• Introduction
  • The basics of delayed onset muscle soreness
  • What causes DOMS?
  • Can DOMS be treated?
  • Can DOMS be prevented?
  • Final thoughts
  • Sources
  • Eccentric movement: a movement where the muscle lengthens while contracting.
  • Homeostasis: a biological system's process of maintaining stability while adjusting to changing conditions.
  • Motor unit: a motor neuron and the muscle fibers it innervates.
  • Muscle fiber: a single muscle cell.
  • Myofibril: long filaments that run parallel to each other to form muscle fibers.

Introduction

Delayed onset muscle soreness (DOMS) is a common experience for sportspeople and athletes alike. It refers to the soreness you feel after an intense workout or new activity.

DOMS is not an acute diagnosis. The first symptoms usually set in within 12-24h after training and last approximately 3-5 days. During this time you may also experience reduced range of motion, stiffness, swelling, fatigue, and loss of strength.

This phenomenon has led sports scientists to find ways to alleviate or even prevent DOMS symptoms entirely. Despite their best efforts, the majority of studies have been either inconclusive, or shown no positive effect. To date, no universal protocol exists for treating delayed onset muscle soreness.

This post explains the basics of delayed onset muscle soreness, and examines the best treatments for it.

The basics of delayed onset muscle soreness

Delayed onset muscle soreness starts around 12-24h after training and peaks 24-72h after the workout. Usually these symptoms last for three to five days before fully subsiding. DOMS is common especially in untrained individuals, or when trying out a new exercise that your body is not used to.

Delayed onset muscle soreness a result of tiny microscopic tears that occur in your muscle fibers as a result of intense training. To repair these tears, the muscle tissue releases enzymes that cause inflammation and soreness. The severity of these symptoms are directly related to the intensity and volume of the activity, and therefore the extent of the muscle tissue damage.

Delayed onset muscle soreness is a result of your body’s physiological adaptation to exercise, and a sign that the body is healing itself. However, this recovery process does not stop when homeostasis (body’s internal balanced state) is restored. In fact, your body overcompensates for the tissue damage and makes it stronger than before. This is known as supercompensation and it is one of the cornerstones of physical training.

As your body adapts to a certain level of activity, you will experience less muscle tissue damage, less soreness, and faster recovery. This allows you to increase training intensity and volume to progressively strengthen the muscle.

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Delayed Onset Muscle Soreness

Refers to the soreness 24h-48h after a workoutCaused by the micro tears inside the muscleMore common after high-resistance trainingConsistent training has proven to prevent DOMSNo universal treatment exists

What causes DOMS?

Previous scientific finds suggested that DOMS is caused by the accumulation of lactic acid in the muscle. We now know it is mainly caused by exercise-induced muscle tissue damage – specifically the mechanical disruption of sarcomeres (the smallest functional unit of striated muscle tissue), leading to an inflammatory response. This muscle tissue damage can also be seen as elevated creatine kinase (enzyme that indicates tissue damage) levels in your blood.

Interestingly, eccentric contractions (loading while the muscle lengthens) seem to develop a higher degree of delayed onset muscle soreness. This is because in eccentric movements, the muscle lengthens when the force applied to it surpasses the force it produces. For example, the lowering phase of a squat produces more tension than the concentric (lifting) phase. Eccentric actions also function to decelerate and absorb shocks, while also generating 14-50% more force when contracting. Together, these cause more disruption to the structural elements of the muscle and connective tissue. It seems that fast-twitch muscle fibers are more susceptible to DOMS than slow-twitch muscle fibers due to their larger size and higher force capacity.

Contrary to a muscle strain, the sarcomere disruption in DOMS does not extend across the whole muscle fiber, or the length of a myofibril (long filaments that run parallel to each other to form muscle fibers). In fact, adjacent muscle fibers appear relatively normal. This is important because eccentric contractions on an eccentrically damaged muscle will not exacerbate existing damage. In simple terms, working out with DOMS does not make you more susceptible for injuries, whereas training with a muscle strain does.

Can DOMS be treated?

In past decades, delayed onset muscle soreness has been treated it in three main ways: lessening mechanical damage, lowering inflammation and swelling, and reducing free radical proliferation. Methods like foam rolling, stretching, massaging, hot/cold treatment, anti-inflammatory medication, compression garments, and menthol-based lotions all fall under one of these techniques.  

Here is an alphabetized list of techniques used to treat delayed onset muscle soreness – and what science says about them.

Treatment

Effect

Active recovery

Light exercise is proven to be an effective way to alleviate DOMS, although symptoms usually return once your muscles have cooled down.

Anti-inflammatory supplements

Anti-inflammatory supplements seem to be ineffective in treating DOMS. They might even inhibit your recovery process because inflammation is your body’s natural response to injury.

Cold water immersion

Cooling may reduce soreness and inflammation but does not speed up recovery. Hydrostatic pressure during immersion may further help reduce inflammation. However, there is lots of variability between water temperature, duration, etc.

Compression garments

Compression garments alleviate swelling and soreness, and therefore seem useful in treating DOMS. They might also increase blood flow in and out of the muscle which can speed up recovery.

Contrast water therapy

Alternating between warm and cold water has a small but significant effect in treating DOMS symptoms, but not perceived fatigue. Has also shown signs of reducing creatine kinase in the blood.

Cryotherapy

Cooling may reduce soreness and inflammation. However, it does not prevent/reduce muscle tissue damage or speed up recovery.

Foam rolling

The effects of foam rolling on performance and recovery are small and partly negligible. However, they can be relevant in some cases (reducing soreness and loss of strength).

Massaging

Out of all treatments, massaging seems to be the most useful in reducing DOMS and perceived fatigue. It has also showed moderate decrease in creatine kinase levels, indicating reduced tissue damage.

Menthol-based lotions

Menthol-based lotions have shown little benefit in treating soreness.

NSAIDs

Nonsteroidal anti-inflammatory drugs (ibuprofen, aspirin, etc.) are useful in decreasing soreness. But, since inflammation is your body’s own healing mechanism, blocking it with anti-inflammatory drugs may inhibit the body’s natural immune response.

Stretching

Stretching before or after exercise seems to have no meaningful effect on DOMS or risk of injury.

Vibration therapy

Vibration therapy after exercise has shown similar benefits of treating DOMS as massaging. However, this has been studied relatively little. 

Although some techniques have shown good results, we have yet to find the gold standard of treating delayed onset muscle soreness. Therefore, no universal protocol exists for treating DOMS.

Delayed onset muscle soreness (DOMS) is caused by micro tears inside the muscles.

Can DOMS be prevented?

The internet is full of articles and instructional videos on how to prevent soreness from occurring after exercise. For example, using compression materials during exercise, foam rolling immediately after training, or stepping on a vibration plate afterwards are all common sights within the fitness industry.

Unfortunately, none of these seem to be effective in preventing delayed onset muscle soreness. However, the severity of DOMS can be reduced by gradually introducing a new activity or slowly increasing the intensity. This allows your muscles to adapt to a new stimulus without experiencing too much soreness.

Your body also needs time to recover from exercises that produce soreness. Therefore, it is not advised to train the same muscle groups two days in a row. After all, your muscles need up to 48-72h to recover between workouts. 

Final thoughts

There is little conclusive evidence whether DOMS symptoms can be treated or prevented. The good thing is that exercise-induced soreness is completely normal and goes away in only a few days. Your body will also adapt to the way you use it. Thus, consistent training will eventually lead to lower muscle tissue damage, reduced soreness, and faster recovery.

That said, you should also steer clear from higher intensity exercises if you feel sore. There are two reasons for this. First, delayed onset muscle soreness lowers performance, which leads to a less effective workout. Second, some studies have found that DOMS can alter the recruitment patterns of the muscle and cause unaccustomed stress on muscle ligaments and tendons.

In most cases DOMS does not need treatment at all. However, if your symptoms become unbearable, or your urine turns brown, you might be suffering from rhabdomyolysis. This is a medical emergency and requires treatment from a health professional.

Did you learn anything new about delayed onset muscle soreness? Let us know in the comments.

Sources

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