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Injury/Pain

Delayed Onset Muscle Soreness: A Primer

Overview

You may have never heard of the medical term, but you're likely very familiar with delayed onset muscle soreness (DOMS), a condition involving muscle overuse that usually results from a single intensive exercise bout.

Dave Cruz

The discomfort begins at a muscle-tendon junction and spreads throughout the affected muscle. Soreness after almost any vigorous session of exercise is normal. DOMS is less common and probably indicates that you have stressed the muscle tissues beyond their normal capacity. DOMS hurts for a couple of days, but it’s not a serious condition and the symptoms will go away with rest.

How It Happens

Even though DOMS is relatively common, very little is known about the mechanism of the injury. The damage caused by muscle-lengthening—the kind that happens in downhill running, when your arm descends during a bicep curl, or during the lowering phase of a push-up, for example—is thought to last one to three days, followed by a period of regeneration of muscle tissue.

The pain is a result of small tears in the muscle tissue and the inflammation that goes with torn muscle fibers. The more (or longer) you overuse the muscle or muscle group, the greater the tissue damage. There does not appear to be any connection between the development of soreness and the loss of muscle strength. The two problems seem to occur at different times.

By the Numbers

2
DOMS pain is likely to be the worst during the first two days after exercising beyond normal capacity.

3-7
The number of days it can take DOMS symptoms to subside.

Who’s at Risk

DOMS is not associated with any sport, but rather with athletes and exercisers in any sports or physical activity who train beyond their normal limits.

Symptoms

  • Symptoms begin 24-48 hours after an intensive bout of exercise.
  • Minor muscle soreness.
  • More severe muscle soreness in out-of-shape exercisers.

Initial Treatment

DOMS is a self-limiting condition that requires no clinical treatment. The person who experiences the condition should follow these treatment guidelines:

  • Rest for three or more days (until the soreness subsides).
  • Take aspirin, ibuprofen, acetaminophen, or naproxen for pain/inflammation.
  • Apply ice to the sore area for 15-20 minutes at a time, 3-4 times a day.
  • Heat after the first 48-72 hours may diminish the pain, but there is no evidence that it speeds the healing process.
  • Gentle stretching appears to help some people, but there is no compelling evidence to support this practice.

Comeback Strategy

  • Take a few days off (3-7 as a general guideline), then gradually get back into a training routine.
  • Walk, jog, or run (but not at full speed) for 5-10 minutes to warm up before beginning training or competition.
  • Don’t expect peak athletic performance immediately after returning to action.
  • Cross-train in sports that don’t stress the muscles that are sore because of overuse.
  • Use the DOMS experience as a guide for sensible conditioning.

Prehab

Incorporate the following prehab exercises into your workouts:

  1. Foam roll, soft tissue massage after exercise
  2. Light cardiovascular activities (jogging)
  3. Active stretching

How to Avoid This Condition

  • Follow the 10 percent rule: do not increase exercise intensity, frequency, or duration more than 10 percent a week.
  • Allow for weekly regeneration time in your workout schedule.
  • Cool down after vigorous exercise by jogging, walking, or slow-lap swimming.
  • Immersion in cold water is used by elite athletes at Athletes’ Performance.
  • Use Hot/Cold Contrasts. Learn more about them in “Is a hot or cold shower better after a workout?

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Rest, Tightness, Regeneration, Training, Sports Performance, Soreness

References

  1. Athletes’ Performance
  2. British Journal of Sports Medicine
  3. MedicineNet.com
  4. Penn State Sports Medicine Newsletter
  5. WebMD

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