Muscle soreness treatment myths perpetuated in the Globe and Mail

This Monday, The Globe and Mail offered some particularly shabby fitness advice, with an even higher myth content and lower science concentration than usual. Kathleen Trotter, a personal trainer, had some advice for a reader who asked:

I am an avid cyclist but I don’t usually lift weights. Yesterday I did a weight-training class and now I am really sore. What should I do to recover?

Trotter recommended:

  1. Epsom salts
  2. massage
  3. a light workout

The first is goofy, the second is a popular myth, and a light workout is fine but it’s not actually going to make any meaningful difference.

There actually is no solution to this problem, but of course it wouldn’t make for much of a Q&A if Trotter had honestly replied, “I’m sorry, but there’s really nothing you can do about that — it just takes time.” The phenomenon of post-exercise or delayed-onset muscle soreness — often acronymized to PEMS or DOMS — is basically impossible to beat. It involves a complex maze of recovery physiology, and there are no confirmed shortcuts through it, and a long list of failed candidates. While ibuprofen will mask the pain a little, DOMS is indomitable.

Epsom salts is a folk remedy with no basis in evidence. Absence of evidence isn’t evidence of absence, but Epsom salt bathing also has no basis in reason — it’s implausible, and its benefits are universally attributed to “osmosis” and/or “detoxification.” The latter can be debunked by any high school chemistry student, while the former is vague to the point of meaninglessness. Years ago, I wrote an extensive article on Epsom salts that became perpetually popular, and I still keep tabs on the subject. I’ve never yet heard a good argument in favour. The case for the healing powers of Epsom salt is mostly made by people selling the stuff, or recommending it as casually and imprecisely as an old wives’ tale. It’s just one of those things people learn and repeat without examining it. Sometimes in major newspapers.

Massage therapy is a complex treatment with some interesting benefits, but as a treatment for DOMS it falls pretty flat. The evidence on this point is either negative or damning with faint praise. At best it might “take the edge of,” but even that’s a bit doubtful. Massage is also quite guilty by association with the “toxins” claim. Although Trotter didn’t trot out the T word, it’s almost inevitable that it will come up in any conversation about this (especially with a massage therapist). Press for an explanation of how massage treats DOMS, and you’ll hear that “massage detoxifies” … and that’s about as good a reason as you’re going to get. Or maybe another myth: that massage “increases circulation.” So we have a claim based on negative or weakly positive evidence and explain with a couple easily debunked myths. Pretty weak sauce.

A little light exercise is a fine thing in many ways … but not as a treatment for muscle soreness. As far as I know, there is no evidence either way on this point — except over-training evidence, which generally suggests that more recovery time is a Very Good Thing. Meanwhile, as an active amateur athlete, I have had countless occasions to test this one in the Lab of Me, and I am highly confident that I just cannot tell if “active recovery” gets me through the soreness any better than sitting on my arse. If it makes any difference, it’s too subtle to get excited about.

Muscle soreness happens. It’s nature’s little tax on exercise, and it must be paid. As the saying goes, only DOMS prevents DOMS. You can prevent DOMS next time … by surviving it this time.

For more information, see this thorough review of muscle soreness treatments.

Photo from flickr user M-Haftek used under a CC licence.

16 Responses to “Muscle soreness treatment myths perpetuated in the Globe and Mail”

  1. Iain says:

    I’m curious about your comment that massage does nothing for circulation. I always thought that the reason the area of muscle that has been worked on gets so warm during a massage was that the massage was increasing the local blood flow there. Is this another myth? Is that warmth just friction heat? It certainly seems that there is more heat than could be explained by that.

  2. Hi, Iain. Thanks for the question. The phenomenon you’re noticing there is superficial, cutaneous hyperaemia: capillaries in the skin respond to mechanical stimulation by dilating (which is likely an immune function: the body transports blood to the site of possible skin breakage). Blood is hot, so the skin gets quite toasty! But it’s clinically trivial and superficial only, and has nothing to do with the intention of the claim that massage works by increasing circulation.

  3. OCTriathlete says:

    I’m sad to see that you’ve not found any scientific evidence for these strategies for reducing DOMS. I can tell you my own experiences with Massage, which has me convinced that it works.
    I once had a VERY aggressive workout with a trainer lifting weights, and my legs were murdered. Two hours later I was lucky enough to receive a leg massage from a family member who is educated in massage but not a professional. However, I was unlucky in that the massage was interrupted after only one leg was complete!! The next day the leg that received the attention was only hinting at the sensation of the heavy workout the previous day. The leg that missed out? It was DEEPLY sore for 2 days.
    So there you have it- my own little scientific (however unintentional) experiment that taught me NEVER to pass up a finish line massage after a race, and to ALWAYS roll out my own legs with a foam roller or The Stick after hard efforts in order to speed recovery and breeze right into the next hard workout.

  4. Lucky you! I’ve done that experiment deliberately a half dozen times at least (because it’s a no-brainer), and I’ve never observed the slightest difference. If only. And in the early days I did it with the greatest of optimism and the full-on mental bias of someone paying his rent by selling that therapy.

    I wonder what would happen if we took Occam’s razor to your anecdote? Is it more likely that massage has this incredibly potent but unproven effect on recovery? That athletic recovery could be dramatically optimized, but no one has noticed or found any compelling evidence of it? Or that you simply had one leg that was more thrashed than the other to begin with for some reason? Or that the memory and the story have come to support an attractive idea, as memory and stories do?

    I’m being very skeptical, yes, but I’m not actually saying you couldn’t have actually enjoyed a nice effect. Physiology differs. The evidence on this treatment isn’t entirely negative, just mostly, and distinctly underwhelming where it’s positive. There could be interesting cases on the edge of the bell curve, and you could be one of them.

    But … Occam’s razor cuts very hard and deep on a story like that.

  5. CC says:

    I’ve always wondered what epsom salt was supposed to do, other than make the water salty. Never wanted to buy the overpriced stuff at the drugstore to find out.

    Maybe it smells nice.

  6. David Scott says:

    I always thought soreness had to do with lactose buildup as a bi- product of metabolism in the muscles. Or is that just more woo from the health magazines? Ir is that for cramps? In any event, whenever I had a tough workout and felt very sore afterward, I noticed that going back for another workout basically cured the condition. As soon as I was well warmed up, the pain was gone. I put this down to getting blood flowing through the cells and sweeping away whatever it was that was making me feel sore. Of course I would feel sore again after this second workout, but it seemed that I’d need tougher and tougher workouts to keep me sore.
    This is all talking about a combination of light weights and aerobics. Actually pumping heavy iron is a different story, and I’ve had days when I lay with my elbow on a pillow, trying to get my arms to straighten out. That’s when you have to start reveling in the pain, repeating over and over again: No pain no gain. (oh, I’m making such gains now.)
    But now I have a new motivational slogan: No pain. No pain.

  7. CC: it makes the water feel “silky.” ;-) And, hey, who doesn’t want silkier baths? I can dig it.

  8. David, “lactose” is a carbohydrate molecule. ;-) You probably meant “lactic acid.” Like most metabolites, exactly how lactic acid works in the body is rather complex, but for sure it is not responsible for DOMS, and is generally produced and broken down again very rapidly (mostly within minutes).

    Whatever DOMS is, there’s definitely more going on than just leftover chemical junk that can be “swept away” by another bout of metabolic activity and circulation. The impression that a second workout helps is probably a relatively brief neurological effect, and has no substantive effect on recovery. If it did, there would never be any reason to rest, and there would be no such thing as over-training!

  9. Alex says:

    Paul, I’m not sure what’s meant by the term “recovery” here. If all we’re talking about is reducing the intensity and/or duration of soreness/pain, then there’s little doubt that warm baths (with or without salts) and massage can be of benefit. In my experience, stretching also seems to help, and I’ve noticed that working out again the following day (whether light or heavy) always gets rid of any residual pain I may be feeling.

    Are we talking about some other definition of “recovery”? Certainly if you’re referring to the amount of time needed for the muscle cells to “rebuild”, then none of those things are going to help … but I don’t think most people actually care about that – they just want to get rid of the pain.

  10. I’m not using any special or mysterious meaning of recovery: lasting symptom relief and/or restored function (strength). A successful treatment for DOMS would achieve one or both of these ahead of schedule. No such treatment exists.

    You are mistaken that there is “little doubt” that warm baths and massage can be of benefit: there is a great deal of doubt! That is my point, which you have contradicted without any evidence but your own personal impression.

    Perhaps what you meant is that heat and stretch and the right kind of massage can feel pleasant for the duration of their application. But that’s not recovery — I can’t stay in a hot tub for 2 days, and the second I’m out of the hot tub, the symptoms are back. The moment I get up from the pleasant massage, I’m as sore as I was before — even more so, if the massage was vigorous! Stretch is particularly pleasant while I do it, but has no lasting effect either. All of these things have been tested for lasting effects on recovery, and have all conspicuously failed. At best, the effects are mild and transient for most people, most of the time.

    • Alex says:

      *shrug* If we’re looking at “restored strength”, that’s an objective measurement, but I wouldn’t expect that to be affected by hot water or stretching, and I suspect it may be negatively affected by a followup workout. If, on the other hand, we’re talking about “lasting symptom relief”. that’s a subjective measurement for which only subjective evidence can be offered. The site which you link to in your article offers similar claims:

      http://saveyourself.ca/articles/bathing.php

      unfortunately, AFAIK, no real studies have been done on the effectiveness of hot baths for “muscle recovery”, and a check of pub-med doesn’t turn up anything of interest. Regardless, whether it’s entirely psychological or not, I know for a fact that hot baths and stretching reduce both the intensity and duration of my own muscle soreness. The anecdotal evidence from others indicates the same. I’d like to see some actual research done on it, but given that it would be impossible to properly blind the participant I’m not sure how good any such study could hope to be. Until I see some contrary data, I’ll continue to suggest it to others – at worst I’m offering them a free placebo.

      • If you want to see contrary data, the references are available. See the link at the end of the post.

        Probably no one is going to argue that there’s any great danger in recommending hot baths, but I value integrity and truth in health care for many reasons, even if it has no direct or significant safety implications. “At worst,” you will be offering a free placebo and perpetuating a myth.

        Strength restoration is highly relevant, and shouldn’t be dismissed. Is it likely that people would still be affected enough by DOMS to be weak, but have no pain? They correlate pretty strongly. If people have DOMS, they hurt and they are weak.

        All symptoms are subjective. That doesn’t mean they can’t be tested systematically. Subjective evidence is not above analysis and evaluation, and it is not synonymous with “anecdotal.”

        The quality of an article I didn’t cite is irrelevant to this post and discussion. But, yes, that bathing article makes similar claims, and it does need corrections and updating. However, it’s mainly addressing a different phenomenon (“trigger points,” not the same thing thing as DOMS).

  11. Rich says:

    I recently had a benign growth removed from my inner thigh leaving me with a small wound closed by 3 stitches. My doctor recommended me to bathe in a Epsom salts for 20 – 30 minutes a day until I had the stitches removed. The reasoning, I was given, was that it was a disinfectant and would help prevent infection. It seemed reasonable given that I have heard over the years that salt water can be used to as a disinfectant. Have I been waylaid by pseudobandit here?

    • Marion says:

      I recently had a minor surgery on my toe, and my podiatrist recommended the same thing, Epsom salt bath for 20 minutes, three times a day. Table salt as a less preferred alternative.

      When I asked why, he said it was to dehydrate the area around the incision. Seems plausible, although I’m still not clear on why dehydrating the area is beneficial.

  12. Fortunately not, Rich: there’s probably no glaring pseudoscience there. That’s a much different use of and claim for Epsom salt bathing than the usual detoxification rationale. Rare though! I get buckets of email about Epsom salt, mostly defending it with anecdotes, and yet no one has ever reported that prescription to me, not even once. The possibility of using it as a disinfectant has been raised and addressed briefly in my article, but I’ve never actually heard of anyone being told to use it on a wound.

    I do not know if it actually works. But it’s plausible enough in principle.

    • Alex says:

      I remember, back in my teens, being advised by an emergency room doctor to use salt-water on an infected dog bite. He didn’t specify Epsom salts, and he also gave me antibiotics, so I’m not sure how much the salt-water helped, but at least I can add another anecdote to support Rich!

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  • Paul Ingraham

    Paul Ingraham is a former Vancouver massage therapist who quit his job in alternative medicine due to frustrations with anti-scientific attitudes and practices, which led to a legal scuffle. He now makes his living writing about science-based treatment for common injuries and pain problems, and has published hundreds of articles and several ebooks at SaveYourself.ca (see skeptics reading guide). He is also an editor for ScienceBasedMedicine.org.