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ePublication of Australian Fitness Network

By helping clients differentiate between the pain of injury and the soreness caused by post-exercise muscle adaptation, you can better manage their recovery and training, writes physiotherapist Tim Keeley.


  • Clients may struggle to differentiate D.O.M.S from injury.
  • Over-training that results in severe D.O.M.S should be avoided because it can lead to compensatory movement patterns that result in an actual injury occurring.
  • A muscle injury is usually a muscle tear, and features a severe and localised pain in one small area in the muscle.
  • Pain that comes on during exercise, eases afterwards and then returns during exercise, is usually caused by inflammation or irritation of tendons and joints.

For a lot of us, pain in the body will come and go, like a headache. You may have pain for an hour or maybe even a day, but often it will simply go away and you’ll forget about it.

There are many factors and mechanisms that cause pain in the body, and sometimes you may feel it’s not bad enough to actually go and see someone about it. Your clients will feel likewise, and although they may mention pain to you, it doesn’t mean that they have sought any further specific treatment or advice. The best tip I can give is that we should do something about our pain before it becomes severe or long lasting. But how do you know when?

The following information about pain, injury, and when to seek professional advice and treatment will help answer this question.

Delayed onset muscle soreness (D.O.M.S)

As you will know, after training, you can develop delayed onset muscle soreness (D.O.M.S). This pain and stiffness can be felt in the muscle for between 24 to 72 hours, days after strenuous or unaccustomed exercise. It is caused by damage to the muscle during the eccentric (lengthening) part of the contraction and the soreness comes when the muscle is adapting afterwards. It is a common and normal muscle response if you have pushed yourself hard, worked muscles in the outer limits of their flexibility, lifted heavier weights than you usually do, or not exercised for a while.

For example, if you have done a lot of heavy squats, and the next day your thigh and buttocks are sore, this is D.O.M.S. The pain is over a large area throughout the muscles, and usually on both sides. The best thing to do is rest, gently stretch and avoid training the sore body parts at that intensity for 48-72 hours.

Doing muscle building and strength training programs means you will most likely get D.O.M.S. Although many people refer to this as a ‘good pain’, it is a commonly held misconception that unless they are experiencing D.O.M.S they have not worked out hard enough. You need to make sure you are on the correct graded training program for your level of fitness, strength and conditioning.

Severe D.O.M.S

D.O.M.S is one thing, but severe D.O.M.S, whereby you have muscle pain that prevents you from walking properly or standing up from a seated position, means you have pushed it too far. If your client has severe D.O.M.S, they are likely to change their patterns of movement in order to avoid the pain in the muscles. This will make them compensate during exercise with other muscle groups and overload biomechanically, thereby causing an actual injury.

Again, the treatment for severe D.O.M.S is simply rest, then gentle stretching. The client should also adjust their training in order to avoid the problem reoccurring. If the client has experienced severe D.O.M.S as a result of following a training program that you have prescribed for them, then you will need to reassess the program and correct its level and intensity.

Does your client have severe D.O.M.S or an actual muscle injury?

Determining whether it’s just severe D.O.M.S, or whether your client has actually suffered an injury, is all down to the nature of the pain, the surface area and when it happens. With a muscle injury, the pain is localised to one small area in the muscle, is more severe and has an ache with it. There is sharp pain on flexing the muscle and there is a loss of power. With injury the pain comes on either during or immediately after training (not the next day or so like with D.O.M.S). The pain can last for many days, and sometimes weeks or even longer. If your client has pain like this, they most likely have suffered a muscle ‘tear’.

As soon as they feel this type of pain, your client needs to get the injury assessed in order to ascertain the extent of the damage and determine what to do about it. This is not a time to just wait and hope it goes away. Seeing a physiotherapist for rehabilitation will increase the client’s chances of returning to exercise more quickly by helping their recovery, improving their strength and preventing the breakdown in their training regime. The physio will also be able to work out why your client is getting injured in the first place, and help prevent it happening again.

When pain comes and goes, is it an injury?

If your client is experiencing pain that comes on during exercise but eases afterwards and then returns when they exercise again, they need to take notice. This type of pain is usually from inflammation or irritation of tendons and joints, and sometimes other serious structures (like discs in the back).

The pain can occur with certain movements, such as in the shoulder when raising the arm, on the outside of the knee-cap during a run, or in the lower back after bending. As soon as the exercise or movement ceases, the pain subsides, but it always comes back. If the pain increases during exercise, doesn’t ease afterwards and is worse at night, then the problem requires further attention.

Inflammation in a tendon is called tendonitis, and if not seen early, can develop into a ‘tendinopathy’, where the tendon weakens significantly. Rest relieves the pain only temporarily and over time actually makes the injury worse, because the client is getting weaker. It is essential that the pain is addressed before it gets to this stage and becomes a chronic recurring condition. Inflammatory pain is usually tackled with anti-inflammatory medication, but sometimes that’s it. The reason for the inflammation occurring during exercise also needs to be established, and remedied.

When it really is an injury, what next?

Most people know when they have suffered a significant training or sports injury. It’s immediate and it hurts a lot. If the injury pain is severe, your client cannot move an arm or leg, and they immediately have a large amount of swelling, they should seek professional advice straight away as they may also need medications and X-rays or scans.

Unless they happen to be a professional athlete, your client will not happen to have a physio or doctor there by their side when they need them the most! Many people roll their ankle, have it swell up and think it’s just a sprain, only to find out it’s a fracture after hobbling around on it for four days. For acute sprains and strains, the best treatment is still the RICE principle (Rest, Ice, Compression, Elevation) for the first 24-48 hours. The ice element of this should be done for around 30 minutes every two to three hours, and the best compression is a double layer tubular bandage.

Your clients should enjoy their workouts and, while being conscious to train safely, shouldn’t be paranoid about injuring themselves. If they do experience any pain during and after exercise, however, they should take note of when and where it occurs in the body and be aware of its duration, as well as potential triggers or recurrence. As their trainer, you must ensure that their training program is both safe and appropriate for their level, and in the incidence of suspected injury, refer them to an allied health professional to seek advice as needed.

Tim Keeley, B.Phty, Cred.MDT, APAM
With over 20 years’ experience in physiotherapy and the fitness industry, Tim is Principal Physiotherapist and Director of Physio Fitness, a clinic based in Sydney’s Bondi Junction. An internationally credentialed McKenzie Credentialed Spinal Physiotherapist, he specialises in sports, fitness and training injuries. /

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