Normal Muscle Pain or Injury? What to do

Normal Muscle Pain or Injury? What to do

What is the Normal Muscle Reaction Expected after Pilates

Pilates is a strengthening based program, so our aim is to work your muscles in ways they are not used to and address your major needs and goals. From a biological perspective, this means that muscles are worked a little bit more than they are used to coping with so there is a small degree of disruption to the join (z-line) between each small unit (sarcomere) that make up the muscle. This causes a release of inflammatory chemicals in the muscle which begin the process of muscle growth. This reaction can cause “soreness” and a heaviness feeling in the muscles from 24 to 72 hours after exercise and is known as DOMS (Delayed Onset of Muscle Soreness). This reaction is normal and is the first step in your body’s process of building muscle. Your body will then repair and build muscle to a larger degree than the amount of disruption caused by the DOMS.

When we do any exercise process we are always on the edge of causing a degree of disruption to the muscle, a bit less than the body can compensate for and will grow above in the next few days and a bit too much damage, which causes “pain” and is more than the body can grow above. This line is not always well defined, so we will always ask you how you feel on your next session to determine if the exercises were the right amount for you or too much

How Do I Know It Is DOMS (Delayed Onset of Muscle Soreness) and Normal?

DOMS is felt in the muscle itself, usually begins at it’s attachment and extends to the muscle belly, eg in the quadriceps, you will feel a soreness from the top of the thigh, through the front of the thigh up to just above the knee. It usually starts the next day or two days after your exercise session and should feel like a “soreness” or a heaviness sensation. The muscles will feel a bit weaker for a couple of days and you may find it difficult to perform lowering type activities, such as walking down stairs, but this sensation will resolve over the next 2-3 days

How Do I Know It Ts NOT Normal and Should be Addressed?

What you shouldn’t feel is a “pain” sensation, such as a “sharp, stabbing or hurting” sensation. Pain should also NOT be felt on the joint line or areas other than the muscle itself, eg at the front of the knee cap or along the back of the knee joint. If this has occurred, it can mean the lining of the joint has been irritated and we need to assess the area again or adjust your program so that it better meets your needs.

What Do I Do If I Have DOMS or I Think I Have an Injury?

If you have DOMS, the best thing to do is to come in for your regular Pilates session. Counter-intuitively, exercise will help bring blood to the area, help flush out the inflammatory chemicals and make the muscles feel better again.

If you think you have an injury, DO NOT CANCEL YOUR SESSION. It is important that we assess the area again and adjust your plan if needed. It is also a very important time to help you manage the issue so that the problem is resolved as fast as possible.

Michael Dermansky
Senior Physiotherapist & Managing Director of MD Health

Carpel Tunnel Syndrome Explained

Carpel Tunnel Syndrome Explained

What Is Carpal Tunnel?

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.

Causes of Carpal Tunnel

A combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself, is the most likely cause. The carpal tunnel is simply smaller in some people than in others, and therefore some are more predisposed. Other contributing factors include trauma or injury to the wrist that cause swelling, such as a sprain or fracture.

Signs and Symptoms of Carpal Tunnel

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks

Diagnosis of Carpal Tunnel

Specific tests to try to produce the symptoms of carpal tunnel syndrome are used. In the Tinel test, the median nerve is tapped or pressed in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves holding the forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, are felt in the fingers within 1 minute. In order to confirm this diagnosis, a nerve conduction study can be performed.


Conservative treatment involves initial rest until the swelling settles down. A cortisone injection can help relieve the inflammation, combined with physical therapy to strengthen weak areas in the neck or upper limb that may be contributing to the compression of the nerve.
Surgical treatment involves surgical release of the carpal tunnel to offload the median nerve, and is generally recommended if symptoms persist for more than 6 months.

Written by Michael Dermansky
Senior Physiotherapist and Founder of MD Health Pilates

Common Exercise Technique Mistakes: The Squat

Common Exercise Technique Mistakes: The Squat

The squat is a great exercise for a range of different reasons. When done correctly it helps to improve function in elderly people e.g. getting up from a chair, as well as being a great power exercise for athletes wanting to train their quads and glutes.

There are many technique mistakes people make when performing a squat, below we have outlined the three most common and how to correct them.

1. 2Poor Knee Control

Knees coming in together or going too far forward is a very common mistake when people perform squats. This increases pressure on your knees and can result in injury if done repetitively. To avoid this, ensure your feet are facing forward hip width apart and your knees should then track inline with your toes. As you squat down and return up your knees should remain in line with your toes without coming forward past your toes. Keeping your weight through your heels and sticking your bottom back will help to avoid this.

. Poor Lower Back Control

Bending forward too much through your lower back can result in back pain when squatting and can lead to significant long term injury such as lumbar spine disc bulge. When squatting you need to ensure you keep the natural curve or lordosis in your lumbar spine. To do this, ensure you stick your bottom back and keep your chest facing up and forwards.

3. Holding Breath

When performing a heavy multi joint exercise such as a squat it is very easy to want to hold your breath to help brace your lower back. This is called the valsalva manoeuvre and although it is employed by high level weight lifters, it can be detrimental to your health. Holding your breath during heavy resistance training can significantly increase your blood pressure to dangerous levels. It also promotes the use of incorrect muscles to brace the lower back during a heavy lift. To ensure you use the correct abdominal muscles during a squat this you should gently draw your belly button in to brace your lower back and continue to breathe throughout the movement.

Written by Jack Hickey, Exercise Physiologist

For more information check out our Workout Wednesday video on The Perfect Squat:


Time Efficient Exercise

Time Efficient Exercise

We are all busy and can struggle to find time to fit everything in to our day, so when it comes to exercise we want to get as much from our workout as possible. The following tips will help you to make your workout more time efficient, whether it is in the gym, swimming, cycling or going out for a run.

1. Time Your Rest Periods Between Sets and Exercises

Sticking to a set rest period between your exercises at the gym or work periods when doing interval training will not only improve the efficiency of your workout, but it will actually improve your program as rest between sets is a critical exercise variable. Use an alarm on your phone or wear a stopwatch to keep your rest periods on time during your workout.

2. Superset Your Exercises

Supersets are a great way to make the most of your time in the gym. This can be done by alternating between sets going from an upper body exercise straight into a lower body exercise. This allows you to complete two exercises in the time it would have taken to do one, while your upper body is recovering between sets your lower body is exercising.

3. Have a Planned Workout

When you go to the gym it is good to have a plan of the exercises or planned out the amount and type of intervals you will perform when running or swimming. Having your exercises written down and ticking them off as you do them ensures that you don’t waste time during your workout wondering what to do or doing more than you really need to.

4. Leave Your Phone Behind

With today’s smartphones and social media just a finger swipe away, having your mobile with you in the gym can be very distracting and can slow down your workout. It is very easy to use your phone to procrastinate and while you should be doing your next set of squats you are too busy telling your friends on Facebook that you are at the gym!

By Jack Hickey
Exercise Physiologist at MD Health Pilates