DOMS and 5 Questions Every Patient Needs to Ask

I came across the article on “5 Questions Every Patient Needs to Ask”. As the author pointed out, these questions force doctors to be more transparent in their reasoning instead of simply offering what is in their armamentarium without bothering to ask if they really should.

If for example you would consult for body pains that started a day after a very strenuous workout, instead of just prescribing the most potent analgesic available in the market, asking these questions just might save you money as the solution most likely is already in your medicine cabinet at home.

So here are the important questions patients have to ask when a doctor offers them treatment (whether it’s medication or an operation):

What’s the likelihood that it (the treatment) will help me?

  1. If it does, how much will it help me?

  2. What is the likelihood that it will harm me?

  3. If it harms me, how much will it harm me?

  4. What’s likely to happen if I don’t do it?

Let’s apply it to the scenario I earlier posted. If for example, there is no gross abnormality in your musculoskeletal examination, you would most likely diagnose it as Delayed-Onset Muscle Soreness (DOMS). It can be discouraging for those newly engaged in any physical activity or sport but it is a normal response to unusual exertion and is part of the adaptation response that would eventually lead to better muscle strength and stamina. In general, it is usually worse 2 days following a new, intense activity and subsides over the next 3-7 days.

Obviously, the answer to question number 5 would be that, even without prescribing anything, we’d expect the muscle pains to resolve in a week or so. The question then would be why take anything for DOMS?

Well, the pain can be activity-limiting in some cases, so taking simple analgesics may be helpful in reducing the symptoms but it does not impact on the speed of recovery (This answers Questions 1 and 2). By simple analgesics, I mean taking either Paracetamol, Ibuprofen and even low dose Naproxen. No head-to-head comparisons have been made between these agents in DOMS. However, studies advise against taking Ibuprofen before endurance exercises. There may be some concerns about the GI safety of Naproxen even if taken for short durations. Hence, Paracetamol may be the best advise to give your patient. No serious problems with Paracetamol are encountered if taken <4g/day (or <3g/day for the elderly). Probably your only concern would be a hypersensitivity reaction. (And that answers Questions 3 and 4). Just any doctor can prescribe an NSAID for pain but a diligent physician in this setting would advise something that you may already have at home or even in your bag. There may be no harm in prescribing COXIBS in this case but these are far more expensive than Paracetamol.

Aside from medications, what other things should be advised by your physician to treat DOMS?

  • Perform low-impact aerobic exercise following an intense work out. This is referred to as “active recovery” in some studies. It has been shown to increase blood flow to muscles and has been linked to diminished muscle soreness.

  • Rest. As pointed out, the pain and soreness will go away in a couple of days.

  • Massage. Not just any massage but a “sports massage”. Some studies report diminished muscle soreness but it does nothing to affect muscle functions.

  • Avoid any vigorous activity or exercise that increases pain. Listen to your body.

  • Warm up completely before your next exercise/ sports activity. Studies have shown that warm up performed immediately before any unaccustomed eccentric exercise produces “small” reductions in muscle soreness. Unfortunately, there a cool down stretch does not seem to impact on DOMS.

  • Progress slowly. The best treatment for DOMS is to prevent it. There is actually a 10% rule when it comes to exercise progression. Following it may save you from having DOMS when you try something new the next time.

So the next time a newbie gym rat or athlete comes to your clinic, remember the 5 questions I posted earlier.

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