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Delayed Onset Muscle Soreness and Knee Replacements
By Dr. Renae Norton

delayed onset muscle soreness

My knee replacement is officially 2 months old today and in the main, I have had a remarkable recovery, this according to my surgeon, my physical therapists and based upon my research on the subject.  That said, I am struggling with the whole issue of exercise and it finally occurred to me why I am having such a hard time.  I suffer, and have always suffered, from Delayed-onset Muscle Soreness (DOMS.)

DOMS is muscle pain that begins hours after you’ve worked out. It normally starts a day or two after the workout. You don’t necessarily feel pain during the workout, but you sure feel it anywhere from 24 to 48 hours later. For me it is 48 hours later.  

Pain felt during or immediately after a workout is a different kind of muscle soreness called acute muscle soreness.  It’s that burning sensation you feel in a muscle that usually occurs during working out due to a quick buildup of lactic acid. Unlike DOMS where the pain can last a day or two, acute muscle soreness usually disappears as soon as, or shortly after, you stop exercising.

According to the American College of Sports Medicine the symptoms of DOMS may include:

− muscles that feel tender to the touch

− reduced range of motion due to pain and stiffness when moving

− swelling in the affected muscles

−muscle fatigue

−short-term loss of muscle strength

These are all the things I am experiencing every time I do the protocols as set forth by my surgeon and physical therapists.  The problem is that I experience them 48 hours after I do my “exercises.” Given that I am supposed to be doing the protocols every day, this is at times a nightmare.  Even if I skip a day, of doing my protocols, I still have the pain from the two days before.  I have decided not to skip any days, but the upshot is that on some days there is so much stiffness and at times, outright soreness, that I am miserable.  I decided to do some research and found the following:

Causes of Delayed Onset Muscle Soreness?

According to the experts, high intensity exercise can cause tiny, microscopic tears in the muscle fibers. The body responds by increasing inflammation, which may lead to a delayed onset of soreness in the muscles. I experience DOMS no matter what type of exercise I do.  

Since my surgery, most of my “exercising” consists of stretching, riding a stationary bike and walking.  I do modified squats and work out with bands, but the only weights I use are for my arms and I don’t consider any of the other things to be “high intensity” exercise. Likewise, I am much less likely to have DOMS in my upper body than I am in my lower body. Huh?

Back to the experts again, pretty much any high-intensity exercise can cause DOMS, but one kind in particular, known as eccentric exercise, often triggers it. Eccentric exercises cause you to tense a muscle at the same time you lengthen it.

For example, the controlled, downward motion as you straighten your forearm after a biceps curl is an eccentric movement. (Again, this does not cause DOMS in me.) 

The way your quads tense up when running downhill is also an eccentric movement. Ok, I definitely experience that even though I am not “running” down any hills.  Just walking down hills right now is completely different from walking on flat ground. My quads tense up a lot when I am walking down hill, as do my calfs, and even the arches in my feet. (Actually, my foot.)  I really feel a stretch in my right foot, (my right knee was replaced) possibly from an old skiing injury.   I have two hills that I walk up and down during my half hour walk each day. Going up is no problem, while going down is a whole different experience.

It was once thought that a buildup of exercise-induced lactic acid was to blame for DOMS, but this common misconception has been debunked.  And if you are thinking that this is happening to me because I am so old, think again. DOMS can affect just about anyone, from elite athletes, to beginners, to people who haven’t worked out in a long time.  

So, no matter your level of fitness, DOMS may strike whenever you dial up your workout intensity, perform eccentric exercises, or try a new kind of exercise your body isn’t used to.

One thing I want to clarify, DOMS is not a sign of a good workout.  It’s a condition that some people have.  I also want to clarify that I am making progress in spite of the DOMS. For example, I can now go up as well as down stairs normally.  Going up, easy…been doing that for 6 weeks….going down though was much more challenging, but my leg has got it now.

Suggestions for Dealing With Delayed Onset Muscle Soreness:

1. Keep moving. One thing I have noticed is that if I give in to the pain and stop moving it gets worse. I get more stiffness. I do try to listen to my body and take it easier, but I find that moving helps. So when I can barely walk, I skip the half-hour walk and just do the stretches or take a shorter walk. 

2. Massage helps. A 2017 review of several studies found that people who received a massage 24, 48, or 72 hours after an intense workout reported significantly less soreness than people who didn’t get a post-workout massage. Getting a massage 48 hours after workout seemed to work best. This is probably not practical, especially if you work out every day as I do.  However, I have found that if I use my “muscle roller” it really helps.

3. Topical analgesics are products meant to help relieve pain. I use Tiger Balm.  I also use my chinese patch (put picture of both here) 

4. Cold bath – is supposed to help. I don’t see that happening for me, lol. Cold baths have become a popular self-treatment for competitive athletes. More power to them!

5.Moisturize. I take a hot shower every morning and use a coffee scrub that does wonders for keeping my skin, especially around the incision site, moist.  This is really key for me when it comes to the tightness of the incision.  Moisturizing is essential.  I use Manuka honey and ghee every night and that also really seems to help. I also highly recommend soaking in a hot tub with lavender Epsom salts.

6. Stay away from inflammatory foods, especially sugar.

7. Finally, I use Tylenol, an anti-inflammatory to manage the pain. 

In my case, though I have been seeing incredible progress recovering from my knee surgery, but I was discouraged until I made the connection regarding the DOMS.  Up to that point I would make great strides, then have a terrible time with pain a couple of days later, which was greatly decreasing my motivation to continue pushing myself. It was pretty miserable to tell the truth. But, the realization that the DOMS is interfering with some of my goals and progress has really helped.

It is better to know that this is due to a condition I have no control over, then to think I was slacking… Go figure!

Acknowledging that the DOMS is complicating my physical therapy has mentally given me the strength to refocus on my progress and face the rest of my recovery head on. 

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