Management Of Post Physical Therapy / Chiropractic Muscle Soreness

Author(s): Albert Graziosa MD., Edward Blum PT., Rocco Denobile PT., Ariq Rabadi DC

As physicians, physical therapists and chiropractors, we constantly are recommending patients exercise routines and protocols to foster faster healing yet, many patients refrain. Part of the reasoning being the post excercise pain that accompanies fitness activities. Understanding the pathophysiology behind muscle soreness and stiffness may help patients better cope and thus, be more compliant with their physical/chiropractic therapy.

Post exercise muscle soreness comes in all shapes and sizes but we can classify this condition as either acute or delayed muscle soreness. Acute muscle soreness (AMS) most commonly occurs immediately after the exercise routine and represents an accumulation of lactic acid in the surrounding muscle tissue. This process can occur for up to 5 minutes but should in no way restrict further exercise or cause residual effects.

Delayed muscle soreness (DMS) is the result of muscle micro tears that occur with strenuous exercise, most commonly resistance exercise. Eccentric contractions, which occur as a muscle lengthens while under tension will usually cause the most tearing and thus, the most DMS. These micro tears will usually lead to an inflammatory reaction that peaks in 2-3 days then gradually subsides as the muscle regenerates and returns to normal. Substantial muscle micro tearing forms the basis of resistance exercise and the adaptation process that leads to muscle hypertrophy/muscle gain.

There are several techniques available that help reduce both AMS and DMS. The first step involves a thorough warm up session either utilizing mild calisthetics or low impact aerobic excercises to prepare for therapy. Submaximal stretching techniques prior to exercise can benefit from decreasing the incidence of DMS. Low impact aerobics most commonly involves getting on either an exercise bike or a treadmill for 15-30 minutes. Increasing the resistance on the bike or the  inclination on the treadmill will gradually increase difficulty for those patients whose tolerance and aerobic capacity have improved.

Should patients over do it and experience severe discomfort, instituting ICE is the first measure. Iceing the area 20 minutes on and 20 minutes off, accompanied by compression and elevation will usually address most post exercise soreness. Also, ice baths to an extremity such as legs and arms for 10-15 minutes can also address severe to moderate post exercise soreness. In some cases and under medical supervision, instituting an anti-inflammatory medication (NSAIDS) may be helpful to both control pain and inflammation. Most NSAIDS require administration for at least a week to adequately treat severe DMS/muscle strains. The most sensible and logical post exercise soreness management tool is obviously allowing the soreness to slowly dissipate by taking time to heal between sessions. This modality is best managed by your physical therapist/chiropractors who are treating you 3-5x /week.

By working together, both physical therapists and chiropractors can progress their patients along with their treatment protocols and successfully navigate patients through AMS/DMS and achieve acceptable results.

As physicians, physical therapists and chiropractors, we constantly are recommending patients exercise routines and protocols to foster faster healing yet, many patients refrain. Part of the reasoning being the post excercise pain that accompanies fitness activities. Understanding the pathophysiology behind muscle soreness and stiffness may help patients better cope and thus, be more compliant with their physical/chiropractic therapy.

Post exercise muscle soreness comes in all shapes and sizes but we can classify this condition as either acute or delayed muscle soreness. Acute muscle soreness (AMS) most commonly occurs immediately after the exercise routine and represents an accumulation of lactic acid in the surrounding muscle tissue. This process can occur for up to 5 minutes but should in no way restrict further exercise or cause residual effects.

Delayed muscle soreness (DMS) is the result of muscle micro tears that occur with strenuous exercise, most commonly resistance exercise. Eccentric contractions, which occur as a muscle lengthens while under tension will usually cause the most tearing and thus, the most DMS. These micro tears will usually lead to an inflammatory reaction that peaks in 2-3 days then gradually subsides as the muscle regenerates and returns to normal. Substantial muscle micro tearing forms the basis of resistance exercise and the adaptation process that leads to muscle hypertrophy/muscle gain.

There are several techniques available that help reduce both AMS and DMS. The first step involves a thorough warm up session either utilizing mild calisthetics or low impact aerobic excercises to prepare for therapy. Submaximal stretching techniques prior to exercise can benefit from decreasing the incidence of DMS. Low impact aerobics most commonly involves getting on either an exercise bike or a treadmill for 15-30 minutes. Increasing the resistance on the bike or the  inclination on the treadmill will gradually increase difficulty for those patients whose tolerance and aerobic capacity have improved.

Should patients over do it and experience severe discomfort, instituting ICE is the first measure. Iceing the area 20 minutes on and 20 minutes off, accompanied by compression and elevation will usually address most post exercise soreness. Also, ice baths to an extremity such as legs and arms for 10-15 minutes can also address severe to moderate post exercise soreness. In some cases and under medical supervision, instituting an anti-inflammatory medication (NSAIDS) may be helpful to both control pain and inflammation. Most NSAIDS require administration for at least a week to adequately treat severe DMS/muscle strains. The most sensible and logical post exercise soreness management tool is obviously allowing the soreness to slowly dissipate by taking time to heal between sessions. This modality is best managed by your physical therapist/chiropractors who are treating you 3-5x /week.

By working together, both physical therapists and chiropractors can progress their patients along with their treatment protocols and successfully navigate patients through AMS/DMS and achieve acceptable results.