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PERSONAL HEALTH : When Aching Muscles Tell You You've Overdone Things


Just when you feel smug about going that extra workout mile, it hits: the quivery, achy feeling that can spell trouble. A day or two later, sure enough, your muscles are so sore you suspect internal bleeding.

It's the overdo syndrome, or what exercise experts call "delayed onset muscle soreness" because the muscle pain sneaks up and then peaks in about 48 hours. It plagues novice exercisers, but can strike even very fit people, especially if they switch routines or intensify a regular workout.

Researchers and exercise experts concede that you can't completely avoid muscle soreness--nor should you want to, because it's a sign your body is repairing itself. But there are ways to minimize the pain and suffering.

What's Happening Inside

If you've ever had sore muscles, you know the script: You're working out more intensely than usual, impressed with yourself. "Then about 12 to 18 hours later, you're going, Wow, " says Scott M. Hasson, associate professor of physical therapy at Texas Woman's University, Houston, who has researched the condition. Your muscles suddenly feel swollen. The swelling worsens for about two days before declining.

Here's what's happening beneath the skin: At some point during the intense exercise, your muscle reached a critical point and could no longer control the contraction, Hasson explains. Damage occurs in the form of "micro-trauma."

Next, inflammation starts. It doesn't feel good, but it's good for you in the long haul. "If we could stop inflammation completely, we would not achieve healing or strengthening of tissues," Hasson says.

Once damaged, muscles release prostaglandins, naturally occurring substances that attract white blood cells to the area. "Then more fluid moves in, so you begin to get swelling," Hasson says. The entire damage and repair process might take a week and a half.

The Medical Approach

Taking ibuprofen, a non-steroidal anti-inflammatory drug, has been a mainstay of relief once sore muscles occur. Lower-strength ibuprofen (Motrin, Advil) is available without prescription.

But taking ibuprofen before a particularly grueling workout might be an even better strategy, Hasson found in a recent study. His research team compared 20 participants who all did the same exercise: stepping up on a very high step while carrying a backpack, completing 150 muscle contractions in all.

Those who took the ibuprofen after exercise had a decrease in soreness, but those who took it before exercise fared the best. They had about 50% less muscle soreness than people in the other group, says Hasson, whose study was published in Medicine and Science in Sports and Exercise.

The ibuprofen didn't prevent the muscle damage that normally accompanies exercise. Taken ahead of time, the drug probably works by modifying the release of the prostaglandins, lessening swelling and soreness, Hasson speculates.

But he warns exercisers not to exceed the recommended ibuprofen dose and says they should not take it routinely before exercise. Chronic use can increase risk of stomach ulcers and kidney and liver problems. Consider taking ibuprofen, he says, before the first day of skiing or the first day of vigorous gardening, which might trigger soreness.

Taking acetaminophen (such as Tylenol) probably won't help. In a study, Hasson found no difference between acetaminophen and placebo in alleviating muscle soreness. He has not studied the use of aspirin to relieve muscle soreness but suspects its effect would be similar to ibuprofen's.

The Crystal Ball Factor

In another study, Hasson asked subjects to squat slowly after the exercise session and to notice any perceptions of shakiness and fatigue in the worked muscles. If they felt the symptoms, that was their cue to take anti-inflammatory medicine, says Hasson, who will present the findings this week at the annual meeting of the American College of Sports Medicine.

Instead of taking a drug beforehand, Hasson says, it might be better to notice if your muscles feel very shaky and weak after a vigorous activity and to take an anti-inflammatory medicine then.

Hair-of-the-Dog Approach

The temptation is to stop moving if your muscles are sore. Wrong approach, say experts. Work it out, gently.

"Active rest is better than doing nothing," says Don Yakulis, a physical therapist and athletic trainer at St. John's Hospital and Health Center, Santa Monica. Just decrease intensity and duration, he says. A sore runner might walk slowly; a swimmer could cycle slowly.

If you have muscle soreness and don't think it's a serious muscle tear, working the muscle with high-speed contractions (with low or no resistance) can reduce next-day soreness, Hasson has found.

Rub, Spray or Both?

Drugstore shelves overflow with remedies for athletic overachievers. Added to the arsenal of traditional rub-in pain-relieving creams are newer sprays, touted as more convenient.

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