Working out? Why 'No Pain No Gain' is bull

Tegan Taylor: Have you got DOMS?

Norman Swan: Actually I do, I do have DOMS today.

Tegan Taylor: So do I, yes. Where are yours?

Norman Swan: Well, my DOMS…shall we tell people what DOMS is? Most people will know…

Tegan Taylor: The gym bros know; delayed-onset muscle soreness, you know, when you feel sore after working out, which clearly we've both been working out. Where are your DOMS, Norman?

Norman Swan: I'm embarrassed to say that my delayed-onset muscle soreness today, which is two days after my last session, is in my buttocks.

Tegan Taylor: You've been working for those booty gains.

Norman Swan: Yeah, I've been doing…well, where's yours, before I tell you what I've been doing.

Tegan Taylor: Hamstrings. It was yoga, which sounds very chill and relaxed, and it was absolutely not chill and relaxed and I'm really feeling it.

Norman Swan: So for me it was the half-Romanian. It sounds like…

Tegan Taylor: All of this jargon that sounds…the half-Romanian DOMS sounds much saucier than what it actually is. You're talking about a split squat with muscles…

Norman Swan: So a half-Romanian is where you get a hand weight in your hand…and I'm actually simulating it, I don't know why…

Tegan Taylor: I can see you're trying to pretend to do it in the ABC studio.

Norman Swan: And then you just go down on the weight to the floor and then you straighten up, straight back….

Tegan Taylor: Oh, like a deadlift?

Norman Swan: Yes, that's right, the full one is a full Romanian deadlift that you do with barbells, I just do it with a handbell.

Tegan Taylor: Well, it must have worked, because you're sore today.

Norman Swan: Well, that's the question, isn't it?

Tegan Taylor: It is the question, it's actually the actual question today on What's That Rash? I'm health reporter Tegan Taylor, coming to you from Jagera and Turrbal land.

Norman Swan: And I'm physician and journalist Dr Norman Swan, coming to you from Gadigal land.

Tegan Taylor: And today on What's That Rash? we are talking about delayed-onset muscle soreness, thanks to a question from Andy. But before we hear Andy's question, if you like the show, make sure you're following it wherever you get your podcasts, and tell a friend about it. But here's Andy's question.

Andy: When you get sore, like a day or two after a workout, does that mean you've had a good workout? Like, am I building muscle? Or am I doing something wrong?

Tegan Taylor: I guess the question that comes for me straight out of that, Norman, is what's our definition of a good workout? Because it could be anything.

Norman Swan: It could be anything. And if you go to a trainer…I mean, I'll tell you what trainers I've gone to have said, they will always ask you when you come for your next session, 'Were you sore afterwards?' And if you say yes, they say, 'You're welcome.' In other words, that's been their objective, to make you sore a couple of days later. It's a thing.

Tegan Taylor: Seems like you're seeing a string of masochists. Norman.

Norman Swan: Yeah, it's almost as if pain has become part of the exercise process. But delayed-onset muscle soreness, as you're going to find out by listening to this podcast, is not an inevitable part or even part of a good workout.

Tegan Taylor: Okay then, well, are there certain types of exercises that cause DOMS specifically?

Norman Swan: Well part of the definition is that DOMS is caused by what's called eccentric muscle contractions, and those technically are muscle contractions where your muscle is lengthening. So let's just talk about biceps, so you've got a weight in each hand and you're doing a bicep exercise, most people focus on the flexion of the arm bringing the weight up. But in fact you're probably getting more benefit from the downward…straightening your arm and actually stretching the muscle going down, and that's eccentric exercise, that control process. And we don't think about that. And that's probably part of what causes DOMS.

Tegan Taylor: So eccentric exercise is what's building muscle, a good thing, but it's also what's causing DOMS, which is a bad thing.

Norman Swan: That's right.

Tegan Taylor: I just thought it was non-negotiable. I thought if you were going to try to work with your muscles, either strengthening them or building them up, that pain was part of the process, because I was always told that…I'm on the Health Report, I thought I kind of knew a thing or two about it…I was always told that you're creating micro-tears in your muscles as you perform the exercise and then as they heal, that muscle gets bigger and stronger at the same time.

Norman Swan: By and large, that's not true. I mean, there is some evidence that muscle damage will build up muscle, but it's not necessarily related to delayed muscle soreness, or indeed the inevitability that you have to have muscle damage and pain in order to build up muscles, there are other mechanisms altogether. So when you do a squat, most people think, well, what's counting is the explosive thing as I stand up from a squat, but in fact the real benefit of a squat is when you go down and you go down really slowly, and you hold it a little bit and then you come back and you can come back quite explosively. If you're doing stairs, it's coming down the stairs rather than going up. So it's these controlled exercises that really tend to tense the muscles and fatigue them.

Tegan Taylor: The stairs thing has blown my mind because I always thought the benefit from taking the stairs was from going up. But in my research for this chat, I found a study that showed that people had more benefits (like all of the benefits and not just muscle related ones) from descending stairs rather than going upstairs, which is the easier way to go.

Norman Swan: Yeah, I mean, probably the aerobic benefit is going up. But it's definitely the muscle benefit…by a factor of about three to one.

Tegan Taylor: Crazy.

Norman Swan: So it is crazy and important but people just don't think that way. So DOMS, delayed-onset muscle soreness, comes on after eccentric exercises. And because eccentric exercises aren't what you think about, you probably are doing muscle exercises in the gym or what have you, and, without thinking about it, you're actually doing quite good eccentric exercises, which you're not used to doing, and therefore you get a problem a couple of days later. So one definition is unaccustomed and strenuous exercise comprising repetitive, fatiguing, eccentric contractions, and that is what can…not inevitably but can cause delayed-onset muscle soreness.

Tegan Taylor: So what we've got is something that you're not used to, something that's actually wearing you out, and the eccentric exercise is part of it.

Norman Swan: That's right. But it's more than that. It includes muscle stiffness, everybody knows that, you know, you've got DOMS, you're stiff, you may well have swelling, so your muscle feels tight, you actually might be quite weak. And, interestingly, the joint that's involved may well be restricted. So in other words, if it's around your quads you may not be able to bend your knee to the same extent.

Tegan Taylor: That's so interesting, because I've definitely felt that, I feel like kind of a little bit clumsy. When it's really bad, or when it's a lot of different muscle groups, like I've worked my legs really hard, getting in and out of the car becomes a nightmare.

Norman Swan: Exactly.

Tegan Taylor: But you have this sort of clumsiness.

Norman Swan: Well, I'll come back to your clumsiness in a minute. But I know what you do for exercise and it's all eccentric exercise, and clumsiness wouldn't be good for that, would it?

Tegan Taylor: What, rock climbing? It's definitely not if you fall and hit the floor. Well, you're pulling but you're also pressing sometimes as well. And yeah, it's everything.

Norman Swan: It's about control.

Tegan Taylor: Yeah, definitely, definitely.

Norman Swan: So when you come off the face, having done a difficult rock climb, do you get DOMS?

Tegan Taylor: Oh yeah, for sure. And it's funny because often when I feel like I've had a really poor performance on the wall and feel like I haven't been able to climb stuff that I feel like I should be able to but if I feel sore the next day, I'm like, well, I must have done something. But now you're telling me even that's not true?

Norman Swan: Well, the other thing about rock climbing…I mean, I've done a little bit in my life and I must say it scares the hell out of me when I do it, but you absolutely have to know where every joint is in space.

Tegan Taylor: Yeah, yeah, proprioception, isn't it, one of those senses that we have that aren't one of the five senses that we're taught.

Norman Swan: Yeah, and yours must be highly tuned because you're talking about proprioception in your hands, your arms, your feet, and so on. So that when you actually go for the handhold above, you know exactly what the other three points that you're holding, you're doing.

Tegan Taylor: You're being very kind. You've obviously never seen me climb before.

Norman Swan: So proprioception, loss of it or diminished proprioception is part of delayed-onset muscle soreness, so people think this is just muscle pain, but it's a whole range of stuff, including loss of proprioception.

Tegan Taylor: So then what actually governs proprioception then? Is it your nerves?

Norman Swan: Yeah, it's a neurological phenomenon. And there are nerve fibres that go to your joints and pass through your muscles and then go to your spinal cord, go to your spine, and then transmit up to your brain to give you that sense of where you are in space. Now, there's been all these theories as to why you get delayed-onset muscle soreness, so one is muscle damage. Well, that does not seem to be the reason why you get delayed-onset muscle soreness. And they've had all sorts of other reasons.

And one of the latest reasons (it's all theory) is that you get damage, it's called non-contact injury, to the cables that are called axons, basically the nerve cells have cables a bit like electrical cables, and the electrical cable from repeated eccentric exercise gets damaged. And what they've also shown in some experimental work is that in order for nerves to work, ions (in other words, charged particles like sodium, potassium, calcium) have to go in and out of the cell to create the electrical activity of the nerve cell. And that requires a channel, a little channel opens up which allows these ions to come in and out. And there's one particular channel which seems to be a problem in DOMS, and that happens in other conditions as well. Now, one of them is ACL injury.

Tegan Taylor: Like a knee injury, you hear about it so much in sport. I actually did a story about it for the Health Report not that long ago.

Norman Swan: You did indeed. And if you go into the Health Report podcast, you can find that out. So here's the theory, and it's still all theory; you do a lot of exercise which requires eccentric contractions, you get DOMS, you then play again while you've still got the effect of DOMS, and you've got reduced proprioception, and you don't quite know where your knee is in space, and when you land, you land the wrong way and damage your ACL.

Tegan Taylor: So does that mean that avoiding DOMS is potentially a much better training tactic than pursuing it, thinking that you're building your muscles up?

Norman Swan: Well, Shelby Traynor, our producer, has been speaking to exercise physiologists, and they think that pain is not inevitable, and should not be an objective necessarily for training because you lose function, you lose a day or two of your training, without necessarily the benefit. And that, in fact, it should not be the goal here.

Tegan Taylor: So tell me more about the science into this nerve side of things, because it's not something I've ever really heard about before.

Norman Swan: Well, this is where orgasms come in.

Tegan Taylor: Sorry, what?

Norman Swan: Well, there's another condition which is very rare in men, I didn't think it was a real thing but in fact it is, called post-orgasmic illness syndrome.

Tegan Taylor: Stop it, stop it. Like flu-like symptoms after sex?

Norman Swan: It's a man's thing and it happens after ejaculation. And they can feel fatigue and flu-like symptoms and sometimes muscle pain after ejaculation, and it can last a couple of days.

Tegan Taylor: Part of me wants to…that would be debilitating.

Norman Swan: Yeah, not great fun. And it's been a mystery, but they've studied this, and this same ion channel seems to be a problem in post-orgasmic illness syndrome, at least some research suggests that, and in fact might be induced by the eccentric muscle contractions involved in ejaculation. Well you may laugh, but I suspect if you've got post-orgasmic illness syndrome, you're not. All I can say is the questions we're getting to What's That Rash? are opening up…it's like going into Dr Who's TARDIS; 'delayed-onset muscle soreness', and then you open the door and you think 'bloody hell'.

Tegan Taylor: Poor Andy just wanted to know whether he could skip leg day or not.

Norman Swan: So the message for Andy is you don't need delayed-muscle soreness to feel that you've got a benefit from your exercise.

Tegan Taylor: Well, yes, physiologically, as I'm discovering during this conversation, but there's actually a sort of social science aspect of this as well that I've found really interesting, where gym goers perceive the pain to be kind of good and that it's giving you a good effect. And so when you feel it, you're like, oh yeah, love that, that's the good stuff right there. And that's at an individual level, and then as like a community of gym goers you're kind of sharing those stories, like we have been doing this chat, where you're kind of like, 'yeah, yeah, me too, bro'. And so it becomes this good feedback loop, where it's actually a motivator for people to go to the gym.

Norman Swan: It might well put some people off, so that's the other side of it. So the people who are gym junkies, that pain might well be a feedback loop. And of course the key here (and this is where DOMS gets in the way) is progressive training. So if you're doing aerobic exercise, it's constantly pushing yourself to do more and more and more so that you're doing the same amount of coverage, jogging or walking in less time, or you're jogging faster, deliberately faster, or with weights you're progressively doing bigger weights as time goes on, and you're getting the right period of rest between times.

Tegan Taylor: Well, Andy, I hope that's answered your question. It sounds like if you've been exercising, you're doing all the right things, and it's stopped hurting, that is not a bad thing, that pain doesn't have to equal gain. Well, that gain doesn't have to equal pain.

Norman Swan: Exactly. So if this has been useful for you and you think it would help a friend, why don't you share it and pass on the link to What's That Rash?, and if you are getting a lot of benefit from What's That Rash? in general, why don't you subscribe?

Tegan Taylor: Yeah, tell the friend who is always whinging about how sore they are and kind of brag-whinging about it. And if you've got a question about muscles or about any part of your health (but not a rash), please email us, thatrash@abc.net.au

Norman Swan: Or you can always direct message us off the ABC's Instagram site.

Tegan Taylor: We're @ABChealth. We'll see you next week.

Norman Swan: See you then.