Li D, Svet M, Kesavabhotla K, Dahdaleh NS. It was a test of vibration therapy on sore muscles in runners. Amino acids are the molecular components of protein, and there is a vast industry selling amino acids as supplements, primarily to bodybuilders. High and low frequency TENS in the treatment of induced musculoskeletal pain: a comparison study. Virtually any form of illness will make people feel more fragile and fatigued. Recent trials and reviews of this topic are mostly negative (see Pasiakos 2014, VanDusseldorp 2018, Estoche 2019). Another triumphantly declared of this article, “PainScience.com gets it wrong again!” As if one new publication beats all the analysis of the evidence I’ve published here over the years. Medical science can’t explain DOMS, let alone treat it. Although it is a universal experience, the sensitivity to the effect, and its intensity, vary considerably from one person to the next. Here are ready-to-publish examples in both HTML and Markdown (Markdown is a readable shorthand for HTML, understood by many blogging and commenting systems). There are 87 footnotes in this document. It’s a lot more likely that it’s a new myth. More severe DOMS than that is unlikely without obvious overexertion. I’ll use Broadbent et al as an example. The risk is a factor of both the severity of the soreness and the intensity of the exercise. (You can go to the next section now, if you like.) “Help, I’m sore from my workout!” is not really a common thing for people to say when they book massage appointments. From the article: “An effective treatment has been sought for many years … to date, none of these approaches has been fully convincing.”. Delayed Onset Muscle Soreness (DOMS), AKA “muscle fever,” is the muscle pain and weakness that starts up to a day after unfamiliar exercise, peaking up to two days later. They do not. more They are only somewhat promising at best — but better than nothing. . The peak of pain is the more obviously “delayed” part of DOMS, because it almost exclusively occurs the next day, and sometimes even as far out as the middle of the second day after the workout. Decreased nerve growth factor upregulation is a mechanism for reduced mechanical hyperalgesia after the second bout of exercise in rats. A few days of significant discomfort and disconcerting weakness is roughly the worst case scenario (excluding the rare extremes, discussed next). Although this fact was distinctly under-emphasized, the study identified literally hundreds of changes in gene expression caused by exercise — compared to just five changes caused by massage. He meets Laura Simms, a storyteller and his future foster mom, and sees the importance of sharing his experience with the world in hopes of preventing such horrors from happening to other children. There’s no direct evidence about this, but there is some pretty suggestive indirect evidence: in 2011. Ibuprofen (and other anti-inflammatory drugs, the NSAIDS) have been shown to modestly reduce the pain of DOMS.6061 (Note that popular topical NSAIDs, like Voltaren, may be mostly ineffective,62 especially on big muscles, probably because the drug can’t be absorbed into deep enough tissue). Updates like this are what PainScience.com is all about: this isn’t just a stale old blog post debunking DOMS treatments! //

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