Delayed Onset Muscle Soreness
Exercise,  Recovery

Delayed Onset Muscle SorenessThis article is a 7 min read

Imagine, you’ve finally made the decision to get in shape. You put on your running shoes and hit the road. After you’ve finished, you feel very accomplished completing your first 3-mile jog in a few years! But your good feelings soon turn to pain and the inability to get out and jog again for almost a week. You get discouraged and quit.

Does the above sound familiar? Have you ever started a new sports season, exercise program, increased your current training program significantly, or tried something novel and experienced pain and soreness over the next 24 to 72 hours?

Many athletes both competitive and recreational will experience Delayed Onset Muscle Soreness (DOMS) at least one time during their career. In fact, DOMS is not limited to athletes, but can also be experienced by people who have lower fitness and start an exercise program and do too much at the start.

In this article three keys in prevention and treatment will be identified:

  1. Exercise design/progression is important; but even though warm-up is important to a productive exercise session, it may not help with DOMS.
  2. Massage is helpful in the treatment of DOMS
  3. There may be some nutritional strategies to help with DOMS

What is DOMS?

Delayed Onset Muscle Soreness is an exertional related condition which can lead to a range of symptoms which may be mild to severe. The onset will usually occur starting at about 12 hours post exercise and intensify between 24 – 72 hours (1). Symptoms may include:

  • Localized muscle pain/soreness (1,2)
  • Stiffness (1,2)
  • Swelling (1,2)
  • Reduced range of motion at the affected joints (1,2)
  • Reductions in power of affected muscles (1,2)
  • Tenderness in the muscles affected (1,2)
  • In rare cases, muscle breakdown that impacts the kidneys (1,2)
  • Elevated creatine kinase (CK) enzyme in the blood, signaling muscle tissue damage (1,2)

DOMS can be a mere inconvenience or rarely, in its worst case a major medical problem impacting the kidneys (1,2).

What causes DOMS?

There are common etiologies for DOMS, however, the exact causes are still poorly understood. Many fitness specialists will refer to build up of lactic acid as one primary cause of DOMS, but this is not supported by research (1).

Most likely a combination of factors plays into the formation of DOMS. Some common theories have been suggested. For example, high tension in eccentric movements (downhill running or jumping movements) and isometric contractions of the muscle have been associated with DOMS due to possible structural damage (1,4,5). Cell membrane damage is implicated as it leads to disruption of calcium balance in the injured fibers, resulting in necrosis (death) of the injured fibers (4). Neutrophil release in the damaged muscle and may be part of the inflammatory process (6). Possible increase in free nerve activation due to Macrophage (they play an important anti-inflammatory role) activity and the ensuing waste products in the muscle may lead to pain sensation (4).

Practically, exercise intensity and/or changes in exercise routines can lead to the formation of DOMS. When exercise intensity is either too great for one’s current level of conditioning or increased too quickly a person may develop symptoms of DOMS. Additionally, even well-trained persons can experience DOMS if they engage in novel or activities they are unaccustomed to (5).

Can it be prevented?

It is often said that prevention is the best medicine, this is very true with DOMS.

Appropriate exercise progression is the most important preventative measure to take for the prevention of DOMS Click To Tweet

For example, new eccentric activities should be phased in over a two-week period with appropriate increases in duration and intensity. For athletes who train every day, a period of 48 hours of Non-DOMS (lower intensity) stimulating activities should be engaged in after activities that subject one to increase risk. Alternatively, one could train varied muscle groups on specific days to allow others to recover (7). Recovery days are important.

When considering exercise prescription and training the principle of specificity must be kept in mind. If you train on a bike you are conditioned for cycling, if you wish to start running start slowly and build your “running fitness”. This change in activity can lead to DOMS, even though you may have high levels of aerobic fitness from cycling.

A dynamic warm-up is important for a safe and productive exercise session. Range of motion activities improve flexibility but may be best done at the end of your session while muscle core temperatures are high and muscle viscosity is lower, therefore allowing greater stretching of a muscle. However, warm-up may not prevent DOMS (1).

How is it treated?

It is important to understand that pain reduction, even with treatment, may not equal recovery (1). Several approaches can be taken to lessen the pain and discomfort associated with DOMS.

Staying active may help. For mild to moderate cases of DOMS research and clinical experience have demonstrated that “active” recovery helps reduces symptoms. Data suggests that low-level activity will reduce symptoms, but the effect is temporary (8). When one experiences severe symptoms, it is “best to rest” and employ other remedies (1).

Massage Therapy may help. Various studies have demonstrated that massage therapy is effective at reducing the pain and inflammation associated with DOMS (9,10,11,12). In a 2012 meta-analysis, massage therapy was found to be superior to cryotherapy, stretching, and low-intensity exercise (9).

Other methods that may help. Besides pharmacotherapy, options for reducing pain and swelling from DOMS exist. There are some data to support the use of cryotherapy, hydrotherapy, whole-body vibration, acupuncture, foam rolling, and/or heat applications.

Nutritionally, the most common applied strategy is the use of post-exercise protein supplementation. Even though protein supplementation has been demonstrated to enhance muscle anabolism, it has not yet been validated as useful for reductions in muscle damage and enhanced recovery (13).

Protein/carbohydrate milk product ingestion have shown promise. Several studies have demonstrated that  milk-based protein-CHO supplementation may reduce perceived pain, enhance muscle repair, and attenuate the reduced performance associated with DOMS (14,15,16,17). The dose and timing are not clear (15,16).

Other nutritional methods of preventing or treating DOMS include ingestion of caffeine which has been demonstrated to both enhance performance and also reduce perceived pain post-exercise. However, the studies on this are small and this stimulant has deleterious side effects. There also have been studies done evaluating curcumin, ginger, vitamin C, vitamin E, and omega-3.


  1. American College of Sports Medicine. Delayed Onset Muscle Soreness (DOMS). N.p.: American College of Sports Medicine, 2011. Print.
  2. Dierking, Jenny K., and Michael G. Bemben. “Delayed Onset Muscle Soreness.” STRENGTH AND CONDITIONING JOURNAL Strength and Conditioning 20.4 (1998): 44. Web.
  3. Schwane, James A., Scarlet R. Johnson, Carol B. Vandenakker, and Robert B. Armstrong. “Delayed-onset Muscular Soreness and Plasma CPK and LDH Activities after Downhill Running.” Medicine & Science in Sports & Exercise 15.1 (1983): n. pag. Web.
  4. Armstrong, R. B. “Mechanisms of Exercise-induced Delayed Onset Muscular Soreness.” Medicine & Science in Sports & Exercise 16.6 (1984): n. pag. Web.
  5. Byrnes, W. C., and P. M. Clarkson. “Delayed Onset Muscle Soreness and Training.” Clinics in Sports Medicine 5.3 (1986): 605-14. Web.
  6. Kanda, Kazue, et al. “Eccentric exercise-induced delayed onset muscle soreness and changes in markers of muscle damage and inflammation.” Exerc Immunol Rev 19 (2013): 72-85.
  7. Cheung, Karoline, Patria A. Hume, and Linda Maxwell. “Delayed onset muscle soreness.” Sports Medicine 33.2 (2003): 145-164.
  8. Andersen, Lars L., Kenneth Jay, Christoffer H. Andersen, Markus D. Jakobsen, Emil Sundstrup, Robert Topp, and David G. Behm. “Acute Effects of Massage or Active Exercise in Relieving Muscle Soreness.” Journal of Strength and Conditioning Research 27.12 (2013): 3352-359. Web.
  9. Torres, Rui, et al. “Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis.” Physical Therapy in Sport 13.2 (2012): 101-114.
  10. Kargarfard, Mehdi, et al. “Efficacy of massage on muscle soreness, perceived recovery, physiological restoration and physical performance in male bodybuilders.” Journal of sports sciences (2015): 1-7.
  11. Visconti, Lorenzo, et al. “Effect of massage on DOMS in ultramarathon runners: A pilot study.” Journal of Bodywork and Movement Therapies (2014).
  12. Zainuddin, Zainal, et al. “Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.” Journal of athletic training 40.3 (2005): 174.
  13. Pasiakos, Stefan M., Harris R. Lieberman, and Tom M. McLellan. “Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: a systematic review.” Sports Medicine 44.5 (2014): 655-670.
  14. Cockburn, Emma, et al. “Acute milk-based protein-CHO supplementation attenuates exercise-induced muscle damage.” Applied physiology, nutrition, and metabolism 33.4 (2008): 775-783.
  15. Cockburn, Emma, et al. “Effect of milk-based carbohydrate-protein supplement timing on the attenuation of exercise-induced muscle damage.” Applied Physiology, Nutrition, and Metabolism 35.3 (2010): 270-277.
  16. Cockburn, Emma, et al. “Effect of volume of milk consumed on the attenuation of exercise-induced muscle damage.” European journal of applied physiology 112.9 (2012): 3187-3194.
  17. Papacosta, Elena, George P. Nassis, and Michael Gleeson. “Effects of acute postexercise chocolate milk consumption during intensive judo training on the recovery of salivary hormones, salivary SIgA, mood state, muscle soreness, and judo-related performance.” Applied Physiology, Nutrition, and Metabolism 40.11 (2015): 1116-1122.
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