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What Causes Muscle Soreness?

Your muscles should feel sore on some of the days after you exercise. If you go out and jog the same two miles at the same pace, day after day, you will never become faster, stronger or have greater endurance. If you stop lifting weights when your muscles just start to burn, you won’t feel sore on the next day and you will not become stronger. All improvement in any muscle function comes from stressing and recovering. On one day, you go out and exercise hard enough to make your muscles burn during exercise. The burning is a sign that you are damaging your muscles. On the next day, your muscles feel sore because they are damaged and need time to recover. Scientists call this DOMS, delayed onset muscle soreness.

It takes at least eight hours to feel this type of soreness. You finish a workout and feel great; then you get up the next morning and your exercised muscles feel sore. We used to think that next-day muscle soreness was caused by a buildup of lactic acid in muscles, but now we know that lactic acid has nothing to do with it. Next-day muscle soreness is caused by damage to the muscle fibers themselves. Muscle biopsies taken on the day after hard exercise show bleeding and disruption of the z-band filaments that hold muscle fibers together as they slide over each other during a contraction.

Nobody really knows how these hard bouts make muscles stronger, but the most likely theory depends on the fact that hard exercise damages muscle fibers. Then other cells release chemicals called cytokines that cause inflammation characterized by soreness (pain), increased blood flow to the injured fibers (redness), and increased flow of fluid into the damaged area (swelling). The damaged muscle cells release tissue growth factors to heal the damaged muscle fibers, and if the athlete allows the muscle soreness to disappear before exercising intensely again, muscle fibers become larger and increase in number by splitting to form new fibers. If the athlete does not wait until the soreness goes away before exercising intensely again, the fibers can be torn, the athlete becomes injured, and the muscles weaken.

Next-day muscle soreness should be used as a guide to training, whatever your sport. On one day, go out and exercise right up to the burn, back off when your muscles really start to burn, then pick up the pace again and exercise to the burn. Do this exercise-to-the-burn and recover until your muscles start to feel stiff, and then stop the workout. Depending on how sore your muscles feel, take the next day off or go at a very slow pace. Do not attempt another intense workout until the soreness has gone away completely. Most competitive athletes exercise at low intensity during recovery, rather than taking days off; this makes their muscles more fibrous and resistant to injury. If you’re not interested in competing, you can take one or more days off until your muscles feel fresh again.


Dear Dr. Mirkin: Does blood pressure vary at different times of the day?

Yes. You raise your blood pressure in the morning just by being active instead of lying in bed. Blood pressure is the force of your heart contracting times the resistance in your arteries. It stands to reason, then, that being active causes your heart to contract with more force and therefore raises your blood pressure. So if you have high blood pressure and take your blood pressure frequently to follow the effects of your diet and exercise program or any drugs to lower it, be sure to take your blood pressure when you first awake, and before you are active, because any activity raises blood pressure. But don’t use this information as an excuse to stay in bed; inactivity weakens your heart muscle and increases your risk for a heart attack.


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Dear Dr. Mirkin: What’s the best way to treat a pulled muscle?

Muscle pulls are a hazard of exercising. The immediate treatment is RICE: Rest, Ice, Compression and Elevation. Stop exercising immediately, apply an ice bag wrapped in a towel on the injured part, wrap a bandage loosely over the ice bag, and raise the injured part above the heart. Remove the ice after 15 minutes and reapply it once an hour for the first few hours. After a few days of rest, you can start a program of massage and stretching.

The only drugs that have been shown to help heal muscles are anabolic steroids or beta agonist asthma medications such as clenbutarol or albuterol. Anabolic steroids can have dangerous side effects and are illegal. Clenbutarol and albuterol appear to be safe in the low doses that are required to hasten muscle healing, but have not been approved by the FDA for this purpose in the United States. You can take pain medicines such as ibuprofen, but they do not speed healing. They may make matters worse if you mask the pain that warns you not to use the injured muscle. Cortisone-type injections block pain and reduce swelling, but they may actually delay healing. The most effective treatment is rest. You should not exercise that part of your body until you can do it without feeling pain. When you return to the activity that caused the injury, start out at reduced intensity and duration, then gradually work back up to your normal program. Stop immediately if you feel pain.

If you have chronic pain in several joints or muscle groups, see reports #J106 and #G115 .


Recipe of the Week
A delicious, sophisticated salad for your picnic buffet:
Artichoke-Wild Rice Salad

List of Diana's Healthful Recipes


June 26th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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