5 Exercises You Should Perform If You Sit All Day

Rehab Specialist Mike Reinold, provides the following article to make sitting not so bad for the body:


Do you sit all day? Don’t worry you are not alone.

Sitting throughout the day, and a more sedentary lifestyle in general, has dramatically increased over the last several decades as desk jobs have become more popular and our devices have taken over as our form of entertainment.

The media loves to tell you that “sitting is the new smoking.” This is backwards in my mind, and something I’ve discussed in detail in a past article sitting isn’t bad for you, not moving is.

In the article, I listed 3 things you should do if you sit all day to stay healthy:

  1. Move, Often
  2. Reverse your posture
  3. Exercise

For those looking for some specific exercise, here are 5 great exercises to perform to combat sitting all day.


5 Exercises You Should Perform if You Sit All Day

I’ve been talking about the concept of Reverse Posturing for years. The concept is essentially that we need to reverse the posture that we do the most throughout the day to keep our body balanced and prevent overuse.

Sitting involves a predominantly flexed posture, so doing exercises that promote the posterior chain would be helpful. These will depend on each person, but if I had to pick a basic set of exercises these would be the 5 exercises to combat sitting all day.

Thoracic Extension

The first exercise is for mobility of your thoracic spine. This is the portion of your back that becomes the most flexed while sitting all day. This is probably the biggest bang for you buck exercises in my mind:

Thoracic Extension Stretch

True Hip Flexor Stretch

The second exercises is another mobility drill, this time for the pelvis. We always perform mobility drills first to maximize range of motion. This exercise is called the true hip flexor stretch, something I termed several years ago after seeing so many people do this stretch poorly.

This exercise will help prevent your hips from getting too tight, as well as put your entire spine in a better position.

True Hip Flexor Stretch

Chin Nods

Now that we’ve done a couple of mobility drills, let’s try to reinforce a few movement patterns to reverse your sitting posture and activate a few select muscle groups.
The first is the chin nod, which is great for the neck muscles and forward head posture. Many have heard of the chin tuck exercise, but the chin nod exercise is a little different in my mind.

Chin Nods Stretch

Shoulder W’s

The next exercise builds off the chin nods, and now combines the chin nod posture with retraction of your shoulders. This will help turn on your posterior rotator cuff and scapular muscles all in one drill.

Shoulder W’s Stretch

Glute Bridge

Lastly, we want to focus on the glutes and their ability to extend the hips, and taking some pressure off your low back. This glute bridge exercise, in combination with the above true hip flexor stretch, will be a great combo to help with your overall posture and core control.

Glute Bridge Stretch

How to Integrate These Exercises into Your Day

An easy way to start and keep it simple is to perform each of these 10 times. These should take less than 5 minutes to perform and will make a big impact on how you feel throughout the day.
Many people ask, “how many times a day should I perform these?” Or even, “do I need to do these every day?”

You don’t need to do these every day. Just on the days that you sit… 🙂

But seriously, remember these are 5 exercises you should do if you sit all day, so doing them at the end of each day to reverse your posture is a great idea. Many people who sit for a really long time like to perform them during the day as well.

As you get comfortable with them, you may find that certain ones help you feel better than others. Feel free to add repetitions to those as needed.

Written by Mike Reinold, PT


Looking to make sitting not so bad,

Dr. Phil Kotzan, DC

Sorry, Sitting Isn’t Really That Bad For You

Here is rehab expert Mike Reinold’s article on sitting:

Over the last several years, the health concerns surrounding sitting have really been highlighted by the health and fitness crowds, as well as the mainstream media.  In fact, there have been entire books published on this topic.  I’ve seen articles with titles such as “Sitting is Evil,” “Sitting is the New Smoking,” and even “Sitting will kill you.”

Wow, those seem pretty aggressive.  We’ve been sitting since the beginning of time!  I’m going to really shock the world with this comment…

Sorry, sitting isn’t really bad for you.

Yup.  There is nothing wrong with sitting.  I’m actually doing it right now as I write this article.  You probably are too while you read this article.

Don’t get me wrong, sedentary lifestyles are not healthy.  According to the World Health Organization, sedentary lifestyles increase all causes of mortality and raises the risk of health concerns such as cardiovascular disease, diabetes, obesity, cancer, and even depression and anxiety.

But let’s get one thing straight:

It’s not sitting that is bad for you, it’s NEVER moving that is bad for you.

By putting all the blame on sitting, we lose focus on the real issue, which is lack of movement and exercise.  We are seeing a shift in people switching to standing desks at work, still not exercising, but thinking that they are now making healthy choices.

This is so backwards it boggles my mind.

It it all begin with the negative myth that “sitting is the new smoking” and completely ignores the true issue.

The body adapts amazingly well to the forces and stress that we apply to it throughout the day.  If you sit all day, your body will adapt.  Your body will lose mobility to areas like your hips, hamstrings, and thoracic spine.  Your core is essentially not needed while sitting so thinks it’s not needed anymore during other activities.  And several muscles groups get used less frequently while sitting and weaken over time, like your glutes, scapular retractors, and posterior rotator cuff.

Your body is a master compensator, and will adapt to the stress applied (or not applied) to make your efficient at what you do all day.

Unfortunately, when all you do is sit all day, and you never reverse this posture or exercise, your body adapts to this stress to make you the most efficient sitter.
That’s right, you get really good at sitting.

For example, think about what happens to the core when you sit all day.

One of the functions of your core is to maintain good posture and essentially to keep the bones of your skeleton from crashing to the floor.  The core is engaged at a low level of muscle activity throughout the day for postural needs.

The problem with sitting is that the chair also serves this function, so your core isn’t needed to keep you upright, the chair serves this function. If sitting is all you do, then when you stand up, your core essentially isn’t accustomed to providing this postural support so you rock back onto your static stabilizers by doing things like standing with a large anterior pelvic tilt and lumbar extension.

Unfortunately, this becomes the path of least resistance, and most energy efficient, for your body.  Your core gets used to relying on the chair to function, then when you need it, gets lazy.

Despite what you may read in the media, it’s OK to sit all day.  That is, as long as you are reversing this posture at some point.  This can be as specific as exercises designed to combat sitting and as general as simply taking a walk in the evening.

3 Strategies to Combat Sitting All Day

I want to share the 3 things that I often discuss with my patients.  You can apply these yourself.  But if you sit all day, you really should:

  1. Move, Often
  2. Reverse your posture
  3. Exercise

But the real first step is to stop blaming sitting and start focusing on the real issue.  It’s lack of movement and exercise that is the real concern, not sitting.

Step 1 – Move, Often

The first step to combatting sitting all day is to move around often.  The body needs movement variability or it will simply adapt to what it does all day.

I get it, we all work long days, and sitting is often required in many of our jobs.  But the easiest way to minimize the effects of sitting all day is to figure out ways to get up and move throughout the day.

This doesn’t need to be 10 minutes of exercise, it could simply be things like getting up to fill up a water bottle or taking quick 2 minute walk around the office.  When I am not in the clinic or gym, I personally tend to work in my home office.  What I do is try to work in one hour chunks, so I will get up and walk around in between chunks to get a glass of water, snack, or use the bathroom.

This works well for me, but you need to find what works for you.  I know of others that use things like Pomodoro timers, or even some of the newer fitness tracking devices, which can remind you to stand up and move around at set times.

Step 2 – Reverse Your Posture

I’ve been talking about the concept of Reverse Posturing for years.  The concept is essentially that we need to reverse the posture that we do the most throughout the day to keep our body balanced and prevent overuse. Sitting involves a predominantly flexed posture, so doing exercises that promote the posterior chain would be helpful.

Step 3 – Exercise

Remember going back to some of the past concepts above, the body adapts to the stress applied.  To combat this perfectly, a detailed exercise program that is designed specifically for you and comprehensively includes a focus on total body and core control is ideal.

This will assure that the muscle groups that are not being used while sitting all day get the strength and mobility they need, while the core gets trained to stabilize the trunk during functional movements.

If you want to get the most out of your body and stay optimized, you need to do things like work on your hip and thoracic spine mobility, strengthen your rotator cuff, groove your hinge pattern, and learn how to deadlift and work your glutes.

Sitting Isn’t Bad For You, Not Moving Is

As a profession, we need to get away from blaming sitting as the enemy and labeling it evil.  Our society is sitting more and more each generation.  We need to be honest with ourselves and realize that sitting isn’t the problem, it’s not moving enough that is the concern.  We need to stop pointing fingers and get to the root of the problem.

Go ahead and sit, just move more often and use these 3 strategies to combat sitting all day.

Written by Mike Reinold, PT

Sit yet move…

Dr. Phil Kotzan, DC

5 Ways To Get More Out Of Your Self-Treatment

“It’s not always just about WHAT you are using to roll out, it’s also about HOW you are performing self myofascial release that is important,” says physical therapist Mike Reinold. “If you combine some of our basic understanding of functional anatomy with our understanding of movement, we can really enhance how you perform self myofascial release to get even better results.”  He suggests to follow these 5 techniques:


Reduce The Surface Area for certain areas of the body

Roll In 360 Degrees to loosen tissue in multiple directions

Hold A Spot to decrease tenderness

Add Active Motion to run the tissue through its range of motion

Move Another Muscle to release it from the one you’re stretching

Credit: Mike Reinold, PT

I hope these help you’re self-treatments.  If you have any questions, please feel free to ask. Good luck!

Dr. Phil Kotzan, DC

Doing Treatment On Yourself? MOVE! while doing it

When we do treatment on ourselves, it is done to facilitate improvement during movement/use.  It only makes sense to do the movement while we are treating!

Foam rollers

Lacrosse balls


ART-type fascia pulls

Add movement!  Do it while walking/swinging/bending/etc.

Dr. Phil Kotzan, DC

The Best Hip Flexor Stretch

Physical therapist Mike Reinold says, “The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.” He offers the following stretch as a way of preventing too much back extension and anterior hip capsule strain.  Try this stretch out:

Hip Flexor Stretch

Credit: Mike Reinold, PT

Looking to offer the best way to do your hip flexor stretch…

Dr. Phil Kotzan, DC

6,000-Year-Old Knee Joints Suggest Osteoarthritis Isn’t Just Wear And Tear

American doctors have been noticing an increase in osteoarthritis of the knee. They have suspected two driving forces: more old people and more people who are overweight.

A study published in this week’s Proceedings of the National Academy of Sciences argues that’s far from the whole story. Even correcting for body mass index and age, osteoarthritis of the knee is twice as common now as it was before the 1950s.

“That’s an incredible difference,” says Daniel Lieberman, a professor of human evolutionary biology at Harvard University and co-author of the study.

Lieberman started wondering about arthritis a few years ago as he was compiling a list of diseases that modern humans aren’t well-adapted to cope with — such as heart disease, lower back pain and nearsightedness.

“I wanted to include arthritis in the list, but realized that there wasn’t any good data,” he tells NPR.

So Lieberman asked Ian Wallace, a postdoctoral research fellow in his lab, to fly around the country and study human skeletons that had ended up in museums or had been donated to medical schools for scientific research. The skeletons were from people who died as long ago as 4,000 B.C..

“The oldest specimens that we looked at were some skeletons from prehistoric Inuit hunter-gatherers from Alaska,” Wallace says. The most recent were the remains of people who died in Tennessee in 2015.

Conventional wisdom is that osteoarthritis of the knee results mostly from wear and tear, which is why, these days, it’s more common among older people and those whose excess body weight puts extra stress on those joints..

But that’s not what the evidence showed.

“I was actually extremely surprised to find that [osteoarthritis] is much more common today” than it was in Americans long ago, says Wallace.

That higher rate held true even after scientists corrected for body mass and age. So there’s apparently something else driving the increase in knee arthritis. The current study doesn’t pinpoint that cause.

“If I were a betting man, I would guess physical activity is especially important,” Lieberman says. “One of the things that’s really shifted in our world today is that we sit all the time, and kids sit all the time. And that may be affecting how our joints are forming and how our joints are aging.”

This makes sense to Dr. Richard Loeser a rheumatologist who directs the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill.

“Your joints aren’t just like your automobile tires that wear out as you use them,” he says. In fact, exercise helps nutrients diffuse into cartilage in the knee and keep it strong and healthy.

If cartilage “is formed and more healthy when you’re younger, then your joints are more likely to be functioning better and have less osteoarthritis when you get older,” Loeser says. And exercise also helps fully grown people.

“By strengthening your muscles and by stimulating your cartilage you can still improve the health of your joint,” Loeser says.

That’s not to say that exercise fully explains the trend that the Harvard researchers have noted.

“There may be dietary factors that may be important,” Loeser suggests. And sports injuries, which he says “have become more and more common” may be contributing to arthritis, too.

As Lieberman and his colleagues try to figure out exactly what’s behind the problem, they’re hopeful that a lot of what’s driving it may be preventable.


Written by Richard Harris of NPR.


Protect those knees!

Dr. Phil Kotzan, DC

Does Balancing Cause Stability-Specific Strength Gains?

When using machines to perform an exercise, the balance challenge involved is smaller than when using free weights to perform a very similar exercise. Similarly, when using unstable surfaces, the balance challenge is greater than when using the same exercise on a stable surface.

More stability = less need to balance; less stability = more need to balance.

Does the need to balance cause stability-specific strength gains (part 2)?

Surprisingly, balance training on its own can increase strength.

This could mean that the balance aspect of unstable surface training could lead to strength gains irrespective of the loading used.

Studies show that balance training even without concomitant strength training leads to strength gains (Heitkamp et al. 2001; 2002; Bruhn et al. 2006; Myer et al. 2006; Beurskens et al. 2015; Cug et al. 2016). Such gains seem to be connected with increases in rate of force development (Gruber & Gollhofer, 2004; Bruhn et al. 2006; Gruber et al. 2007; Behrens et al. 2015), probably caused by increases in early phase neural drive, through faster motor unit firing rates (Gruber & Gollhofer, 2004).

What is behind these changes is unclear.

Increases in neural drive after strength training appear to be partly caused by increases in corticospinal excitability (Beck et al. 2007; Griffin & Cafarelli, 2007; Kidgell et al. 2010), and partly because of reductions in corticospinal inhibition (Latella et al. 2012; Weier et al. 2012; Christie & Kamen, 2014; Rio et al. 2015).

At first glance, it might seem that balance training produces completely different neural adaptations, as it causes reductions in corticospinal excitability in balance tests (Taube et al. 2007; Beck et al. 2007; Schubert et al. 2008). However, these reductions in corticospinal excitability are very task-specific, just like improvements in balance (Kümmel et al. 2016). In fact, corticospinal excitability is elevated after balance training in tests that have not been practiced, including strength tests.

This shared mechanism could explain why additional gains in strength do not arise either when balance training is preceded by a period of strength training (Bruhn et al. 2006), nor when a program of balance training is performed together with a program of strength training (Manolopoulos et al. 2016). It may also explain how strength training can improve balance in a range of populations (Heitkamp et al. 2001; Anderson & Behm, 2005; Orr et al. 2008; Manolopoulos et al. 2016), and also increases co-ordination (Carroll et al. 2001).

This shared mechanism of strength gains by changes in neural drive may partly account for the larger-than-expected gains in strength after training on unstable surfaces, but given the similarity between the changes after balance and strength training, probably cannot explain stability-specific gains in strength.

Does the need to balance cause stability-specific strength gains (part 3)?

The need to balance seems to affect the co-ordination patterns of muscles during multi-joint exercises. This affects the extent to which force can be produced during specific, dynamic movements.

Performing an exercise in an unstable environment produces greater activation of the synergist and antagonist muscles compared to the exact same exercise performed under more stable conditions, even where agonist activation is similar (Cacchio et al. 2008; Schick et al. 2010; Ostrowski et al. 2016; Signorile et al. 2016).

More importantly, training in the unstable environment reduces the antagonist activation, and increases the activation of the stabilizers.

These changes lead to a more efficient pattern of muscular contractions in that specific, dynamic movement under unstable conditions, which improves strength very substantially, in a  stability-specific way.

For example, when comparing training with cable machines and with fixed bar path machines, Cacchio et al. (2008) found that training with the cable machines led to increases in the EMG amplitudes of the stabilizers, and reductions in the EMG amplitudes of the antagonist muscles during a cable machine strength test, while training with the fixed bar path machines did not.

Given that performance in balance tasks is very task-specific (Kümmel et al. 2016), and also that changes in neural drive after balance training are very task-specific (Beck et al. 2007; Schubert et al. 2008), it therefore seems very likely that such changes in inter-muscular co-ordination during specific dynamic movements are the underlying mechanism that causes stability-specific strength gains.

Since free weight exercises performed on the ground (like barbell squats) are most similar in terms of stability requirements to athletic ability tests (like vertical jumps), this also explains why free weights could indeed be described as “just right” in terms of external load stability, and therefore transfer most effectively to sport.


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  56. Ostrowski, S. J., Carlson, L. A., & Lawrence, M. A. (2016). Effect Of An Unstable Load On Primary And Stabilizing Muscles During The Bench Press. The Journal of Strength & Conditioning Research.
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  59. Prieske, O., Muehlbauer, T., Borde, R., Gube, M., Bruhn, S., Behm, D. G., & Granacher, U. (2016). Neuromuscular and athletic performance following core strength training in elite youth soccer: Role of instability. Scandinavian Journal of Medicine & Science in Sports, 26(1), 48-56.
  60. Ratamess, N. A., Beller, N. A., Gonzalez, A. M., Spatz, G. E., Hoffman, J. R., Ross, R. E., Faigenbaum, A. D., & Kang, J. (2016). The Effects of Multiple-Joint Isokinetic Resistance Training on Maximal Isokinetic and Dynamic Muscle Strength and Local Muscular Endurance. Journal of Sports Science and Medicine, 15, 34-40.
  61. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277-1283.
  62. Rossi, Schoenfeld, Ocetnik, Young, Vigotsky, Contreras, Krieger, Miller, & Cholewa. (2016). Strength, body composition, and functional outcomes in the squat versus leg press exercises. The Journal Of Sports Medicine And Physical Fitness.
  63. Saeterbakken, A. H., van den Tillaar, R., & Fimland, M. S. (2011). A comparison of muscle activity and 1-RM strength of three chest-press exercises with different stability requirements. Journal of Sports Sciences, 29(5), 533-538.
  64. Saeterbakken, A. H., & Fimland, M. S. (2013a). Muscle force output and electromyographic activity in squats with various unstable surfaces. The Journal of Strength & Conditioning Research, 27(1), 130-136.
  65. Saeterbakken, A. H., & Fimland, M. S. (2013b). Effects of body position and loading modality on muscle activity and strength in shoulder presses. The Journal of Strength & Conditioning Research, 27(7), 1824-1831.
  66. Saeterbakken, A. H., & Fimland, M. S. (2013c). Electromyographic activity and 6RM strength in bench press on stable and unstable surfaces. The Journal of Strength & Conditioning Research, 27(4), 1101-1107.
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  78. Taube, W., Gruber, M., & Gollhofer, A. (2008). Spinal and supraspinal adaptations associated with balance training and their functional relevance. Acta Physiologica, 193(2), 101-116.
  79. Wahl, M. J., & Behm, D. G. (2008). Not all instability training devices enhance muscle activation in highly resistance-trained individuals. The Journal of Strength & Conditioning Research, 22(4), 1360-1370.
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  81. Weier, A. T., Pearce, A. J., & Kidgell, D. J. (2012). Strength training reduces intracortical inhibition. Acta Physiologica, 206(2), 109-119.
  82. Welsch, E. A., Bird, M., & Mayhew, J. L. (2005). Electromyographic activity of the pectoralis major and anterior deltoid muscles during three upper-body lifts. The Journal of Strength & Conditioning Research, 19(2), 449-452.
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Written by Chris Beardsley for Strength and Conditioning.


Looking to bring awareness to adding stability drills to strengthening,

Dr. Phil Kotzan, DC

Comparing Training On Stable Versus Unstable Surfaces

The advantages and disadvantages of unstable surface training have been discussed ad nauseam (e.g. Hubbard, 2010; Behm & Sanchez, 2013). Here, I want to focus on if strength gains are stability-specific. To do this, we can look at studies exploring:

  1. Training with stable vs. unstable surfaces, then testing strength on stable surfaces
  2. Training with stable vs. unstable surfaces, then testing an athletic ability

#1. Comparisons of training on stable vs. unstable surfaces on strength on stable surfaces

Very few studies have compared the effects of training on stable vs. unstable surfaces on strength on stable surfaces. Those that have are summarized in a recent systematic review (Behm et al. 2015), although the measures used to test strength were not differentiated from one another, which makes the results difficult to interpret.

The most stable surface typically measured in studies is maximum isometric force, using a dynamometer. Training on unstable surfaces tends to produce similar gains in maximum isometric force as training on stable surfaces (Kibele & Behm, 2009; Sparkes & Behm, 2010; Prieske et al. 2016).

The second most stable surface typically measured in studies is maximum dynamic force, using the strength exercise used in the stable-surface training group, such as 1RM bench press (Cowley et al. 2007; Marinković et al. 2012; Premkumar et al. 2012; Maté-Muñoz et al. 2014), 3RM bench press (Sparkes & Behm, 2010), 6RM bench press (Saeterbakken et al. 2016), 1RM back squat (Marinković et al. 2012; Maté-Muñoz et al. 2014), and 3RM back squat (Sparkes & Behm, 2010). Training on unstable surfaces seems to produce similar gains in dynamic strength in the exercise used during training, compared to training with the same exercise on stable surfaces.

This suggests that there is no evidence of stability-specific strength when testing strength on stable surfaces after either stable or unstable surface training. However, although not as well-researched, there are some suggestions that gains in strength on unstable surfaces might be greater after training on unstable surfaces (Sparkes & Behm, 2010; Saeterbakken et al. 2016), which would mean that stability-specific strength gains still occur, albeit only in one direction.

Importantly, however, all of these studies were performed in untrained individuals. 

Since there are indications that unstable surface training does not lead to greater EMG amplitudes than stable surface training with the same absolute loads in resistance-trained individuals (Wahl & Behm, 2008; Li et al. 2013), training on unstable surfaces may not be as effective as training on stable surfaces in trained subjects.

#2. Comparisons of training on stable vs. unstable surfaces on athletic performance

Very few studies have compared the effects of training on stable vs. unstable surfaces on athletic performance measures. Those that have are summarized in a recent systematic review (Behm et al. 2015), although the measures used to assess athletic ability are not differentiated, which makes the results difficult to interpret.

Looking only at those studies exploring the effects of lower body strength training on countermovement jump height, a majority have found that performing the exercises on stable surfaces is better than performing the exercises on unstable surfaces (Cressey et al. 2007; Oberacker et al. 2012), although a minority have found no differences (Maté-Muñoz et al. 2014).

This suggests that lower body training on unstable surfaces may not transfer as well the same exercises performed on the ground to common tests of athletic ability, such as vertical jumping.

Summary of results

• Unstable surface training does improve strength on stable surfaces to a similar extent as stable surface training in untrained subjects. However, this may not apply to trained individuals.

• Unstable surface training may not improve common tests of athletic ability as well as the same exercises performed on the ground.


Written by Chris Beardsley for Strength and Conditioning.

Looking to bring awareness to adding stability drills to strengthening,

Dr. Phil Kotzan, DC

The Science Of Sore—Delayed Onset Muscle Soreness (DOMS) Explained

We’ve all experienced the agony. The pain of trying to get out of your car, wobble up the stairs, or move normally after a hard workout. This soreness is called delayed onset muscle soreness (DOMS). If you’ve been exercising long enough, you’ve probably felt it. Some lifters relish this pain as an indicator of success, but is that really the case?

What is DOMS?

I frequently see DOMS occur after a daunting leg day. It can also occur in experienced lifters after taking a few weeks off. Studies show (1) that it’s not restricted to any particular muscle group, but some people tend to experience it more in certain muscles.

Technically speaking, DOMS is (primarily) caused by a type 1 muscle strain – some degree of fiber damage, but nothing too serious – predominantly as a result of unaccustomed exercise. As you may have experienced, DOMS can range from slight muscle discomfort to severe pain that limits range of motion. Generally, muscle soreness becomes noticeable ~8 hours post-workout and peaks 48-72 hours later, although the exact time course can vary.

There is little doubt that DOMS is correlated with exercise-induced muscle damage to some degree; however, measures of muscle damage at a microscopic level are poorly correlated with reports of soreness. Basically, if you’re really sore, it doesn’t mean you completely “shredded” your muscles. This is supported by MRI images showing little damage to some muscles post-exercise. Not only do the time course of changes in the markers of muscle damage differ from one another, but they also don’t match the time course of muscle soreness (Newham, 1988). It is possible for severe DOMS to develop with little or no indication of muscle damage, and for severe damage to occur without DOMS.

Certain types of exercise can cause significant muscle damage. The image below is taken after an extensive eccentric exercise protocol. As you can see, the muscle fiber just looks messed up. The majority of studies examining exercise-induced muscle injury and DOMS use untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of most people who workout. However, it does give us some insight into what happens in the muscle.

Another DOMS-inducing stimulus that occurs during exercise is metabolic stress (and I’m not talking about the build-up of lactic acid, which does not cause DOMS.  Thinking that lactic acid causes muscle soreness is a dogmatic idea that is thoroughly outdated and flat-out wrong). After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between training sessions. However, there is some evidence that hydrogen ions and reactive oxygen species – both of which increase in concentration during exercise – may contribute to DOMS (2). Metabolic stress during exercise can cause changes on a structural level at the cell membrane (sarcolemma). The damage allows fluids and other factors to enter the cell, which promotes inflammation (3).

Does DOMS mean more muscle growth?

Some studies show the presence of DOMS after long-distance running, which indicates it doesn’t just occur during resistance training. This should be an anecdotal indicator that DOMS isn’t a good gauge of muscle growth since running causes minimal hypertrophy.

People who are new to working out often have the most pronounced DOMS. They also happen to grow the most, so you can see how the two may be intertwined. This is due to the new stimulus that exercise provides. Again, they get sore because they aren’t accustomed to exercising – not because they are growing like monsters. Interestingly, there is no difference in DOMS between sexes even for beginners (4).

There is some evidence to show DOMS may negatively affect workouts by altering motor patterns in subsequent workouts. This could cause reduced activation of the desired muscle (5). Hence, DOMS could actually hinder your next workout. In addition, severe DOMS can decrease force capacity by up to 50% (6). This causes functional deficits that may impair training at a certain level, which could hinder muscle growth in the long term.

Exercising while having DOMS does not seem to make muscle damage worse (7), but it may interfere with the recovery process. In extreme cases, exercise-induced muscle damage can cause rhabdomyolysis, a serious condition that can lead to renal failure. So be careful when throwing a newbie into an advanced program – especially if they’ve never exercised. You could do some serious damage.

How do I feel DOMS?

So if you aren’t destroying your muscles or burning them up with lactic acid, then why do they hurt? I recently discussed this concept with a member of my lab.

Nociceptors are free nerve endings that respond to damaging stimuli by sending pain signals to the brain. In muscle tissue, these receptors can sense chemical stimuli such as inflammation or disturbances in microcirculation to blood vessels. These receptors are not inside the muscle because muscle cell death is not painful. In comparison, tearing a muscle can be extremely painful. The pain is due to the release of muscle substrates into the space where nociceptors are located. This also helps us appreciate that DOMS probably doesn’t occur due to something inside the muscle (i.e., in the contractile apparatus) (7).

How can I reduce DOMS?

One of the best ways to decrease the risk of DOMS is to slowly progress into a new exercise program. If you’ve ever had an advanced program, you’ll notice the first week or two may have reduced volume. The “prep” phase of programs has two purposes: 1) allowing the muscle time to acclimate to a new movement, and 2) leaving room for more adaptation.

We all know we should warm-up properly. This is probably one of the only times you’ll hear it doesn’t help. While it may prepare you for exercise (I highly suggest it), neither warming up nor stretching before exercise has been shown to reduce or prevent DOMS.

Something a lot of people use to relieve DOMS is foam rolling. However, it has only been shown to improve DOMS in some studies. During foam rolling, you use your own body mass on a foam roller to exert pressure on an area of soft tissue. The motion places direct pressure on an area, which stretches it. It is considered self-induced massage because the pressure somewhat resembles the pressure exerted on muscles by a massage therapist. Again, there are only a few studies that have measured the effects of foam rolling on performance. These studies found foam rolling can enhance recovery after DOMS and alleviate muscle tenderness. Self-massage through foam rolling could benefit people wanting to recover in an affordable, easy, and time-efficient way.

Another intervention commonly used is massage. Some researchers have shown decreases in pain associated with DOMS after a massage (8). However, massage has no effect on muscle metabolites such as glycogen or lactate. One study found massage decreased the production of the inflammatory cytokines by mitigating cellular stress resulting from muscle injury (8). Many people believe massage can provide increased blood flow to specific areas, reduced muscle tension, and mood enhancement. Massage produces direct pressure, which may increase ROM and stiffness. These benefits are expected to help athletes by enhancing performance and reducing injury risk.  The effects of timing of massage (pre- or post-exercise) on performance, injury recovery, or injury prevention are not clear because the mechanisms of each massage technique have not been widely studied.

Supplements to reduce DOMS

Caffeine has long been known to increase alertness and endurance, shown by the the average person’s morning grumpiness before drinking the black gold. Interestingly, a recent study by Hurley et al., reported caffeine has the ability to reduce DOMS. They mesured perceived soreness in males consuming caffeine one hour before a workout. They found a lower level of soreness in the biceps on day 2 and 3 compared to a placebo after subjects completed a bicep curl protocol.  Using a dosage of 5mg/kg bodyweight they found a beneficial effect of caffeine on soreness. For comparison, a 185lb (~84kg) male would take about 420mg of caffeine preworkout. That is a ton of caffeine! An 8oz Red Bull contains roughly 85mg. Does your preworkout supplement have that much caffeine? Probably not. If you’re wondering when caffeine peaks in the blood, it’s about one-hour post ingestion. Caffeine is an adenosine antagonist and affects the activity of central nervous system (CNS) by blocking adenosine receptors, thus resulting in decreased levels of soreness. This suggests that short-term caffeine ingestion before a strenuous workout may decrease overall soreness levels.  However, the subjects who took caffeine were able to perform more reps than the control group, which could be a confounder.

Taurine is found in muscle and has multiple biological functions. Remember that Red Bull I mentioned earlier? Well, it has about 1,000mg of taurine. For reference: Up to 3,000mg a day of supplemental taurine is considered safe. One double-blind study (10) of males completed over 21 days measured the effects of 50mg of taurine (20x less than the content in a Red Bull) after 7 days of eccentric exercise.  The researchers found a reduction in DOMS and oxidative stress markers after exercise; however, there was no effect on inflammatory markers. Could this be a way to battle the other side? If inflammation is one component to DOMS and oxidative stress is another component, we need a study to combine the two. That probably won’t happen soon, but it would be fun to see if they were synergistic.

Omega-3 fatty acid is found in fish and is becoming increasingly used to fortify foods. You can also find EPA/DHA in those lovely pills that make you burp fish all day. Several studies reported positive effect of omega-3 fatty acids on DOMS, presumably due to the decrease in pro-inflammatory factors such as IL-6 and TNF-alpha. There are a ton of studies to show taking an omega-3 supplement is good for you in many ways, and this seems to hold true for DOMS. If you’re interested in the results, the main table from Jouris et al 2013is below.

Cryotherapy, on the other hand, probably doesn’t reduce DOMS.  This goes directly against the current trend of athletes jumping in a tube surrounded by liquid nitrogen to help recovery. Whole body cryotherapy exposes athletes to cold, dry air below -100C for between two and four minutes in a specialized chamber. A recent Cochrane Review by Costello et al., found that there was insufficient evidence to determine whether cryotherapy can reduce muscle DOMS or improve recovery.

No guidelines currently exist for its clinical effectiveness or for safe usage. Cryotherapy is thought to work by reducing  temperature in the skin, muscle, and core. The theory is muscle soreness is relieved by reducing muscle metabolism, skin microcirculation, nerve conductivity and receptor sensitivity. In addition, it could have a placebo effect by reducing the subjective feeling of DOMS post-exercise. Using a meta-analysis based on four eligible studies, it seems cryotherapy does not reduce DOMS or improve recovery. Furthermore, insufficient evidence exists on whether this therapy could actually be harmful.  We do know, however, that cold water emersion post-exercise can decrease rate of muscle growth. For the time being, cryotherapy and cold water emersion are probably two things you should avoid – you probably won’t recover any faster, and you may not build as much muscle.


Soreness can provide some insight, but don’t use it as a marker for a good workout. High levels of soreness indicate the lifter has exceeded the capacity for the muscle to undergo repair. Indeed, soreness can impede the ability to train properly, and it may decrease motivation.

The consensus among researchers is that there is no single component that causes DOMS. Instead, there are a number of complex events that may explain this phenomenon. It is the main cause of reduced exercise performance including decreased muscle strength and range of motion for both athletes and non-athletes. Common supplements to combat DOMS include caffeine, omega-3 fatty acids, and taurine.


  1. Sikorski EM, Wilson JM, Lowery RP, Joy JM, Laurent CM, Wilson SM-C, Hesson D, Naimo MA, Averbuch B, and Gilchrist P. Changes in perceived recovery status scale following high volume, muscle damaging resistance exercise. J Strength Cond Res 27: 2079–2085, 2013.
  2. Close, Graeme L., Tony Ashton, Tim Cable, Dominic Doran, and Don P. M. MacLaren. “Eccentric Exercise, Isokinetic Muscle Torque and Delayed Onset Muscle Soreness: The Role of Reactive Oxygen Species.” European Journal of Applied Physiology 91, no. 5–6 (May 2004): 615–21. doi:10.1007/s00421-003-1012-2.
  3. Stauber WT, Clarkson PM, Fritz VK, and Evans WJ. Extracellular matrix disruption and pain after eccentric muscle action. J Appl Physiol 69: 868–874, 1990.
  4. Flores, Débora F., Paulo Gentil, Lee E. Brown, Ronei S. Pinto, Rodrigo L. Carregaro, and Martim Bottaro. “Dissociated Time Course of Recovery between Genders after Resistance Exercise.” Journal of Strength and Conditioning Research / National Strength & Conditioning Association 25, no. 11 (November 2011): 3039–44. doi:10.1519/JSC.0b013e318212dea4.
  5. Trost Z, France CR, Sullivan MJ, and Thomas JS. Pain-related fear predicts reduced spinal motion following experimental back injury. Pain 153: 1015–1021, 2012.
  6. Paulsen, G, Mikkelsen, UR, Raastad, T, and Peake, JM. Leucocytes, cytokines and satellite cells: what role do they play in muscle damage and regeneration following eccentric exercise? Exerc. Immunol. Rev. 18: 42-97, 2012.
  7. Cheung, Karoline, Patria Hume, and Linda Maxwell. “Delayed Onset Muscle Soreness : Treatment Strategies and Performance Factors.” Sports Medicine (Auckland, N.Z.) 33, no. 2 (2003): 145–64.
  8. Proske U and Morgan DL. Muscle damage from eccentric exercise: Mechanism, mechanical signs, adaptation and clinical applications. J Physiol 537: 333–345, 2001.
  9. Zainuddin, Zainal, Mike Newton, Paul Sacco, and Kazunori Nosaka. “Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function.” Journal of Athletic Training 40, no. 3 (September 2005): 174–80.
  10. Crane, Justin D., Daniel I. Ogborn, Colleen Cupido, Simon Melov, Alan Hubbard, Jacqueline M. Bourgeois, and Mark A. Tarnopolsky. “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage.” Science Translational Medicine 4, no. 119 (February 1, 2012): 119ra13-119ra13. doi:10.1126/scitranslmed.3002882.
  11. Sikorski, Eric M., Jacob M. Wilson, Ryan P. Lowery, Jordan M. Joy, C. Matthew Laurent, Stephanie M-C Wilson, Domini Hesson, Marshall A. Naimo, Brian Averbuch, and Phil Gilchrist. “Changes in Perceived Recovery Status Scale Following High-Volume Muscle Damaging Resistance Exercise:” Journal of Strength and Conditioning Research 27, no. 8 (August 2013): 2079–85. doi:10.1519/JSC.0b013e31827e8e78.

Written by Brandon Roberts for The Science Of Sore

Bringing awareness to DOMS,

Dr. Phil Kotzan, DC

31 Flavors Of Protein Shakes

Thanks to local fitness and nutrition coach Brien Shamp (650-654-4604) for the following article:

Protein is an essential macronutrient for building lean muscle mass and protein shakes can be an important tool for health, fitness gains and fat loss.

Not only does a protein shake meal replacement take only a few minutes to prepare, it keeps you on point with your nutrition while making it easy to avoid unhealthy fast food alternatives for a quick meal. However, blending up the same combination of protein powder, ice and water sure does get boring.

The following 31 Flavors of Protein Shakes will destroy your protein shake boredom once and for all! For each of the recipes below simply combine the ingredients in a blender and blend until smooth. Add extra water, milk or ice as needed to create your desired consistency. Serve immediately and enjoy!

Oatmeal Shake

  • ¼ cup dry oats (look for gluten free)
  • 1 serving vanilla protein powder
  • ½ teaspoon ground cinnamon
  • 1 teaspoon pure maple syrup
  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • handful of ice cubes

Banana Nut Shake

  • ½ banana
  • 1 cup milk (raw organic pastures, coconut or cashew) or water
  • 10 almonds
  • 1 serving vanilla protein powder
  • handful of ice cubes

Vanilla Coffee Shake

  • ½ cup vanilla almond milk
  • ½ cup cold brewed black coffee
  • 1 serving vanilla protein powder
  • liquid stevia to taste
  • handful of ice cubes

Café Mocha Shake

  • ½ cup milk (raw organic pastures, coconut or cashew)
  • ½ cup cold brew black coffee
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • liquid stevia to taste
  • handful of ice cubes

Sunny Morning Shake

  • 1 seedless, peeled orange
  • 1 cup milk (raw organic pastures, coconut or cashew)
  • 1 serving unflavored protein powder
  • handful of ice cubes

Orange Creamsicle Shake

  • ½ frozen banana
  • ½ cup vanilla organic, whole fat Greek yogurt
  • 1 cup fresh squeezed orange juice
  • 1 serving vanilla protein powder
  • handful of ice cubes

Thin Mint Shake

  • ½ frozen banana
  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • ¼ teaspoon peppermint extract
  • 4 fresh mint leaves (optional)

Bright Berry Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 8 raspberries
  • 4 strawberries
  • 12 blueberries
  • handful of ice cubes

Strawberry Vanilla Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 1 handful of ice cubes
  • 1 teaspoon vanilla extract
  • ½ frozen banana
  • 3 frozen strawberries

Raspberry Cheesecake Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 15 frozen raspberries
  • 2 Tablespoons organic low or whole fat sour cream
  • liquid stevia to taste

Peanut Butter Cup Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • 1 Tablespoon creamy organic peanut butter
  • handful of ice cubes

Creamy Chocolate Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • 2 Tablespoons organic low or whole fat sour cream
  • liquid stevia to taste

Papaya Ginger Mint Shake

  • ½ cup fresh chopped papaya
  • ½ teaspoon fresh minced ginger
  • 4 fresh mint leaves
  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • handful of ice cubes
  • drizzle of honey to taste

Blueberry Mango Shake

  • ½ cup fresh or frozen chopped mango
  • ¼ cup fresh or frozen blueberries
  • ¼ cup plain organic, whole fat Greek yogurt
  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder

Spinach, Kiwi and Chia Seed Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 cup packed spinach
  • 1 ripe kiwi, peeled and cut into chunks
  • 1 serving vanilla protein powder
  • 1 Tablespoon chia seeds
  • handful of ice cubes

Oatmeal Cookie Shake

  • ¼ cup dry oats
  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ frozen banana, peeled and chopped
  • 1 teaspoon honey
  • ½ teaspoon ground cinnamon
  • ½ teaspoon vanilla extract
  • pinch of ground ginger, nutmeg and salt

Peanut Butter and Jelly Shake

  • ½ frozen banana
  • 1 cup milk or water
  • 2 Tablespoons creamy organic peanut butter
  • ½ cup frozen strawberries
  • 1 serving vanilla protein powder
  • handful of ice cubes

Vanilla Matcha Avocado Shake

  • 1 ½ cups milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • ¼ teaspoon vanilla extract
  • ½ an avocado, pitted and peeled
  • 2 teaspoons matcha powder
  • 1 handful of spinach

Cherry Almond Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ cup frozen, pitted cherries
  • 2 Tablespoons almond butter
  • handful of ice cubes

Honey Banana Shake

  • 1 ½ cups of water or milk (raw organic pastures, coconut or cashew)
  • 1 frozen banana
  • ¼ cup plain organic, whole fat Greek yogurt
  • 1 serving vanilla protein powder
  • 1 teaspoon honey
  • sprinkle of ground nutmeg

Carrot Cake Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ cup shredded carrots
  • ¼ cup chopped walnuts
  • ¼ cup plain organic, whole fat Greek yogurt
  • ¼ teaspoon ground cinnamon
  • pinch of ground nutmeg and ground ginger

Key Lim Pie Shake

  • ½ cup vanilla organic, whole fat Greek yogurt
  • 1 cup milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • 1 Tablespoon lime juice
  • stevia to taste
  • handful of ice cubes

Peach Oatmeal Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ cup dry oats(choose gluten free)
  • 1 peach, pitted, peeled and chopped
  • handful of ice cubes
  • ½ frozen banana, peeled and chopped
  • stevia to taste

Vanilla Chai Shake

  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving vanilla protein powder
  • ¼ cup strong brewed, chilled tea
  • ¼ teaspoon vanilla extract
  • pinch of ground cinnamon, cloves and cardamom
  • handful of ice cubes
  • sprinkle of chia seeds

Apple Pie a la Mode Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 apple, peeled, cored, and finely chopped
  • ¼ cup vanilla organic, whole fat Greek yogurt
  • 1 Tablespoon apple butter
  • ½ teaspoon ground apple pie spice
  • 1 serving vanilla protein powder
  • stevia to taste

Cinnamon Roll Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ teaspoon ground cinnamon
  • ½ cup vanilla organic, whole fat Greek yogurt
  • ¼ cup dry oats (choose gluten free)
  • ½ banana, peeled

Hawaiian Sunrise Shake

  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving vanilla protein powder
  • ½ banana
  • ½ cup pineapple
  • ½ cup plain organic, whole fat Greek yogurt
  • stevia to taste
  • handful of ice cubes

Snickerdoodle Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ banana
  • 1 Tablespoon creamy almond butter
  • ¼ teaspoon ground cinnamon
  • ¼ teaspoon vanilla extract

Chocolate Chip Cookie Shake

  • 1 ½ cups milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • ¼ cup dry oats (choose gluten free)
  • ¼ teaspoon Kerrygold butter
  • ¼ teaspoon vanilla extract
  • pinch of salt
  • handful of ice cubes
  • 1 Tablespoon mini chocolate chips
  • stevia to taste

Chocolate Brownie Shake

  • 1 frozen banana, peeled and chopped
  • ¼ cup brewed coffee, chilled
  • ¾ cup milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 2 Tablespoons unsweetened cocoa powder
  • ¼ teaspoon vanilla extract
  • pinch of salt
  • 1 Tablespoon mini chocolate chips

Pina Colada Shake

  • 1 frozen banana, peeled and chopped
  • ½ cup fresh pineapple, chopped
  • 1 cup coconut milk
  • 1 serving vanilla protein powder
  • 1 Tablespoon shredded, unsweetened coconut

There you go! 31 Flavors of Protein Shakes to keep you happily sipping those fitness friendly macronutrients needed to achieve your big transformation goal. Now your only protein shake dilemma is deciding which of these amazing shakes to try first!

Remember that exercise is an essential component to achieving any fitness goal, so supplement your protein shake regimen with high intensity bouts of exercise as tolerated.

We will adapt your program as needed to progress you to high intensity bouts over time!


Looking to encourage healthy protein consumption…

Dr. Phil Kotzan, DC