Why am I sore? Does massage help?

Go to any athletic event and you’ll see a variety of trendy T’s sporting forms of encouragement along of the lines of “No Pain, No Gain!” You may even admit to owning, or wishfully admiring, one of those “Pain is Weakness Leaving the Body” shirts.

Exercise-related muscle pain that shows up in your calves the next day as you try to get down the stairs is called Delayed Onset Muscle Soreness, or DOMS. What is the point of this muscle pain? Is it necessary? Most importantly (of course!), does massage help it go away?

For starters, the version starring lactic acid as the evil-doer was discredited some time ago. More current research points toward muscle and connective tissue damage that occurs as we tax our muscles beyond what they’re used to. In a nutshell, the hypothesis is that as this exercise-induced muscle damage (EIMD) occurs in muscles under new stress, an inflammatory process results. Inflammatory mediators are released and swelling occurs (on a minor level), and both of these can contribute to the muscle pain you feel. It’s this inflammatory reaction and the resulting damage repair that is believed to help build muscle bulk (hypertrophic adaptation). (This is a wildly “nutshelled” version, science buffs can find a thorough review by Schoenfeld and Contreras below.)

So lots of muscle pain means lots of muscle growth, right?  No. Toss your trendy T-shirt.

The actual soreness you feel is one of many indicators of exercised-induced muscle damage (EIMD) and doesn’t actually correlate very well with other EIMD indicators or with muscle hypertrophic growth. Training status and the type of activity have more effect on whether DOMS occurs. For example, a marathon runner might get really sore, but that kind of non-eccentric muscle stress doesn’t usually result in hypertrophic growth (bulk). Yes, muscle damage is part of building muscle. No, soreness probably isn’t, although trying to eliminate entirely it will likely compromise your workouts.

Why try to get rid of soreness if it’s part of a positive process? Because it hurts, DOMS causes changes to the way you move (altered kinematics). Moving incorrectly, even subconsciously, to avoid pain gets you injured, not just sore. It changes your range of motion and the stresses that are placed on your locomotor tissues (the ones that create movement). While DOMS is the byproduct of something productive, it isn’t necessary or desirable to get really sore trying to prove you worked hard.

Does massage help? It appears that it does, but the timing and the therapists’s skill are important. Most studies I came across compared it either to compression (wear a nice body sock or compression tights) or other remedies like cryotherapy, anti-inflammatories, stretching, and electrical current modalities (TENS units, etc). None of the above therapies had an effect on DOMS except compression and massage.

Massage was shown to lower the intensity of soreness, but none of the other effects of EIMD – which is probably good, since they help create muscle growth while DOMS can adversely affect it. Massage didn’t eliminate DOMS in these studies, but lowering its intensity helps prevent the negative effects of being very sore. Massage needs to be done fairly soon after your effort – which is why we call it post-event massage. If you wait until the next day or two, your massage therapist can still accomplish some great things but she probably won’t be able to lessen the DOMS you’re already feeling. It’s not the typical massage, so make sure your sports massage therapist knows what to do. A traditional therapeutic massage is unlikely to help much and can even contribute to soreness.

And a final interesting study – the massage therapists’s level of education had a strong effect on the reduction of soreness. The lesson – get a therapist who knows what she’s doing!

Being a science nerd, I never trust people who can’t produce their sources, so mine are below. The DOMS review in particular has great information about EIMD, and of course, more sources!

And don’t forget to book your massage:

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Schoenfeld and Contreras. “Is Postexercise Muscle Soreness a Valid Indicator of Muscular Adaptations?” Nat. Strength & Cond. Asc. 2013;35(5):16-21.

Cheung, Hume and Maxwell. “Delayed onset muscle soreness : treatment strategies and performance factors.” Sports Med. 2003;33(2):145-64.

Hilbert, Sforzo and Swensen. “The effects of massage on delayed onset muscle soreness.” Br J Sports Med. 2003 Feb;37(1):72-5.

Moraska. “Therapist education impacts the massage effect on post-race muscle recovery.” Med Sci Sports Exerc. 2007 Jan;39(1):34-7.