When Exercise Hurts, Do This…
February 15, 2011 by Dr. Mark Wiley
The top three excuses for why Americans are not getting enough exercise are: 1) There’s not enough time; 2) A lack of stick-to-it-ness; and 3) exercise hurts. The issues of time management and sticking with something are personal choice issues. Why and how to make those choices are a topic of another column. In this article, I’d like to address the pain issue.
A little stiffness and soreness is both expected and healthy after exercise. When the muscles are placed under stress, the bones placed under a load and the lungs made to kick into high gear, the body is strengthening itself. Inflammation comes as part of the healing response, protecting the area and sending signals to the brain that healing (repair) needs to be done.
Prolonged soreness and pain, however, is not good. Chronic inflammation and delayed onset muscle soreness (DOMS) are two examples of bad exercise pain. The body remains inflamed when repair is not happening as a result of too much physical stress, depth of injury or simple lack of adequate rest. DOMS occurs when muscle tissue has torn and is in need of repair. Both occur when wrong exercise is carried out.
Exercise should not lead to lasting or chronic pain. If pain associated with exercise or any physical activity is common for you, then you are doing something wrong. Even too much of a good thing is bad. Here are some things to be aware of…
Keep your cardio training within your target heart rate. If you are wheezing and huffing just to say hello to the person next to you, or experience burning in the lungs, then it is best to ease off the strain until pain subsides. If you are jogging, slow down. If on a treadmill, decrease the incline.
If you are weight training and usually feel pain in specific areas after workouts, you may be overtraining strong muscles at the expense of weaker ones. Many people choose to keep adding weight to their bench presses to increase the size of their pectoral muscles. However, they neglect their back and neck muscles and then experience shoulder and neck pain.
The key is to work the weaker muscles to build them up while backing off the stronger ones for a period of time. Muscular balance is the key to creating healthy physical scaffolding.
If your body hurts, you are doing something very wrong and may need to hire a trainer or fire the one you have. If you experience exercise aches and pains that don’t seem to go away, then you need to address the inflammation response.
With chronic inflammation comes pain, stiffness and limited range of motion. None of these are healthy. Here are seven simple ways of reducing exercise-induced inflammation and pain:
- Reduce exercise levels to more reasonable ones.
- Proper warm-ups and cool-downs.
- Drink plenty of fresh water.
- Do light stretches before a workout and deeper stretches after the body is warmed and the blood is moving.
- Have a full body massage to help move lactic acid and relax muscle stiffness. Thai massage is high on my list for this purpose.
- Avoid consuming foods that cause inflammation, and consume more of those that help reduce inflammation. For more information about what these foods are, click here.
- Apply ice and/or heat to the painful areas. Since this is a widely debated topic and incorrect use can make a situation worse, let’s discuss it!
The answer is simple even though the debate can be heated. But there can be no debate when one understands the mechanisms behind pain, spasm and inflammation and how the application of cold and heat affect them.
When an injury happens (such as a sprain) inflammation occurs to protect the affected site. When the nervous system senses an injury, it sends signals to the brain that interprets them as “pain.” The new signal is sent to the injured area, telling the muscles to reduce blood supply in an effort to reduce swelling. However, this blood deficit causes more pain, swelling and spasms.
In response to the physical trauma and inflammation, the body sends white blood cells to the area to begin the healing response, which includes the removal of waste products at the area and, thus, pain reduction.
There are several types of white blood cells and two are important in this discussion. Neutrophils release chemicals involved in the inflammatory response while also recruiting other inflammatory cells and protecting the injured area from infection. Basophils release two chemicals at the injury site, histamine and heparin. Histamine relaxes blood vessels and heparin helps prevent clotting. Both aid in the free movement of blood to help heal the damaged tissue site.
If left unchecked, chronic inflammation can result in fewer red blood cells, less oxygen and fewer nutrients available at the site to begin the healing process. This cycle of pain, elevated white blood cells, lower red blood cells, excess waste material, more pain and inflammation can continue for days, weeks, even years if not treated properly. Correct application of ice and heat is the method of treating soft tissue injuries, pain, spasms and inflammation. Incorrect application, however, can prolong the problem and make it become chronic.
While at opposite ends of the temperature spectrum, heat and cold both create a healing response. If you think of your stove and your freezer, you can easily see the result of either. Heat melts and increases surface area. Cold constricts and prevents expansion of fluids. Heat moves things along while cold keeps them in a state of suspended animation. So how do these temperatures affect the body?
Heat causes the body to circulate more blood and to remove toxins. This allows more fresh oxygen and nutrients to the injured area, which begins and continues the healing process while removing the toxins that cause scar tissue and chronic pain. Cold, on the other hand, retards swelling and reduces pain.
Within limits, both temperature extremes shut off pain signals; heat by relaxing the affected nerves and cold by numbing them. This is good because when pain signals are not sent to the brain there is no response signal generated telling the muscles to contract (spasm) in order to protect the injury site.
After proper application of heat or cold over time, the pain-spasm-inflammation cycle is broken and effective healing of the area can begin.
So… to determine whether it’s better to apply ice or heat to an injury, you must first determine whether the pain you are experiencing is caused by inflammation or muscle constriction (spasm). Once this is determined, follow these three rules:
- If an injury is acute (caused by new trauma, like a twisted ankle or pulled neck muscle), it is best to apply cold within the first five minutes to reduce swelling, inflammation and pain. Ice packs, ice cubes, a frozen bag of peas or cold gels can be applied. Apply ice for 20 minutes, remove it for 20 minutes, then repeat as necessary.
- When swelling is down and the pain cycle is broken, stop the cold and apply heat. This will bring oxygen and nutrient rich blood to the area to relax muscles, remove waste products and promote healing.
- Never heat an inflamed area and never ice a constricted area. Inflammation is an expanding reaction and needs to be reduced, so cold is the answer. A spasm is a constriction that needs relaxing, so heat is the answer.
Now that you have several tools to help you prevent pain and inflammation related to exercise, why not give it a try again? The results can be life changing.
–Dr. Mark Wiley