A case for getting sore (DOMS)
You probably know what it feels like.
The painfully tight sensation of delayed onset muscle soreness (DOMS). Maybe in your arms and shoulders after lots of pushups and pull-ups, your lower back and hamstrings after deadlifts, or in your lower legs after a long run or hike. When it is intense, it can even interfere with the most basic functions like walking or sitting on the toilet.
What I am about to argue is that this soreness could have a hidden benefit, and it is not what you think.
First - what is DOMS?
It is a type of muscle pain that happens after exercise. It is often caused by mild/small scale (ultrastructural) damage to the muscle and surrounding connective tissue. It typically lasts for 48-72 hours but could be longer if severe. DOMS tends to be more pronounced after unfamiliar exercises, and eccentric (muscles lengthening while contracting) exercise. (1) The damage results in an inflammatory response, which starts the healing process, but also irritates the pain sensing nerves that are nearby, resulting in pain or soreness.
Some people enjoy this soreness or think that if they don’t feel it then that means they did not have a good workout. This is not true. Again, DOMS is most pronounced after unfamiliar exercise, or eccentric loading. So once you have done an exercise a few times, you will no longer get as sore, but can absolutely continue to make progress. If anything, after the novelty wears off you will make more progress because it won’t take you so long to recover, and you can actually do more volume and work at a higher intensity too.
Other people hate this soreness, and go to great lengths to find a remedy or to avoid it altogether. While this is understandable, it can also be counterproductive. As mentioned, the inflammatory response that causes the pain, is the same thing that starts the healing and adaptation process. So blunting the inflammatory response will actually disrupt the adaptation process. This has been demonstrated countless times in the literature using various methods including various drugs (ibuprofen for example), and ice bathing. As far as avoiding it altogether, while you don’t need to be sore to know you had a productive workout, if you never get sore you could probably be working a little bit harder.
If you or someone you know has suffered with chronic pain, you know how draining it can be. Most will be familiar with chronic neck or back pain, but there are all sorts of chronic pain conditions that can leave you hurting anywhere in your body.
I will limit this discussion to chronic musculoskeletal pain, because that is my area of expertise. For these conditions, medication and surgery are often unhelpful or not worth the risks. Manual therapies and various other physical modalities can be of some help, but tend to only provide short term relief. What does tend to show more robust, longer lasting improvements is exercise. Other types of behavioural modifications or counselling can be helpful too, depending on the nature of the condition.
But it takes time for most of the benefits of exercise to be realized. I think one ‘benefit’ may act a little more quickly.
Stay with me.
The last time you hit your funny bone, or stubbed your toe what did you do? I bet you sat down, grabbed the assaulted limb and maybe started to rub or massage it. Did it help? My guess is it probably helped a little, but not completely because of how intense those pains can be.
Chronic neck or back pain is not often as intense as stubbing your toe, that would be extremely debilitating. So rubbing it would probably be a greater relief in terms of the proportion of pain relieved. In fact, this is partly the same way that various manual therapies help. There is a well understood mechanism for this too, and it is described by the Gate Control Theory of Pain, first proposed in 1965. (2)
What this theory describes (among other concepts) is that nerve signals of pressure, tension, and others can modulate or interfere with pain signals at the level of the spinal cord. So putting pressure on your elbow after hammering it on your desk, covers up the pain sensation to some extent.
Now for the leap.
What I am suggesting is that DOMS could be a helpful gatekeeper for chronic pain, so to speak. Though this is not the same mechanism as that described above, it makes for a nice analogy. Getting sore will pull attention away from the chronic issue because it will likely be more intense and it is novel and therefore more ‘interesting’. Given the undeniable benefits of exercise for health in general, and the great potential in many cases of chronic pain there is very little downside here.
One important caveat to this would be to work a different body part than the region with the chronic pain. Chronic pain is tricky and can be improved by exercising that specific region, but it can also be sensitized in some cases. (3) So at least initially, it is probably best to experiment with a different region.
This may be part of the reason why exercise helps with any sort of painful condition, but I just have not seen this laid out explicitly anywhere before. I have, however, experienced the effects I am describing. I have had full relief of multiple different chronic joint pains from DOMS. So I think this is worth a try for others.
You will be getting fitter, healthier and you will be giving yourself a break from the previously relentless pain you have been dealing with. You just need to do a workout that has some novelty or a significant eccentric component. Novelty is the name of the game with CrossFit, so that would be a good choice, but is by no means the only option.
References
Hotfiel T, Freiwald J, Hoppe MW, Lutter C, Forst R, Grim C, Bloch W, Hüttel M, Heiss R. Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletz Sportschaden. 2018 Dec;32(4):243-250. English. doi: 10.1055/a-0753-1884. Epub 2018 Dec 11. PMID: 30537791.
Campbell, T.S., Johnson, J.A., Zernicke, K.A. (2020). Gate Control Theory of Pain. In: Gellman, M.D. (eds) Encyclopedia of Behavioral Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-39903-0_1134
Nijs J, Kosek E, Van Oosterwijck J, Meeus M. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician. 2012 Jul;15(3 Suppl):ES205-13. PMID: 22786458.
