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Feeling sore after starting a new exercise routine is common, but you might have heard alarming accounts of people landing in the hospital due to overexertion during extreme workouts. While your discomfort is likely normal, here’s how to determine if it’s within a healthy range.
Understanding typical workout soreness
Delayed onset muscle soreness (DOMS) typically emerges a day after an intense workout. Its severity dictates its duration, often reaching its peak between 48 to 72 hours post-exercise. Mild cases may cause slight discomfort for a day or two, while more severe instances could make simple activities like descending stairs painful for nearly a week.
The sensation can vary from a mild ache to an intense burning pain. It tends to feel most severe when you engage the affected muscle, particularly after periods of inactivity. You might wake up thinking, oh no, everything hurts, but moving around and stretching often provides some relief.
Returning to the gym during this period—which is recommended—you’ll notice that while you can still perform the same exercises, the soreness may limit your ability to lift as much weight or complete as many repetitions as before.
Interestingly, experiencing soreness now can reduce future soreness. This phenomenon, known as the “repeated bout effect,” allows you to benefit from continuing your workouts even if you’re not fully recovered. DOMS typically occurs after new or highly intense activities, so once your body adapts, severe soreness becomes less likely.
Could it be rhabdomyolysis?
An extreme form of muscle soreness, known as rhabdomyolysis or “rhabdo,” can lead to severe health issues. This condition arises when muscle damage is so extensive that your body, particularly your kidneys, struggles to process the resulting metabolic byproducts released into your bloodstream.
That said, rhabdo is quite rare. If you’ve just tried a new workout and are experiencing widespread soreness, it’s far more probable that you’re dealing with severe DOMS rather than rhabdo. To put its rarity into perspective, this study identified only 29 cases over four years (2010-2014) at a single New York City hospital. While there were likely more cases citywide, this number represents an extremely small fraction of exercisers.
However, rhabdo can occur. It’s more common among absolute beginners who overexert themselves compared to seasoned athletes, who typically recognize their limits. If you’re experiencing extreme soreness for the first time, it can be challenging to determine whether it’s normal or a cause for concern.
Who is at risk for rhabdo?
Exercise-induced rhabdo—though rare—is more likely to affect individuals who:
Are dehydrated.
Work out in excessively hot conditions.
Engage in extremely intense or prolonged exercise sessions.
Are new to exercising and push themselves too hard.
Are taking specific medications, such as ibuprofen or other NSAIDs.
In addition to intense exercise, rhabdomyolysis can also result from injuries causing significant muscle tissue damage, certain medications, or underlying health conditions.
Symptoms to be aware of, as noted by the CDC, may appear within days after the workout and include:
Intense muscle pain, weakness, and swelling.
Dark-colored urine (resembling tea or cola).
Severe exhaustion.
If you experience these symptoms, seek immediate medical attention, even if it requires visiting the emergency room or urgent care.
At the hospital, a blood test can diagnose rhabdo, ensuring you receive the necessary treatment to prevent kidney damage or other severe complications. The CDC recommends testing for creatine kinase or creatine phosphokinase levels, ideally monitored over several hours or days.
How to handle general soreness
Aside from ensuring you don’t miss your next workout, we’ve got some helpful suggestions. Unfortunately, there’s no quick fix for DOMS; recovery is essential. Proper rest, nutrition, and time are key to healing.
While you wait for recovery, a few strategies might ease discomfort. Gentle movement, like walking or light cardio, can help. Massage, whether from someone else or using tools like a foam roller or lacrosse ball, can also provide relief.
Stretching may help some people, but avoid overstretching to prevent further muscle damage. A hot bath or heating pad can be soothing. (Heated car seats are especially comforting after workouts targeting your back and hamstrings.)
And, as always, consult a doctor if something feels unusually concerning. While online articles can’t diagnose serious injuries, a medical professional can provide the clarity you need.
