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Delayed Onset Muscle Soreness (DOMS) - What it is, how to deal, and how to prevent it

By Jessica Kelner, D.O. - December 9, 2019

The technical term for post-exercise soreness is DOMS, or delayed-onset muscle soreness.

Delayed onset muscle soreness (DOMS) usually peaks 48 to 72 hours after a workout, as your body really goes to work on the process to repair muscle fibers that were torn during exercise. It is a familiar experience for the elite or novice athlete. Although DOMS is considered a mild type of injury, it is one of the most common reasons for compromised sport performance. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS.

It is typically caused by eccentric types of exercise (activation of a muscle while it is lengthening under a load) or when you're doing an activity that your body isn't used to. This is compared to concentric exercises that the muscle shortens when it tries to move a load. During eccentric exercise, you're creating tears in the muscle. Although the exact pathophysiological pathway remains unknown, the primary mechanism is considered to be due to structural damage of muscle cells that occurs after excessive eccentric exercise. This leads to protein degradation, apoptosis (cell death) and local inflammatory response. The development of clinical symptoms is typically delayed (peak soreness at 48 - 72 h post-exercise) as a result of complex sequences of local and systemic physiological responses.
There are varying degrees of pain depending on how much damage has been done (and other factors like genetics and how hydrated you are), but regularly experiencing an extreme level of soreness isn't something you should make a habit of.

The research shows that the muscles can actually atrophy [or break down too much] when they get that sore—it's almost like the muscle was overworked, and it can't repair itself adequately. So just because you are more sore, doesn't mean you're getting better results. Also, since you need more time off to recover, it can throw a wrench in your workout plan and make you miss out on additional days of training.

Extreme soreness can happen occasionally, usually after you've done something your muscles aren't used to

DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. In the past few decades, many hypotheses have been developed to explain the etiology of DOMS.  Up to six hypothesized theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories.

DOMS can affect athletic performance by causing a reduction in range of motion, decreased muscle force, and the ability of the body part to absorb shock. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.

The best remedy for soreness is time—but there are a few things you can try that might help ease the pain a bit

Unfortunately, if you're already in the throes of monumental soreness, the only sure-fire remedy is time (generally, DOMS lasts about two to three days after the soreness peaks). There are a few things you can do to hopefully help ease the pain while you wait, and in some cases, maybe even speed the process along.

1. Get in some light movement.

Exercise is the most effective means of alleviating pain during DOMS, however the analgesic (pain reduction) effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover.

Yea, it may suck to move when you are already in pain. The activity increases circulation, improving blood flow throughout the body.
It’s thought that increased blood flow and nutrients to the muscles does, in fact, speed up the repair process, which should reduce DOMS. Blood carries nutrients and oxygen to muscle tissue. In particular, amino acids are brought to the area, which are the “building blocks” of muscle repair. The idea is that the faster these nutrients get to their destination (via blood flow), the faster they can get to work, and the faster you’ll feel better.

Now, this doesn't mean you should go back to your regularly scheduled workout programming. We're talking gentle activity, like going for a walk or hopping on a recumbent bike at the gym. If you can manage it, you can try some very light strength training. But seriously, light means super light, since you don't want to do more damage to the muscle fibers. Perhaps start at 25% of the weight you would normally lift.

2. Hydrate, hydrate, hydrate.

Drink water. There is research that shows a correlation between dehydration and increased muscle soreness and DOMS. While more research needs to be done, if dehydration increases soreness, than hydration can minimize it. Your tissues will have more fluid to fill the cells, which means blood flow will be better able to remove damaged products and cells and bring nutrients in. The main theory here is that water helps flush out waste products. When muscles break down, they release waste products and toxins that need to be filtered out of the body. These waste products are associated with increased soreness. While your kidneys and liver are ultimately responsible for filtering out toxins, (after all, it’s our organs, not anything we eat or drink, that detox our bodies) staying hydrated may help move along this process.

3. Do some light stretching.

Again, the keyword is light. Stretching can be a great way to release tightness and increase your range of motion when you're sore, which can make you feel better, even though it’s not actually healing the tears in your muscles or making them repair any faster. Be careful not to overstretch a muscle that feels really tight. If it's too painful, you may want to skip this step.

4. Make sure you're getting enough protein.

Protein is a critical nutrient for building and maintaining muscle, so it plays a huge role in helping your muscles recover from a tough workout.
While you should be consuming enough protein all the time to prevent recurring or long-lasting soreness from your workouts, it can still be helpful to double check that you're eating enough protein after the damage is done. This doesn't mean excessively high amounts of protein, necessarily. People's needs may vary.

5. Try heat to ease the pain. (and ice if you have to)

Heat can minimize tension and pain signals. It also helps open blood flow to the area which will help remove toxins. You can try a warm bath. The debate between heat therapy and cold therapy is ongoing, but when it comes down to it, it's really just about what feels good to you—for the most part, the effects are temporary. But when you’re super sore, any fleeting relief (as long as it’s safe) is worth it. Ice can help reduce the swelling that sometimes comes along with extreme soreness,

6. Nonsteroidal Anti-Inflammatory (NSAID) Medication

NSAIDs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. I'm not crazy about this option, but if you're that uncomfortable, go for it.

7. Massage and Other Therapies

Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.

In order to avoid DOMS in the future, eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption.

Overall, time will heal all soreness—as long as it's not something more serious.

While you're recovering, it's also important to watch for signs of something more serious. If your pain persists longer than a few days or you notice any other abnormalities with your body, you should seek medical attention. This could be a sign that you are actually injured.

If you need help recovering from an injury or would like to find out more information about how to optimize your exercise plan, contact us at 720-370-9559 or check us out at