Weekend-Warrior Injuries: Soreness or Something More?

By Dr. John Mishock, PT, DPT, DC 

 

Americans experience approximately 8.6 million sports- and recreation-related injuries annually—about 34 injuries for every 1,000 people. (Yahtyng et al. National Health Statistics Reports in 2016)

Those numbers do not include every adult who wakes up after a weekend of basketball, pickleball, golf, running, or yard work and wonders, “Is this normal soreness, or did I injure something?”

Some soreness after strenuous or unfamiliar activity is normal—even for older adults. It does not automatically mean the body is breaking down or that you should stop exercising. A study of more than 350,000 adults published in JAMA Internal Medicine in 2022 found that those who completed their recommended activity during one or two weekly sessions experienced mortality benefits similar to adults who spread their exercise throughout the week. The goal is not to fear soreness. It is to distinguish normal adaptation from injury.

Why am I sore the next morning?

Delayed-onset muscle soreness, or DOMS, commonly develops after unfamiliar exercise—especially when muscles produce force while lengthening. Examples include lowering a weight, landing from a jump, running downhill, decelerating from a sprint, or controlling the body during throwing and swinging. DOMS commonly becomes noticeable after exercise and may be most evident approximately 24 to 48 hours later.

Normal soreness is generally diffuse, achy or stiff. It affects heavily exercised muscles, improves after several minutes of movement, and gradually resolves over the following days. Older adults can still build muscle, improve cardiovascular capacity and strengthen bones and connective tissues. The primary problem is often not age but a mismatch between the body’s current capacity and the workload imposed upon it.

Soreness and adaptation

Exercise temporarily challenges the body. During recovery, tissues repair and remodel so they can better tolerate similar activity: Load → recovery → adaptation → increased capacity

Resistance exercise stimulates muscle-protein synthesis. Repeated training, adequate nutrition, and recovery can increase strength and muscle mass. (Felipe et al. Sports Medicine in 2015) Mechanical loading can also increase tendon stiffness and force tolerance. Aerobic training challenges the heart, blood vessels, and muscles’ oxygen-processing systems, producing cardiovascular adaptations that improve aerobic capacity and endurance. (Ylva et al. Comp Phys, 2016)  However, soreness is only a possible byproduct of an unfamiliar training stimulus. It is not the cause of adaptation or proof of a productive workout. As the body adapts, the same activity usually causes less soreness—a protective response known as the repeated-bout effect. Becoming less sore does not mean the exercise stopped working.

How common are these injuries?

• Lower-back pain: A review found a one-year prevalence ranging from 17% to 94% among athletes, reflecting substantial differences between sports. (Farahbakhsh et al. J of Back and Mus Rehab, 2018)
• Knee pain: The annual prevalence of patellofemoral pain is estimated at 22.7%. (PLOS ONE, 2018)
• Shoulder pain: Shoulder pain occurred at a median rate of approximately 38 cases per 1,000 people annually. (BMC Mus Dis, 2022)
• Tennis and golfer’s elbow: A population study found 1.3% for lateral epicondylitis and 0.4% for medial epicondylitis. (American Journal of Epidemiology in 2006)
• Achilles tendinopathy: The annual incidence of 1.85 cases per 1,000 people, mainly among runners. (Suzan et al. J of Sports Med in 2011).
• Plantar-heel pain: Nadine Rasenberg and colleagues reported approximately 3.8 new cases per 1,000 patient-years in the British Journal of General Practice in 2019.
• Hamstring strains: Hamstring injuries accounted for about 10% of injuries in field-based team sports and affected about 13% of athletes over nine months. (Nirva et al.  Brit J of Sport Med, 2023).
• Ankle sprains: Ankle sprains happen most commonly in court sports—approximately 7 sprains per 1,000 athletic exposures—in (Sport Med in 2014).

When is soreness more likely to be an injury?

An injury is more likely when pain is sharp, focal, or worsening; follows a traumatic event; or is accompanied by substantial swelling, bruising, weakness, instability, locking, numbness, or an inability to bear weight.

The trajectory matters. Mild soreness that improves daily is different from pain that intensifies or progressively limits function. Major trauma, suspected fracture, rapidly increasing weakness, chest pain, breathing difficulty, fever, loss of bowel or bladder control, saddle numbness or unexplained severe night pain require prompt medical evaluation.

Why consider physical therapy first?

For an uncomplicated muscle, joint or movement problem, seeing a physical therapist first may shorten the healthcare pathway. Physical therapists evaluate strength, mobility, balance, gait, neurological function and movement mechanics. They can begin treatment while also screening for conditions requiring medical or orthopedic referral. A systematic review and meta-analysis by Stephanie Hon and colleagues, published in Physical Therapy in 2021, concluded that direct-access physical therapy was more cost-effective and involved fewer visits than physician-first care, without worse outcomes.

A 2025 systematic review by Abuhl and colleagues found that first-contact physical therapy likely reduces diagnostic imaging and may reduce prescription-medication use while producing outcomes similar to or superior to usual primary care. Pennsylvania law permits appropriately qualified physical therapists with direct-access authorization to treat patients without a referral for up to 30 days, although individual insurance plans may impose additional requirements.

Physical therapy does not replace family medicine or orthopedics. It provides an efficient first stop for many musculoskeletal problems while directing patients with warning signs to the appropriate physician.

Exercise remains one of our best tools for preserving health and independence. Respect the dose, progress gradually, and allow time to recover. Some soreness may mean the body encountered a new challenge.

Do not allow every ache to frighten you away from activity—but do not ignore a worsening problem until it forces you out of the game.

We can help!

Visit our website to read more physical therapy related articles, learn more about our treatment philosophy, our physical therapy staff, and our 5 convenient locations in Gilbertsville (610-327-2600), Skippack (610-584-1400), Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800)  at www.mishockpt.com or request your appointment by clicking here.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.