It’s been three months since I have been on my yoga mat. Monday I went back. Two days later, I am sore. My hamstrings are screaming; my abs and low back are tight; but I feel great.

Yesterday I woke up stiff but feeling good and firm — like I have been rolled over by a massage ball. Today, I ache. Enter the delayed onset muscle soreness or DOMS. Most likely you are familiar with this sensation if you have done any physical activity. It is the pain and discomfort that occurs 24 to 72 hours after strenuous exercise, and it is perfectly normal.

I think one of the most interesting things is there isn’t any difference between immediate pain and DOMS except for time. As outlined in a 2012 scientific review published in Clinics in Sports Medicine, both share the same quality of pain, and a varying degree of making functioning difficult.

What’s more: There is no single mechanism for muscle soreness; instead, it is a culmination of six different ones. DOMS begins with microtrauma to muscles and then to the surrounding connective tissues. Microtrauma is then followed by an inflammatory process and subsequent shifts of fluid and electrolytes, says the researchers.

There are many ways to help alleviate muscle soreness. There is evidence that suggests that supplementing with cumin may help.  Some studies have also found heat to help ease delayed onset muscle soreness, and one study found massage did so by 30 percent. And while all these options sound great, I may resort to the tired and true method of continued exercise, with some Ibuprofen on the side.

The thing is I need to be careful about how much Ibuprofen I take, since it is a NSAID — short for non-steroidal anti-inflammatory drug. Honestly, everyone should be careful about these over-the-counter meds.

Last year the FDA slapped a warning on these drugs: May cause stroke or heart attack. It was just one more addition to an already long list.

These drugs — Ibuprofen (Motrin), Naproxen (Aleve), Diclofenac (Voltaren) and Celecoxib (Celebrex) — increase the risk of clots, elevated blood pressure, cardiac failure, and sudden cardiac death (from arrhythimia). All things that I am already at high risk for thanks to my surgery and family history.

Why NSAIDs have this side effect is built into the way they work: They relieve pain by inhibiting the synthesis of prostacyclin — a substance that helps relax blood vessels and restrain clot formation — in the blood vessels. Exactly the opposite of what you want to occur if you are trying to prevent stroke and heart attack. And the thing is, this occurs in everyone, not just people with or at risk for heart disease, said Sanjay Kaul, MD, a cardiologist at Cedars Sinai Medical Center in Los Angeles who was a member of the FDA’s expert panel.

I don’t know about you, but Ibuprofen is my go-to pain reliever. So when I was interviewing Dr. Kaul about the FDA’s decision for Prevention.com, I asked him if I should abstain. He told me the answer to that question will come from a large ongoing randomized trial called PRECISION that is comparing the rate of heart problems among patients with high cardiovascular risk for Ibuprofen, Naproxen, and Celecoxib. Until then, Dr. Kaul says that it isn’t necessary to stop taking these drugs; especially without consulting your physician. “As with all medications there are benefits and there are risks,” he said, “How you weigh them and what is an acceptable tradeoff is a highly individual choice.”

For me, I will deal with my DOMS by continuing to exercise and take the ibuprofen for my migraines. I can deal with a little soreness.

For more information about how to take painkillers safely, see the aforementioned Prevention.com article.

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