Muscle soreness after exercise can put a real kink in your training. Find out what DOMS is, how to prevent it and what you can do to ease delayed onset muscle soreness if you get it.
Nearly anyone who works out regularly has experienced sore muscles after exercise. Sometimes you’ll feel it later that night, or the next morning … and in some cases, you may actually think you’re out-of-the-woods, only to wake up two days later with stiff, tender muscles that feel as tight as rubber bands.
It’s known as Delayed Onset Muscle Soreness (also called “DOMS”), and it’s both loved and reviled by exercise fanatics. Loved, because many people view DOMS as a sign that yesterday’s workout was effective, but hated at the same time because in severe cases, Delayed Onset Muscle Soreness can prevent you from comfortably hitting the gym again.
And in the case of calf muscle soreness — which plagues runners as often as weight lifters — it can literally make going down a flight stairs in the morning a three minute ordeal.
Symptoms of Delayed Onset Muscle Soreness
You probably have a case of Delayed Onset Muscle Soreness if you experience any of the following symptoms:
- Muscle tenderness
- Muscle soreness
- Loss of mobility or reduced range of motion
- Muscle tenderness, including when the muscle belly is pressed with the fingers
- Loss of strength
- Acute muscle twitches or spams
The extent and duration of these symptoms may vary from person-to-person and are largely dependent on the amount of resistance — especially eccentric resistance — placed on the muscles during exercise.
There also seems to be a continuum to DOMS — so additional symptoms may appear over a period of time that can last as long as seven to ten days. For example, loss of strength in the muscle tends to peak immediately following exercise or within 48 hours, even in the absence of muscle soreness or other overt symptoms of DOMS.
In fact, by the time of the actual onset of muscle soreness, strength will often have returned to previous levels — although in some cases, it may take as long as five days to experience the return of peak muscle strength.
Pain and tenderness may peak 1-3 days after exercise, with muscle stiffness and swelling peaking 3-4 days after exercise. It’s unusual for symptoms of Delayed Onset Muscle Soreness to persist longer than 7-10 days. If they do, you may want to visit your doctor, since you could have a more serious muscle strain or tear.
Signs That You Might NOT Have DOMS: When You Should See The Doctor
DOMS is typically short-lived, and while it may cause some muscle tenderness, stiffness and reductions in mobility, it isn’t serious. Generally it never warrants a visit to the doctor.
However, it is important to distinguish between Delayed Onset Muscle Soreness, and more serious strains or pulls to the muscle or connective tissue that won’t simply disappear within a few days.
Signs of a more serious muscle or connective tissue strain which may require medical attention include:
- Sharp pain during movement
- Extremely reduced movement or mobility
- Excessive bruising or swelling
- Constant or intermittent throbbing or pulsating pain, even when the muscle is immobile or at rest
- Inability to bear weight
Any or all of these symptoms can indicate a more serious strain to the muscle or connective tissue, including ligaments and tendons.
Typically, with DOMS, you’ll experience tightness and soreness in muscles only during activities that cause muscle contraction, stretching or during movement. While you may experience some feeling of “muscle fatigue” with Delayed Onset Muscle Soreness, the muscle should still be able to bear weight without too much discomfort. If the pain is constant — even at rest — or if it persists for more than 10 days, you should see a doctor.
Causes of Delayed Onset Muscle Soreness
The causes of Delayed Onset Muscle Soreness aren’t entirely understood by doctors and scientists. But there are a couple of theories.
Sore Muscles = Lactic Acid Buildup?
For years, the leading hypothesis for Delayed Onset Muscle Soreness was that DOMS was caused by a build up of lactic acid in the muscle during intense, prolonged exercise.
L-lactate is a chemical continuously produced from pyruvate during metabolism and exercise. Under normal circumstances, L-lactate is removed by the body a rate that exceeds production of it, but intense exertion (like weight training or running) can result in more L-lactate being produced than the body can immediately remove.
This is actually a good thing — since it allows (through a related process that I won’t get into here) energy production to be maintained and your body to continue the exercise.
However, until this was widely understood, many people believed that L-lactate caused acidosis in muscle tissue — in other words, that “burning” sensation you feel during a particularly long or grueling set of squats, sprints or bicep curls. Scientists now believe that muscle burn during exercise is not a product of L-lactate (or the acid form of L-lactate – lactic acid), but rather a result of tissue pH falling when the body switches from aerobic metabolism to anaerobic during activities like weight training.
The other reason scientists have eliminated L-lactate as a cause of DOMS is that L-lactate is cleared fairly quickly from the body once the the activity causing the concentrated build-up has ceased (often within 30-60 minutes). It’s just not present in the tissue long enough to explain muscle soreness that develops 24-48 hours after experience.
So scratch that hypothesis.
Cellular Damage and Microscopic Tears?
The newest theory around what causes Delayed Onset Muscle soreness has nothing to do with L-lactate or Lactic Acid. In fact, it’s a much simpler explanation: muscle tears.
Now, before you start getting freaked out, understand that what we are really talking about here is tiny, microscopic tears in muscle fibers as result of performing high-intensity work. We’re not talking about a ripped bicep or pulled groin.
One of the things exercise physiologists observed when trying to find an explanation for DOMS was that certain types of exercises caused more severe cases of Delayed Onset Muscle Soreness — specifically exercises or activities that involved eccentric contraction of the the muscles — activities like downhill running, plyometrics, or lowering a weight very slowly under tension or resistance. This suggested that maybe the type of muscle contraction was important to understanding DOMS.
For some time now, exercise physiologists have known that eccentric muscle contractions (when the muscle “lengthens” during movement) can cause greater damage to muscle tissue than concentric motions (when the muscle “shortens” — for example during the first part of a bicep curl.) And since Delayed Onset Muscle Soreness seems to be more severe after exercise that involves a higher-degree of eccentric contractions, they put two-and-two together.
A New Hypothesis For What Causes DOMS
So here’s the new hypothesis of what causes Delayed Onset Muscle Soreness:
Whenever you put the muscle under more stress than it’s used to, tiny, microscopic tears develop in the muscle tissue. In other-words, you’ve literally caused structural “damage” to the muscle and underlying cells. This isn’t necessarily a bad thing — since the process of repairing the muscle will typically make it stronger or larger.
There is also cell membrane damage that occurs in the injured tissue, which causes a nasty sounding thing called “necrosis.” Necrosis describes the death of cells, in this case due to muscle trauma. When this happens, the body sends in macrophages, which are immuno-cells that clear away the dead cellular material and flush it from the body.
However, this process also sets off an inflammatory process that may create soreness, swelling and tenderness in the muscle tissue. As the body clears the waste material, inflammation decreases and symptoms subside.
While there still is a fair amount of debate around what the actual bio-chemical and physiological mechanisms are that cause Delayed Onset Muscle Soreness, the prevailing theory is that the muscle soreness you experience is likely a combination of both physical damage to muscle tissue, as well as secondary bio-chemical reactions by the body to that damage — for example the production of free radicals and scavenging cells as part of the recovery and reinforcement process.
There is also some evidence that fast-twitch muscle fibers are more susceptible to eccentric-contraction muscle damage than slow twitch muscle fibers. The length of the actual muscle during exercise may also determine severity of DOMS. This may explain why the calves are particularly prone to developing Delayed Onset Muscle Soreness.
Could Gender Play A Role in DOMS?
Interesting enough, there is some evidence that men may be more prone to Delayed Onset Muscle Soreness than women.
Researchers believe the mechanism for this may be estrogen, which could have a protective effect on muscle and cells, reducing damage. This effect has been observed in both rats given estrogen and then exposed to muscle stress, as well as in humans using oral contraceptives. However, these studies did not look at reported muscle soreness, but rather Creatine Kinase (CK) activity, which may not be a reliable measure of muscle damage.
Preventing Delayed Onset Muscle Soreness
Techniques for preventing — or at least minimizing — Delayed Onset Muscle Soreness are controversial. Indeed, some would argue that a little bit of muscle soreness isn’t something to worry much about — especially if it doesn’t interfere with your training.
However, since a severe case of DOMS can prevent you from training according to schedule, many people are interested in lessening the severity of post-exercise muscle soreness. There are a number of training techniques and nutritional angles you might experiment with, all with varying degrees of effectiveness and clinical “proof” to back them up.
DOMS Remedies That Haven’t Been Proven To Work
First, let’s look at the techniques for treating or preventing Delayed Onset Muscle Soreness that don’t have solid clinical research behind them. That doesn’t mean they won’t work for you, but rather that they haven’t been studied in-depth, so their effectiveness is highly-subjective.
In some cases, like whey powder supplementation, the effects may not be directly related to preventing or treating DOMS, but rather providing nutrients that allow the muscle tissue to heal — which can help with reaching your fitness goals — but not necessarily curing or preventing DOMS.
Glutamine is one of the most abundant amino acids in the body and is critical to protein synthesis, digestion, immune function and possibly preventing muscle catabolism by blunting cortisol levels (a hormone that’s released when the body is under stress.)
While Glutamine is plentiful in the body, because it’s so widely utilized, it can also be depleted quickly. Many people report that supplementing with L-Glutamine before their weight training or running — as well as immediately after — can reduce the severity of Delayed Onset Muscle Soreness.
However, there appears to be no peer-reviewed, published, clinical research to validate these claims. You can try it for yourself, and if it works, fine — but otherwise there is not an established correlation between L-Glutamine supplementation and reduced muscle soreness after exercise.
Whey Powder and Macro-Nutrients
Diet may also play a role in the severity of Delayed Onset Muscle Soreness as a result of intense exercise. However, this has not been extensively studied.
Because of the structural and cellular damage that training can wreck on the muscle, providing sufficient recovery nutrition is critical. Increasing both protein and complex carbohydrates may provide the muscle with the nutrients it needs to repair the damage and grow stronger.
Anecdotally, some people report less severe symptoms of DOMS when they increase protein consumption to a minimum of one gram per pound of lean body mass. This may be one of the reasons that a post-workout whey protein shake has been clinically-shown to increase lean body mass.
There also is a myth — especially among runners — that DOMS may be exacerbated by low hydration levels.
While proper-hydration is important to athletes and runners for a wide-range of reasons, there is no direct correlation (nor any clinical research) to indicate that Delayed Onset Muscle Soreness is caused by lack of water or prevented by better hydration. So while drinking more water is generally a good idea, don’t expect it to keep your muscles from becoming sore after training.
Stretching & Massage
Surprisingly, there is very little evidence to suggest that stretching or post-workout massage can alleviate or prevent Delayed Onset Muscle Soreness. A 2007 study published in the Scandinavian Journal of Medicine and Science in Sportsfound that pre-exercise static stretching had no preventative effect on post-exercise muscle soreness, tenderness or loss of force in eccentric exercise.
In fact, there is no real explanation from stretching advocates as to why muscle stretching – either before, during or after — exercise should relieve DOMS.
Generally, theories around massage and stretching have focused on the ability of these activities to “clear” lactic acid or “toxins” from muscle tissue. However, as we discussed earlier, lactic acid buildup has been eliminated as a cause of DOMS. The body does a fine job clearing L-lactate just fine on it’s own.
While stretching a sore muscle may help increase mobility — or at least the sense of mobility — it hasn’t been shown to actually alleviate DOMS.
Techniques for Reduced DOMS That May Work
There are a couple of treatments for Delayed Onset Muscle Soreness that appear to be promising, even though the clinical research is mixed. They include:
Vitamins and Antioxidants
The connection between certain vitamins and antioxidants and reductions in the symptoms and severity of DOMS is still being studied. While research is sparse, there are a few clinical studies which have shown vitamin or antioxidant supplementation as a promising treatment for Delayed Onset Muscle Soreness.
Theoretically, supplementation with antioxidants makes sense: Damage to cells during intense exercise can produce free radicals, which may then cause secondary, additional damage to tissue until those free radicals are neutralized by the body. Vitamins and compounds in certain food that have high antioxidant properties may assist in helping the body blunt free radicals.
In terms of Vitamin C, there are few well-controlled studies on the effectiveness of Vitamin C supplementation at preventing and treating DOMS.
The most encouraging study was conducted by Kaminski and Boal and it did show that subjects who were treated with 1 gram of Vitamin C three times a day before ”induced calf muscle damage” and then continued the supplement regimine for seven days, showed reductions in reported soreness ratings from 25-44%. However, there appear to be no additional studies to either refute or confirm these results. There also were some methodology limitations to the study.
So while Vitamin C may be effective at reducing Delayed Onset Muscle Soreness, the connection has not been well-studied.
Vitamin E, however, has been more extensively researched as a treatment and preventative for DOMS. Even here, the results are mixed. Two studies showed reductions in muscle soreness or reduced chemical markers of cell damage — as well as improved recovery – with Vitamin E supplementation pre-exercise (the Vitamin E was taken for several days prior to training.) Two other studies — one conducted in rats and another in humans – reported no effect of Vitamin E supplementation on reduction in muscle damage or symptoms or DOMS.
The inconsistencies could be the result of mixed human-animal studies as well as differences in mode of exercise and supplementation routines and concentrations. So the jury is still out on this one.
Other foods or compounds high in antioxidants like Green Tea, White Tea or Black Tea — as well as Goji Berries, Pomegranates, Tart Cherry Juice, Blueberries and Acai — have not been specifically-studied as a treatment for DOMS. In theory, they may have similar effects as other antioxidants like Vitamin C or Vitamin E, but research is thin. Because these foods are generally harmless, and have other beneficial healthy properties, experimenting around with them as a DOMS treatment probably won’t hurt.
L-Carnitine, Arnica 30 and Coenzyme-Q
There are additional supplements which have been studied as possible treatments for Delayed Onset Muscle Soreness.
Again, clinical-results are mixed. There is some evidence that Arnica30, a homeopathic compound, may have a protective effect in runners, but another study refuted this. L-Carnitine did produce lessened symptoms of DOMS in untrained subjects, but the study size was very small — only six subjects. Coenzyme-Q (dietary ubiquinone) showed no effect on antioxidant activity, and indeed, actually may have increased cellular damage according to one study.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Since inflammation is one of the main physical markers of DOMS, conventional wisdom would say that over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Acetaminophen or even Aspirin should be effective in reducing the symptoms of Delayed Onset Muscle Soreness.
However, clinical research is decidedly mixed around this, with the preponderance of the evidence showing that NSAIDs are not particularly effective for treating or preventing DOMS. In fact, a few studies have shown that certain NSAIDs may actually increase cellular damage from eccentric exercise. There are some studies that demonstrate the contrary, but the prevailing attitude toward NSAIDs and DOMS is that they don’t work.
Some research also suggests that the use of NSAIDs could result in less lean muscle gain and strength by interfering with protein synthesis. And since that is probably your goal to resistance training in the first place, you might just want to skip the Ibuprofen and “grin and bear it.”
Methods for Preventing DOMS That Have Been Clinically-Prove To Work
There are several techniques that researchers have found are effective at treating the symptoms of DOMS and may lessen the soreness and tightness. In some cases, the rapid utilization of these techniques after exercise may actually prevent the development of Delayed Onset Muscle Soreness in the coming days.
Reducing Eccentric Contractions
Exercises that emphasize eccentric contractions (forced reps or many plyometric or static-body-weight exercise) seem to result in more severe muscle soreness. Research indicates that reducing these types of exercises may lessen the chances of developing DOMS.
On the other hand, eccentric movements have also been shown to be more effective at building muscle mass and strength than concentric contractions. If fact, eccentric exercises like forced reps are one of the staples of weight training plateau-breaking routines, for this very reason. So maybe the temporary soreness is worth the payout. That’s something you have to determine for yourself.
Scientists aren’t exactly sure what causes this. A 2004 study by Kazunori Nosaka and Kei Sakamoto and published in the Journal of Athletic Training found that increasing muscle temperature alone did not produce a measurable difference in post-workout muscle soreness or DOMS. So it appears that the protective characteristics of warm-up are not due to an increase in body or muscle temperature.
A more interesting hypothesis is that performing “warm-up” sets of exercises – which has long been recommended by trainers — creates an environment in the trained muscle that reduces the damage of subsequent sets of exercise in the same muscle group. A separate study by Nosaka published in the February 2002 journal Acta Physiologica Scandinavica found that the first set of eccentric exercise that a person performs has a protective effect on subsequent bouts of exercise — and that this “warm-up” wasn’t due to central nervous system adaptations (the researchers controlled for this by stimulating the muscle with electricity.) Instead, it may be the result of a cellular adaptation caused by the initial bout of exercise.
Practically speaking, this makes a case for warm-up sets prior to performing heavy eccentric exercise, although it’s important to understand that most of the research around warm-up is carefully controlled. You may not experience the same effects in an uncontrolled, gym-environment.
Ice/Cryotherapy: Why Ice Is Nice
There is a fair amount of clinical evidence that cryotherapy, or treatment with cold or ice can prevent or reduce symptoms of Delayed Onset Muscle Soreness. I know ice isn’t as glamorous as L-Carnitine or Acai Berries — but it appears that it is effective in treating at some symptoms of DOMS.
Cold water immersion — think “ice-baths” here — are one of the most widely studies techniques for treating DOMS. A 1999 study published in the Journal of Sports Sciences found that immersing the trained muscle in cold water 15 minutes after completing eccentric exercise, and then following up every 12 hours with a similar 15 minute immersion, reduced muscle stiffness and damage. However, the researchers noted that it didn’t seem to improve muscle tenderness or loss of strength. So while it may help with some symptoms of Delayed Onset Muscle Soreness, it doesn’t appear to treat others.
With DOMS, you win some and lose some.
What about ice massage?
Based on the current research, ice massage does not appear to be effective at reducing the symptoms of DOMS. However, this may simply be a result of the construction of the studies around ice massage therapy — especially since cold water immersion seems to have some advantageous effects.
Compression therapy also looks like a promising technique for treating Delayed Onset Muscle Soreness.
A 2001 study by the Human Performance Laboratory at Ball State found that wearing a compression sleeve for five days after performing eccentric exercise reduced strength loss, swelling, muscle soreness and stiffness.
Mixed Treatments: The Key to Reducing Symptoms of DOMS?
As researchers Declan and Connelly of the Human Performance Laboratory at the University of Vermont — Burlingame have pointed out in their excellent review of the current research around treatment of Delayed Onset Muscle Soreness, the most promising area of additional research is around combining multiple therapies together to treat DOMS. For example, they are particularly intrigued with the idea of combining cold therapy with compression therapy, which may have a synergistic effect on DOMS treatment.
Alternative and Experimental Treatments for DOMS
There are a number of other “alternative” or highly-experimental treatments for DOMS that warrant more attention. These include acupuncture, hyperbaric oxygen treatment, and application of electromagnetic shielding fabric. While a few studies suggest positive results with all three of these methods, with the exception of acupuncture, they are treatments that are just not practical for the average gym-goer or athlete who doesn’t have access to high-tech equipment.
Can I Still Workout With Sore Muscles?
While allowing your muscles time to rest and recover after training is critical, there appears to be very little evidence that working out when your muscles are still sore will cause additional damage or impede strength or muscle gains.
In fact, many people report that performing anecdotal improvement in symptoms of Delayed Onset Muscle Soreness after performing additional bouts of exercise in subsequent days. While it’s generally advisable to give yourself at least 48 hours of rest and recovery time before exercising again, performing lower-intensity exercise with the effected muscles can sometimes lessen stiffness, even 24 hours later.
Research seems to back this up.
A 2000 study published in the Journal Medicine & Science in Sports & Exercise found that light exercise following bouts of heavier eccentric exercise resulted in better strength recovery, than when the exerciser only rested. In this case, the light exercise was performed 90 minutes after the initial bout of exercise, so it’s different than performing light exercise the next day. However, the results are encouraging and if you are able to perform lower-intensity exercise within 24-48 hours of developing symptoms of muscle soreness, you may want to try it.
The Take-Away: Practical Advice for Treating Your DOMS
I’ve discussed a lot of clinical research and physiology here because it’s important to understand that there is no “silver bullet” when it comes to treating and preventing Delayed Onset Muscle Soreness.
Even much of the research is contradictory, and for every study that shows something works, you can typically find another study to refute it. And because scientific research is an ongoing process, there are all kinds of interesting therapies and treatments that just haven’t been given much attention.
So, if there are no “silver bullets” what’s the average exerciser to do? After all, this is supposed to be about providing some practical fitness and training advice that you can take to the gym.
The best approach to preventing and treating Delayed Onset Muscle Soreness is to take a multi-faceted, holistic-approach. You may want to experiment with including one of more of the following tactics into your training routine to help promote recovery and minimize serious post-exercise muscle soreness. They include:
- Providing yourself with good nutrition pre-and-post-workout, including plenty of protein, complex carbs and some healthy fats which all support muscle recovery and growth.
- Including plenty of fruits and vegetables in your diet, which are naturally-high in antioxidants. Supplementing with a multi-vitamin, Vitamins E and C and including other sources of antioxidants, for example Green Tea may help.
- Performing warm-up sets prior to your main, higher-intensity sets. This is generally good practice just to prevent muscle pulls and strains, but it may also reduce the severity of DOMS as well.
- If you do develop DOMS, consider trying an “active rest” approach to recovery, by performing light exercise the following day — provided you can do this without too much discomfort.
- If you feel that you’ve had a particularly intense training session or run, consider ice baths or immersion of the trained muscles in cold water to aid in healing and reduce inflammation and stiffness. Try to do these for 15 minutes, every 12 hours for the first 24 hours after exercise. Many runners report good results with this approach after particularly grueling runs like marathons.
- While compression wear is sometimes impractical for certain muscle groups (for example the chest) there are compression sleeves available that you can use for things like the calves, which are particularly prone to DOMS and can make walking a real pain. Combining this with cold therapy may also be even more effective.
- If you can, consider skipping the NSAIDs. They don’t seem to be particularly effective at reducing the symptoms of DOMS, and may actually interfere with muscle recovery and growth. Instead, consider supplementing regularly with fish oil capsules, which have been demonstrated to reduce inflammation and have added benefits for your heart and brain. While I have not found any research that looks directly at whether fish oil is an effective treatment for DOMS, there is plenty of research that shows it can be as effective as NSAIDS in treating inflammation. So you may find that it helps.
- Massage: While message has not been shown to be particularly effective at reducing the longer-duration symptoms of DOMS, many people do find that it provides at least temporary relief from muscle soreness and stiffness, and is pleasant and relaxing. If you feel like it helps, then by all means, try it.
What do you think? Have a treatment for Delayed Onset Muscle Soreness that works particularly well for you? Leave us comment with your DOMS cure or experiences coping with sore muscles after exercise.