Stomach pain after exercise

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How to Tell the Difference Between Good and Bad Pain

Have you ever given thought to the meaning behind the statement: No pain, no gain?

A great many people take this statement literally, and unfortunately, the end result can be orthopedic injury. It is of utmost importance that we listen to what our bodies tell us both during and after exercise. There is in fact “good pain” and “bad pain”. The following information will hopefully help you to tell the difference.

The most common type of good pain is clinically referred to as “delayed onset muscle soreness,” or DOMS for short. This occurs as the result of challenging a muscle or muscle group with exercise. One to two days after exercising a soreness will be felt in the belly of the muscle. It can be quite tender to touch and tends to be spread out over a large area.

One such example that I recently encountered involved a trip to the batting cages. It had been years since I had swung a bat. I was in the batting cage swinging for a mere fifteen minutes. Starting the next day, my entire rib cage and my abdominal muscles felt incredibly tender and sore. I had not used these muscles in that fashion for some time: sneezing and coughing were quite painful for the next week.

With this type of soreness the muscles actually remodel and become stronger and more efficient. If I had gone back to the batting cages once the pain had subsided, the pain response would have been much less pronounced the second time because of the adaptive changes of the muscles. In this case, “No pain, no gain” holds true.

“Bad pain” comes in many forms. The most common type of bad pain that I see in the clinic involves joint pain. When pain occurs in a joint (such as the knee) rather than in muscle (the quadriceps), it is the body trying to tell us that something is not right. Do not try to work through joint pain while working out. If it occurs each time that you exercise you should have it checked out by your doctor. If your pain is sudden and sharp, stop whatever you are doing and have it assessed.

Another type of pain that should be brought to the attention of a health care professional is radicular pain, or pain that shoots from one area to another. Pain that shoots down your arm or leg may be spinal in origin. Pressure or trauma to the nerve roots as they exit the spinal column tends to be manifested in this way.

As a final note, it is always a good idea to be assessed if pain is recurrent, or if you cannot decide if the pain you are experiencing is “good” or “bad.” Pain can very often be brought under control and even eliminated with proper guidance from your doctor or physical therapist.

Why are my ribs sore after doing push ups and sit ups?

Yes there are muscles between your ribs. They’re called the intercostal muscles, though “soreness in ribs” might also be caused by soreness in your pectoralis minor (which connects to the front of the rib cage) or your serratus anterior (which connect your back to the side of your rib cage). A good hint that it’s muscle soreness instead of connective tissue soreness is that muscle soreness usually feels good to massage, while tendon/ligament/joint soreness does not.

The main use of the intercostal muscles is in opposing the diaphragm in breathing, but they’re used in lots of movements. I get rib soreness after doing planks for a long period, so I suspect that is the main source of the soreness (a pushup being a like plank++).

I would guess that the reason that your intercostal muscles are sore is because they are being used to hold the rib cage rigid, while forces are being transmitted between the serratus, pectoralis minor and rectus abdiminous. Dynamic tension between these muscles (and many others*) lets your back stay flat and rigid while you’re doing planks or pushups, but since a lot of the force is transmitted through the rib cage, your intercostal muscles contract and get stretched as you go through the movements. Like any other muscles after a working/stretching them, they get sore. It’s probably especially noticeable since you do very few exercises which exercise your ribs.

Here’s a video showing the main muscle groups used in pushups, and here’s an animation showing them in action. Hopefully you can see the stresses put on the rib cage.

Pushups are really great exercises precisely because (if done properly) they strengthen so many different muscle groups (even ones you were unaware you had!). This is also one of the problems with Nautilus machines for strength training: by isolating muscles you miss out on strengthening small stabilizing muscles like the intercostal muscles and you can end up with big muscles but not genuine strength (and an increased risk of injury).

I find that stretching my rib cage can help with soreness (though stretching beforehand or immediately after doesn’t do very much). For soreness from pushups, my ribs tend to get more sore on the sides of my body, and a good stretch for that is the side angle pose from yoga.

Finally, it’s interesting that you get rib soreness after situps. I haven’t had that experience, though situps are also complex exercises which use a lot of different muscles groups. Perhaps another answerer can go into that in more detail.

* There are a ridiculously enormous number of muscles in your back and shoulders. Planks are really complicated exercises.

Athletes, fitness buffs and novices alike all know the saying, “No pain, no gain.” To some extent, this saying is true.

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Weight-bearing and cardiovascular activities stress the body. As a result of that stress, we enhance our strength and endurance. By pushing our physical boundaries, we optimize our athletic performance. But this process is almost always at the cost of feeling some level of pain.

How do we know if the pain we are experiencing is normal, or if the pain is far more serious and due to an injury?

What is good pain?

Good pain, believe it or not, does exist. The most common type of good pain is the burning muscle pain you experience while performing an activity such as weight lifting. This burning sensation ends immediately after you stop the activity. The cause is a buildup of lactic acid, a natural byproduct of exertion that your muscles produce.

Delayed onset muscle soreness (DOMS) is another common pain. DOMS is a generalized ache that begins after your workout. The feeling may begin at a few hours after your workout or up to a couple of days later.

You most likely will experience DOMS when you begin a new exercise to which your body is unaccustomed, or if you have increased the intensity of your workouts.

Injury to muscle fibers and connective tissues, which you can see only under a microscope, occurs because of the stress of the exercise, which is the culprit of this generalized ache.

DOMS typically resolves within a day or so. It does not impede your ability to perform normal daily activities or keep you from moving your limbs and joints.

Pain that you shouldn’t ignore

While there are instances when you can expect pain from exercise, always take caution if you feel pain coming on while you work out or if the pain persists afterward. Serious injuries such as a stress fracture or tear could be the reason for this pain — and you should seek medical attention.

Here is a list of pain conditions that should not be ignored and merit a visit to your doctor:

  • Sharp pain that prevents you from moving a body part, decreases your range of motion, or prevents you from moving altogether.
  • Pain in an area that was previously injured or where you’ve had surgery.
  • Pain associated with deformity or massive swelling.
  • No pain relief after several days of rest, ice or over-the-counter anti-inflammatory medication.
  • Constant pain or pain that is worsening in severity.
  • Pain coupled with pressure and bruising.
  • Pain that is so intense that it causes nausea and/or vomiting.
  • Pain associated with fevers and chills.

Use the proper technique

Recurring pain connected with sports often is due to incorrect form or technique. If you can catch these errors early, you can retrain yourself so that you avoid re-injury or chronic recurrences.

I always recommend that serious athletes seek assessment by athletic trainers or physical therapists in a clinic that specializes in your sport. This way, you will receive expert advice that can help you achieve your best results — without pain.

Read more expert advice from Jamie Starkey, LAc, on her blog.

Is Working Out When Sore a Bad Idea?

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Muscle soreness after a hard sweat sesh can feel like a badge of honor; it’s a reminder that you got your butt up in the morning to make time for a workout and really pushed yourself. But what does that mean for the next day’s workout? Is working out when sore a bad idea?

While some soreness after a new or intense workout (such as this crazy-effective butt-sculpting routine) is totally natural, a “no pain, no gain” mindset can have serious consequences if you’re going full steam ahead when you should really be slowing down. Yes, the work you do in the gym is important, but it’s just as important to give your body sufficient time to recover in between workouts, according to Kirk Campbell, M.D., a sports medicine surgeon and assistant professor of orthopaedic surgery at NYU Langone Medical Center.

While you may be tempted to power through, there’s great danger in not allowing ample time for your muscles to rest, explains Leesa Galatz, M.D., chair of the orthopedic department at the Icahn School of Medicine at Mount Sinai. Since the soreness you’re experiencing is actually due to microscopic muscle damage, the muscle needs to recover before it can work at its optimal capacity again. A tired muscle that hasn’t had time to recover is more susceptible to a serious muscle tear or excessive tissue damage, she explains.

That burn you feel 24 to 48 hours after an intense workout is called delayed onset muscle soreness (DOMS), and it’s enough to make you want to put down the kettlebell and pick up a cocktail. But press on! We talked to fitness and nutrition expert Harley Pasternak, M.Sc., trainer to celebrities like Lady Gaga, Megan Fox, and Halle Berry, about why (some) pain is good.

“The idea behind resistance training is that you’re basically tearing something and creating a microtrauma in the muscle,” Pasternak says. “When the muscle recovers, it’s going to recover stronger and denser than it was before.” (This is all the science you need to know about burning fat and building muscle.)

Just make sure what you’re suffering from is DOMS and not an injury. “A good way to tell the difference is if the pain is bilateral,” Pasternak says. Having one very sore shoulder after you’ve worked both shoulders could spell injury. If you feel normal soreness in a muscle, ligament, or tendon, it’s DOMS and you can continue working out around it, Pasternak says. In the case of arms and shoulders, you can work your quads, abs, or glutes and then move back to your upper body in a few days.

To avoid feeling the pain of DOMS the next time around, Pasternak suggests starting your exercise routine slow. “Increase your resistance gradually so that your muscles adapt to your new workout plan.” (And add these 10 recovery-aid eats to your menu!)

But should you work out when sore? Or are you too sore to work out? We break it down below.

Should You Exercise with Sore Muscles?

The answer is a hard and fast NO if…

  1. Getting out of bed makes you want to cry. We all know that feeling. But if you’re having a hard time getting out of bed in the morning, or it’s difficult to sit down or stand up the next day after a heavy squat sesh, you have a clear answer. Give your body more time to rest and instead focus on recovery with dynamic stretching or using a foam roller, says Campbell.
  2. It’s hard to take the stairs. If it’s excessively difficult to walk up the stairs, you know your body is telling you to cool it for a couple of days and focus on working different muscles. Instead, try a low-intensity, low-impact workout like going for a walk, using the elliptical, or going for an easy bike ride or swim, which may help speed up the recovery. (Related: Is it OK to Get a Massage If You’re ~Really~ Sore?)
  3. You need a pain reliever to help you “push through.” It’s important not to mask muscle pain by popping Advil before working out, just to help you grin and bear it, Campbell says. If you need to take a pain reliever to make it through, you haven’t given your muscles enough time to recover.
  4. If your muscle soreness doesn’t feel better with movement. Yes, your body might feel stiff and sore when you first get out of bed in the morning, but if it doesn’t get better after you walk around, it’s a sign you’re too sore to work out. (Related: 4 Muscle Roller Sticks That Are Almost As Good As a Real Massage)
  5. You’re still feeling sore days later. As you’ve likely experienced, muscle soreness may not set in immediately—it’s usually at its worst 24 to 48 hours after a workout, Galatz explains. But if you’ve given it three to four days and are still feeling sore and it hasn’t improved, this is a key sign you’ve ventured into too-sore-to-work-out territory and should go see a doc to make sure it isn’t something more serious, Campbell advises.
  6. If your urine is dark and your muscles are swollen. Go see your doc, stat. This could be a sign of rhabdomyolysis, a rare but life-threatening condition if not treated right away. It’s caused by the body actually breaking down muscles and releasing myoglobin and creatine kinase into the blood stream, which can lead to kidney damage. Although uncommon, it has been found in people performing intense conditioning workouts such as CrossFit, Campbell warns. (Snooze off the soreness! These tech products can help you recover from exercise as you sleep.)

4 Tips for Reducing Muscles Soreness

Did you fail the “should I work out when sore” test? There are plenty of things you can do to ease those lingering aches as you get back up to speed (in fact, we have a full list of ways to relieve sore muscles).

Try four of Pasternack’s faves:

  1. Warm up. “Increase body temperature to help prepare your muscles for the shock of an intense workout,” Pasternak says.
  2. Stay hydrated. “A lack of electrolytes can make muscles sore,” Pasternak says. He recommends drinking easily digested fluids so you can power up and avoid an upset stomach. “Look for beverages with no protein or stimulants, like Powerade Zero.” (Related: “Spending An Entire Weekend Focusing on Recovery Opened My Eyes to How Much I Needed It”)
  3. Ice sore muscles. “Have a cold pack handy to reduce pain and inflammation,” Pasternak says. ACE has an Instant Cold Compress that’s super convenient. “Give it a twist and you’ve got instant ice.”
  4. Do cardio. “A cardio workout increases blood flow and acts as a filter system. It brings nutrients like oxygen, protein, and iron to the muscles that you’ve been training and helps them recover faster. As the blood leaves the muscles, it takes some of the metabolic by-products with it (like carbon dioxide and lactic acid) that may be causing DOMS.”
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Is Soreness an Indicator of a Good Workout??

“I didn’t get a good workout, I don’t feel anything. The weight was heavy but I am just not sore at all.”

OR…

“I had the best workout ever yesterday!! I am so sore I can barely walk!!”

To be sore, or not to be sore, that is the question!

It’s a common belief among exercisers that muscle soreness and quality of workout exist in a linear relationship. That is, the more sore you get from a workout, the better it is, right? WRONG! Soreness from a workout is NOT always a sign of a good workout.

WHAT IS MUSCLE SORENESS
Muscle soreness resulting from a workout is known as delayed onset muscle soreness (DOMS). Typically DOMs takes 24 – 48 hours to develop and peaks between 24 – 72 hours post exercise. Any significant muscle soreness lasting longer than 5 days could be a sign of significant muscle damage beyond what is beneficial.

So what causes DOMS? It’s a common misconception that lactic acid is the main cause of DOMS. Research performed on runners showed no muscle soreness following HIGH intensity running on flat ground (LOTS OF LACTIC ACID) while the same study showed significant DOMS during downhill running at low intensities to limit lactic acid buildup. So why did the runners get more sore in the downhill running portion of the study? It is believed that tiny microscopic tears in the muscle tissue result in inflammation, and inflammation is the main cause of soreness. The reason that downhill running causes muscle soreness is because it requires a significant amount of lengthening (or eccentric) contraction to resist the pull of gravity. A lengthening contraction is simply a muscle resisting a stretch. For example, when you perform a bicep curl and you are taking the dumbbells from your shoulder back down to your sides you are performing the lengthening portion of the exercise. In fact, when you perform the lengthening portion of an exercise you actually use FEWER muscle fibers than on the shortening phase (lifting the dumbbell to the shoulder, from above). So if you use 100 muscle fibers to lift the weight during the shortening phase, you’ll use 80 to lower it (during the lengthening phase). Same weight, fewer muscle fibers, equals damage, inflammation, and finally soreness.

HOW MUCH SORENESS IS ENOUGH?
This varies for everyone! Some research shows that 33% of individuals do not experience DOMs when heavy lengthening-based lifting protocols are followed but still experience significant training adaptations (muscle growth, strength, muscle endurance, etc).

Not only does excessive soreness not equal a better workout, it could actually delay you from reaching your goals. If you are so sore that you can’t workout for 3 days and have a hard time performing activities of daily life, your energy expenditure will be significantly less and any benefit gained during the workout from an energy balance standpoint would be negated. This phenomenon has actually been studied and is called a reduction in “non-exercise activity thermogenesis” (“NEAT”… for more about NEAT go to: (http://www.appliedfitsolutions.com/articles/neat-new-research-on-fat-loss). Also in severe cases of soreness the muscle can be damaged so much, critical structures can actually “leak” out. With these critical structures gone, the muscle can be rendered incapable of change.

PREVENTING DOMS
Severe DOMs are not essential to anyone’s fitness goals. However, some people (myself included) enjoy a moderate level of soreness from workouts. These “moderate DOMS” that last no more than 72 hours and do not inhibit daily activities are not necessarily beneficial physiologically, but are also not detrimental. Severe DOMS lasting more than 72 hours and effecting your typical exercise or activity routine are potentially detrimental.

Non-steroidal anti-inflammatory drugs (NSAIDs; like Motrin or Aleve) have long been used to treat DOMS; however, current research does not support the efficacy of NSAIDs for the treatment of DOMS. Mixed and conflicting results in addition to inconsistencies in type, dosage, and timing make recommendations difficult. Furthermore it is reasonable to assume that since a critical aspect of exercise-related adaptation IS inflammation inside of the muscle, NSAIDs could very well stop adaptation dead in its tracks due to completely knocking out the inflammatory effect.

One addition you can make to your exercise program to reduce the severity of DOMS is the intake of simple sugars and high quality proteins around your workout. This concept is referred to as nutrient timing and is supported by a significant amount of research. See our blog on nutrient timing for a detailed explanation of its role in the recovery process. (http://www.appliedfitsolutions.com/articles/nutrient-timing-supplements-critical-to-all-training-adaptations).

Another technique to combat DOMS is to simply MOVE! A light warm-up (5 minutes on an elliptical) and low intensity bodyweight exercises (squats, lunges, pushups, etc) followed by stretching can increase blood flow and aid in the recovery process. Next time you are really sore take an additional 10-12 minutes the next day and try it, I guarantee it will help!

If you are experiencing debilitating soreness levels talk to your fitness practitioner so they can appropriately modify your current exercise prescription. At the end of the day please remember, how sore you get and how good of a workout you had are definitely NOT the same thing!

Delayed muscle soreness after exercise

Why do I feel sore a day or two after a hard workout?

The exercise-related muscle pain you’re asking about is called “Delayed Onset Muscle Soreness” or DOMS for short. As its name implies, DOMS has symptoms of muscle tightness, pain, and tenderness similar to a strain. Strains happen during or immediately after exercise. For instance, if you are sprinting and suddenly feel a sharp pain in the back of your leg while gutting out that last 10 yards, you likely have a hamstring strain. DOMS, on the other hand, usually starts well after the exercise that caused it, typically around 24 hours later. DOMS often lasts five or as long as seven days. It’s important to recognize the difference between DOMS and other musculoskeletal pain and injury, as strains may take longer to heal and may require you to rest from certain activities.

The pain from DOMS is caused by damage to the muscle tissue and inflammation associated with the damage. Due to this, you may have noticeable weakness or soreness when you move a certain muscle group. Most people notice reduced pain within five to seven days, but you should see your physician if the pain lasts longer than a week or gets worse. Persistent or worsening pain could be due to rhabdomyolysis, which is a different but serious—maybe even life-threatening—condition that includes severe muscle pain with swelling. Other symptoms of rhabdomyolysis may be tea-colored or dark, cola-colored urine. If you notice any of these symptoms, you should see a physician right away.

Can I prevent and/or treat DOMS?

There is limited research on treatments and their effectiveness for DOMS. However, there are some strategies that you can try yourself to help relieve your symptoms of pain and soreness from DOMS (as well as pain experienced shortly after exercise), as well as some you can explore to prevent it.

  • Stretching. While widely practiced, stretching has not been proven to help prevent or reduce pain or DOMS after exercise. However, you can give it a try, and if seems to help reduce your symptoms of pain and soreness it may be a good idea for you.
  • Recovery drinks. Carbohydrates and protein may help prevent DOMS. Several studies show that protein-based drinks such as chocolate milk can help reduce muscle soreness and fatigue after prolonged exercise. But before you consider a post-workout supplement, research dietary supplements to make sure you aren’t getting things you don’t want. Many products marketed as recovery and sports drinks may contain ingredients that can actually hurt your performance.
  • Cold-water immersion, or an “ice bath,” is very uncomfortable, but it can help reduce the pain associated with DOMS. Immersing sore muscles in ice-cold water for 10-20 minutes at 50-60 degrees Fahrenheit, immediately after exercise may improve recovery compared to regular rest and recovery.
  • Anti-inflammatory over-the-counter medicines such as ibuprofen or naproxen can also help reduce inflammation caused by muscle damage, which may also reduce pain. Studies suggest that taking anti-inflammatories also can speed up recovery, but you should limit their use to less than one week. Pain that lasts longer than one week is generally not DOMS, and you should see your doctor.

Should you exercise if your muscles are sore?

We’ve all been there. After a couple of weeks of holiday, you come back and have a pretty hard training session. You figure you were in pretty good shape before you left, so you add some extra weights to your barbell and do your squats as usual.

The next day is another matter, however.

Your thighs are so stiff you have to hang on to the banister to totter downstairs. Just the thought of putting on pants to go to work nearly makes you cry. And then there’s the question of the next training session.

Should you wait until you’re not sore anymore, or continue to train as usual?

Not sure what causes sore muscles

Kristoffer Toldnes Cumming is a postdoctoral researcher at the Norwegian School of Sport Sciences. He has studied what happens inside muscle cells when they are subjected to stress (Photo: Andreas B. Johansen / NIH.)

Kristoffer Toldnes Cumming from the Norwegian School of Sport Sciences, and Jan Helgerud from NTNU say that researchers don’t really know what happens with your muscles when you get sore.

“There have been many hypotheses across the ages,” says Cumming, who is a postdoctoral researcher specializing in training and recovery. “It used to be that we blamed lactic acid.”

Lactic acid is a substance that is produced when muscles need a lot of energy over a short period but do not have access to enough oxygen — a situation that often occurs during endurance training. But lactic acid is no longer believed to be the reason for why you are sore the day after exercising.

“Lactic acid is gone after an hour,” says Jan Helgerud, a professor at NTNU who studies both endurance and strength training.

Jan Helgerud is a professor of sports physiology at the Norwegian University of Science and Technology. Helgerud and his colleague Jan Hoff have conducted a great deal of research on the concept of 4×4 training for endurance and strength training (Archive photo: NTNU).

He points out that you may have a sky high level of lactic acid during endurance training without being sore the day after.

Small tears and inflammation

Helgerud says the most likely cause of soreness is small tears or injuries to the muscles that occur when you make an unaccustomed movement with a great deal of effort or strain. The result is an inflammatory reaction that causes painful and sore muscles for a few hours after the session is complete, and can be at its worst 24-48 hours after your workout.

Researchers call this delayed-onset muscle soreness (DOMS).

“Any training involves breaking down your muscles. The body responds by building them up again to withstand greater stresses the next time you train,” explains Helgerud.

But Cumming believes that there are questions around this theory, too.

“For example, scientists have not found a correlation between how sore you feel and how injured your muscles are. The injury occurs during your training and you might not feel stiff at all while you are exercising or immediately afterwards, either,” Cumming said.

Waiting out the stiffness might be smart

Whatever it is that causes your muscles to feel stiff, both scientists are clear that it is nothing to be worried about.

“There is nothing dangerous about feeling sore, other than that it is extremely unpleasant,” says Cumming.

But that doesn’t mean it’s smart to keep training if your muscles are really sore, the researchers said.

“When you’re sore, you can’t give your all, so you don’t get as much out of your workout,” Cumming said. “Your technique also might not be that good.”
Both Cumming and Helgerud recommend waiting until the worst soreness is gone before embarking on a new session with the same exercises.

But that is no excuse to lie on the couch for the next five days, they say. Instead, you could do a different kind of exercise, like endurance training if you are sore from lifting weights, or working out your upper body if you have sore feet.

No real treatment for muscle soreness

Not only do we not know exactly what happens in the body to make our muscles stiff— there is no scientifically proven treatment that helps with the pain.

Researchers have studied massage, cold therapy, compression garments, antioxidants, protein supplements and stretching, Cumming says, but nothing has been shown to really work.

The only thing that really helps with muscle soreness is to get in shape and exercise regularly, the researchers say.

“If you only do squats once a week, you will most likely be sore afterwards. If you train twice a week, you’ll feel better. If you do squats three times a week, you may not experience soreness at all,” Cumming says.

Nevertheless, you shouldn’t train so hard that you are unable to train for two to three days after a hard session because of soreness. “That’s just not a good way to train,” Helgerud said. “But being a little stiff isn’t dangerous, and it tells you that you have worked your body hard.”

Read the Norwegian version of this article at forskning.no

  • Kristoffer Toldnes Cumming’s profile
  • Jan Helgerud’s profile
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How Sore Is Too Sore?—and Answers to All Your Other Muscle Soreness Q’s

When you finish a grueling Aaptiv workout, do you say “I am going to be SO sore tomorrow!” in anticipation or agony? It’s no secret that we all crave the good feeling a demanding routine provides, but muscle soreness in the aftermath is a totally different story.

Depending on your fitness surroundings and experiences, you might have a slightly (or largely) skewed view on being sore. If you’ve ever considered muscle soreness a sort of validation, you’re not alone. If you’ve ever thought that your workout wasn’t effective because you didn’t “feel it” the following morning, you’re also not alone.

Whether you look forward to that all-too-familiar ache or keep your pre- and post-workout routines consistent to prevent it, we’re here to settle that.

We tapped April Oury, founder, president, and physical therapist at Body Gears Physical Therapy in San Diego, St. Louis, and Illinois to answer all our pressing muscle soreness questions.

Grab your foam rollers and read on.

Where does soreness come from?

“Delayed Onset Muscle Soreness, or DOMS, used to be attributed to a lactic acid build-up,” says Oury about the soreness you might suddenly feel hours after a workout.

More recently, though, new theories suggest soreness is due to calcium stored in the muscle where microtrauma, or micro-tears in the muscles, from the workout occurs. It sounds awful, but no reason to panic. It’s completely normal. This causes inflammation, which leads to that sore feeling.

Is being sore a good or bad result of working out?

In a word: both. “In my physical therapy practice, I think that being sore—particularly in a portion of a muscle that feels new—is a great result, because that means those dormant fibers have been called on to work and are responding,” Oury explains. Basically, if you’re achy after trying a new routine or focusing on a new set of muscles, there’s little to worry about. Cue the collective sigh of relief.

On the other hand, if you’re uncommonly sore in a part of the body that doesn’t usually experience muscle soreness, take note. If it still feels that way 72 hours later (the longest DOMS typically lasts), contact a physical therapist.

Was my workout effective if I don’t feel sore the next day?

To go off of that last bit, we have to wonder if not feeling sore means anything of significance, too. “If you aren’t sore the day following a workout, you’ve likely already conditioned your body into that workout routine, pattern, or movement,” says Oury. “Soreness shouldn’t be the determining factor of whether or not you had an effective workout. As long as you know you did the reps, you did the time, and you did the full motion, you had an effective workout.”

Should I workout if I’m sore from the day before?

We know that allowing our body to rest and rebuild is a crucial. But sometimes we just want to keep the momentum going. You should allow yourself at least one active-recovery day a week, but what should you do if you feel sore before your rest day? “Acute soreness where you simply have a dull ache 12 to 72 hours post-workout should be a sign to do a workout where you move the muscles slowly and without much resistance,” says Oury. “Getting fresh blood flow to the sore muscles via gentle exercise is key to returning them to a more normal resting sensation.”

In other words, speeding up the blood flow to your muscles can aid in faster recovery—and less pain. Focusing on another muscle group and including gentle workouts like stretching and yoga will do the trick.

Aaptiv has stretching and yoga workouts you can try in app. Check them out today.

Is there such thing as being too sore?

“As a physical therapist, my general advice is that if you have 1-2 weeks of the same soreness, you should get physical therapist to determine if there is mechanical or neuromuscular damage,” explains Oury. “A good PT will evaluate you first and determine how serious the issue is. Depending on the state, her or she can administer treatment on that first session. Some injuries will spontaneously resolve, and many others won’t.”

Oury also emphasizes that chronic soreness shouldn’t be ignored. “It’s often a symptom that a muscle isn’t firing appropriately within the chain, and tendonitis or muscle strain can result.” Always, always enlist a professional’s guidance if you relate to any of these symptoms.

What can we do before and after a workout to prevent too much muscle soreness?

We’re foam rolling (this one is our favorite) and stretching champs. Is there anything else we can do? “As old fashioned as it sounds, a good old Epsom salt bath can do wonders to decrease inflammation,” suggests Oury. “Plus, who doesn’t like to relax in a warm tub for a bit?” We can’t argue with that.

“Calf soreness is a big one after a long or hilly terrain run,” she includes. “Doing seated calf raises can get the tissues moving and blood flowing without excessive weight of the entire body. Think gentle motion and slowly going through the full range of muscle firing as key.”

What if I wake up and feel almost too sore to move?

We’ve all been there. And we don’t know what to do…short of groaning in agony, of course. “If you wake up and feel almost too sore to move, I recommend doing gentle stretches in bed prior to getting up),” says Oury.

For hip or back DOMS, try lying on your back with knees bent and gently rock back forth. For lower body, pain, lay on your back with your leg extended toward the ceiling and perform ankle circles. This will help mobilize all of the lower leg compartments and the sciatic nerve.

“What doesn’t help is being sedentary,” says Oury. Apologies to those who’re tempted to sleep it off; it’s for your own good. “As many in the physical therapy community now say, ‘motion is lotion.’ So if you want to feel more fluid and gently work through DOMS, measured motions are the way to go.”

Once your pain has passed, get back on track with our newest Aaptiv workout plans! Or check out our stretching and meditation classes in the meantime.

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  • Physical therapy and/or rehabilitation: Supervised exercise and therapy often can help you heal faster and prevent re-injury. Learn about our physical therapy and rehabilitation services.
  • Broken Ribs and Rib Fracture Stabilization

    If your rib is broken (fractured), you’ll be in a lot of pain. Broken ribs are quite common but can take 6 weeks to 6 months to heal.

    If you have multiple broken ribs, complicated fractures or an active lifestyle that makes recovery challenging, we can help you recover more quickly and less painfully. This treatment option is called rib fracture stabilization.

    About Rib Fracture Stabilization

    A few things to know about rib-fracture stabilization:

    • We’ll connect titanium plates across your broken rib(s). We can’t put your ribs in a cast, as we can with other broken bones, because ribs constantly move, particularly when you breathe.
    • Rib fracture stabilization is a surgical procedure. You’ll need to be in the hospital for approximately 5 days. Your doctor can tell you more about the benefits of this surgery.

    Learn more about thoracic surgery.

    Summit Medical Group Web Site

    What is a rib injury?

    A rib injury is a bruise, strain, break, separation, or irritation of one or more of the ribs in your chest. It can also be an injury to the tissue called cartilage that attaches the top 10 ribs to the breastbone.

    What is the cause?

    A fall or direct blow to the chest may bruise, strain, or break the ribs or injure the rib cartilage. Breaks usually happen in the outer curved part of the rib cage.

    When a rib tears away from the cartilage, the injury is called a costochondral separation. It may result from a blow to the ribs, a fall, or landing hard on your feet. It might even be caused by forceful coughing or sneezing.

    Irritation of a rib is called costochondritis. It may be caused by an infection or repeated coughing, or by overuse, like from rowing or heavy lifting. Sometimes the cause is not known.

    What are the symptoms?

    A rib injury causes pain and tenderness in the ribs. You may have pain when you breathe, move, laugh, or cough.

    How is it diagnosed?

    Your healthcare provider will ask about your symptoms and medical history. Your provider will examine your chest and listen to your lungs. Tests may include X-rays or other scans.

    How is it treated?

    Rib injuries can be painful and make it hard to cough or take a deep breath. Your healthcare provider may prescribe pain medicine.

    You may need to do breathing exercises while you heal to prevent lung problems.

    Rib injuries usually heal without surgery. Bruised ribs or a costochondral separation usually take 3 to 4 weeks to heal. Broken ribs take 6 to 8 weeks to heal.

    How can I take care of myself?

    To relieve pain and help the injury heal:

    • Rest.
    • Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured ribs every 3 to 4 hours for up to 20 minutes at a time.
    • Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or naproxen, may cause stomach bleeding and other problems. These risks increase with age. Unless recommended by your healthcare provider, do not take an NSAID for more than 10 days.
    • If coughing is painful, holding a pillow against your chest may help.

    Follow your healthcare provider’s instructions. Ask your provider:

    • How and when you will hear your test results
    • How long it will take to recover
    • What activities you should avoid, including how much you can lift, and when you can return to your normal activities
    • How to take care of yourself at home
    • What symptoms or problems you should watch for and what to do if you have them

    Make sure you know when you should come back for a checkup.

    How can I help prevent rib injury?

    Ribs are often injured in accidents that are not easy to prevent.

    In contact sports like football it’s important to wear the proper protective equipment.

    If you’re like the majority of runners, you’ve experienced this at one point or another: You’re out for a run, and then in creeps a sharp, localized pain, right under one of your ribs. You think, “What is that, and how to I banish it to hell forever?”

    This may help.

    Welcome to Fitmodo, Gizmodo’s gym for your brain and backbone. Don’t suffer through life as a sniveling, sickly weakling—brace up, man, get the blood pumping! Check back on Wednesdays for the latest in fitness science, workout gear, exercise techniques, and enough vim and vigor to whip you into shape.

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    What Is a “Runner’s Stitch”?

    It goes by many names: side stitch, runner’s cramp, side ache, Beelzebub, but the medical name for it is “exercise-related transient abdominal pain,” or ETAP. Despite it being one of the most common phenomenas in the exercise world (particularly common in runners and swimmers) there is little consensus as to what precisely it is and what causes it. There are, however, commonalities in most of the prevailing theories.

    Virtually everyone agrees that it has to do with the diaphragm (the muscle, not the contraceptive device). The thoracic diaphragm is a sheet of muscle that extends along the bottom of the rib cage, and it’s largely responsible for your breathing. As the diaphragm contracts it pulls air down into your lungs. As it relaxes, it pushes the air out. It is believed that the sensation of ETAP occurs when that muscle cramps (like your calf would) or becomes irritated.

    What Causes It?

    There are a few leading theories, but the answer most likely lies in a combination of them. One is that as a runner starts getting tired, his or her breathing is likely to get shorter and more shallow. Because your diaphragm is only fully relaxed when you’ve fully exhaled, those shallow breaths mean that the diaphragm is in a state of constant tension. Like any muscle, when it’s hyper-exerted, it can cramp. This seems like the most likely theory to us.

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    A somewhat stranger theory is that it’s caused by your guts (your internal organs, not your beer-bellies) shaking and wobbling around. There are ligaments stretching between your internal organs—especially your liver—and your diaphragm. It’s been well-proven that the jarring motion of running causes your internal organs to shake about—the idea here is that your shaking organs tug on the strings (ligaments) between them and diaphragm, thus irritating it.

    A final popular theory is that it’s caused by eating too much or too close to exercise. There isn’t much in the way of hard science to back this up, the idea is that when your stomach is more expanded with food, it puts increased pressure on the organs and tissues around it. Combine with the aforementioned jiggle-factor and whammo, cramp.

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    What Cures It?

    There’s all manner of myth and sorcery and miracle cures here, including something about running with clumps of grass or pebbles in each of your hands. Silliness. That said, different methods work for different people. Here is what we have found to work best, both in our own experience and in our research.

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    1. As soon as you feel the cramp coming on, slow down a bit. This will allow you to take bigger, deeper, slower breaths. Inhale fully, and even more importantly, exhale fully. This will allow your diaphragm to relax more. Focus on bringing your breathing down lower, into your belly. This will also help oxygenate your blood. Raise your arm on the side that is cramping and gently stretch it as you run. If the pain keeps getting worse, slow down to a walk until it start to subside. This has been the most effective for us, and anecdotally, it seems to work best for others as well.

    2. Another technique which you may already be doing instinctively is to press your hand into the place where it hurts. Generally this involves pushing your fingers or the palm of your hand slightly under you ribs and inward toward your center. Not only can this help by passively stretching your diaphragm, but it may help stabilize your innards, if all that bouncing around is indeed the cause.

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    3. Change up your breathing. This piggybacks on #1. If you are always exhaling when you land with your right foot, that could be wearing on you unevenly. Try breathing every third (or fifth) step, which will alternate the side you breathe on and will also help you slow things down a little. While you’re at it, try taking smaller, smoother steps, with less bouncing. You don’t have to slow down, you just have to quicken your cadence.

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    4. Eat less before your run, or at least eat smarter. If you suspect that your full stomach is playing role in your cramping, look to eating more complex carbohydrates, which are primarily digested in your small intestine and thus have a faster gastric emptying rate (i.e. it leaves your stomach faster). Make sure you’re properly hydrated, but not overly hydrated.

    5. Lastly—and this is the good news—the more you run the more infrequent runner’s stitches will become. Not only will you get more efficient with practice, but the muscles in your core will get stronger and stronger, including your diaphragm. You can further help this by doing core work when you aren’t running. Pilates, for example, is really great for getting deep into your core, not just strengthening your rectus abdominis (your six-pack muscles on the outside). Not only will a stronger core be less susceptible to muscle fatigue (one of the probable causes of runner’s stitch), it will help your guts not bounce around so much (another probable cause of runner’s stitch).

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    Final Thoughts

    Above all, use your common sense. This article is not a replacement for the advice of a doctor or physical therapist. If you have constant, nagging pain, get it checked out, as it could be something far more serious (a hernia, possible, or other un-fun things). Be safe and run smart.

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    Image credit: /Christo

    12 Tips To Avoid A Side Stitch When Running

    Whether it’s 10k, a half-marathon, or a full marathon, we try our best to be fully prepared for our runs. We plan in recovery phases and tapering , we swear by carboloading, and are careful to eat an easily digestible runners’ breakfast. We are prepared for heat, pouring rain, and wind with the right equipment. Basically, nothing could go wrong… right?

    And then we get a side stitch…

    Oh no, did I start off too fast? Did I breathe irregularly? Was my breakfast too heavy? And, while the unpleasant stabbing sensation slows you down, you wonder if it ever will go away.

    You’ll find answers to the most common questions in this article on side stitches:

    How does a side stitch develop?

    Today there are different theories on how and when the stabbing pain below the ribs – or even in the entire abdominal cavity – develops during running. The explanations range from poor blood supply in the diaphragm resulting in cramps in the abdominal muscles, to irritation of the peritoneum, the serum lining in the abdominal cavity. The theory of poor blood circulation and decreased oxygen supply to the diaphragm makes a lot of sense.

    The diaphragm…

    … plays a crucial role in breathing. Through shocks while running, the internal organs move with every step, as does the diaphragm when we breathe in and out – this creates tension in the body and cramps can occur in the diaphragm.

    Also, nervousness, improper breathing, posture problems, starting off too quickly, weak abdominal muscles, a full stomach, or the wrong running style can provoke a side stitch.

    Although a side stitch is basically harmless, it can be quite painful. And oftentimes we are forced to drop out of a race in the middle because of it.

    How to prevent a side stitch

    1. Breakfast: Eat a light breakfast, low in fiber and fat.
    2. Breakfast 2.0: Eat your breakfast 2 – 3 hours before the start. A small power snack right before the race, like a banana, is an exception.
    3. Warm-up: Warming up is required. A casual running warm-up prepares not only the muscles, but also promotes optimal breathing.
    4. Slow & Steady: Start slowly and increase your speed. A side stitch is a signal that your body is overwhelmed.
    5. The upper body is the key: A side stitch occurs more frequently in sports where the upper body is heavily involved – running, swimming or horse back riding. A well-trained core reduces rotational movements in the trunk of the body. The internal organs are actively supported and you are less prone to cramps. By the way: a strong trunk not only improves your running efficiency, but also prevents injuries.
    6. Control your breathing: The faster you run, the more oxygen your body needs. Irregular and shallow breathing can provoke a side stitch. Like an efficient stride, your breathing rhythm is key.
    7. Strong abs: Well-trained oblique muscles have been shown to prevent a side stitch. Five to ten minutes of daily abs training can pay off.

    Are you well prepared but still get pain in the abdominal area? Then try out the following tips …

    Tips for an acute side stitch

    1. Breathe: Proper breathing can contribute to relaxation of the diaphragm and respiratory muscles. Breathe in two steps and on the third step breathe out – that improves your breathing depth and relaxes your muscles. A deep breath in the abdomen (belly breathing) is especially helpful.
    2. Apply pressure: Press your hand on the painful area and release the pressure while breathing out. Conscious, deep breathing helps when trying this strategy.
    3. Shift down a gear: Slow down or take a walking break.
    4. Stop for a moment and stretch: Small stretching exercises can help relieve the tension. Just lean your upper body to the side and stretch a little farther with each exhalation.
    5. Stop and bend your upper body forward: To relax the diaphragm and the abdominal cavity, you can put your arms above your head while inhaling & then lean your upper body forward while exhaling and let your arms dangle.

    Hopefully one of these strategies will help you enjoy your next run without any side stitches or relieve the pain faster so you can continue “stitch-free”.

    Good news: running is the best way to prevent a side stitch. The higher your endurance, the less often a side stitch will occur. This is because while running, you train your diaphragm and your respiratory muscles!

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