(Delayed Onset Muscle Soreness)
“Yesterday I worked out and today all my muscles hurt”.
Maybe it was the first session back after the holidays, or maybe coach just really felt like making everyone run hills last night. Maybe it was a new gym program with a heap of new exercises that you weren’t really used to or maybe you really felt like pushing yourself this week to break a new personal best.
It is pretty normal to be a bit sore for a few days after intensive, strenuous exercise. Whilst the physiological mechanisms behind delayed onset muscle soreness (DOMS) are not properly understood, it is accepted that the development of DOMS is likely related to mechanical damage to the muscle tissue. In particular, straining of the connection within the muscle fibre resulting in cell changes and local inflammation.
Whilst DOMS is not typically considered an “injury”, it is accepted as one of the most common reasons for reduced sporting or athletic performance. In fact, DOMS is so commonplace within the realm of sport and exercise that Assaf Lev investigated the psychological and social role the phenomenon has within gym-goers. For many, this “soreness” becomes a means of social recognition and validation and is something that many will even actively pursue in their workouts.
As opposed to a discrete muscle injury, which will typically be painful at the time of the event, DOMS typically will not manifest until 6-12 hours after the exercise. From there, it will develop with variable symptoms of muscle soreness, tenderness, impaired mobility and pain typically peaking between 48-72 hours after the event and in some cases taking up to a week to completely resolve.
“What can I do about it?”
Research has consistently demonstrated ongoing performance impacts due to the development of DOMS. This has led to the development of, and study into, a myriad of different management strategies aimed at preventing or reducing the impact of DOMS and accelerating the recovery from exercise. These include different forms of thermal therapies, compression therapies, active recovery strategies, physical therapies and various oral medications and supplements. These have varying depths of research surrounding them and are often conflicting. What research does exist can help point athletes (professional and recreational alike) in the right direction depending on their needs and exercise goals.
Thermal Therapy
Cold water immersion
Research has consistently demonstrated ongoing performance impacts due to the development of DOMS. This has led to the development of, and study into, a myriad of different management strategies aimed at preventing or reducing the impact of DOMS and accelerating the recovery from exercise. These include different forms of thermal therapies, compression therapies, active recovery strategies, physical therapies and various oral medications and supplements. These have varying depths of research surrounding them and are often conflicting. What research does exist can help point athletes (professional and recreational alike) in the right direction depending on their needs and exercise goals.
Heat therapy
When used in the right setting, and at the right stage of the healing/recovery process, heat therapy has been suggested as a useful pain management strategy for DOMS. Previous research has demonstrated protective impacts on cellular and protein damage as well as possible increased muscle growth and strength increases to heat therapies. Further research is required in this area, however it is important to note that local heat application in the early stages of tissue injury and healing may reinforce the initial inflammatory response and should be treated with caution.
Cryotherapy
The use of cryotherapy, in varying forms from whole body cryotherapy in contained rooms to local ice application has been used to manage painful inflammatory and chronic conditions, such as rheumatoid arthritis and fibromyalgia. It’s analgesic effects are believed to be the result of slowed neural signals due to local tissue restriction from the cold temperatures. Despite this effect, the use of icing sore muscles is suggested to be avoided. Research by Isabell, et al (1992) suggested that the use of ice had not effect on DOMS and may have even increased the peak soreness reported in their study.
Compression
Compression during exercise
There are conflicting reports of the effectiveness of compression garments during exercise. Whilst some studies (investigating across a range of different compression levels) report no change in performance during exercise or symptoms after exercise. There is some evidence supporting their use in performance during running tasks, however these are not consistent.
Compression after exercise
Whilst it is not entirely understood why, the use of compression garments after exercise does appear to reduce the clinical symptoms of DOMS as well as improve the rate of recovery. However these studies are not consistent, often reporting different measures or results. Importantly, these studies often simply used off-the-shelf compression garments, applying a compression of only 10-15mm Hg.
Intermittent compression therapy
Dynamic or intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System, have become increasingly popular, particularly amongst endurance athletes. This is despite lacking a large body of evidence to support its use. A critical appraisal by Sledge and Armstrong (2021) found that the devices offered similar clinic benefit to massage interventions (discussed below). They found that a single use of an IPC device may provide immediate pain relief but will be unlikely to reduce the duration or overall impact of the DOMS. As such, they may be a useful tool if an athlete is required to perform during a congested schedule.
Active Recoveries and Physical Therapies
Low-intensity exercise
Continued low-intensity exercises has been utilised as a short-term pain alleviator, although is often varied and inconsistent. The impact of the exercise on reducing pain from DOMS is likely most related to the exercise that resulted in the initial DOMS and further activity should be individualised to the person engaging in it.
Stretching
Aside from brief (and often minimal) improvements in range of motion and pain, a large review by Herbert, de Noronha and Kamper (2011) found no meaningful effect or change from stretching on the development of DOMS. This was further established by a more recent study in 2018 that examined dynamic stretching and contract-relax protocols on the development of DOMS and found similar results.
Foam Rolling
The use of a foam roller following exercise appears to be useful in the short-term reduction in pain from DOMS. Similar to other soft-tissue modalities, the underpinning mechanisms are not fully understood
Massage
As stated above, massage and soft-tissue therapies appear to offer a brief improvement in pain and function following the development of DOMS. There are a number of theories that have been proposed to explain this phenomenon, including alterations to the parasympathetic nervous system, increases in blood and lymphatic flow as well as the psychophysiological role of massage in pain management. Ultimately, multiple studies have supported the use of massage therapy in reducing DOMS following strenuous exercise.
Oral Medications & Supplements
There is a growing body of evidence regarding the use of medications and supplements to assist in the management of DOMS, ranging from oral non-steroidal anti-inflammatories to branched-chain amino acids and Vitamin D supplements. The evidence for the use of these is often contradictory and lacking in clinical significance. The use of these should always be made in consult with a qualified dietician or medical practitioner.
“So which one is the best for me?”
Ultimately, DOMS is a transient phenomenon that impacts people to varying degrees. There is a range of evidence for different management strategies, all with different applications. At an individual level, the best was to manage DOMS is to manage the initial stress of the task that induced it and to employ the management strategy that is most available to you and that you feel has the best impact on your body. A physiotherapist can help guide and manage you through that process to ensure you continue to perform when you most want to.
References
Heiss, R., Lutter, C., Freiwald, J., Hoppe, M., Grim, C., Poettgen, K., . . . Hotfiel, T. (2019). Advances in Delayed-Onset Muscle Soreness (DOMS) – Part 2: Treamtent and Prevention. SportverLetzung Sportschaden, 21-29.
Herbert, R., de Noronha, M., & Kamper, S. (2011). Stretching to Prevent of Reduce Muscle Soreness After Exercise. Cochrane Database of Systematic Reviews, 7.
Hill, J., Howaston, G., van Someren, K., Leeder, J., & Pedlar, C. (2013). Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine, 1-7.
Hotfiel, T., Freiwald, J., Wilhelm Hoppe, M., Lutter, C., Forst, R., Grim, C., . . . Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part 1: Pathogenesis and Diagnostics. SportverLetzung Sportschaden, 243-250.
Isabell, W., Durrant, E., Myrer, W., & Anderson, S. (1992). The Effects of Ice Massage, Ice Massage with Exercise, and Exercise on the Prevention and Treatment of Delayed Onset Muscle Soreness. Journal of Athletic Training, 208-217.
Lev, A. (2022). “The Glorious Pain”: Attaining Pleasure and Gratification in Times of Delayed Onset Muscle Soreness (DOMS) among Gym Goers. Jounral of Contemporary Ethnography.
Moore, E., Fuller, J., Buckley, J., Saunders, S., Halson, S., Broatch, J., & Bellenger, C. (2022). Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Perforance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression. Sports Medicine, 1667-1688.
Vaile, J., Gill, N., & Blazevich, A. (2007). The Effect of Contrast Water Therapy on Symptoms of Delayed Onset Muscle Soreness. Journal of Strength and Conditioning Research, 697-702.
Xie, Y., Feng, B., & Chen, K. (2018). The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals: A Randomized Clinical Trial. Clinical Jounral of Sport Medicine, 28-26.
