My Aching Muscles

Anyone who has ever participated in physical exertion from playing sports in the backyard with family and friends to highly competitive, high performance competition, has their own stories about sore muscles both during and after activity.

And at a very basic level, physical activity produces cardiovascular, neurologic, chemical and musculoskeletal stresses on the body which, as a result, build muscle mass, muscle strength and flexibility, neurologic fitness, and cardiovascular endurance.  These stress-events in both training and competition, when monitored closely, are the primary way to improve our over all on-field athletic performance.

Soccer, for example, is one of the most physically demanding cardiovascular and physiologic sports in the world.  Depending on the level of participation and the length of the training interval or competition, it is not uncommon for soccer players to log their participation in miles traveled rather than minutes played.  Did you know that the average professional soccer player will cover over 5-6 miles (9-10 km) in the course of a 90-minute match?  Ironically, many studies report that less-experienced soccer players actually log more mile as a result of having to work harder due to a lack of technical and tactical expertise and soccer IQ.  In other words the youth players and 'weekend warriors' have to work harder in order to make-up for not being able to work-'smarter'!  

This blog post answers the questions that many athletes in every sport and at every level often ask sports health and performance professionals:

     - Why do my muscles burn during training or competition?
     - Why do my muscles ache sometimes for days following physical exertion?
     - How do I know if  the pain I am experiencing is ‘normal’?

EXPECTED PAIN WITH ACTIVITY
Muscles contain nearly 75% water, 20% protein, 4% fat and 1% glycogen (the storage form of glucose).  Additionally, skeletal muscles (muscles that control movement) are huge consumers of oxygen, meaning that hydration and good cardiovascular fitness are essential to proper muscle function.  

But like any other engine that ‘burns’ fuel; active muscles also produce a by-products that must be eliminated.  One of these by-products is called lactic acid.  Lactic Acid is often responsible for the ‘burning’ sensation that athletes experience during exertion.  Typically, this burning sensation lasts only as long as the exertion event (say a 30-yard sprint to track down a ball); and ends once that event is over.  Provided that the athlete remains properly hydrated throughout the competition and does not actually ‘injure’ a muscle or joint, this burn-recovery cycle will repeat itself throughout the event, though the period of time between burn and recovery may get longer as the contest wears on.

TYPICAL MUSCLE SORENESS AFTER EXERTION
Unlike the ‘burn’ of discomfort during exertion, most athletes have their own personal stories of the lingering soreness that occurs after exertion.  This soreness is often described as a dull ache and is typically accompanied a sensation of muscle ‘stiffness’ typically begins within thirty minutes of completing the exertion event and can linger for several days.  This condition is called Delayed-Onset Muscle Soreness (DOMS).  This condition is not only associated with highly strenuous or rigorous activity, but may also occur when beginning a new activity that requires muscles or muscle groups not typically used.  Unlike the activity-induced ‘burning’, lactic acid is not the culprit in DOMS, but rather it is due to physiological stress to individual muscle fibers and connective tissue causes microscopic stretching of these fibers and the release of inflammatory chemicals and sometimes the chemical creatine phosphokinase (CPK).  

DOMS does not typically impact continued performance, although the athlete my report that it seems to take longer to 'warm-up' prior to participation.  In general, pain due to DOMS typically resolves over several days and sometimes can improve with dynamic recovery and neuromuscular activation sessions, replenishment of nutrients and calories, and continues hydration with water and electrolyte drinks.

PAIN YOU SHOULD NEVER IGNORE
Beyond exertion-related ‘burning’ and delayed-onset soreness, there are circumstances that should not be minimized or overlook, because they may signal a true musculoskeletal injury.
 
And because this is often very difficult to determine in younger athletes at every competitive level, it is always better in this sub-group to always err on the side of caution because contrary to many parents, coaches and the players themselves—the young athlete will live to compete another day.

The list of musculoskeletal pain conditions that should never be overlooked or minimized include:

  - Sharp, sudden pain in a muscle or joint that prevents that body part from moving normally or limits the normal range of motion for that body part.

  - Unusual pain in the vicinity of any ,musculoskeletal area where the athlete has had previous surgery

  - Any pain that is associated with or accompanied by swelling or any other deformity that can be seen or felt.

  - Any muscle or joint pain that persists more than 3-5 days despite rest, ice, compression (ace wrap), elevation and/or over-the-counter pain and inflammation medications

  - Any muscle or joint pain that appears to be getting worse, even without swelling or noticeable deformity

  - Any pain involving a muscle or joint that produces, numbness or tingling or an inability to move that injured part (paralysis)

  - Any pain involving a muscle or joint that is associated with nausea, vomiting or fever

Sometimes exertional burning, delayed-onset soreness as well as the more serious injuries requiring prompt attention can be traced-back to overuse, over-scheduling (insufficient rest.recovery intervals) and/or improper technique or body-shape or position.  Other times, these conditions may be related to serious or ongoing muscle or joint injury, or may indicate a significant electrolyte or other chemical imbalance.  

This is why it is important to seek the help of trained individuals not only for evaluation and treatment, but for help in developing proper technique, body mechanics, preparation and recovery strategies.  These individuals might include sports medicine doctors, sports performance professionals, athletic trainers and physical therapists.

At the end of the day, even the most competitive among us are looking to seek enjoyment from sports participation.  Understanding the facts, listening to your body, and learning how to self-evaluate discomfort can keep you healthy, safe, satisfied and at your best on and off the field, court or other sports venue.

At Steel City Direct Care, we place athletes and student-athetes of all ages, skill and level of participation at the center of all that we do.

Whether you are active sports enthusiast, 'weekend warrior' or highly conditioned, accomplished, elite-level athlete, Steel City Direct Care looks forward to partnering with you to keep you healthy, well, 'balanced', in the game, and at your best!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.