DOMS advice, please!

[Gala123]

Hi All

I have read through some posts here and came across a mention of DOMS - delayed onset muscle soreness. This is really timely, as I am currently struggling with this very thing.

I have had my PMR under control for a while, very minor tendon discomfort at the collar bone area and some permanent damage in my knees (due to concurrent inflammatory arthritis), otherwise rally stable for months and tapering slowly.

I have been exercising consistently though not quite to the same intensity and weights as I did before PMR. In December I fell (not while exercising) and broke my humerus bone (I have also been diagnosed with osteoporosis recently) . It healed really well, but I had been in a sling until about a month ago. I did exercise as much as I could even with a sling on. No issues with muscle pain. Now the sling is off and I am working with a PT, who is happy with my progress. We are working on retaining the full range of motion in my shoulder and restoring muscle strength in the affected arm. I really need to do these exercises, including strength exercises to avoid long-term deficits in my arm strength and function. I expected some DOMS after being in a sling for so long, but it just does not ease. I have had it for a month now and it stays there. I try to ease off a bit and if I miss a couple of days, it gets better, but as soon as I resume any upper body exercises, it comes back with a vengeance. I am constantly in muscle pain. It does feel different from PMR and I do not have any stiffness. Also, my lower body is not affected and I can do lower body exercises without experiencing DOMS.

So, it is probably not a flare, but I am getting worried that it might cause a flare. Any advice about how to deal with this? Thank you!

[PMRpro Ambassador]

I don't know it will cause a flare as such - but if you can't rest from the exercises the DOMS will remain until you can. Repetitive actions are poison in PMR - because the pred and PMR effects on muscle mean they don't heal as well as normal muscle does. Exercise in training, which is effectively what you are doing, results in microtears between the constituent parts of the muscle fibres. When those tears heal, the muscle is stronger, it is "trained". But to achieve that, the tears have to heal. What is happening is that they keep tearing so are unable to heal. In exercise you not only have to have training units, you also have to have rest units which are equally important to allow that healing to occur. In PMR it takes longer - so a single day between training units isn't enough.

You have to discuss it with the physio - but I would say rest until the pain resolves and then restart the physio with much less intense exercises. Much lower load, far fewer reps. Hydrotherapy - exercise in water - would be better. Concentrate on ROM and less on strength initially. And is there any pain relief that works for it?

[Gala123 in reply to PMRpro]

Thank you! This is what I was thinking, but it is so frustrating after I thought I have turned the corner with exercise. I think I still struggle to accept my limitations. I am not sure about pain relief either. I have not tried any, but paracetamol would be the only one I know, that I could try. I don't want to take NSAIDs, as they do not go well with either MTX or steroids, plus my pre-existing reflux. We do not have hydrotherapy facilities in my area, unfortunately. I just have to slow down, obviously, and it the hardest advice for me to follow, but I will try to be more disciplined with it

[PMRpro Ambassador in reply to Gala123]

What - not even a local pool? There are hydrotherapy pools at the hospitals here but you only get it when you really need it. So my physio got the details of the aquafit classes at the local pool, run by the rheuma charity, and sent me off to there. You don't have to go to a class though - and I have realised just how much of a workout arms and back muscles get just with hand and arm movements done underwater with your shoulders under water. The instructor uses all the items in the top row here

kuebler-sport.com/water-spo...

as well as the kickboxing gloves further down and plain old floats to increase the resistance but anyone with problems doesn't need to use them, just your hands against the water is low level resistance.

You even get online videos to show you how. I put the link but it didn't work so try googling this:

Aqua Aerobics: The Ultimate Guide for Beginners, Seniors, and Limited Mobility FIIT with Stacy

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Try this-

youtu.be/hgU3xTxCwBA?si=GME...(Not working as expected?)

[PMRpro Ambassador in reply to DorsetLady]

Thank you!!!!

[Gala123 in reply to DorsetLady]

This is great! Thank you.

[Gala123 in reply to PMRpro]

Yes, we have a pool. I might have to do it myself like you recommend. It looks potentially very useful now that I can actually get in and out swimsuit

[PMRpro Ambassador in reply to Gala123]

Tight swimsuits are a deterrent I admit!!! But you do get versions that are easier!!

[Gala123 in reply to PMRpro]

I am fine with it these days, fingers crossed, but I did acquire a font-zip one when I struggled to move my arms.

[camshall]

I haven't been to the gym since Xmas, when I had a flare. A lot of the pain and aches in my arms has subsidised and I feel generally better. I'm going to stay out of the gym until the PMR is finished with me. I walk up to 90 minutes every day, weather permitting. And I'm still playing golf 2 or 3 times a week.

[Gala123 in reply to camshall]

Looks like you found your balance. I am still looking for the right balance of rest required by PMR and exercise that I need to do for my other conditions. I will get there eventually.

[Groggrim in reply to Gala123]

One of my sons is a PT and he often recommends resistance bands. He got me some. You can get varying strengths.

[Gala123 in reply to Groggrim]

Thank you, I do us them. Unfortunately, after my injury everything seems to aggravate pain in the upper body, even the light resistance bands, though I used heavy before. It is always hard to take a step or quite a few steps back