Dr. Patrick: So, the other thing would be...you mentioned soreness, people using it for soreness. But should you be sore? Like, should you train to be sore? Does that play a role in hypertrophy? And then, you know, like, do you get more sore with age as well or what's that indicative of? I mean...

Dr. Schoenfeld: Yeah. So, another interesting question, soreness, to some extent, is genetically-influenced. And interestingly, women seem not to have as much soreness as men. There's been some speculation it might have to do hormonally with estrogen, it could be other effects as well. But, so, it's an interesting question. Soreness generally is due to a novel response or novel stimuli. And usually it's primarily due to the eccentric component of exercise. And that, by the way, can also be done through, let's say, downhill running would be an eccentric form of aerobic training.

But let's just focus on the resistance-training aspect where the lowering...so, eccentric is a lowering...basically, lengthening, muscles are lengthening under tension. And even concentric exercise can cause soreness and there's muscle damage that occurs but it seems to be also more specific to, so, muscle damage and even damage within the epimysium or extracellular matrix. Again, these aren't necessarily clear, so, connective tissue might be even more relevant, it's speculative that that might have greater relevance to soreness with nociceptors that are exposed to free nerve endings and there's interaction with free radicals. So, there's a whole theory behind this.

Do you need to be sore to make gains? No, I think that's pretty clear. But could being sore potentially be indicative that there may be some additional positive gains? It's not clear but a novel response, again, why does the body adapt? It adapts because it is being challenged beyond its present state. A novel response would generally indicate it's being taxed beyond its present state and, thus, having some degree of soreness might indicate that you are challenging it beyond its present state.

But again, some people, it's genetically influenced, so, some people just don't get sore and some people are very responsive to soreness regardless. There does seem to be a repeated bout effect whereas, if you keep doing the same thing over and over again, the body adapts and gets less and less sore over time. But some people keep doing the same thing and they keep getting somewhat sore.

Where soreness is an issue... So, if you are mildly sore, I think it's probably not only okay, maybe it's positive. It certainly shouldn't be a negative. If you're not sore, I don't think you should worry about that per se. But, on the opposite, if you are very sore, that is a negative because that's going to impair your ability to train again hard. And that would be an issue.

Dr. Patrick: Are there things people can do to help with the soreness that aren't going to blunt their hypertrophy or, I mean, maybe, you know, be bad for them health-wise, so, that you know about, any evidence-based things that people can do to improve their soreness?

Dr. Schoenfeld: Improve their response to soreness?

Dr. Patrick: Yeah, so that they're maybe not as sore as long or...

Dr. Schoenfeld: Well, I mean, could you? Yeah, you can not focus on the eccentric component, which probably is not a great thing because not only is the eccentric component as important, there seems to be a synergism between eccentric and concentric exercise where the intracellular signaling cascade for eccentric exercise is somewhat different than that of concentric, and that would imply a synergism in terms of the hypertrophic response.

There is also evidence that muscles develop regionally. So, there's interesting research that, like, certain parts of muscles will develop more than others, and eccentric exercise seems to work more in the distal portion of the muscle, whereas concentric seems to work more in the mid portion of the muscle. And, thus, combining them again would be beneficial.

So, it doesn't seem to be...although, yes, you can reduce the soreness that's developed by not, you know, focusing on your concentric, I wouldn't suggest that. By the way, I don't know if they're still around but there was a gym chain called Curves, I don't know if you've heard of them, but they had these machines that just did the concentric exercise because the whole thing was they focused on older women and they thought that the soreness would scare them away and they just had these machines that focused on the concentric portion. But again, if your goal is to optimize gains, that's not a great strategy.

So, look, you can do warm-water baths seem to, again, help to alleviate soreness, doing active recovery, just walking around. And if it's for upper body, doing certain motions, aerobic, you can, yeah, pump arms, you can do the elliptical that has the arm crank. Just to get blood flow to the area would help to alleviate the soreness.

And the other thing I would say, if that's the goal, stick to the same exercises over and over. Now, again, one of the benefits...exercise selection is another potentially important thing if you want to optimize gains. And that's, again, promoting a novel response factoring in different movements can be beneficial to optimizing results. And that would, again, have to do with the novelty of the movement but that will come with the caveat that there'll be some soreness.