What to do about sore muscles After intense exercise, it's tempting to reduce muscle pain by whatever means necessary to stay on a training regimen or routine. But common pain-relieving practices like taking ibuprofen or using ice may not be best post-workout. Instead, research shows that supplements like fish oil, collagen, and curcumin, along with active recovery methods, are more efficacious in alleviating muscle tenderness. Here’s how.

The development of muscle soreness from exercise

Exercise is just as hard as it is beneficial to the body. It puts direct stress on muscles, tendons, bones, and ligaments, and initiates internal stress and inflammation. [1] Those who train regularly are more resilient when it comes to managing and recovering from this exercise-induced stress. But no matter how trained you are, engaging in rigorous exercise, specifically excessive eccentric contractions (AKA EECs, types of exercises that lengthen the muscle, as in lowering a dumbbell during a bicep curl or running down a hill) can cause delayed-onset muscle soreness (DOMS).[2] DOMS is especially relevant when training intensity ramps up or at the start of the season after a period of rest [3].

What is delayed onset muscle soreness?

Most people have likely experienced DOMS in their life. If you’re not sore immediately after a workout but start to feel it roughly two days later, that’s DOMS. Symptoms can range from slight tenderness to debilitating pain and tightness, typically peaking 24-48 hours after exercise. [3,4]

DOMS can also impact athletic performance, manifesting as an impaired range of motion of joints, reduced peak torque, and stress on other muscles as the body compensates for sore areas. [3] Although it’s established that DOMS stems primarily from EECs, the exact internal mechanism of how that pain is produced is still up for debate. Some theories attribute this soreness to lactic acid buildup, tissue or muscle damage, muscle spasms, or inflammation; but it’s likely a combination. [3]

While DOMS can often resolve on its own through rest, many people, especially athletes, want to speed the process along. And they do that by trying to block inflammation. But acute inflammation from exercise is actually needed for the body to recover and grow muscles, and blocking or delaying that process from happening can inhibit that recovery and muscle growth.

What’s the connection between inflammation and recovery?

Inflammation is the body’s natural, protective immune response to illness or injury in the body. [5] During intense exercise, muscle fibers and cells are damaged, spurring the inflammation process. This inflammation helps the body to repair the damaged muscle by increasing blood flow to the area, clearing out cellular debris or waste from the affected area, replenishing oxygen, and providing fuel to the muscles. [5] This process often causes swelling, pain, redness, and heat at the site of the injury.

This is uncomfortable, but this acute inflammation is needed for muscles to repair themselves and grow back stronger. The goal shouldn’t be to block inflammation altogether, but rather to get it under control as soon as possible.

NSAIDs block inflammation and aren’t a cure-all for muscle soreness

Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs like ibuprofen, aspirin, naproxen, and diclofenac and are frequently used by athletes. They work by blocking certain enzymes (COX-2) that initiate the body’s inflammatory response. [6] This helps to reduce that pain and swelling associated with muscle soreness, but it also means that the impacted muscles aren't getting that extra blood flow, oxygen, nutrients, and debris clean-up crew.

A review of the scientific literature on NSAIDs and sport performance measures like maximum performance and self-reported pain found that there were no significant differences between NSAID groups and control groups for these measures.[7] Though this research is still evolving, there is currently no apparent evidence that NSAIDs offer a performance boost or even a significant pain relief in some situations. And a small study indicates that a large NSAID dose attenuates muscle gains from resistance training.

A randomized controlled trial published in 2017 investigated the effects of a daily high dose of ibuprofen (1,200 mg—a safe 24-hour dose) or a low aspirin dose (75 mg) for eight weeks in healthy adults undergoing resistance training. [8] Researchers measured participants’ muscle volume and strength as well as inflammatory markers at the beginning and end of the study. Results showed that, at the end of the study, muscle volume was twice as large among those taking the low dose of aspirin compared to the high dose of ibuprofen.

Limitations to this study include a small sample size, lack of a control group (AKA a group who didn’t receive medication but still participated in resistance training), and comparison of two doses of two different medications. But this study does provide evidence for avoiding consistently high intake of NSAIDs for muscle growth.

Key takeaway: NSAID use for occasional muscle soreness is safe and may offer some pain relief, but consistent NSAID intake does not seem to improve sport performance indicators. In fact, consistent high doses of NSAIDs may even inhibit muscle growth.

Icing muscles and cold baths provide short term relief but don’t speed up recovery

Icing sore muscles or taking cold baths interferes with the body’s inflammatory response. Ice causes blood vessels to constrict, limiting blood flow and mediators of the inflammation process to the area being treated. But this cold and constriction can be effective in ameliorating muscle pain, swelling, and heat in affected muscles. So yes, they can help to soothe and reduce exercise-induced pain for short-term recovery, like between matches or on race days. However, it may be best to skip icing on a regular basis as a preventative measure for pain to maximize training results.

A study from 2013 looked at the impact of applying cold packs after exercising arm muscles compared to no ice. [9] Results showed that those who iced had higher subjective fatigue three days later and blood measures that indicated delayed recovery compared to those who trained without ice. A 2017 study showed that cold water immersion was no more effective than a standard active recovery (warm down) after resistance exercises.

A few recent small studies and animal studies have even indicated that icing after training results in lower muscle volume gains and reduced strength after exercise compared to no icing.[9,10] Read more about cold and sauna therapy here.

Key takeaway: Ice and cold water immersion can be valuable short-term recovery tools between events, but aren't beneficial as preventative or cautious practices—and may even interfere with beneficial muscle adaptations from exercise.

*Acute inflammation is needed for muscle recovery. However, for injuries and in situations where that inflammation may be doing more harm than good, NSAIDS and ice can be beneficial in controlling that inflammation. Talk to your healthcare provider for more information.

Here’s what may work to reduce muscle pain and soreness

Active recovery

It doesn’t get more back to the basics than this: take time after a workout for active recovery. Exercise increases blood flow to the working area, which is beneficial to initiate the recovery process. In fact, research shows that active recovery of 20 minutes post-exercise using the fatigued muscles is more effective in reducing DOMS compared to working other muscle groups.[11] So if you cycle to fatigue, for example, an effective active recovery could be cycling at a lower intensity for 20 minutes.

A review including 99 studies showed significant decreases in DOMS in athletes who participated in active recovery methods. The best recovery methods are dependent on the sport and athlete, but proper active recovery should help muscles feel more rested for the next training session and help an athlete stay injury-free.

Fish oil supplements

Studies show that taking fish oil supplements rich in omega-3 fatty acids DHA and EPA may reduce muscle soreness and improve measures of muscle recovery, like range of motion. This is likely due to the positive impact these fatty acids have on inflammatory and immune processes.[1,2,12]

However, the optimal dose of this supplement isn’t clear yet. A seven-week randomized controlled trial found that a 6g fish oil supplement lowered soreness ratings after exercises compared to lower supplemental doses of 2g or 4g per day. [1] However, other studies have shown that ~1g or 2g daily fish oil supplements may still be beneficial for perceived pain after exercise.[2,12] Talk to a healthcare provider or registered dietitian for questions on what dose may be best for you. And check out this article on the heart health benefits of fish oil.

Collagen supplements

Collagen is a type of protein that supports connective tissues (including tendons and ligaments). Collagen supplements, often sold as powders, appear to reduce joint pain in athletes, both during physical activity and at rest.

Separate studies show that supplementation regimens of 5g of collagen peptides per day for 12 weeks and 10g of collagen hydrolysate per day for 24 weeks are both viable options to significantly improve measures of joint-related pain.[13,14] Collagen supplements can be taken any time of day, before or after a workout.

Curcumin supplements

Curcumin is the main active compound in turmeric and has antioxidant and anti-inflammatory effects in the body. A systematic review of 11 studies found that curcumin supplementation of 150-1,500 mg per day reduces perceived muscle pain and muscle damage while increasing muscle performance.[15] Study investigators concluded that curcumin plays an important role in controlling inflammation and protein breakdown associated with muscle damage. Read more about curcumin’s effect on inflammation here.

Foam rolling

This is a self-messaging technique used to target fascia, the connective tissue around the muscles. Foam rolling can bring oxygenated blood into your fascia and may help to reduce the perception of muscle pain. This can also be done with tennis balls, lacrosse balls, or massage sticks.

While it is a well-accepted technique among athletes and trainers, the scientific literature on foam rolling is still emerging. Though some studies have shown that it does improve range of motion and pain indices, others do not show a significant effect.[16] Either way, foam rolling is generally safe to practice. To get the most benefit, roll out fatigued muscles for 20 minutes after exercise.

Summary of exercise-induced fatigue relief methods

Exercise induces acute inflammation, which is needed for recovery and muscle growth.
NSAIDs like ibuprofen are designed to block that inflammation, and while they are safe to use for occasional relief, consistent use is not beneficial for athletes or muscle growth.
Ice and cold water immersions aren't beneficial as a preventative measure of reducing muscle pain but can be beneficial as a short-term recovery method.
Active recovery and self-massaging techniques like foam rolling increase blood flow to the fatigued muscle and can help relieve symptoms of DOMS.
Fish oil, collagen, and curcumin supplements all appear to improve pain in athletes.

Molly Knudsen, MS, RDN

Molly is a Content Writer and Team Nutritionist at InsideTracker. As a Registered Dietitian, Molly enjoys connecting people to the food they eat and how it influences their biomarkers. When she’s not writing about the latest nutrition science, she’s likely in the middle of a yoga flow or at the beach with a good book.

References

[1] https://pubmed.ncbi.nlm.nih.gov/32727162/

[2] https://www.ncbi.nlm.nih.gov/pubmed/27085996

[3] https://pubmed.ncbi.nlm.nih.gov/12617692/

[4] https://www.ncbi.nlm.nih.gov/pubmed/11701094

[5] https://www.ncbi.nlm.nih.gov/books/NBK556083/

[6] https://www.ncbi.nlm.nih.gov/pubmed/30002579

[7] https://www.ncbi.nlm.nih.gov/pubmed/32346802

[8] https://pubmed.ncbi.nlm.nih.gov/28834248

[9] https://pubmed.ncbi.nlm.nih.gov/22820210

[10] https://pubmed.ncbi.nlm.nih.gov/33764172

[11] https://pubmed.ncbi.nlm.nih.gov/27706260/