Delayed Onset Muscle Soreness

Medically reviewed & edited by Dr. Max Trotz,
MBBS (State Examination), MRCP (Edin), DCH

Delayed onset muscle soreness (DOMS) is pain and stiffness in the muscles that develops after a period of athletic activity such as a workout. It can appear several hours or days (sometimes as much as 72 hours) after unaccustomed or unusually strenuous exercise. Typically, however, the soreness arises within the first day after exercise and peaks in intensity at around 48 hours. The soreness can be accompanied by swelling as well.

Anyone, whether an elite athlete or a “weekend warrior”, is liable to experience this condition. However, it most typically occurs in individuals who haven’t exercised for a long while.

Individuals who feel pain during or even immediately after a workout are not experiencing delayed onset muscle soreness. Instead, this is a distinct condition called acute muscle soreness that is a result of the accumulation of lactic acid in the muscles. It is temporary in that it will disappear once the period of strenuous activity has ended.

Causes

Delayed onset muscle soreness can appear after any type of high intensity exercise. The series of events leading to muscle soreness is not fully understood. However, it is particularly likely to appear after any exercise involving eccentric contractions with controlled muscle lengthening. The muscle lengthening required by eccentric exercise causes small scale damage to the skeletal muscle fibers. This damage (microscopic tears in the muscle tissues) results in a build up of inflammation. That in turn causes muscle soreness after a period of delay. Even though lengthening and damage to the muscle fibres is often accompanied by swelling and inflammation, it is the tears in the muscle rather than the swelling and inflammation that is thought to be responsible for the muscle soreness.

During the recovery period, the body adapts to prevent the same type of damage if the eccentric muscle exercise is repeated. This process of recovery causes the pain and stiffness to appear in the affected muscle groups.

Symptoms

The symptoms of delayed onset muscle soreness usually include one or more of the following:

• Pain and stiffness in the muscles and joints;
• Muscle soreness after exercise, and muscles that are “tender to the touch”;
• A reduction in the range of motion of muscles and joints due to the pain and stiffness;
• Swollen muscles;
• Temporary loss of muscle strength.

How To React To Delayed Onset Muscle Soreness

In contrast to many of the other types of injuries we discuss on this site, the best way to react to delayed onset muscle soreness is not to start a period of rest. Although this may seem counter intuitive, a complete cessation of athletic activity may make the muscle pain and stiffness worse, not better.

The one exception to this rule is if your symptoms are especially severe. In this circumstance, a 24-48 hour rest period may be of some benefit. However, be careful not to extend the rest period any longer than that.

However, if the pain and stiffness are not exceptionally severe, completely refraining from athletic activity for a period may actually be counter productive. Instead, it is usually better to temporarily switch  to a lower intensity exercise program which does not place as much stress on the sore muscles. Examples may include yoga, moderate intensity walking, cycling or swimming.

Alternatively, you could switch to exercises requiring the use of less affected muscles in order to allow the most affected muscle groups time to recover.

There is some evidence to suggest that starting any new exercise program gently and gradually helps to minimize muscle soreness by giving the muscles time to adapt to the new movements.

Treatment

The only real treatment for delayed onset muscle soreness is patience. The good news is that this condition will resolve itself over time. This usually happens within about 72 hours of the soreness appearing.  However, while waiting for the muscles to repair themselves, individuals with DOMS can take a number of steps to reduce their muscle pain and stiffness:

• Get a massage. Studies have reported that a massage 1,2 or even 3 days after a workout can result in a significant decrease in delayed onset muscle soreness. This reduction in symptom severity is thought to be due to an improvement in the blood flow to the muscle. A similar effect can be achieved with low-intensity work and hot baths or showers.
• If getting a regular massage is not convenient, a self massage tool like the Original Tiger Tail can also yield many of the same benefits.
• Using a foam roller can also reduce the pain, stiffness and soreness of DOMS.
• Non-steroidal anti-inflammatory tablets and topical analgesics can also be effective in reducing the symptoms of DOMS. There is some evidence that NSAIDS attenuate muscle injury and perceived soreness while hastening strength recovery. Menthol based analgesics (and especially those containing arnica) can be effective in mitigating DOMS.
• Cold baths immediately after a game or workout have been shown to be effective in reducing DOMS. A 10-15 minute immersion can be all that is needed to achieve the desired effect. In recent years, ice baths have become popular among serious athletes for this very reason.

Dietary Changes

In some cases, severe instances of DOMS can be traced back to the diet. Certain foods can increase the levels of inflammation in the body and therefore exacerbate delayed onset muscle soreness.

It is also important to stay adequately hydrated both during and after the workout – something that many individuals neglect to do.

Ensuring you consume enough protein as soon as possible after a workout can help to boost the process of muscle repair. As we have explained above, DOMS is caused by the process of the body repairing its own muscle tissues. Consequently, anything that speeds up this process will also help to shorten the period of delayed onset muscle soreness.

Continued Exercise

Continued exercise may temporarily suppress the soreness. Exercise increases pain thresholds and pain tolerance. This effect, called exercise-induced analgesia, is known to occur in endurance training (running, cycling, swimming), but little is known about whether it also occurs in resistance training.