Muscle Damage Affects Your Running Gait

Picture from Aspetar

I was away for my Kinesio Taping recertification for Instructors last week and had to exercise in a new environment. As the gym was much bigger and had equipment that I do not normally have access to, I chose to use mostly those. 

As a result I ended with muscle soreness almost all over. I went for a run a day after I came home and my running stride felt 'off.' Turns out I was not imagining it. That is how our bodies try to protect itself. So is that good or is that a problem?

Turns out it may be both (Markus et al, 2025). The muscle soreness indicate that adaptations are beginning. However, that soreness can also change our running form, increasing injury risk.

To assess how exercise induced muscle damage (EIMD in this study) or delayed onset of muscle soreness (DOMS) affects running biomechanics and recovery, researchers got their subjects to run downhill for 60 minutes. This was done on a treadmill at -10 percent gradient. The runners ran at 65 percent of their max heart rate.

The researchers tracked running gait changes, muscle soreness, blood markers for muscle damage and also did MRI scans of thigh muscles immediately post run, 24, and 48 hours after.

The runners took shorter steps 24 and up to 48 hours after that run, likely as a compensating mechanism since taking a smaller stride is the body's way of reducing impact when muscles are fatigued or damaged. Damaged muscles were verified (significantly elevated) using blood markers (creatine kinase and lactate dehydrogenase) and MRI scans showed thigh muscles damage. 

Take home message? If you just had a hard training session or especially a race, you have to expect some biomechanical changes for at least 48 hours after that if you still want to run. Since you have a reduced stride length, your pace will be slower and you will be running less eficiently. 

Anything else that will help? My personal experience suggests that performing reduced intensity and low volume exercise will increase blood flow to the affected muscles and often reduce pain. Pedaling at low resistance on a stationary bike is ideal as you don't have to worry about traffic (if you ride on the roads). An easy swim or just walking in waist or chest height water works well too.

 Wearing compression garments will help reduce it as well. These above mentioned strategies do have some support in the research.

Or better still, give yourself a few days of well earned rest (especially after a race) before going hard again. 

Reference

Markus I, Arutiunian A, Ohayon E et al (2025). Kinetics Of Recovery And Normalization Of Running Biomechanics Following Aerobic-Based Induced Muscle Damage In Recreational Male Runners. J Sci Med Sport. DOI: 10.1016/j.sams.2025.01.002

Thoracic Outlet Syndrome

picture from mountainhp

We had a Team Singapore cyclist who came to our clinic complaining of arm weakness, tingling sensations, pins and needles in his biceps and forearms after full on sprints. This did not happen during the sprints, but after. He also complained of neck pain and some sensations of electric currents in his neck region when he tried looking upwards.

picture from J Manip Phy Therapeutics

The doctor he saw at the Singapore Sports Institute diagnosed him with compartment syndrome in his arms. With compartment syndrome, as physical activity ceases, all symptoms should start to ease. My patient's discomfort and symptoms only started after he stopped sprinting.

Individuals with compartment syndrome will usually complain of pain, paraesthesia (or pins and needles), their limbs (usually legs) being very tight, tense and full of pressure during training or doing the offending activity. Temporary paralysis can occur sometimes. It usually happens to athletes at the start of the season, after their break when they train too hard, too soon. 

During exertion, the muscles expand and they fill up the space in the legs and "squeeze" the nerves and blood vessels there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

My patient probably has thoracic outlet syndrome (TOS) instead of compartment syndrome. TOS occurs when blood vessels or nerves in the space between the collar bone and first rib (this space is known as the thoracic outlet) are compressed causing neck, shoulder and arm pain and numbness in the arms and fingers.

There are a few types of TOS. My patient probably has the most common version known as neurological TOS, when the brachial plexus is compressed. The brachial plexus is a big network of nerves from the spinal cord and it controls muscle movements in the shoulder, arm and hand.

A common area where TOS occurs is in the interscalene triangle (formed by the brachial plexus, the subclavian artery exiting the neck area between the anterior and medial scalene muscles and the inner surface of the first rib). 

Brachial plexus

Entrapment in the interscalene triangle may be due to brachial plexus passing through the anterior scalene (especially when the anterior scalene is larger). In my patient's case, since he is a track cyclist (with bulging neck and arm muscles) who sprints in a velodrome with excessive traction forces while sprinting plus deadlifting and snatching the Olympic bar during weight training, all these factors could very well contribute to his TOS.

After a detailed questioning and physical assessment, we managed to treat his spine and and the nerves in that region. That cyclist was able to train without the accompanying pain and symptoms after.

Reference

Dahlstrom KA, and Oliver AB (2012). Descriptive Anatomy Of The Interscalene Triangle And The Costoclavicular Space And Their Relationship To Thoracic Outlet Syndrome: A Study of 60 Cadavers. J Manip Physiol Therapeutics. 35(5): 396-4001. DOI: 10.1016/jmpt.2012.04.017

Team Singapore Asian Games Athlete Has Compartment Syndrome? No Way

My first patient at 830 am today was an interesting case. The patient (who shall remain anonymous) was told that he/she had compartment syndrome and he/she had so far received acupuncture/ needling with current, massage (many times), electrical stimulation plus other treatment on the leg and foot etc but did not get better at all.

Now my patient is due to fly out to Guangzhou to represent Singapore for the Asian Games early next week and presented this morning with tingling sensations on the lower third of the right leg and the patient also complained there was decreased sensation there and also had pain in the web space between the big and second toe. Now those of you (who are physiotherapists) reading this should already be thinking to yourselves that nooooo, this cannot be a case of compartment syndrome.

If a patient has compartment syndrome he/she will complain of pain, paresthesia (or pins and needles), the limbs (usually legs) being very tight, tense and full of pressure. Temporary paralysis sometimes occurs. It usually happens to athletes at the start of the season after their break when they train too hard, too soon. The muscles expand and they fill up the space in the legs and "squeeze" the nerves there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

Now, my patient is at the tail end of the season (not at the start of the season and certainly not after a break from training), the symptoms he/she complains of doesn't resemble compartment syndrome at all I thought. Why? My patient's pain did not subside after training/ cessation of activity. In compartment syndrome, with cessation of physical activity, the muscles will stop working and subsequently stop squeezing on the nerves and the patient's pain/ pressure/ tightness should settle (but did not).

The biggest clue to me was the pain between big and second toe. This is a definite L5 (deep branch) nerve root distribution (which I confirmed after checking my patient's lumbar spine).

After assessing my patient fully, I treated my patient's spine and nerves, taped his/her foot and taught a nerve stretch and I just found out my patient was better and able to train later.

Well, I am no longer working at the Singapore Sports Council and I can only treat the athletes that come and look for me at our clinics. So my best wishes to Team Singapore at the Asian Games.

All the best at the Asian Games, Team Singapore. Do us proud.

*Picture shows treatment of my patient before coming to see me

Got DOMS?

This is what one of my patients who had DOMS did with his pain (cupping), hope you didn't do the same.

DOMS or delayed onset of muscle soreness is a condition where you have muscle pain, soreness or stiffness that is usually worse 2-3 days after exercise, hence the word delayed, and the pain usually subsides over the following few days.

Certain activities are more likely to cause DOMS. Those that require your muscles to forcefully contract while lengthening (eccentric contractions) seem to cause the most soreness. Ever took part in a race where there were lots of running downhill? Then you should know the feeling in your legs a couple of days later. Other examples of eccentric contractions are going down stairs or lowering your barbell slowly during weights. 

I've also seen patients/ athletes who had DOMS at the beginning of a new an exercise program (especially a new gym/ weight program), after a change in sports activities, or after prolonged or higher than usual intensity efforts.

DOMS is different from the muscle pain or fatigue you experience during exercise. The onset of pain from DOMS always occurs 2-3 days after the cessation of exercise. This helps differentiate it from more acute injuries such as a muscle rupture or sprain.

The soreness will go away on its own after a few days. There are a few things you can do to help. Icing or contrast baths (hot/cold) seems to help although no clear evidence proves they are effective. I had severe DOMS in my legs after my first half marathon race about 12 years ago and tried contrast baths and they didn't seem to help much. Gentle stretching of the affected muscles has also been recommended although there is again no real published evidence found.

There is some evidence that massage seems to help alleviate DOMS by about 30%, but it had no effects on muscle function.

Wanna know what seems to work? My personal experience suggest that performing reduced intensity and low volume exercise will increase blood flow to the affected muscles and often reduce pain. Pedaling at low resistance on a stationary bike is ideal as you don't have to worry about traffic (if you ride on the roads). An easy swim or just walking in waist or chest height water works well too. Wearing compression garments will help reduce it as well. These above mentioned strategies do have some support in the research.

Can you prevent it? Szymanski (2003) suggests the repeated-bout effect as a way of reducing DOMS. This is a progressive adaptation to eccentric exercise. If you perform repeated bouts of lower intensity eccentric exercise 1-6 weeks before your key event,it will help reduce DOMS and exercise induced muscle damage. Thus, a gradual introduction of eccentric exercise, over a period of weeks, is encouraged.

References

Herbert,RD and De Noronha, M. (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews. Issue 4. The Cochrane Collaboration.

Szymanski, D. (2003). Recommendations for the avoidance of delayed-onset muscle soreness. Strength and Conditioning Journal 23(4): 7–13.

Zainuddin, Z et al (2005).Effects of massage on delayed-onset muscle soreness, swelling and recovery of muscle function.Journal of Athletic Training.Jul-Sep;40(3):174-80.