I'm too sore to exercise!
Updated: May 26, 2022
People often don't know where to start with getting back into exercise, or doing activities they enjoy after injury, especially if they suffer from persistent pain. The common roadblock to getting active is, "I'm too sore, or it makes me sore". While we know that acute bouts of exercise can increase pain in people with chronic pain issues, regular exercise can be a very effective treatment. Some of the science to help is below and at the bottom are some guidelines of how to start and what to aim for.
Macrophages are a specialist white blood cell that are very important in the bodies immune system. Macrophages are considered plastic in that they can be in 2 different forms based on their external environment. We are going to briefly touch on 2 types of macrophages, M1 which secrete inflammatory cytokines (proteins made by your immune system), and M2 which secrete anti-inflammatory cytokines and promote tissue repair. Inflammatory cytokines activate nociceptors (special neurons that transmit noxious/painful information to your central nervous system) and can promote pain. Whilst anti-inflammatory cytokines inhibit nociceptors and help promote analgesia (pain reduction) [1,2,3].
"In physically active animals there was an increase in the number of macrophages that expressed the M2 markers, suggesting a change in phenotype.These data together suggest that the effects of regular physical activity are to increase M2 macrophages in muscle tissue, which results in an increase in IL-10 in muscle that reduces nociceptor activity".
So what does this mean??? In summary it appears regular exercise causes your body to produce more M2 macrophages which have an anti-inflammatory and a pain reducing effect. If we sit on the couch all day , we make more M1 macrophages, which promote inflammation and pain. So if you are sore get checked out first by one of our osteopaths and then we can set you on a path back to activity and making lots more M2!
Addis, Dylan & DeBerry, Jennifer & Aggarwal, Saurabh. (2020). Chronic Pain in HIV. Molecular Pain. 16. 174480692092727. 10.1177/1744806920927276.
How Do I Start? And what should I aim for?
Start slow and build up. You should eventually aim for 150-300 minutes a week (20-40 a day) of moderate exercise or 75-150 minutes of vigorous activity a week.
Do some sort of resistance or weight training exercise once to twice a week.
Try to do something everyday
When starting resistant work for the first time use body weight supported exercises eg cycling or swimming, weight machines, instead of using free weights.
Everyone starts with a lot of vigour, start slow, aim for half of the targets to begin with you have been sedentary. Increase at roughly 15% a week.
Finally, preempt the inevitable drop in motivation a few months in. Have a plan in place to switch sports, train with friends or switch to a new gym or try a new activity!
 Leung A, Gregory NS, Allen LA, Sluka KA. Regular physical activity prevents chronic pain by altering resident muscle macrophage phenotype and increasing IL-10 in mice. Pain 2016;157:79.
 Gong WY, Abdelhamid RE, Carvalho CS, Sluka KA. Resident macrophages in muscle contribute to development of hyperalgesia in a mouse model of non-inflammatory muscle pain. J Pain 2016.
 Sluka KA, Frey-Law L, Hoeger Bement M. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation. Pain. 2018;159 Suppl 1(Suppl 1):S91-S97. doi:10.1097/j.pain.0000000000001235
Landmark T, Romundstad PR, Borchgrevink PC, Kaasa S, Dale O. Longitudinal associations between exercise and pain in the general population–the HUNT pain study. PLoS One 2013;8(6):e65279.
Zhang R, Chomistek AK, Dimitrakoff JD et al. Physical Activity and Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Med Sci Sports Exerc 2015;47:757-764.
Sluka KA, O’Donnell JM, Danielson J, Rasmussen LA. Regular physical activity prevents development of chronic pain and activation of central neurons. J Appl Physiol 2013;114(6):725-733.