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Beating DOMS

DOMS – what is it?

DOMS or delayed onset muscle soreness is something that everyone has experienced regardless of training history. You don’t even have to have trained to experience it. You have just decorated the bedroom and you have sore shoulders, that soreness is DOMS. Often thought of as a sign of a good training session, nothing could be further from the truth.

In tech speak the pain is caused by an increase in the acute loading that is sufficiently above your chronic loading level that you aren’t ready for. You react to this in an adverse manner that is painful.  The unwanted pain of DOMS is a secondary reason why you should build up the volume and intensity over a period of weeks. The primary reason for the gradual build-up is to reduce the risk of injury. DOMS is painful but it isn’t an injury. A good rule of thumb is to use increases of no greater than 10% per week.

Why 10%?

10% isn’t set in stone but most people will not suffer any negative symptoms at around this level, This goes for DOMS or actual injury, more on this in another blog later. Some can’t tolerate 10% yet others can go above this but it is a good starting point. That said you can’t avoid the potential for it after a holiday and in this case you just have to expect it and suck it tup.

IS IT INFLAMMATION?

In short no. There is little inflammation present where there is DOMS type pain. In fact, one of the ways of dealing with the pain, exercising again, actually causes more inflammation! it may be that the pain you experience is caused by the suppression of the inflammatory process. In the study below they found that inflammation held steady or went up with repeated bouts of exercise but the pain went down.

Deyhle MR, Gier AM, Evans KC, et alSkeletal Muscle Inflammation Following Repeated Bouts of Lengthening Contractions in Humans. Front Physiol. 2015;6:424.

“Overwhelmingly, our data undermines the idea of a muted inflammatory response after the second bout of exercise. On the contrary, the data suggest a neutral or increased inflammatory response! … We saw that inflammatory indicators only increased after a second workout. This suggests that the initial workout may have sensitized the muscle toward a stronger, longer inflammatory response after the second workout. In other words, the muscle seems to “remember” the stress of the first workout and responds with a stronger recruitment of immune cells when the stress is repeated — much like the way our immune system responds to an invader by preparing for an even stronger response the next time. Furthermore, muscle soreness goes down when the inflammation goes up, indicating that’s unlikely the soreness is caused by inflammation.”

WHAT ABOUT LACTIC ACID?

Lactic acid, or more correctly lactate, production is essential to proper muscle function, especially at higher intensities. It is also cleared very quickly so doesn’t hang around long as it is used as fuel. Lactate reduces the pH of the muscles as it uses up the hydrogen ions that are floating around as a result of muscle contractions. Lactate, therefore, is helpful in avoiding another means thought to cause DOMS in the acidification of the environment within the muscle.

COULD IT BE YOUR NERVES?

This one may have some legs.

A Japanese study looking into the causes of DOMS studied the possibility of it being related to the effect on the nerves. In the study, they investigated what happened if you suppressed the development of new nerves after exercise. When the substance that is secreted to stimulate new nerve growth was blocked from doing its job there was no pain in the 24-72 hour period where one would normally expect to see it.

Bradykinin and nerve growth factor play pivotal roles in muscular mechanical hyperalgesia after exercise (delayed-onset muscle soreness).

What can you do?

Check the internet you’ll find that there are many different ways to deal with your unwanted pain but what amongst them actually work?

MASSAGE

Pretty much a no, unfortunately.

Often touted as a means of reducing inflammation it doesn’t help in this manner either. This is for two reasons

1. massage doesn’t reduce inflammation

2. inflammation isn’t responsible for DOMS in the first place.

sports massage

 

On top of this, a hard massage can actually make you sore. It can be useful for some immediate relief but it still doesn’t help with the longer period involved with DOMS. In this post, I looked at when best to get a massage with regards to getting the most out of it.

The conclusion from the study stated.

“Massage therapy was more effective than no intervention on the post-race recovery from pain and perceived fatigue in long-distance triathlon athletes.”

This, as I said, wasn’t about DOMS but the post-race pain and fatigue.

ANTI-INFLAMMATORIES

Anti inflammatory tablets

As I noted above inflammation doesn’t play a role in the pain you experience. As such NSAIDs aren’t of any use, at least from the reduction of inflammation point of view. They do help alleviate the pain but at a cost. Inflammation doesn’t play a role in the pain you are experiencing but is involved in the recovery process. Therefore if you are taking NSAIDs of any kind you can have a negative impact on your recovery.

On top of the fact that anti-inflammatories don’t help with DOMS specifically, they are of no use when taken in the absence of injury at all. In this article in the BJSM Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes they found that they are potentially harmful if the practice of using them as a prophylactic is continued long term.

“There is no clinical evidence to suggest that regular use of NSAIDs reduces injury risk or improves function in the typical athlete…”

 HEAT

The use of heat can be beneficial but needs to be used for such a long period. To be effective heat pads must be worn for many hours rendering them impractical. Even if it wasn’t, application of heat for long periods is a stressor and will negatively impact overall recovery.  20 minutes in a hot tub is great for recovery it just won’t prevent the classic pain 24-48 hours later.

MORE EXERCISE

Unfortunately doesn’t really work either. Anecdotally it seems to help alleviate the symptoms to some extent but you’ll still suffer the pain of DOMS. There are no studies showing any large positive effect of more exercise. More exercise helps you reduce the stiffness that accompanies DOMS and because you are moving better you feel a bit better.

STRETCHING

Stretching has it’s uses but two where it doesn’t have any positive impact are related to pain. It has no significant impact on reducing injury rates and has no effect on post-exercise pain. The two studies below take different approaches. The first was a direct study of the impact on people of the use of stretching and the second was a review of 12 studies that looked at the impact. Neither found that there was any beneficial effect from passive stretching.

The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise.

“It is concluded that passive stretching did not have any significant influence on increased plasma-CK, muscle pain, muscle strength and the PCr/P(i) ratio, indicating that passive stretching after eccentric exercise cannot prevent secondary pathological alterations.”

Stretching to prevent or reduce muscle soreness after exercise.

“The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.”

FISH OIL, VITAMIN D, CURCUMIN

FIsh oil is touted as a cure for many, many things but it doesn’t help DOMS.

Vitamin D is really important for many processes in the body. For those of us in northern latitudes, it is worth taking some through the winter to help out with the lack of sunlight to help prevent Vit D deficiency. Vitamin D deficiency is much more common than you might think, we really only get it from sunlight, so it is one of the few supplements that are worth taking. A lack of vit D is related to pain perception and fatigue so it is worth making sure you get enough.

Curcumin is a compound found in the spice turmeric. It is one of the few things that seem to have a positive impact on post exercise pain. The study below found it to have a significant impact, though it was a small sample size. The results were very positive so all we need now is some repeated testing.

Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS).

“Oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance. Further study is required on mechanisms and translational effects on sport or vocational performance.”

SUMMING IT UP

There isn’t anything you can do to alleviate DOMS!

The best thing you can do is avoid spikes in your training load and have an easy week after a long break from exercise. Stay on top of your general recovery strategies, making sure you sleep well and eat well.

 

http://www.performancesportstherapy.net/2018/04/how-to-beat-doms/

3 KNEE PAIN SOLUTIONS THAT AREN’T REALLY HELPING YOUR KNEE PAIN

Knee pain is never simply knee pain it is always a lot more than this. We’ll have a look at 3 knee pain solutions that don’t really work long term.

Why?

Because the knee is affected by what happens at the ankle and the hip. Ankle injuries in particular often cause knee pain in the long term when they aren’t rehabbed fully. Having a full range of movement in the ankle ensures that you are much more likely to distribute the forces through the leg properly rather than overloading one aspect of leg. The most common thing that happens as=fter the likes of an ankle injury is that you overload the quads.

This extra load on the quads is fine in the initial stages as it helps offload some of the stress in the injured ankle but it isn’t a great long term solution. If you don’t start to spread the load more evenly again the quads will become irritated and you can experience pain around the knee cap, either above or below and sometimes over the surface of it.

This is just one example of what can happen that starts somewhere other than your knee but ends up causing knee pain.

3 KNEE PAIN SOLUTIONS THAT DON’T WORK

1- ALWAYS WEARING KNEE SUPPORTS

Lots and lots of people wear knee supports be they simple elasticated bandages to more complex and sophisticated looking ones. These can be useful in the very short term in that they help keep the area warm and also make you stop worrying about your knee. Long term they provide no benefit in terms of actually helping your knee pain. They don’t in any way resolve the underlying issue which is most likely somewhere else.

2 – PAIN KILLERS

Absolutely fantastic short term. Painkillers help let you move around when you might otherwise be avoiding movement but a real hindrance long term. In the long term if you are continuing to have to take them to do things it’s a good sign that things are more than just a “sore knee”.  This does not mean anything serious is wrong but simply the issue isn’t resolved.

3 – AVOIDING ACTIVITY AND COMPLETE REST

Complete rest of the knee is almost impossible but even avoiding activities isn’t a great idea.

During the initial stages avoiding some activities is a good idea and is something I suggest. In the long term though it really doesn’t help. To begin with you want to reduce the level of any activity to the point where any irritation is minimised. After this period you want to start getting back into these activities as fast as is reasonable.

Our tissues need load, read to be used, in order for them to fully heal so avoiding stressful activities beyond the initial stages isn’t a good idea.

Runners are a good example of this. Where possible I want any runner I treat back running as soon as it is safe to do so. This doesn’t mean that they will be completely pain free.  At this point, they will have reached a stage where they can run in complete safety so long as they follow the guidelines I give them. They will have been hopping, skipping and jumping but still need to adjust to the specific demands of running.

http://www.performancesportstherapy.net/2018/05/3-knee-pain-solutions/

 

Benefits of Pre and Post game massage

Pre Event Massage

A pre event massage is usually not more than 10 or 15 minutes in duration and performed on the day of the event. Sports psychology is important at this time, whilst providing the massage, the therapist should be talking to the athlete in an encouraging and positive way. Telling athletes that their muscles feel good, and that they seem well prepared for competition can be as encouraging as the massage. If athletes seem nervous, the therapist can encourage them to talk to help dissipate the nervousness but should try to discourage them from talking negatively about themselves or the competition. Understanding the athletes is important. Athletes prepare for their events in different ways. Some like to sit quietly to prepare for competition; others have a lot of nervous energy and are talkative and active right before competing. The therapist should observe what each athlete’s needs are and not interfere in the process of getting ready.

A pre event massage should include these techniques:

  • Friction to create heat to warm up the superficial tissue
  • Compression to increase blood flow to the muscles
  • Tapotement to stimulate the muscles
  • Range of motion of the joints to increase or decrease stiffness
  • Gentle stretching to prepare muscles for the warm-up

The goal is always to have the athlete leave the table feeling prepared for athletic competition. Pre event massage is for stimulation and inspiration for the athlete.

Post Event Massage

Post event massage is administered immediately after the event or competition. Post-event massage is done to decrease muscle soreness and/or cramping and to facilitate a faster return to training after an athletic event. 

A post-event massage is designed to aid the athlete in recovering from the activity; flush out the lactic acid buildup, reduce post-exercise soreness; and re-establish range of motion and blood flow to tight muscles. It also can give the athlete a big psychological lift. Before administering the massage, allow the athlete to cool down and re-hydrate. Conduct a brief interview to ensure that he or the is coherent and rational. I like to ask if the athlete is really sore. I also ask the athlete to tell me if he or she experiences any discomfort during the massage, so I can adjust my technique; post-event massage should never be too painful to the athlete.An on site post-event massage is administered for approximately 10 to 15 minutes. A typical post-event leg routine might consist of compressive effleurage for calming the nervous system and pushing fluid; pettrisage for easing tension in the muscle; compression for spreading muscle fibres and restoring blood flow; broadening strokes to lengthen tight muscles; and compressive effleurage as a finishing stroke to soothe. Following the massage, therapeutic stretching can be administered to relieve muscle tension and restore range of motion.

https://www.disc-me.com/benefits-of-pre-and-post-event-sports-massage-for-athletes/

Post 3: Kinesiology Taping- Adema Taping

A method of taping is known to be Edema taping.

It has been proven to have positive physiological effects on the skin, lymphatic and circulatory system, fascia, muscles, ligaments, tendons, and joints. It can be used in conjunction with a multitude of other treatments and modalities within your clinic and is effective during the rehabilitative and chronic phases on an injury as well as being used for preventative measures.

https://kinesiotaping.com/about/what-is-the-kinesio-taping-method/

There are many ways to which Kinesiology taping can be used. The picture above shows what style of taping can be used for Achilles injuries and possible tight calves. The pink tape is located on each of the gastrocnemius heads to support them and allow the blood to be able to circulate around that surrounding area. Some of the benefits that Kinesiology tape provides is that it has structural support to injured areas of the body- the Achilles for example. Kinesiology tape works in the way to which it lifts the skin, the tape has similar properties to skin. kinesiology tape works as a swelling reduction to which it creates drainage systems that allow swelling and bruising to heal quicker.

Another method that tape gets used with both athletes and the general public is that it has psychological benefits.

What does it mean to be a professional in Sports Therapy and the skills and attributes you need to develop to become and effective professional in Sports Therapy?

Being a professional within Sports Therapy means as an individual meeting specific criterion with the support of themselves for future practising with treatment itself. A quality that they need is whether they have a Sports Therapy organisation membership (STO). Having an STO membership can provide development around their qualification and build further knowledge. (Alsop & Ryan, 1996) states the benefit of having an accredited qualification and what it means. Furtherly, creating the difference between an individual with and without an STO membership.  The characteristics of a professional is someone who shows awareness of being prepared, both physically and mentally. Having the ability to prepare themselves before and after a client, for example the return-to-play stage for a client (Menta et al 2016). They are providing a service to achieve optimum fitness and progression. Furthermore, a professional sports therapist would maintain a positive attribution style in any given situation – this being any of the following; problem-solving, learning and pressurised situations.

There are many attributes and skills that sports therapists have acquired during training and experience which allow them to establish a high standard of professionalism. Within this paragraph I and going to discuss the attribute of communication and interpersonal skills. By providing the desired level of communication, you are increasing the levels of interaction, confidence and positive mind-sets through your relations with your clients (Thomas J. Socha & Gary A. Beck, 2015). Strong levels of communication provided from a therapist alleviates the possibility of isolation and also creating a distance with an individual’s identity. (Lattimore 2017)

Having communication as a sports therapist is effective, as it allows both clients and therapists to be able to open to one another. Eye contact from a sports therapist shows confidence, therefore engaging with their client. This shows that as a therapist you are focused on the client and paying full attention to the client’s individual needs. A result of this, is that a professional relationship is formed. From this we can see that communication is essential to build information around the client and create an effective treatment based on their individual needs. A sports therapist can determine the specific diagnosis through information provided by the client (communication between both the sports therapist and the client) and their own personal viewpoint after assessing the injury. (Keith Ward et al, 2016)

As a follow on from this, it is important that a sports therapist provides high quality and knowledgeable information around the subject area/the client’s situational requirements. Having a broad subject knowledge and experience in various situations/treatments can provide the individual in need, with specific and detailed solutions. The sports therapist shows a high understanding of what the client’s situation is and what needs to be done to establish progressions.

A final skill that is required to become an effective professional is time management. Being punctual and alert before a client has their session shows professionalism and organisation. Having time management provides stability to the client indicating that their therapist will commit to them fully and give adequate timings to each session. For example, they won’t run over a session or finish a session before it is over. This may cause a client to reconsider a returning visit.

Reference list:

Alsop, A. & Ryan, S. (1996) Making the most of fieldwork education : a practical approach Chapman & Hall. [Online] Available from: https://books.google.co.uk/books?id=ImYFCAAAQBAJ&pg=PA37&dq=qualities+of+being+accredited&hl=en&sa=X&ved=0ahUKEwiL0ZaXsY_bAhWJD8AKHd5XD9kQ6AEIJzAA#v=onepage&q=qualities of being accredited&f=false [accessed May 18th, 2018].

Thomas J. Socha & Gary A. Beck. (2015) Positive Communication and Human Needs: A Review and Proposed Organizing Conceptual Framework. Review of Communication. Vol. 15, No. 3: 173-199.

Ward, K, et al. (2016) Routledge Handbook of Sports Therapy, Injury Assessment and Rehabilitation. Oxon: Routledge.

Lattimore, D. (2017) On the sidelines : An athlete’s persepctive of injury recovery. Sport and Exercise Psychology Review. Vol. 13, No. 2: 13.

Menta, R. and D’Angelo, K. (2016) Challenges surrounding return-to-play (RTP) for the sports clinician: A case highlighting the need for a throrough three-step RTP model . Journal of the Canadian Chiropractic Association . Vol. 60, No. 4: 311-321.

 

 

 

 

The difference between a Physio and a Sports therapist

There are many differences that people tend to get confused about with sports therapist and physiotherapists.

The short answer is that both professions are trained and insured to treat musculoskeletal disorders back but there are some key differences in their training and approach.

Both Physiotherapists and Sports Therapists are highly educated in dealing with musculoskeletal disorders, treating pain and injury through hands-on treatment modalities, rehabilitation and patient education. Both focus on restoring, maintaining and maximising movement, relieving pain and increasing quality of life.

Both therapists possess the skills and knowledge to:

  • Assess and diagnose injuries
  • Deliver a personalised treatment plan to maximise movement and physical independence
  • Teach patients how to reduce pain and manage chronic injuries
  • Implement rehabilitation programmes
  • Teach patients how to stay fit and well

Some of the shared treatment approaches used to aid recovery include:

  • Massage, body work and mobilisations
  • Electrotherapy modalities
  • Taping
  • Varied stretching techniques
  • Biomechanics analysis
  • Acupuncture
  • Patient education
  • Exercise prescription

Physiotherapist or Sports Therapist?