How to Handle Muscle Soreness After Exercise: Tips from Physical Therapists

If you’ve ever done a new or tough workout, you’re probably not a stranger to sore muscles that hit you afterward. Maybe you were achy before you even left the gym. Or maybe you felt great after your workout but couldn’t lift your arms above your head by the time you got out of bed the next day. Both scenarios are normal. 

Although post-exercise muscle soreness is expected, let’s not pretend it’s pleasant. If you’re like most people, you want to know what you can do to make it go away — and fast. 

Here, learn about the different types of muscle soreness, what causes muscle soreness after exercise, and what you can do to prevent and treat it, especially with exercises from Hinge Health physical therapists. 

Acute vs. Delayed Onset Muscle Soreness 

There are two types of muscle soreness: acute (right away) and delayed onset muscle soreness (sometimes called DOMS). You can experience either type of soreness after a workout that’s challenging for you. Both types are a good thing — they signal that you’re getting stronger — but they do differ in a few ways. Here’s how: 

• Acute muscle soreness is usually felt immediately after you’re done exercising. It’s caused by a buildup of certain substances within your muscle, such as lactic acid, during high-intensity exercise. This type of muscle soreness resolves quickly — usually within a couple of hours. 

• Delayed onset muscle soreness (DOMS) usually starts about 12 hours after your workout and peaks around 48 hours post-workout. Rather than being related to lactic acid, DOMS is caused by changes in your muscles and the resulting repair process your body goes through. 

Tell Me More About My Sore Muscles

Post-exercise muscle soreness may seem like a sick joke. You’re doing something good for your body. Why does it have to hurt? The answer depends on what type of muscle soreness you experience. 

Acute muscle soreness is often due to a buildup of lactic acid. This is a substance that’s produced in your muscle cells and red blood cells that forms when your body breaks down carbohydrates to use for energy during exercise. After a hard workout, your muscles may have a lot of lactic acids built up. While this can contribute to temporary soreness, it generally clears out a couple of hours after stopping activity.

“Delayed onset muscle soreness is most likely due to the tiny microtears that can form in muscles,” explains Steven Goostree, PT, DPT, a physical therapist at Hinge Health. This creates an inflammatory response that’s the source of your discomfort. While microtears may sound like a bad thing, it’s not. The process your body goes through to repair those tiny tears is the very thing that makes your muscles stronger. 

So, ‘No Pain, No Gain’ — Right?

It’s important to know that if you’re not sore after a workout it doesn't mean you’re not getting stronger or that you’re not challenging your body enough. “No pain, no gain” is a myth. Our Hinge Health physical therapists tell members all the time that more soreness is not equivalent to a better workout. So keep on moving!

How to Heal Your Sore Muscles

As frustrating as achy muscles can be, try not to let the soreness discourage you. And let’s not forget the silver lining: As you get stronger and your muscles become accustomed to different types of movements, you’re less likely to experience muscle soreness after exercise.

In the meantime, your muscle soreness will most likely peak between 24 and 72 hours after your activity and ease up on its own. But here are additional steps you can take to promote relief from sore muscles: 

• Stay active. If you’re sore, you may not want to jump right back into an intense workout. “But light activity, such as walking, may make you feel better since it increases blood flow to the area,” advises Dr. Goostree.

• Rub it out. Massaging a sore muscle can help relieve tightness and increase blood flow to the area, which can help with recovery. A 2017 study published in the Frontiers in Physiology journal found that a massage within 24 hours of intense exercise helped reduce soreness.

• Stretch. Light basic stretches that you hold for a few seconds can help increase blood flow to sore areas without overstressing muscles, says Dr. Goostree. Many Hinge Health members report using their exercise playlists for post-workout stretches. 

• Heat. While ice is often recommended to reduce inflammation, heat is often preferred for post-exercise soreness since it increases blood flow to the area, says Dr. Goostree. Even a warm bath or hot shower can help.

• Over-the-counter (OTC) creams and gels. Look for one that contains menthol or capsaicin, such as IcyHot and Aspercreme, to help ease muscle soreness. A 2020 study published in the Journal of Strength Conditioning and Research found that OTC creams and gels helped speed up recovery from exercise-induced microtears in the muscle.

• Compression garments. These are typically made from nylon, spandex, or similar material and fit tightly around the skin to apply gentle pressure to certain muscle groups. A 2016 review published in Physiology and Behavior concluded that they help to decrease post-workout muscle soreness. “This is probably due to increased blood flow from compression to the area,” says Dr. Goostree.

What About Pain Medication? 

You may be tempted to pop an over-the-counter pain reliever such as ibuprofen (Advil, Motrin) to help relieve pain and muscle soreness after a workout. It might be worth reconsidering, though. 

One study found that ibuprofen did not alter muscle soreness among ultramarathoners, and was actually associated with higher levels of inflammation after running. Other studies point to long-term consequences of using NSAIDs for DOMS, such as a greater likelihood of experiencing kidney damage. 

Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen work to stop the inflammatory process in the body, but your body needs the inflammatory response to repair muscle. Inhibiting inflammation can negatively affect long-term tissue healing, especially when higher dosages are used, according to the British Journal of Sports Medicine.

When to See a Doctor

Sore muscles are a sign that you’ve challenged them and they’re being built up. As unpleasant as the post-workout soreness is, it’s usually a good thing. In some cases though, pain can indicate that you’ve injured muscles, tendons, or even joints. See your doctor if: 

• Your muscle soreness lasts for more than a week

• Your pain is so bad you can’t move or do normal day-to-day activities

• You are dizzy or have trouble breathing

• Your sore muscles are red, swollen, or warm to touch 

• You notice pain in a surrounding joint, over the bones, or in a tendon

• Pain doesn’t seem to get better with at-home treatments, such as those mentioned above

How to Prevent Sore Muscles When You Exercise

As reassuring as it may be to know that sore muscles are actually a good thing, acute soreness, and DOMS are still unpleasant. Here’s what Hinge Health physical therapists recommend to minimize post-exercise pain and discomfort while building muscle and maximizing recovery: 

Warm-up. It increases blood flow to your muscles and reduces the risk of injury. “I recommend light cardio, such as a slow walk or cycling at a low setting on an exercise bike,” says Dr. Goostree. Contrary to popular belief, you don’t need to stretch as a part of your warm-up. Experts say that it doesn’t reduce your chances of developing muscle soreness. 

Drink plenty of water. It helps loosen joints and transports nutrients that your body needs to promote muscle healing. “Your muscles need a lot of water so if you are dehydrated, it can trigger cramps,” explains Dr. Goostree. 

Think light. Just did a tough workout? While you may want to wait 48 hours before the next one, you still want to do some light exercise that involves the sore muscles. So if you’re sore after a long run, take a short walk or bike ride and focus on strengthening your upper body muscles for a few days instead of vegging out on the couch.

Apply moist heat. Moist heat such as a warm towel or a hot water bottle may prevent soreness better than dry heat sources. If you’re worried about DOMS, it’s best to do this right after a workout as opposed to waiting until later in the day, according to a study published in the Journal of Clinical Medical Research. 

Cool down. “It’s very important to stretch after you exercise since muscles are more relaxed and flexible,” says Dr. Goostree. Research shows it can help reduce post-workout muscle soreness and aid in recovery.

Dynamic stretches are any movement-based type of stretching that uses your muscles to bring about a stretch. They can help prevent and treat muscle soreness, says Dr. Goostree. The best muscle groups to focus on depend on your workout and personal factors, but the given exercises target large muscle groups that help most people. Those can be done before exercise if it feels good for you, or after exercise to prevent and alleviate soreness.  

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Pile on the Protein

“Protein makes up the building blocks of your muscles. It helps increase muscle fibers, which enhances muscle strength and stability,” Dr. Goostree explains. Aim to get an extra serving of protein within 45 minutes of a hard workout. Try a protein shake, Greek yogurt, or a salad topped with grilled chicken breast. Be careful though about eating too much protein on a regular basis, especially if you are prone to kidney disease (talk to your doctor about this if you’re not sure).

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Delayed Onset Muscle Soreness. (n.d.). American College of Sports Medicine. Retrieved from https://www.acsm.org/docs/default-source/files-for-resource-library/delayed-onset-muscle-soreness-%28doms%29.pdf

2. McCallum, K. (2021, October 19). Is Lactic Acid Buildup Really What Causes Muscle Soreness After a Workout? Houston Methodist. https://www.houstonmethodist.org/blog/articles/2021/oct/is-lactic-acid-buildup-really-what-causes-muscle-soreness-after-a-workout/ 

3. Guo, J., Li, L., Gong, Y., Zhu, R., Xu, J., Zou, J., & Chen, X. (2017). Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 8. doi:10.3389/fphys.2017.00747

4. Gillis, D. J., Vellante, A., Gallo, J. A., & D’Amico, A. P. (2020). Influence of Menthol on Recovery From Exercise-Induced Muscle Damage. Journal of Strength and Conditioning Research, 34(2), 451–462. doi:10.1519/jsc.0000000000002833

5. Marqués-Jiménez, D., Calleja-González, J., Arratibel, I., Delextrat, A., & Terrados, N. (2016). Are compression garments effective for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis. Physiology & Behavior, 153, 133–148. doi:10.1016/j.physbeh.2015.10.027

6. Nieman, D. C., Henson, D. A., Dumke, C. L., Oley, K., McAnulty, S. R., Davis, J. M., Murphy, E. A., Utter, A. C., Lind, R. H., McAnulty, L. S., & Morrow, J. D. (2006). Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain, Behavior, and Immunity, 20(6), 578–584. doi:10.1016/j.bbi.2006.02.001

7. Lipman, G. S., Shea, K., Christensen, M., Phillips, C., Burns, P., Higbee, R., Koskenoja, V., Eifling, K., & Krabak, B. J. (2017). Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emergency Medicine Journal, 34(10), 637–642. doi:10.1136/emermed-2016-206353

8. Dubois, B., & Esculier, J.-F. (2019). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2), bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

9. Kormos, W. (2015, July 17). Ask the doctor: Stretching before exercise Harvard Health. https://www.health.harvard.edu/staying-healthy/ask-the-doctor-stretching-before-exercise

10. Petrofsky, J., Berk, L., Bains, G., Khowailed, I. A., Hui, T., Granado, M., Laymon, M., & Leea, H. (2013). Moist Heat or Dry Heat for Delayed Onset Muscle Soreness. Journal of Clinical Medical Research, 5(6), 416-425. doi:10.4021/jocmr1521w

11. Sands, W. A., McNeal, J. R., Murray, S. R., Ramsey, M. W., Sato, K., Mizuguchi, S., & Stone, M. H. (2013). Stretching and Its Effects on Recovery. Strength and Conditioning Journal, 35(5), 30–36. doi:10.1519/ssc.0000000000000004

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