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Injury and Rehab: Is Your Pain Injury or Soreness?

For many of my clients, pain in the body will come and go, like a headache. You may have pain for an hour or maybe even a day, but often it will simply go away and you’ll forget about it.

There are many factors and mechanisms that cause pain in the body, and sometimes you may feel it’s not bad enough to actually go and see someone about it. There are times that you will feel hesitant, and although you may mention a pain, it doesn’t mean that you have sought any further specific treatment or advice. The best suggestion is to do something about your pain before it becomes severe or long-lasting.

But how do you know when?

The following information about pain, injury, and when to seek professional advice and treatment should help answer this question.

Delayed onset muscle soreness (D.O.M.S)

As you may know, after training, you can develop delayed onset muscle soreness (D.O.M.S). This pain and stiffness can be felt in the muscle for between 24 to 72 hours, days after unaccustomed or strenuous exercise. It is caused by damage to the muscle during the eccentric (lengthening) part of the contraction and the soreness comes when the muscle is adapting afterward. It is a common and normal muscle response if you have pushed yourself hard, worked muscles in the outer limits of their flexibility, lifted heavier weights than you usually do, or not exercised for a while.

For example, if you have done a lot of heavy squats, and the next day your thigh and buttocks are sore, this is D.O.M.S. The pain is over a large area throughout the muscles, and usually on both sides. The best thing to do is rest, gently stretch and avoid training the sore body parts at that intensity for 48-72 hours.

Doing muscle building and strength training programs mean you will most likely get D.O.M.S. Although many might refer to this as a ‘good pain’, it is a commonly held misconception that unless one is experiencing D.O.M.S one has not worked out hard enough. It needs to be understood if you have been programmed the correct graded training for your level of fitness, strength, and conditioning.

Severe D.O.M.S

D.O.M.S is one thing, but severe D.O.M.S, whereby you have muscle pain that prevents you from walking properly or standing up from a seated position, means you have pushed yourself too far. If you have severe D.O.M.S, you are likely to change your patterns of movement in order to avoid the pain in the muscles. This may make you compensate during an exercise with other muscle groups and overload biomechanically, thereby causing an actual injury.

Again, the treatment for severe D.O.M.S is simply resting, then gentle stretching. You should further adjust your training in order to avoid the problem reoccurring. If you have experienced severe D.O.M.S as a result of following a training program that is prescribed to you, then your fitness professional will need to reassess your program and correct its level and intensity.

Is it severe D.O.M.S or an actual muscle injury?

Determining whether it’s just severe D.O.M.S, or whether you actually suffered an injury, is all down to the nature of the pain, the surface area and when it happens. With a muscle injury, the pain is localised to one small area in the muscle, is more severe and has an ache with it. There may be sharp pain on flexing the muscle and possibly a loss of power. With an injury, the pain comes on either during or immediately after training (not the next day or so like with D.O.M.S). The pain can last for many days, and sometimes weeks or even longer. If you have pain like this, you most likely have suffered a muscle strain or ‘tear’.

As soon as you feel this type of pain, you need to get the injury assessed in order to ascertain the extent of the damage and to determine the treatment plan. This is not a time to just wait and hope it goes away. Seeing an allied health professional (A.H.P) such as a physiotherapist, chiro practitioner or doctor for rehabilitation will increase your chances of returning to exercise more quickly by helping your recovery, improving your strength and preventing the breakdown in your training regime. The right A.H.P will also be able to work out why you are getting injured in the first place and help prevent it from happening again hand-in-hand with your fitness professional.

When pain comes and goes, is it an injury?

If you are experiencing pain that comes on during exercise but eases afterward and then returns when you exercise again, you should inform your fitness professional. This type of pain is usually from inflammation or irritation of tendons and joints, and sometimes other serious structures (like discs in the back).

The pain can occur with certain movements, such as in the shoulder when raising the arm, on the outside of the knee-cap during a run, or in the lower back after bending. As soon as the exercise or movement ceases, the pain subsides, but it always comes back. If the pain increases during exercise, doesn’t ease afterward and is worse at night, then the problem requires further attention.

Inflammation in a tendon is called tendonitis, and if not seen early, can develop into a ‘tendinopathy’, where the tendon weakens significantly. Rest relieves the pain only temporarily and over time actually makes the injury worse, because the associated muscles become weaker. It is essential that the pain is addressed before it gets to this stage and becomes a chronic recurring condition. Inflammatory pain is usually tackled with anti-inflammatory medication, but sometimes that’s it. The reason for the inflammation occurring during exercise also needs to be established and remedied.

When it really is an injury, what next?

Most people know when they have suffered a significant training or a sports-based injury. It’s immediate and it hurts a lot. If the injury pain is severe and you cannot move a limb or place load on the affected area, and you immediately have a large amount of swelling, you should seek the advice of an A.H.P straight away as you may also need medications, X-rays or scans.

Unless you happen to be a professional athlete yourself, you may not happen to have a physio or doctor there by your side when you need them the most! Many people roll their ankle, have it swell up and think it’s just a sprain, only to find out it’s a fracture after hobbling around on it for four days. For acute sprains and strains, a known treatment is still the RICE principle (Rest, Ice, Compression, Elevation) for the first 24-48 hours. The ice element of this should be done for around 30 minutes every two to three hours, and the best compression is a double layer tubular bandage. There are some suggestions to not treat an injury using the RICE principle, too!

As a registered fitness professional, I want you to enjoy your workouts with me and, all the while being conscious in training you effectively and safely. I don't want you to be paranoid about injuring yourself. If you do experience any pain during and after exercise, however, you should take note of when and where it occurs in the body and be aware of its duration, as well as potential triggers or recurrence. As your trainer, I will ensure that your training program is both safe and appropriate for your level, and in the incidence of suspected injury, refer you to an A.H.P to seek advice as needed.

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