I got a frantic call from one of my high-flying patients, who I thought was doing very well with his back pain. It wasn’t about him, though, but his 27-year-old investment banker brother, Vikram, who had recently acquired a new girlfriend.
This wasn’t really about the girlfriend—or maybe it was, a little.
The morning after
Vikram could not move. Everything in his body hurt. He hadn’t done anything unusual in the last 24 hours. I couldn’t imagine what was going on.
On some probing, it transpired that Vikram had gone to Mussoorie for a vacation with his girlfriend two days earlier. At the hotel, he hit the gym with a vengeance so that he could lose the extra tyre around his waist and grow bigger biceps (Vikram had not been very active since he left school; this was his first gym session in 10 years). He spent 2 hours working on all the machines, from weight training to cardiovascular, followed by 1 hour of running downhill. He felt great afterwards, and went for dinner and a movie with his new-found love.
The next day they returned to Delhi. The pain started the morning after, when he tried to get out of bed.
I agreed to see Vikram early at the clinic. As I arrived, his brother’s SUV pulled in. The passenger-side door opened, but no one came out. After a while, I saw someone twist and turn his way out of the car with great difficulty.
Each step was agony for Vikram. It took him a full 5 minutes to walk 15m, which included a few steps that made matters worse. He finally made it to my consultation room, but then it was a struggle to sit.
Eccentric exercises and muscle damage
What happened to Vikram is a typical case of “delayed onset muscle soreness”, also called Doms.
It happens after—sometimes one-three days after—unaccustomed exercise, especially at the beginning of a new regimen, or when there is a dramatic increase in intensity or duration of exercise. Usually, it happens with exercises that involve eccentric muscle contractions —movements that cause muscles to forcefully contract even as they lengthen. There are many such motions, from walking or running downhill to doing “negatives” in weight training (lowering weights slowly) or the slow downward motion of push-ups and squats.
Slow burn: Lowering weights slowly can cause more delayed muscle soreness.
The odd thing is that the pain doesn’t come on till much later and doesn’t stop at just the few muscles that were put through the drill. There is whole body soreness, pain or stiffness—as much as 12-72 hours after exercising. Why this happens is still a matter of scientific debate. However, eccentric exercises are known to cause more muscle damage (microscopic tearing of muscle fibres) compared with other types of exercise.
Typically Doms settles down on its own in three-seven days and leaves no permanent trace. The bad news is that we know of no proven effective remedy—but amateur and elite athletes alike have found these of help, anecdotally.
• Immerse yourself (except the head) in ice water. This is most popular among elite athletes, and current preventive practice among high-level sportspersons in Australia is to immerse for a minute, come out for a minute, for a total of three cycles immediately following exercise
• Gentle massage
• Gentle stretching
• Anti-inflammatory medication, such as Brufen (ibuprofen)
• Do not resume vigorous exercise till the symptoms settle down
• If they don’t settle down in seven days, see a doctor if you haven’t already. They can then rule out serious conditions such as a severe muscle pull or tear, though that pain is typically very localized. Start with a sports medicine specialist, as other specialists may be equally baffled by this all-body phenomenon at first
Take it easy
Help yourself and others on their fitness route by steering clear of beginner’s errors.
Baby steps: Always start slow. As a rule, don’t exceed 30 minutes for the first session of any new exercise. And make time to warm up and cool down.
10% rule: Build up exercise duration and intensity (speed or weight) no more than 10% per week. This applies to each exercise you do.
Learn before you do: Seek expert guidance from a personal trainer or instructor before starting anything new.
The author is a practitioner of sports and exercise medicine and musculoskeletal medicine, and CEO of Back 2 Fitness.
Write to Rajat at firstname.lastname@example.org