Is it DOMS or an injury?
How to tell the difference between DOMS (post exercise soreness) vs Injury, and what to do about both.
How to tell the difference between normal post exercise soreness (DOMS), and injury, and what you can do about both.
DOMS (Delayed onset muscle soreness) is the normal muscle achiness you get after starting an unfamiliar exercise, coming back to training after time off, or after a particularly heavy or high rep training session.
At a microscopic level it is tiny tears of the muscle fibres which is the necessary evil (depending how you look at it!) to stimulate your body to adapt and come back stronger/fitter once the muscle has repaired.
If you’ve never felt it before, or sometimes after a particularly intense session, the discomfort can be so intense that you might start to worry that you might have done something else this time!
We’ve got you covered! Read through the checklists below for the difference between the common DOMS symptoms vs Injury and what you can do about both.
DOMS
TIME FRAME: Usually occurs ~12-24 hours after unfamiliar or intense training, begins to ease after ~48-72 hours. DOMS straight after training often feels more like “jelly-legs” that can still function but are not painful.
WARMS UP: The soreness should ease with continued movement or a warm shower.
LOCALISED PAIN: You’ll be able to find it by pressing the muscle group or area of your body that you trained (e.g. quads if you did squats, lats if you did pull ups). Usually the pain will be about equal on both sides of your body if you trained both sides.
MUSCULAR ACHE WITH USE: No pain at rest - you shouldn’t feel DOMS unless you are using the affected muscle group.
SORENESS WITH STRETCH: Usually you will feel DOMS in the movement direction that stretches that muscle - eg: straightening your elbows with bicep DOMS, walking down stairs with quad DOMS.
WEAKNESS OR ”JELLY ARMS/LEGS”: You might feel like your limbs give way with similar movement patterns as above (we call this eccentric movements), this might improve with warming up.
What you can do about it:
1. Keep moving! Generally DOMS warms up, so once you’re up and going or moving the area it should ease a little. A warm shower can help ease the symptoms too.
2. Wait it out. Don’t worry - it should start to ease up after about the 48 hour mark.
3. Don’t take anti-inflammatories. The inflammation associated with DOMS is a necessary process in adapting and getting stronger/fitter after the training session. Reducing this process can reduce the effect of all your hard work.
4. Don’t over stretch, not to ease the symptoms anyway, it won’t do a whole lot to speed up the recovery so you’re better off just using the time to move gently!
5. Gentle massage might help ease the symptoms slightly for a little while, but it won’t really speed up the process either.
5. Train gently, but don’t go too hard on the same area or with a similar workout, give your body time to adapt or you may end up overloading yourself and in the injury section.
INJURY
TIME FRAME: More severe pain felt during/soon after your training session, or 1-2 hours later once you cool down and doesn't begin to ease naturally. If it worsens after ~48-72 hours it is unlikely to be DOMS.
MIGHT NOT WARM UP: Some injuries won't improve or will worsen with continued movement/use of the painful part. Be careful as some tendon/muscle injuries or strains will also warm up, but then are likely to feel worse once cooled down.
WHERE IS IT: One side notably worse, or pain felt further up or down from the area is likely to not be DOMS. Pain that doesn’t feel like it’s in the muscle, or if it’s very obviously in the joints or tendons is also not normal DOMS symptoms.
TYPE of PAIN: Burning/shooting or sharp, deep throbbing pain at rest, or when the muscle is unloaded is not a DOMS symptom. Catchy, pinchy or clicky pains are also not typical of DOMS.
OTHER SYMPTOMS/NIGHT PAIN: Pins and needles/numbness, and severe resting/night pain that keeps you awake is not typical of DOMS.
WEAKNESS: More severe weakness in a concentric pattern (opposite direction to the muscle stretching), that has no associated pain is less typical of DOMS.
What you can do about it:
If your symptoms are mild you can try to wait-and-see for a few more days and just keep the area moving gently to give the area time to heal on its own.
If the niggling lasts longer than about 4-5 days after the training session in question, it may be worth getting it checked out.
For any severe symptoms, pins and needles/numbness or shooting pain, painful clicking and locking, or simply if you are worried its best to go and see your Physiotherapist or another health professional.
Check out our blog on managing Acute Injuries with “PEACE & LOVE”
Often when we catch and manage injuries early they are easy to manage and you’ll reduce your time off in the long run!
We’d love to hear from you and answer any questions if you are concerned. Or click through to book an appointment.
Formotion Physio is a boutique Physiotherapy practice based in West Perth , Joondalup & Osborne Park, Western Australia
How to talk to your clients about women's health issues
Personal trainers and coaches are in a unique position where they can screen the general population and the athletes they work with for issues that they may otherwise not feel comfortable bringing up, or not even know that there are solutions to in the first place.
For personal trainers, coaches and fitness professional.
Women’s health issues are very common, but sadly there is not much awareness around it which leaves huge gaps in potential not only for health and quality of life, but also performance.
Women’s Health Physiotherapists and other health professionals who specialise in this area will often only see people when the symptoms have become very extreme.
Personal trainers and coaches are in a unique position where they can screen the general population and the athletes they work with for women’s health issues that they may otherwise not feel comfortable bringing up, or not know that there are solutions to in the first place!
We know that it can be pretty daunting and uncomfortable talking about these issues, especially for men.
Some advice we can give on this is to try and include regular general discussions about it in all of your sessions. Many women may feel embarrassed to raise these issues themselves which is why it’s important to not make it taboo by discussing it regularly, so they know that whatever they are experiencing is nothing to be embarrassed about.
Upskilling in this area will also help you to feel more confident talking about it, see the end of this blog for some links to great resources.
If you don't feel comfortable talking about it, putting a few of the questions below into your initial screening can alert you to refer on if necessary.
Women’s Health Questions to ask:
1. Do you ever experience leakage, or feel like you may leak, during things like heavy lifting, skipping, sneezing or coughing?
Answering yes to this could indicate Stress Urinary Incontinence.
2. Do you ever experience the feeling of pressure in your pelvis/pelvic floor during during things like heavy lifting, skipping, sneezing or coughing
Answering yes to this could indicate symptoms of prolapse.
3. Has your menstrual cycle been normal the past couple of months? (Assuming client is not pregnant or on hormonal contraceptive).
Changes to menstrual cycles can alert you to signs of RED-S in athletes or people that train intensely.
4. How does your cycle affect your mood/energy levels?
Understanding your client’s individual responses to their cycle can help you to plan sessions around this to help them perform at their best.
What to do if your client is having issues?
Considering the pelvic floor and menstrual cycle during training is important, but if your client is having issues they will often need a health professional to diagnoses and treat, at least initially.
Normally these health professionals will aim to work with you and your client to get them back to training with confidence.
At Formotion Physio we have an interest in Women’s Health, and are able to assist with returning to exercise with consideration of the pelvic floor, but we would recommend referring to a Women’s Health Physiotherapist for pelvic floor issues first.
For menstrual cycle or hormonal issues we would recommend referring to a Women’s Health GP or Sports Medicine Physician, particularly if you suspect RED-S (see below) or other more serious health issues.
You can find directory of Women’s Health Physiotherapists on the Australian Physiotherapy Association - Find Physio page here.
A few resources on the topic that we think are helpful and important are listed below:
Continence Foundation of Australia
Julie Wiebe - Women’s Health Physical Therapist
“Pop Up Lift” Instagram page & Website
Jessie Mundell - Pregnancy and Post Natal Fitness Coach
RED-S Relative Energy Deficiency in Sport
RED-S Clinical Assessment Tool
If you know of anymore to add to this list please get in touch or comment on this blog.
Incontinence During Exercise
Leaking during exercise. What causes it, and what you can do about it.
Does the idea of double unders, box jumps or running make you need to rush off to toilet before you start your workout?
If you've ever leaked, or felt like you might during these movements or things like sneezing or laughing, you might have something called Stress Urinary Incontinence (SUI).
SUI is a pelvic floor issue that affects many women (and men!) whether you've had kids or not, and is common in sports that have movements involving jumping/high impact or heavy weights.
While it is common, it does not mean it is normal.
There are exercises and strategies you can learn that can teach your pelvic floor how to function during these more demanding activities.
What is the Pelvic Floor?
The culprit is likely to be the trampoline-like group of muscles at the bottom of your pelvis called the Pelvic Floor.
The pelvic floor is important when it comes to controlling when, and when you don't go to the toilet. It is also important for supporting and keeping all your abdominal and pelvic organs inside you, as well as during sexual function.
If this group of muscles isn't working correctly and the pressure in your abdominal area increases suddenly - for example if you lift heavy/jump/cough/sneeze or bend over quickly, the control and contraction it normally puts around the urethral and anal sphincters to stop you going, can be overcome by the pressure, which can lead to leaking either urine or faeces.
What can you do about it?
Traditional pelvic floor exercises, sometimes known as "kegels", are the ones that are recommended most often. These are the ones where you squeeze as if you're trying not to go to the toilet, and are usually encouraged while you’re relaxing in sitting or standing, like at traffic lights or queue at the checkout.
While these can be a good first step to creating awareness of these muscles, they don’t give you the full picture. This may be why you can you still have problems when it comes to intense exercise and coughing/sneezing, even if you are religiously doing them.
Pelvic floor “weights” have also become quite popular recently, however these also have their limitations (see below).
Make sure you are able to contract, and relax correctly.
It may be that you are weak, the muscles are too tight, or you are not using the muscles correctly.
It is important that you are able to gently “lift” the muscles. The action is the one you would use to stop yourself going to the toilet, you should have awareness and be able to control both the front and back passage. Often people will have more control of one but not the other so it may give the perception of good function, but in reality there is a lack of control where it matters.
The ability to relax when required is also just as important as this allows you to go to the toilet, for sexual function and also to rest the muscles.
A muscle that is always wound up and switched on will eventually become too fatigued to react and work when it is required. They can also cause pain with penetration in some cases.
*This is why pelvic floor “weights”, which you generally walk around with for a long time without getting that all important rest and relax time, are not recommended.
Try it.
1) Lie down or sit in a deep squat if you can.
2) Imagine you are trying to hold in a wee. A cue we love is “Pick up a jelly bean with your vagina”. For men a good cue is “Nuts to guts”. It should just be a small contraction, imagine it is moving about 5mm.
3) Relax and notice if it feels like the pelvic floor is dropping back down.
4) Now try it with your back passage, as if you are trying to hold in wind. Usually this one is easier so make sure you can differentiate between the front and back.
5) Then try and do them both at the same time. Making sure to relax in between.
6) You can build strength by performing a strong or hard contraction, for example a “1cm” lift which you can try to hold for 2-5sec.
7) For endurance try to hold a gentler contraction for a longer; 10-20 seconds for example.
A cue we don’t love is “belly button to spine” because this generally cues the upper abs and can create more downward pressure on the pelvic floor.
Test it.
A quick test you can try is attempting to stop a stream of wee while on the toilet, if you can then you’re likely to be contracting the muscles correctly.
If you can’t, or you end up “pushing down” then this is probably a sign that you lack strength and awareness and you’ll probably need some help from a Women's/Men’s Health Physiotherapist to teach you how to to activate correctly.
Make sure you only do this very occasionally as doing it too often increases your risk of urinary tract infections.
Combine it with functional exercise.
Once you are confident with this then the next step is to make sure your strength and timing is working well during more complex and intense activities.
As we explained before, instead of being constantly contracted, your pelvic floor should be able to respond fairly automatically to these sudden increase in pressure at the right time, and relax when the pressure subsides so that the muscles can rest.
Randomly squeezing and relaxing your pelvic floor, without training towards a functional goal can be likened to just tensing and relaxing your biceps, instead of using them to bend your elbow at the time you need to lift something up.
Functional Example
Gently squeezing and lifting right before you go for a 1RM squat.
Cueing a few “quick squeezes” before you start a round of skipping to get the muscles and nervous system ready for the type of contraction it will need to be doing.
Your body is also designed to work in movement patterns, as opposed to using single specific muscles. When there is a functional goal this cues a movement pattern that can create more force than an isolated contraction. For example your bicep will create more force by climbing up a rope than by simply tensing it as hard as you can. In the same way, your pelvic floor is better engaged during an action that has the context of a useful function.
Consider the big picture of technique.
To give your pelvic floor the best chance of being able to manage extra pressure, make sure the rest of your technique is spot on to put your body in the best position for the pelvic floor to work at its best.
For example if you are “donkey kicking” during your double unders (skipping) the force you are hitting the ground with a lot more, this means that the downward force of your abdominal contents onto your pelvic floor is also a lot more which can overcome even a relatively strong and coordinated pelvic floor.
Your running and lifting technique will also play a big part in this.
Train your pelvic floor like you would any other muscle.
Once your technique has been considered, train in a way that works within your body’s limits.
For example if you are leaking after 20 skips then this is more than your max. Instead try building up your endurance by starting with 3x10 skips and build up from there.
If you feel like you are about to leak with an 80kg squat, then maybe 79kg is your 1RM? Adjust your mindset so that even if you can lift the weight it doesn’t count unless your pelvic floor is able to lift it to.
This is how you’ll keep yourself safe and be able to continue the sport you love in the long run.
Where to from here?
We can only fit so much information in a blog, and this information might not be appropriate for your individual needs.
So as usual we’d suggest getting help from a professional to first help you figure out the reasons it might not be functioning correctly and address these issues first.
Once you’ve done that you can begin learn how to improve your awareness of it and incorporate it into your daily life or training. This is something we can help you with as it is often a lot more complex than what we’ve written here.
If you have any issues related to traumatic childbirth or have severe issues we’d suggest seeing a specialist Women’s Health Physiotherapist. Feel free to contact us for any recommendations.
By Lucia Tennant
Principal Physiotherapist
B.Sc. Physiotherapy
Director - Formotion Physio
lucia@formotionphysio.com
Formotion Physio is a Physiotherapy practice based in West Perth & Osborne Park, Western Australia
3 Running Tips to Improve Overstriding
Overstriding can slow you down and make running feel heavy and painful. If this is something you do try these 3 tips to improve your technique.
Despite what you’d think, running isn’t something everyone naturally does well, and overstriding is probably the most common issue we see in beginners and even our more seasoned runners.
Simply put, overstriding is when your foot stretches out and contacts the ground too far in front of your body when you take a step.
This effectively causes a stopping, breaking action which can also be quite jarring on the body. It tends to make running feel heavy and hard, and is often the culprit of pain in the shins, knees, hips and back during running.
It also means there is extra time needed for your body to get into the right position to then push off for the next stride, which slows the whole process down even more and wastes precious running energy!
See the video below for an example:
3 tips to improve overstriding.
Stride faster, not longer.
A more efficient way to run faster is by taking quicker steps that land close to the body, avoiding the stopping action, and allowing you to be in a better position to push back to propel yourself forwards in the next step.
See the video below for our same client a few months after practising!
To do this you can try focus on these three things next time you run:
Take shorter, quicker steps, rather than striding out
Often we’ll see people striding out to try to pick up their pace, which may sound correct, but usually results in more overstriding.
Aim to land close to your body, more towards the middle of the foot.
While the research tells us that there is nothing wrong with a heel strike, in practice with our clients we find that cues to pull your foot back to land more in the middle to front of the foot can help to achieve this better.
Think about “staying tall” & leaning forward.
Imagine a string pulling you ‘up towards the sky’ as you run, this will keep you extended and stable in your hips and core.
Lean forward slightly with the whole body, as opposed to just bending at the hips. It should feel like you would fall over if you didn’t put your foot out to stop yourself.The faster you go the further forward you should lean (up to a point!)
Staying too upright, especially as you try to pick up the pace, will cause you to reach out too far in front of you again.
If you are having trouble getting your head around these tips, or for advice that is specific to you, book an appointment with us or come along to one of our running technique workshops.
4 Reasons You Can't Maintain your Mobility
There is more to flexibility than you might think.
4 Reasons You Can't Maintain your Mobility
“I stretch every day before bed but I never seem to get any more flexible?”
Sound familiar?
Here we’ll go into some other things you probably aren’t considering much in your flexibility/mobility routine - but they may have a bigger impact than you might think!
We’ll be using the terms flexibility and mobility interchangeably, as they are often both used to simply refer to how much your muscles, tendons, joints and nerves allow you to stretch and move freely.
1. You're only moving for 1 hour out of 24.
Possibly the most important one that we don't consider enough. Your body will adapt to what is continuously demanded of it. If the majority of your day involves being in one position - sitting at your desk or in an Uber, or standing at a checkout or reception desk, your body will change to allow you to do these things well. In this example, most likely tightening up the muscles that help to hold you in these positions like your hip flexors and glutes!
If you really want your 30min/day mobility gains to stick, you need to put your body in those positions as often as possible or it won't bother to maintain them. Things like an interchangeable sit/stand desk and taking regular breaks to move or walk can help. If your work makes this difficult you'll need to make sure that every chance you get to move or put your body in different positions outside of work is used.
2. You have nervous nerves.
Your nervous system (Including the brain, spinal cord, and peripheral nerves) is what allows your joints and body to move - it also serves as a protective mechanism by preventing movement if it senses that what you are doing is unsafe or risks causing you injury. In terms of mobility and range of motion - there is a threshold of when your nervous system starts to sense something as "risky" and it subsequently tries to protect you by doing things like tightening up the muscles so you don't move any further, or perceiving a movement as uncomfortable or painful so you stop the action.
Your nervous system can begin to reign you in earlier (i.e. lower the threshold) when it is sensitised or feels out of control - things like overloading in training with back to back difficult, heavy or repetitive sessions without adequate recovery time can cause neural sensitivity or pain. Think of that feeling in your hamstrings/lower back when you try to touch your toes after a heavy deadlift session.
Image: firepowerteams.com
By foam rolling an already overly sensitive structure, or trying to "stretch through the pain", all you are doing is playing tug of war with your own neural system and adding to the sensitivity.
One of the ways you can avoid excessive sensitivity is by discussing optimal training loads and recovery times with your instructor, coach or Physiotherapist.
3. You're not in control.
Uncontrolled or unstable movements can also stress out your nerves to the point they revoke your movement privileges. Your nervous system will allow movement in joints when it feels there is enough stability further up the chain to make that movement safe. For example hamstring "tightness" can often be caused by poor lower back and pelvic control and similarly poor shoulder range of movement can be caused by poor scapular stability.
Image: angliahandling.co.uk
Imagine a crane trying to raise a heavy cement block to the top of a building when its base has not been properly secured and stabilised. It would most likely reach a point where the torque would topple it over. In the case of the human body our sensory system aims to stop us before this point of fail.
By working on your proximal control and stability (joints closer to your midline), you can improve the achievable range of movement in the joints further away. This is a principle that is used often in disciplines like Pilates and Yoga, as well as the bracing techniques taught in weightlifting.
4. You're not cementing movements.
Image: kingofthegym.com
So you've done all the right things - kept moving throughout the day, ensured your loading and recovery is correct, stabilised proximally to the joint you're working on, and have spent hours doing all the cutting edge stretches and mobility exercises you can find. Yet you are still pulling up a couple of days later feeling just as stiff?
The last point to consider is cementing. If you are not strengthening and training into this new range of movement soon after, your body isn't going to bother maintaining it. For mobility routines I generally encourage the steps of active mobilisation, specific strengthening and then application into your training; the cement!
By being strong into the new range you will be able to use the movement as you are able to move into it actively under load during your training. You will also calm the nervous nerves by showing them that you are in control of this new range and are therefore not at risk of any injuries.
In closing remember that improving mobility is a long process and your body needs time to change and adapt to new movements and exercises (weeks to years!). So as cliché as it might sound, patience and commitment to the process is what will allow you to reach those goals in the end.
Please get in touch if you need advice that is specific to you.
Formotion Physio is a boutique Physiotherapy practice based in West Perth & Osborne Park, Western Australia
Lucia Tennant
Physiotherapist and Founder of Formotion Physio
BSc Physiotherapy
Stretch Series for Tight Lower Backs and Hip Flexors.
Your QL (quadratus lumborum), obliques and hip flexors are often tricky to find a good stretch for, these are our go to!
How to stretch your tight lower back and hip flexors
Your quadratus lumborum (QL), obliques, and hip flexors often get tight if you have been doing any heavy lifting, running or sitting for long periods. They can also be quite tricky to find good stretches for!
This series are a few of our favourites and cover all 3 of those areas.
Give them a go and let us know how they feel, but please remember that not all pain and injury is because of tightness. Sometimes the tightness that you feel is because of injury or weakness and is a protective mechanism that your body is using to keep you safe!
Stretching during these times might not be helpful so if this is the case rather get in touch with us before trying these!