A woman photographed from behind in activewear gripping her back

Pain vs injury: what’s the difference between DOMS and damage?

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Muscle soreness is expected after a tough workout. But how much pain is too much pain? 

If you’re new to exercise, going back to training after some time off or on a bid to really increase your training, you can expect that your workouts will be a little uncomfortable. Heck, even if you’re used to hitting the gym hard, training can come with a whole lot of aches and pains.

Firstly, it’s totally normal to feel a little sore during and after your training. But there’s a fine line between pushing hard and pushing too hard. The latter is when injuries occur. “The really important bit is that exercise is fantastic for lots of reasons, from muscle and bone development, regulating hormones, improving metabolism and supporting physical, social and mental health,” says Christine Fletcher, senior physiotherapist at UltraSports Clinic. “Even if people are experiencing a bit of pain, it’s really important to exercise and to modify it depending on injury risk and comfort levels.”

The problem is that so many people don’t know where the line between normal pain and bad pain sits. “At the moment, I’m mainly treating people for injuries related to the fact that they’re overdoing it,” says Fletcher. “It’s not so much that the activity is bad or they’re using bad technique, but simply down to the fact that they’ve been sedentary for so long due to Covid and now are jumping back to what they used to be able to do. The body isn’t able to cope with such quick change.”

How much pain is normal during exercising?

Adaptation comes from tearing muscles or pushing your cardiovascular system – both processes that require at least a little bit of discomfort. “Think about holding a wall sit for a minute, for example. There’s going to be a burn and achy feeling – that’s expected,” says Fletcher. 

A key sign of risking an injury is if that discomfort lasts after the exercise has stopped. “If the pain lingers for more than that two or three minutes, then you need to think about whether you’re overdoing it,” says Fletcher.

“If you’re worried that an exercise is more painful than expected, you should check where the pain is coming from. We expect muscular pain, but bad form will usually make itself known in your joints,” she adds. 

A woman sat on the floor in activewear gripping her knee due to pain
You can expect muscle soreness, but joint pain may be a sign of overdoing it.

What’s the difference between DOMS and injury?

How you feel when you stop training is a massive signifier. There are three key indicators for when your DOMS (delayed onset muscle soreness, or the ache you feel the day after exercise) might be a sign of something more sinister.

Time scale

“A big distinction between DOMS and injury is time,” says Fletcher. DOMS will usually become apparent within 24 hours and have reduced, or gone altogether, by 72 hours. “If it comes up immediately after or isn’t resolved after three days of discomfort, you’re probably looking at an injury.”

Location

“If you’re not sure if your pain is a problem, the location will also give you an idea,” says Fletcher. Normal DOMS will present their pain through the ‘muscle belly’ – the largest sections of the tissue. “Post-exercise pain is going to be your quads, your biceps, triceps or maybe in your abdominals, as opposed to occurring around your joints or in a very pinpoint specific place,” she explains. That’s because DOMS are caused by muscle tissue tearing during the eccentric loading phase of an exercise. Joint tissue isn’t loaded in the same way, and therefore can’t be torn or experience post-session pain the same way. Joint pain is often a sign of inflammation.  

The feeling

You can expect to feel generally achy, stiff and tight from training. But an injury is more likely to be “really deep, sharp or persistent – even hurting when you’re sleeping or sitting for example, whereas muscle soreness generally only occurs with movement. If you’ve got swelling, you definitely want to have that injury checked out.”

Remember that injury can be prevented by tuning into your body. Don’t push through if you feel like your training is too intense, you’re getting joint pain or aches in muscles you weren’t expecting them in, or you’re pushing your range of motion past its natural point. If you’re worried, check in with a personal trainer about your form or talk to a physio about your discomfort during training. 

Images: Pexels

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Chloe Gray

Chloe Gray is the senior writer for stylist.co.uk's fitness brand Strong Women. When she's not writing or lifting weights, she's most likely found practicing handstands, sipping a gin and tonic or eating peanut butter straight out of the jar (not all at the same time).