By Becca Newell
Sore muscles are something most of us experience when we first start up a gym routine or after a particularly intense exercise session. A little post-workout aching is to be expected—and perfectly normal. But when does pain indicate something more significant? What if you’re injured? How important is it to rest? Is medical attention always required?
To help navigate the often confusing path of pain, we turned to local medical professionals for their advice.
The Body's Ability to Self-Heal
The body is well-equipped in its ability to recognize an injury and repair itself. Upon sensing an injury, the body’s immune system sends cells to help clean up the damage and kill any foreign cells, like bacteria, says Executive Vice-President Kamran A. Saraf, M.D., of Kure Pain Management in Annapolis. Those cells also help to rebuild the injury with healthy tissue.
The length of the healing process—between two months to a year—differs depending on the type of injury. And, Saraf adds, there are some parts of the body, like the heart and ain that cannot be rebuilt.
The Three Phases of Healing
Acute/Inflammatory Phase:
Occurs up to 72 hours after injury • Represented by swelling, redness, inflammation, and warmth around the injured area • May result in loss of function or limited movements • Rest, gentle movements, and physical therapy recommended
Sub-Acute/Reparative Phase:
Lasts for up to six weeks after injury • The “repair” stage, represented by the new growth of scar tissue to reconstruct damage and decrease inflammation • The new connective tissue is fragile; too much stress can prolong recovery
Remodeling Phase:
The newly formed tissue is now relatively strong and can withstand stress; mobility work is crucial to restore proper function of healing tissue • Expect elasticity to be limited; end ranges of motion may result in pain or restriction • The length of this phase varies depending on the injury and one’s healing potential
Exercising in Pain
Experiencing a tightness or soreness while exercising isn’t exactly normal, but it’s not an immediate cause for concern. “Mild pain during exercise may just mean you are not performing the exercise properly and an expert should be sought out to teach proper technique,” says Orthopedic Surgeon Benjamin Petre, M.D., of Anne Arundel Medical Group Orthopedic and Sports Medicine Specialists in Odenton.
Similarly, muscle aches and pains after a workout are to be expected, particularly if it’s a new exercise regimen. DOMS—which stands for Delayed Onset Muscle Soreness—is a common post-workout occurrence that causes discomfort in muscles as the body adapts to the added stress. “[The soreness is] similar to how you would feel the day after you hit the slopes for the first time of the year,” says Lead Physical Therapist Dr. Katherine Rainey, of Advanced Rehab Center in Annapolis. “The best thing to do is keep moving and stretch.”
However, if you feel a sharp or stabbing pain during light to moderate exercise, you should stop immediately and consult with your doctor.
“Pain is typically a signal from your body telling you something is wrong,” Chiropractor Dr. Joseph Kling, of Effective Integrative Healthcare in Crofton.
The same is true for pain that causes significant joint swelling or uising, or pain that lasts for several days. Continuing to exercise through any of these indications of an injury could elongate the healing process or prevent the injured body part from healing at all.
“The normal rehabilitation process after injury will cause discomfort, but it should not be excruciatingly painful,” says Saraf. “In this situation, ‘no pain, no gain’ does not apply!”
Exercising After an Injury
Continuing to exercise after the treatment of a mild sprain or strain is often approved by medical professionals.
“For example, a Grade 1 ankle sprain can be taped properly and the player can be allowed to return to their sport right then,” says Petre.
It’s still important though to avoid stressing the affected tissue since—depending on the severity of the sprain—it could prolong recovery. Additionally, it’s important to heat or ice the sprain. Heat should be used for tightness, soreness, and aching; ice is for swelling and sharper pains, according to Kling.
“Ice constricts blood vessels and helps to reduce swelling and inflammation,” he says. “The heat dilates the blood vessels which helps to loosen the soft tissue.”
Even fitness fanatics suffering from a more severe injury will most likely gain approval for a specific set of exercises.
“A lot of injuries can be managed without having to completely stop exercising,” says Kling.
Petre gives an example of a oken leg that prohibits someone from walking.
“I will still allow them to swim laps—with a pull buoy and without pushing off the wall during turns—to [maintain] a cardiovascular workout and upper body strength,” he explains.
Similarly, recent research has suggested that mobilizing the joints and muscles following an injury is key to the healing process. “[It] maintains good oxygenation of the tissue,” says Rainey.
It’s important, however, to seek advice from a physical therapist as to what movements are safe and beneficial.
“The extent of the injury, location, and tissues involved will determine what physical exercises are safe to continue,” Rainey adds. “When acutely injured the goal is to steer clear of specific movements that will aggravate the injured tissue and delay the healing response.”
In addition to preventing further tissue damage and inevitably restoring tissue strength, physical therapy will also help to prevent atrophy and weakness of muscles.
Exercises for Back Pain
As we age, our back muscles become weaker, which inevitably increases the incidence of injuries in that area.
“Low back pain is one of the most common injuries of this day and age,” says Rainey, who recommends regular exercise to prevent pain. “Making sure you lead an active lifestyle … will greatly mitigate your risk of having low back pain.”
The main focus of exercise should be core stability and flexibility, focusing on the abdomen and back muscles that support the lumbar spine. Other areas that deserve attention include hip mobility and glute strength.
“Strengthening them will give the spine more support,” says Saraf.
Seeking guidance from a physical therapist or personal trainer is important—incorrect form is a major culprit of back pain, as is poor posture, and can greatly increase the risk of an injury.
The Myth of Broken Toe
We’re all familiar with the theory that nothing can be done for a oken toe, but that’s far from reality.
“If not treated correctly, serious complications may develop,” says Rainey.
It is true, however, that some toes are more important than others—while the big toe often requires treatment, fixing the fourth and fifth toes often relies on a little tape, according to Petre.
Since the big toe bears the unt of our weight, a walking boot may be required if a fracture is present. The smaller toes, if fractured, can be immobilized through taping. A splint or cast may be required to ensure immobilization and, in some cases, the oken bone may necessitate pinning to heal properly. Additionally, impact cardio, like running, or exercises that cause the toes to flex should be avoided.
“The tissue can’t heal if it is constantly moving around,” says Kling. “Modifying exercises, like stable resistance exercise or biking, can be done as long as it is not aggravating the toe.”
Still, medical attention should be sought in any situation where fractured or oken toes are suspected, especially if there is significant sign of deformity, such as the toe pointing in the wrong direction.
“Our toes are one of the most used and abused parts of our body,” says Saraf. “If they are not properly fixed, the oken bone may fuse the wrong way and may cause lifelong pain. It is definitely not something to ignore.”
