Should a weights session hurt more two days later than it did the day after? After your first two strength sessions in years, sitting down on a chair hurts more on the second day than it did on the first, and the ache alone may not tell you whether this is soreness or an injury. Check yourself against the signs below before the third session is due.
Why the second day can hurt more than the first
Delayed onset muscle soreness, the kind typically caused by strenuous or unaccustomed exercise, peaks between 24 and 72 hours after the session, so a second day that hurts more than the first is within its usual timing. Exercise that is hard or long enough, and that makes muscles work while they lengthen under tension, typically causes temporary micro-damage in the muscle and local inflammation, and the soreness is how that inflammation shows itself.
You can expect sore muscles after a workout, but pain while you are exercising is a reason to stop right away.
What would tell you the pain is an injury
Signs of a serious injury include:
- severe pain, swelling or bruising
- pain and swelling that do not go away after a few days
- being unable to put any weight on the area
- an obvious deformity
Check for them whatever you felt during either session. Any one of them means seeing a health care provider, such as your regular doctor. If the injury is serious, or the pain or bleeding is severe, go to the hospital right away or call 911; severe pain is on the list above as well, and it takes this faster route. Serious sports injuries are usually seen first by emergency physicians in emergency rooms. Go to the hospital right away, or call 911, for these too:
- chest pain during or after exercise
- a bone you think is broken
- a joint that looks out of position
- a popping sound followed by immediate trouble using the joint
How long the pain can last before you call your regular doctor
Call your regular doctor's office once muscle pain has lasted more than 3 days, counted from the day it started, even with none of the injury signs above. Do the same for muscle or joint pain that does not go away after self-care. For muscle pain from overuse or injury, home care includes resting the sore part and applying ice for the first 24 to 72 hours after injury to reduce pain, swelling and inflammation. After that, and not before 72 hours after an injury, heat often feels more soothing and may speed healing. Muscle aches from overuse often respond well to massage, and gentle stretching exercises after a long rest period also help.
Muscle pain can also be a sign of a condition affecting your whole body, such as some infections, including the flu, or lupus, which affects connective tissues throughout the body. Whenever one of these signs appears, contact the service named beside it:
| Sign | Who to contact |
|---|---|
| sudden weight gain, water retention, or urinating less than usual | 911 or your area's emergency number |
| shortness of breath or difficulty swallowing | 911 or your area's emergency number |
| muscle weakness, or being unable to move some part of your body | 911 or your area's emergency number |
| vomiting, a very stiff neck or a high fever | 911 or your area's emergency number |
| dark, red or cola-colored urine | your regular doctor's office |
| swelling or redness around the tender muscle, or any other sign of infection | your regular doctor's office |
| poor circulation where the muscles ache, for example in your legs | your regular doctor's office |
| a tick bite or a rash | your regular doctor's office |
| muscle pain linked with starting a medicine or changing its dose, such as one taken to lower cholesterol | the office of whoever prescribed it |
Dark, red or cola-colored urine can be a symptom of rhabdomyolysis, a breakdown of muscle tissue. The muscle's contents enter the blood, where they often damage the kidneys. Severe exertion, such as marathon running or calisthenics, can lead to it, and getting treated soon after rhabdomyolysis will reduce the risk of permanent kidney damage. Urinating less than usual is a 911 sign on its own, so dark urine that comes with it goes to 911.
Whether to do the third session, and what to change in it
Hold the third session until the soreness has gone: avoid weight lifting and high-impact aerobic activities when injured or while in pain. Walking, cycling and swimming are good aerobic activities to try. Pausing the weights is not the same as giving them up: to build strength and stamina you will need to push your body, and the key is to push slowly and gradually.
In general, avoid increasing the number of days you exercise, the length of time you exercise and how hard you work out, all at the same time. Going from no training to two sessions in one week raised all three together, so when you go back, begin slowly and increase your workouts gradually, and do not raise all three at once.
Rest in between workouts. Skipping that rest is one of the most common causes of exercise injuries, and so are pushing your body too hard or too quickly and doing an exercise that is too strenuous for your level of fitness (see Strength work twice a week, and why it matters during weight loss).
Warm up by exercising slowly for the first few minutes, then picking up the pace, because exercising before your body has warmed up is another common cause of injury, and cool down by ending at a slower pace for the last 5 to 10 minutes. If the movements are new to you, lessons or a personal trainer can teach you good form, and learning the right way to do an exercise can help prevent injury.
To stay flexible, stretch at least 2 times a week, though it is unclear whether stretching really helps reduce injury. Stretch after you have warmed up or after you exercise, never with cold muscles, hold each stretch for no longer than 15 to 30 seconds, and do not bounce. Drinking lots of fluids before, during and after exercise may help lower the risk of muscle aches.
If one movement hurts during the next session, stop it right away: working through the pain of an injury, whether it came on suddenly or from overuse, may cause further harm. Being tired all the time can also be a sign that you may be overdoing it.
What a doctor will ask about the pain
A doctor looking at muscle pain will examine you and ask questions such as these, so have your answers ready:
- when the pain started, and how long it lasts
- where exactly it is, whether it is all over or in one area, and whether it stays in the same place
- what makes it better or worse
- anything that came with it, such as joint pain, fever, vomiting, weakness, malaise, which is a general feeling of discomfort or weakness, or trouble using the muscle
- any pattern to the aches
- any new medicines you have taken lately
Include what the two sessions involved and how far apart they were, because a doctor diagnosing a sports injury will likely ask how it happened and whether you recently changed the intensity of your activities.
If you are a NicoCares patient and the pain is linked with starting a medicine, or changing its dose, describe it to your care team in a Spruce message (the invitation to Spruce came to you by email from NicoCares); the physician who prescribed it remains reachable about side effects and dose changes while your subscription is active. The care team answers there without a stated time, so also call your regular doctor's office, and for any sign in the table's 911 rows, call 911 instead of writing.
