Table of contents

  • Is the pain after exercise that I feel the next day sore muscles or damage?
  • How to exercise with a “bad knee,” or “weak back.”
  • How hard should I push myself when exercising if i’m 65 or older? Is it safe?
  • How do I know when to push myself or when i’m overdoing it?
  • Should I use a foam roller for sore muscles?
  • Should I use ice for sore muscles?

I want to thank one of my email subscribers, Pam, for sending these questions over to me. If you have any specific questions you’d like me to answer in a post like this, please send them to nathan@kadalystpt.com

Is the pain that I feel the next day delayed

onset muscle soreness or damage?

dumbbell shoulder press in gym

This is an excellent question. I have many clients who aren’t sure the difference between the two. I’ll try to break down the difference.

 

First off, I want to talk about damage for a second. Damage is a very nebulous term. Usually, what people mean when they say damage is “this hurts, and not in a good way.”

Damage may be actual structural damage (less likely in this situation), and likely what is more common in various pain after exercise is more of a chemical response or inflammatory response. 

Delayed onset muscle soreness, also known as DOMS, usually feels achy and is localized at the site of the muscle. Generally, people describe this as “it hurts, but I know that I worked my muscles and that’s why.”

Delayed onset muscle soreness is the muscle fibers response to an exercise program that is new, or, that you have not done for a long time.

Muscle growth can happen with or without DOMS and if you experience muscle soreness it does not mean that your workout program is good.

Other types of pain like sharpness or achiness around a joint are usually not muscle generated and it doesn’t feel like something that is positive. It’s not a “hurt so good,” type of feeling. It’s more of a “I hope this goes away,” type of feeling. 

long stairway

A practical example would be this. You’ve done a set of squats and the next day your quadricep muscles and glutes are very sore. This is perfectly normal. It hurts to go downstairs and get off the toilet, and each time you exert yourself you feel that discomfort. This is muscle soreness.

In the same example, if you did squats, and then the next day you woke up and you have joint line tenderness of the knee, and just a general ache around the knee joint itself, this would indicate to me that you are experiencing some sort of inflammation or irritation to the joint itself.

This wouldn’t stop me from squatting, but it might make me pay closer attention to how much i’m doing, and potentially changing my form to see if that can help reduce some of the knee symptoms that I might be having. 

One more caveat to add is that if you realize that you have a dull ache and muscle fatigue that persists for four or more days, this is an indication that you like need to rest the muscle groups for a bit longer and perform light exercise. This will allow you to keep training in the midst of moderate muscle soreness.

Stretching and more exercise don’t generally reduce muscle soreness, but, the increased blood flow that occurs with exercise can be enough to relieve pain in the short term.

Ultimately if you are having muscle soreness or DOMS, the most important factor in the muscle tissue recovery is time. This usually lasts 24-72 hours and is a normal part of the recovery process. As I mentioned above, if the pain persists for greater than 72 hours, you’ll likely benefit from reducing the intensity of your physical activity to allow for muscle repair to occur.

How to exercise with a bad knee or weak

back?

I’m not a fan of the terms bad knee and weak back. I believe that the language we use determines who we will ultimately become. 

Instead of bad knee, say “irritated knee.” Instead of “weak back,” say irritated back. Usually when people say “bad knee,” or “weak back,” they are indicating that they generally have recurring issues in those affected areas. 

The bad knee likely has been a problem for a while and they haven’t seen success in improving it so it’s then deemed a bad knee and then the weak back has also likely been a problem for a while so they assume that it’s because the back has an inherent “weakness.” 

This is just a way that humans try to make sense of their ailments. In my opinion, there is no such thing as a bad knee or a weak back. 

Words matter wooden blocks

If a knee is irritated, we can figure out ways to reduce symptoms, and then improve the tolerance of movement and load over time. 

If a back is flared up, we can also figure out methods of reducing symptoms and then improving tolerance of various activities over time. 

This process can be initiated with stretching, strength training, or walking to initially reduce symptoms, and then over time I do believe that adding in a strength and conditioning routine that builds the capacity and tolerance of each joint in the body is a preventative measure for future injury. 

There is evidence to suggest, in the athlete population, that those who are stronger, on average have a much lower injury risk. I can make the assumption that this also applies to the general population. 

The way that I think of it is this way. 

Let’s say that you can only lift 25 pounds off the floor. You have a dog, and the dog food bag weighs 20 lbs. That’s 80% of your total load capacity. If you’re never training to lift at your maximum capacity, it’s possible that as you near max capacity, your body is not prepared to do this, which then results in sharp pain or dull achy pain. 

Let’s say instead that you train regularly, can lift 100 pounds from the floor and have to lift the same amount of weight, 20 lbs. from the dog food bag. Now, that’s only 20% of your total capacity, AND, you are regularly lifting heavy things. Your body is used to it. It’s not a shock to the system any longer. 

Other than that one paper on injury risk reduction in athletes, I don’t have any additional research that i’ve come across to further support my opinion on this. I write this based on some evidence and some of my personal experience working with clients. 

I can’t tell you how many people i’ve worked with who had recurrent back issues, got into training deadlifts and bent over rows for a year or longer, and haven’t had any issues whatsoever, or, even if they do, it only lasts a couple of days or a week. Pretty cool stuff. 

How hard should I push myself when

exercising if I’m 65 or older? Is it safe?

Bent over row 78 years old

Start slow and progress to higher intensities. 

My senior clients, of which I have many, are all encouraged to deadlift heavy weights. This is not to become a world-class powerlifter, but to stave off the 1-2% muscle mass and bone density loss per year and to ensure that they are functional and above average for their entire lifespan. 

If you are 65+, strength training, in my opinion, is more important than even cardiovascular fitness. Of course, a balanced approach and the best is to do cardio and resistance training, but only cardio can oftentimes lead to folks being very frail without any muscle mass left.

I’m not trying to “nocebo,” anyone here, and if you’re only doing cardio, keep going, it’s amazing for your health, but realize you NEED to be strength training. This can even be 1x/week at a sufficient intensity to see gains. 

Strength training is the best way, hands down, to preserve and increase muscle mass and functional strength in seniors. This is one of the only times you’ll ever see me say “the best.” 

So in short, push yourself hard, in a progressive fashion, it’s safe. In fact, not pushing oneself is likely more harmful than “over-exerting.”

How do I know when to push myself or when I’m overdoing it?

If you’re constantly fatigued or you’re continuously aching after starting an exercise routine, you may be overdoing it. 

In the first two weeks, it’s normal to feel some muscle soreness, and maybe a few aches and pains in the joints. I call this “knocking the rust off.” 

What’s not normal is if you continuously have these symptoms after working out. I wrote an article about how to modify activity in this article. It’s an article about deadlifts, but the general advice on modifications is beneficial. 

You’re not pushing yourself hard enough if you’re constantly feeling like the workout was easy. 

You should feel like at the end of the workout that you did something. During the workout you should feel like your muscle are getting fatigued and/or burning. 

Over the course of 6+ weeks, you should absolutely see the amount of weight that you are using increasing, and you might even see some changes in your muscle mass, energy levels, and overall functional strength. 

Functional strength can include getting up from the ground, getting up from a chair, the ability to walk hills with more ease, etc. 

Will Foam Rolling Help Delayed Onset Muscle

Soreness?

foam rolling

I do not recommend using a foam roller to roll out the muscles. As discussed above time is the most important factor when it comes to muscle soreness recovery.

For more information on foam rolling, you can check out this article from a colleague of mine, Dr. Jarod Halll, PT, OCS.

Should I take Anti inflammatory medication

to Help With Delayed onset muscle soreness?

It is acceptable to take NSAIDs for DOMS, however you’ll want to check with your doctor first to make sure you do not have any restrictions or contraindications to taking this medication.

Should I use Ice for sore muscles?

You can use ice or heat to help manage some of the symptoms related to sore muscles. This will not help the soreness go away faster, but it will help you if you need some additional pain relief due to the pain being unbearable.

Check out this article that I wrote that covers ice vs. heat for lower back pain. (it applies to all types of pain).


In Summary

  • Muscle soreness “discomfort,” is normal and expected when starting a new workout routine. Joint pain that persists several days after a workout can be normal in the beginning but should reduce over time. If it doesn’t you need to modify your workout routine. 

  • The difference between muscle soreness from a workout and joint-type pain is a “hurt so good,” vs. “this doesn’t feel right,” type sensation. 

  • Strength training for seniors is of critical importance to maintain muscle mass, bone density, functionality, and independence. 

  • You should progressively push yourself harder over time, even if you are 65+. There are likely diminishing returns as you reach your limit, but this is much higher than you think.

  • “Bad knee,” and “weak back” should be removed from your language database and replaced with something that is more modifiable. Instead of those terms, use “my knee is irritated right now, but I know what I can do to improve my symptoms.”