Addressing misconceptions and issues regarding intensity, soreness, and pain
“No pain, no gain” may be the worst phrase uttered in the gym.
Asking someone the question “is it soreness or pain” is a close second. At the end of the day, it doesn’t matter. Whether it is pain or soreness, the sensation is unpleasant. Attempting to delineate between pain and soreness is meaningless for most individuals. For trained people who are highly attuned to each response their body has after exercise, sure, they can tell the difference. For everyone else, they are typically both deterrents to continue making treks to the gym or lacing up new running shoes.
Pain is not necessary to obtain benefits from exercise. True, exercise does need to be challenging — our bodies adapt when they are pushed — but the pain doesn’t have to be part of the equation.
Physical activity vs. exercise
Physical activity and exercise come in many forms. I use the term ‘physical activity’ with intention as the term ‘exercise’ may bring up negative memories. Perhaps the last time someone exercised or ‘worked out’ they experienced extreme soreness, an injury, or simply hated the experience. The negativity is likely exacerbated if they do not care about sports or athletic competition in general.
This poses a challenge to trainers, coaches, and physical therapists as exercise is at the heart of our programs and treatments. Without exercise, people cannot induce many of the physiologic changes sought. We can’t facilitate muscle hypertrophy (muscle growth) or enhance VO2 max (our endurance) exclusively through positive thoughts, sleep, and diet. These lifestyle changes certainly play a part, but without the stimulus-induced through moderate and high-intensity physical activity, we will rapidly approach a dead end. Intensity Matters
American Heart Association: 150 minutes of moderate or 75 minutes of vigorous exercise per week
American College of Sports Medicine: 150 minutes of cardiovascular exercise PLUS 2–3 sessions of strength training
Centers for Disease Control: Adults should complete at least 150–300 minutes (5 hours) a week of moderate-intensity physical activity, or 75–150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination. Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week
My primary takeaway from these recommendations is the intensity. They don’t specify the frequency or specific mode — other than aerobic/cardiovascular and strength — but instead allow the individual to design a program that meets a necessary threshold. Note the use of the words moderate and vigorous to designate the challenge of the exercise. Unless you are severely de-conditioned — think Willy Wonka grandparents in bed…no the dancing scene was not realistic — or suffer from intermittent claudication (which can be addressed but the activity ramp is very gradual and focused on walking typically), a 30-minute leisurely walk does not count towards the weekly exercise threshold. Yes, a walk around the neighborhood is better than nothing, but it is far from sufficient. For example, low, and even borderline moderate-intensity exercise does not markedly change the collagen content of connective tissue, which is necessary for healing and recovery from exercise. To achieve the net growth of targeted connective tissue we require high-intensity loading
Similar challenges are seen if attempting to develop strength or power. A quick note, strength is the maximal force we can generate — it is necessary for tasks such as getting up from the floor (function) or deadlifting (performance). Power, on the other hand, it the speed at which we can generate force — it is necessary to catch yourself if you trip over a step (function) and dunking a basketball/touching rim (performance). Someone who is severely de-conditioned, either because of a medical condition or lack of interest in exercise, will see rapid changes in both, but it is more of a “they have nowhere to go but up” phenomenon. The changes are primarily neural adaptations and they will quickly plateau if the exercise intensity remains low.
If someone is de-conditioned and decides to start walking around the neighborhood 20-minutes a day for exercise, that is a step in the right direction, but far from sufficient. It is a starting point that should be built upon. Intensity can be increased through difficulty — walk faster or along a route with more hills — or duration.
Exercise provides more benefits than losing weight, building muscle, and lowering a 5K time. This is where exercise and physical activity are commonly separated in people’s minds. Exercise is viewed as a regimented, challenging, sometimes painful experience. This does not have to be the case. One of the reasons CrossFit is so successful is the members join a community that supports one another. The exercises are challenging but the variety is high, they can be scaled to each individual, and the community can even create an atmosphere of enjoyment.
Exercise is about more than looking good at beach season. Exercise can improve power and balance to reduce fall risks, enhance cognition and memory, improve healing times for tissue injury, dampen pain severity and sensitivity, and combat depression and anxiety. I can’t think of a single person who wouldn’t benefit from exercise. While consistent movement and activity can have some effect, people require consistent moderate and vigorous-intensity to achieve all the listed health benefits. As I mentioned, several walls can be put up and I would like to address a couple of them. Let’s start with soreness.
Why am I sore after exercise?
Delayed onset muscle soreness — more commonly known as DOMS — is the prototypical soreness experienced after exercise. Not all people experience delayed onset muscle soreness (DOMS) in the same way. Some people, myself included, relish the feeling of extreme soreness following a squat workout, and we welcome the subsequent two days of waddling about. Others, however, view soreness as a sign their pain is worsening, that they require medication to eradicate it, and that they must avoid future exercise. This is understandable.
Soreness is uncomfortable and it makes it more challenging to move. When we are in pain, soreness can worsen the overall experience. You are going to physical therapy to feel better, not worse. Instead of gritting through, or worse, avoiding activity altogether, there are a couple of strategies that can decrease the frequency and severity of DOMS.
Delayed Onset Muscle Soreness
The repeated bout effect is a protective response in which our body has a blunted inflammatory response following activity we are familiar with. Take squats as an example. If you have been ‘that guy’ who has skipped leg day for 6 months, you are likely to waddle for 3–4 days and avoid all stairs following your squat session. You will notice, however, the severity and duration of the soreness wane with subsequent leg workouts, even as intensity climbs.
Or perhaps you haven’t performed challenging exercise since high school gym class. You may worry that any exercise will cause you to live the life of the grandparents from Willy Wonka — bed-bound with no end in sight.
The good news is you can easily “activate” the repeated bout effect and minimize or possibly eliminate DOMS — even after only a single session.
Slowly increase activity
Increase the activity of movements you are used to first. For example, if your exercise is primarily neighborhood walks, increase your walking speed and duration before jumping on a bike. If you want to lift weights, start with light weights and low resistance bands during basic movements. Don’t start by trying to replicate the CrossFit Games workouts
Start with slow-moving or stationary/isometric exercises (think wall sits)
Gradually increase intensity over multiple sessions, not within sessions.
Stretching does not work (source, source, source)
Your recovery will also be impacted by your overall health. Diet, sleep, and stress can all influence how well you perform and recovery from exercise. If you are getting ready to start a new exercise program or a physical therapy plan of care, ensure sleep and nutrition are prioritized.
At the end of the day, if you maintain a consistent physical activity regimen you will experience DOMS less frequently and at a lower intensity. Keep in mind, if you do experience pain or soreness (can be the same thing) that does not mean damage has occurred. Research is clear that pain does not equate damage. Pain is a complex phenomenon and one of the worst things we can do for it is to stop moving. Movement is the best medicine.
The problem with “no pain, no gain”
When seeking a reduction in pain, exercise is typically at the bottom of the list for most people. “No pain, no gain” readily pops into our heads. It is surprising to many that exercise can have a pain reduction, or analgesic, effect. Our bodies possess a highly efficient endogenous pain inhibiting system which adapts to exercise.
Exercise and conditioned pain modulation use similar mechanisms. Exercise leads to modulation of nervous system function with enhanced inhibition and reduced excitation of pathways responsible for the pain experience. This comes with a large asterisk. In people suffering from chronic pain, they have a loss of condition pain modulation. They experience the opposite effect because of a lack of inhibition and increased excitability of neuronal pathways. This leaves us with a conundrum.
Exercise can elicit a hypoalgesic effect but the people in the greatest need of the hypoalgesic effect possess a faulty pain-reducing mechanism. As with minimizing DOMS, patience is the name of the game. A gradual increase in intensity, which is centrally regulated and relative to the individual, will reduce the increase in excitability. Yes, I did just write intensity is relative. Let me explain.
How do we measure intensity?
Here are the common methods of measuring exercise intensity:
Heart Rate and Heart Rate Reserve
Percent of 1-Rep Max
Rate of Perceived Exertion
Reps in Reserve
I am a big fan of reps in reserve. When performing an exercise, you stop when you have a certain number of reps “left in the tank.” If I am trying to build strength, every set should be between 1–6 reps. To determine the right intensity, I will choose a weight that allows me to complete one more rep than the number I stop at. So if I am planning to complete five sets of five reps, then I choose a weight where I can confidently complete 6 reps. If I am trying to build muscle, I may choose a rep scheme that allows me to have 2–3 reps in reserve. It is a great tool to teach someone how to gauge intensity, and allows for variables, such as fatigue, to be accounted for.
Sleep, nutrition, stress can cause variability in our performance. Our training experience and mindset about exercise will impact our perception of what constitutes difficult or vigorous exercise as well. Motivation and the current mood will affect both the enjoyment of the activity and the difficulty of the exercise. You may have experienced this in the gym.
Put aside the more obvious influences of sleep and nutrition and think back to a session at the gym which felt a complete waste of time. What were your emotions coming into the session? Think back to practices or gym sessions when you were learning a novel task. What was the perceived intensity? If you expect pain, are frustrated by pain with activity, or genuinely dislike the exercise, the positive impact of exercise will be dampened. No matter how squats are if someone dreads the exercise every trip to the gym and performs “well enough” to check the box, the desired impact of the session will fall short.
So what does this all mean for you?
Intensity does matter. Moderate and high-intensity exercise/physical activity is vital for health
Exercise does not need to be painful to be effective. You do not have to be sore after you complete exercise
We can reduce the chances of experiencing soreness with a gradual increase in intensity and slowing adding novel activities. Maintaining a routine will lessen the chance for future soreness.
Pick exercises/activities you enjoy. It will increase the likelihood you stick with it and the intensity at which you can perform. You don’t have to complete the exercises you are “supposed to do.”
Our current training status and training history will impact the effectiveness of exercise. Unfortunately, exercise is typically exclusively associated with weight loss and aesthetics. These are secondary benefits (depending on the weight status). Exercise induces benefits no other activity, pill, or machine can. No amount of weight loss pills, cryotherapy, theraguns, ab belts, or meditation can replace the effects of exercise. Across the board, whether the benefits are developing strength, power, or muscle or reducing pain, anxiety, or depression, moderate to high-intensity is needed. There are many different ways to achieve these desired effects and participate in moderate and high-intensity physical activity. You need to find the right path for you.