Delayed Onset Muscle Soreness (DOMS)

Any type of activity that places unaccustomed loads on muscle may lead to delayed onset muscle soreness (DOMS). This type of soreness is different from acute soreness, which is pain that develops during the actual activity. Delayed soreness typically begins to develop 12-24 hours after the exercise has been performed and may produce the greatest pain between 24-72 hours after the exercise has been performed.

While origins of the soreness and accompanying symptoms are complex, it is well-established that many types of physical activity can cause delayed soreness. Most believe soreness develops as a result of microscopic damage to muscle fibers involved the exercise. This type of damage likely results from novel stresses that were experienced during the exercise.

One common misconception about DOMS is that it is due to lactic acid accumulation, but lactic acid is not a component of this process. DOMS appears to be a side effect of the repair process that develops in response to microscopic muscle damage.

Examples of activities that are known to cause DOMS include:

  • Strength training exercise
  • Walking down hills
  • Jogging
  • Step aerobics
  • Jumping

Activities which cause DOMS all cause muscles to lengthen while force is applied. This is eccentric muscle action. Examples of eccentric muscle actions include the lowering phase of a bicep curl exercise or the lengthening of the thigh muscles while the limb brakes against your body’s momentum as it walks or jogs down a hill. Jogging or running on a flat surface can also elicit DOMS symptoms for those who are unaccustomed to this type of activity.

The severity of soreness depends on the types of forces placed on the muscle. Running down a hill will place greater force on the muscle than walking down the same hill. The soreness that develops will likely be greater after running down a hill. A high number of repetitions will cause more damage and soreness than a low number of repetitions. As a result, work your way gradually into a new exercise program.

All people are susceptible to DOMS, even those who have been exercising for years. However, the severity of soreness normally becomes less as your body becomes adapted to work it regularly performs. Just one bout of soreness producing exercise actually develops a partial protective effect that reduces the chance of developing soreness in that same activity for weeks or months into the future.

DOES DOMS ONLY CAUSE SORENESS?

There are numerous characteristics of DOMS beyond local muscle pain. Some of the most common symptoms include:

  • Swelling of the affected limbs.
  • Stiffness of the joint accompanied by temporary reduction in a joint’s range of motion.
  • Tenderness to the touch.
  • Temporary reduction in strength of the affected muscles (lasting days).
  • In rare and severe cases, muscle breakdown to the extent that the kidneys may be placed at risk.
  • Elevated creatine kinase (CK) enzyme in the blood, signaling muscle tissue damage.

SEEKING MEDICAL TREATMENT

DOMS symptoms do not typically necessitate the need for medical intervention. If the pain level becomes debilitating, if limbs experience heavy swelling or if urine becomes dark, then medical consultation is advisable.

DOMS PREVENTION

One of the best ways to reduce the severity of DOMS is to progress slowly in a new program. Allowing the muscle time to adapt to new stress should help to minimize the severity of symptoms, but it is unlikely that soreness can be avoided altogether. It is also important to allow the muscle time to recover from work that produces soreness, and participating in the same exercises on subsequent days should to be done judiciously. Proper warm-up is also important in preparing the muscle for the types of forces that may cause damage, but there is little evidence that warm-up will be effective in preventing DOMS symptoms. Stretching is sometimes done before exercise, but it is better to stretch after the body is warmed up and after exercise. Stretching has not been shown to reduce or prevent symptoms of DOMS, but DOMS should last only a few days (usually 3-5 days) and the involved muscles will be better prepared for future bouts of the same type of exercise.

DISCONTINUING EXERCISE

Often, symptoms diminish during activity, but they will return after recovery. Performing exercise while experiencing severe symptoms may make matters worse. On the other hand, light activity should not impair your recovery. However, there is also not much evidence that this will hasten your recovery. If you find that your symptoms make it difficult or too painful to perform the activity, then it is advisable to refrain from the activity for a few days and return to the activity as symptoms subside.

EASING DOMS SYMPTOMS

There is little evidence that such treatment strategies will hasten recovery and return to normal function. If the primary goal is to reduce symptoms, then treatments such as ice pack application, massage, tender- point acupressure, and oral pain relief agents may be useful in easing pain. It is important to be aware that pain reduction does not represent recovery. Rather, these treatments may only be effective in reducing symptoms of pain, but underlying muscle damage and reduced function may persist.

NO PAIN, NO GAIN?

It is unlikely that you will avoid soreness altogether when beginning a new exercise program. However, pain does not need to be present to achieve gains in fitness status, and pain may indicate a need to reduce or refrain from an activity. While eccentric loading of muscle to achieve gains in muscle size appears to be important, gains in strength will occur without overemphasizing the eccentric component of a weightlifting exercise. Pain that occurs during exercise (i.e., acute) signals a problem with the exercise (too intense, bad form, etc.) and should be halted before muscle or joint damage occurs.

Republished with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine.

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