How to avoid soreness and recover more quickly from workouts
Will massage help me avoid soreness and recover more quickly from workouts?
There’s one big problem with studying the effectiveness of massage: you can’t control for the placebo effect. “It’s not something where you can do a double-blind experiment,” admits Trish Schiedel, past president of the Canadian Sports Massage Therapists Association. So you often see results like the ones published in 2008 by researchers at the Poznan University of Medical Sciences in Poland.
They asked volunteers to perform difficult exercises with both arms, then massaged just one of the arms, and evaluated recovery over the next four days. Subjects said the massaged arms felt better—but there were no measurable differences in swelling or range of motion. That’s pretty much the story of massage research so far: lots of anecdotal evidence and a scarcity of hard facts. But in the last few years, some studies have emerged that avoid the placebo problem and debunk some old myths.
During the many years that muscle soreness after workouts was thought to result from an accumulation of lactic acid, massage was believed to help flush the acid out. The lactic acid theory is now largely discredited —and even if it wasn’t, experiments published in 2010 by researchers at Queen’s University in Kingston, Ontario, show that post-exercise massage actually slows down removal of lactate rather than speeding it up. The reason, according to lead researcher Michael Tschakovsky, is that massage strokes mechanically compress tissue, which squeezes blood vessels shut and prevents the flow of blood.
To find out how massage does work, researchers at Ohio State University enlisted the aid of rabbits, which aren’t susceptible to the placebo effect. They first exercised the sedated rabbits by triggering a nerve impulse that causes contractions of a leg muscle. They then used a machine to deliver “cyclic compression forces” that simulated 30 minutes a day of Swedish massage (the most common type of sports massage). The results were clear: massaged muscles regained 59 percent of their lost strength after four days, whereas rested muscles regained only 14 percent. The massaged muscles had fewer damaged fibers and almost none of the white blood cells associated with muscle damage. They also weighed less, suggesting that massage had helped prevent swelling. Interestingly, the results were much less pronounced if the first massage was delayed for a day after exercise, suggesting that the sooner you get your massage, the better.
The rabbit results won’t extrapolate perfectly to humans, cautions Thomas Best, the researcher who led the Ohio State study. But these quantifiable outcomes should help scientists begin to figure out the duration, frequency, and strength of the massage stimulus that produces the best results. Right now, the right strength is determined by feel, while frequency and duration tend to be a function of how much you can afford. “If you ask five different therapists, you’ll get five different answers,” Best says. That means finding a good therapist with expertise in sports massage (not aromatherapy and executive stress backrubs) is essential.
Should I take painkillers for post-workout soreness?
“Non-steroidal anti-inflammatory drugs,” more commonly known as NSAIDs, are a class of painkiller whose most famous members are aspirin and ibuprofen. While some NSAIDs are prescription only, others are freely available over the counter, making them the first recourse for many people with exercise-related soreness and pain. A survey of participants at the 2008 Brazil Ironman Triathlon, for example, found that nearly 60 percent had used NSAIDs in the previous three months. Similarly, a quarter of the athletes drug-tested at the Sydney Olympics in 2000 had taken NSAIDs in the previous three days.
The reason they’re so popular is that they work—they’re highly effective at fighting pain, fever, and inflammation. If you twist your ankle, NSAIDs are the way to go. But that doesn’t mean they’re the right choice for exercise-related soreness. Some studies have found that NSAIDs do reduce the feeling of post-exercise soreness. What they don’t do is speed up the repair of your damaged muscles—and in fact, there’s evidence that taking NSAIDs when you’re exercising vigorously can slow down recovery and create a whole new set of problems.
Nobel Prize–winning research by chemist John Vane in the 1970s showed that NSAIDs work by inhibiting the production of chemicals called prostaglandins, which regulate inflammation. But prostaglandins also play a role in the creation of collagen, the main building block of musculoskeletal tissue. The soreness and inflammation you feel a day or two after exercise is directly linked to the repairs that make your muscles stronger. In effect, taking NSAIDs to reduce this inflammation cancels out some of your adaptations to training—and indeed, studies have found that prolonged NSAID use delays the healing of bone fractures, as well as injuries to muscles, tendons, and ligaments.
Some athletes also pop NSAID pills before or during vigorous exercise, hoping to ward off later pain. In a study of ultra-marathoners at the Western States Endurance Run, researchers at Appalachian State University found that runners who took ibuprofen before and during the race didn’t finish any faster than those who abstained, and they had the same levels of perceived exertion, muscle damage, and soreness in the week following the race.
More worryingly, though, blood tests of the ibuprofen users indicated higher levels of endotoxemia, a condition in which toxins leak out of the intestines into the bloodstream. This could be linked to the role of prostaglandins in forming the acid-resistant lining of your stomach and intestine (which is also why NSAID overuse can lead to stomach problems like ulcers and gastrointestinal bleeding).
All these warnings might make NSAIDs seem like dangerous pills that should be avoided at all costs. That’s not the case—they’re extremely useful when used in the right context. That means they’re not suitable for dealing with nagging, chronic problems on an ongoing basis, or for trying to prevent pain before it happens. But if you have an injury that swells and is painful even when you’re not exercising, NSAIDs, for no more than seven days, may be just what your doctor (or therapist) orders.
How long does it take to recover after a marathon or other long, intense effort?
The aches and pains that hit you in the days after an extended bout of exercise can seem worse than the competition itself. When you take part in something like a triathlon, a multi-hour hike, or a long running race, you’re subjecting your body to stress that causes damage and takes time to heal. Different systems return to normal at different rates: acute fatigue might be gone within a day or two; your immune system could be weakened for up to a week; and in some cases, muscular fatigue can linger for several weeks.
In the last few years, researchers have become concerned about the possibility that extended endurance activity could cause heart damage, since the heart has to beat unusually quickly for several hours. Several studies have found evidence of “cardiac injury” in runners after they complete a marathon, including enzymes suggesting that heart muscle has been damaged.
To investigate these claims more closely, researchers at the University of Manitoba used magnetic resonance imaging to perform a detailed analysis of the hearts of participants in the Manitoba Marathon, publishing the results in the American Journal of Cardiology in 2009. They found that, despite initial evidence of damage, normal heart function resumed within a week. In other words, your heart muscles take a beating during a marathon but recover soon afterwards, just like your leg muscles.
The damage to your legs will be considerably more obvious to you, since you may have difficulty walking down stairs or even just getting out of bed the next morning. This delayed onset muscle soreness, or DOMS tends to peak one or two days after the race and can persist for up to a week. Soreness lasting longer than a week could indicate more serious damage and should be examined by a clinician.
But it’s not unusual for muscle fatigue to persist even after the soreness is gone, sometimes for several more weeks. A Danish study in 2007 tested well-trained runners a week after a marathon, when soreness was no longer a factor. Using electrodes to stimulate muscle contractions, the researchers found that the muscles themselves had fully recovered—but when the runners tried to voluntarily contract their muscles, they were still much weaker than before the race.
This suggests that the lasting fatigue after a marathon has a neuromuscular origin—the signal from the brain to the muscle fibers is disrupted somewhere along the signal path (one theory suggests the disruption is caused by overloaded receptors in the spine).
Despite their best efforts, researchers haven’t had much success in figuring out how to speed up the recovery process. A classic study in 1984 compared experienced marathoners who took a week of complete rest to those who ran 20 to 45 minutes a day after the race.
After a week, the rested group had better leg muscle strength and slightly higher levels of energy storage in their muscles, though the differences weren’t large. Other studies with similar results suggest that it’s best to be cautious and make a gradual return to activity. Start with walking (or gentle biking or swimming) instead of running during the first four or five days.
After that, proceed with a “reverse taper” that reaches normal training no sooner than two weeks after the race. And be flexible: if your legs still feel dead after three weeks, congratulate yourself on having pushed very close to your limits in the race—and give them more time to recover.