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Why Do I Feel Sore After Therapy and the Next Day, but Better 2 Days Later?

Why Do I Feel Sore After Therapy and the Next Day but Better 2 days Later?

Many patients have difficulty understanding why participating in therapy results in soreness which can be perceived as pain. This is one of the poorly understood concepts in rehab, which often leads to misunderstanding, poor patient satisfaction, and decreased compliance from the patient. This article will explain in layperson terms and simple to understand sentences why you feel sore after physical therapy or rehabilitation exercises. The patient example below records the conversation between the therapist and a patient with a frozen shoulder or adhesive capsulitis.

Therapist Question: What does trauma mean? Patient answer: If I fell or something hit me, but nothing like that happened.

Muscles move your body. If a muscle is injured, the result is swelling, which activates the area’s pain fibers. The result is pain even while at rest (not using the body part) due to acute inflammation (current swelling).  During the healing process, there is also pain with the use of the muscle. This is because your muscles are being used to move your bones, and when you use your muscle to move your body, the injured muscle activates the pain fibers in the injured area, and you have pain.

As the muscle heals, which occurs through rest, gentle exercise, and anti-inflammatory agents such as medication and ice, you will feel less pain with the muscle use, and your muscle will be able to do more with a lower level of pain. Depending on how many injuries occurred or how many muscles fibers are injured, your healing process can last three weeks to 12 months.

You will see about 5 to 10 degrees of active range of motion improvement during your healing process per month and about 30% improvements in your pain per month using the numerical pain rating scale.

Patient question: I don’t understand. Why was I able to use the pulleys at the beginning of therapy and had no pain, but I have more pain and soreness the next day after therapy; and not only in the problem arm but also the uninjured arm?

When we begin therapy, we are very gentle because you cannot tolerate the strengthening process. Therefore, a short review of strengthening is in order here.

When you strengthen a muscle, it is necessary to make the muscle fatigued. This is known as the overload principle. You must perform this type of fatiguing exercise 3 to 4 sets, at least two, although preferably three days a week. Because of the scientific nature of anatomy and physiology, when you overload a muscle, you are performing a micro-trauma.

This is a controlled injury, somewhat like surgery is controlled damage to the body to heal. The normal and natural result of strengthening is soreness or a low level of pain in the general muscle area the next day or two, and soreness is most especially experienced when using the muscle (See micro-trauma above). However, the muscle heals over the next 24 to 48 hours and is better able to work, and thus over the eight weeks, your muscle gets stronger. It can perform more work for more extended periods. The injured muscles fibers are entirely healed, so no more pain is felt- unless you overuse the muscle in a single macro trauma or repetitive micro-trauma.

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