Muscle soreness is a commonly recurring phenomenon following physical activity or unaccustomed and eccentric exercise. Muscle soreness has been differentiated into two types; acute and delayed onset, depending upon where and how the soreness occurs.

Delayed Onset Muscle Soreness (DOMS) is also known as ‘muscle fever’. It is a sore, aching, or painful feeling in the muscles that usually begins after an intense workout. The pain typically starts a day or two after a workout, as DOMS can’t be felt during a workout.

The pain felt during or immediately after a workout, known as acute muscle soreness, is different from DOMS. Acute muscle soreness is a burning sensation felt during a workout due to the quick buildup of metabolites. This pain goes away shortly after a person stops exercising.

On the other hand, DOMS is caused due to inflammation and temporary muscle damage due to unfamiliar or unaccustomed exercises. DOMS is considered a Type 1 muscle strain injury that has a 12-24 hours period free of any pain leading up to muscle soreness peaking between 24-72 hours and then subsidising within 5 to 7 days (Gulick & Kimura, 1996).

How bad can post-exercise muscle soreness get?

DOMS is mostly mildly painful and annoying for most people due to the cramping, particularly when they’re beginning or getting back into an exercise regime. The worst-case scenario in regard to DOMS, excluding the rare extremes, is only a few days of significant discomfort, lack of flexibility, and disconcerting weakness. For instance, it may be unpleasant to climb stairs even if it is manageable.

In some cases, DOMS can be so severe that it is mistaken for a muscle strain or a serious injury in its own right. In extreme cases of muscle soreness, DOMS can cause significant loss of muscle function for a few days. In cases such as these, the muscle is damaged. When the soreness is more widespread, it is known as rhabdomyolysis or ‘protein poisoning’ from myoglobin spilling out of damaged muscle cells. This can be caused by overexertion, such as extreme endurance exercise, lifting weight, or manual labour (Knochel, 1990). That is why it is essential to understand the symptoms of DOMS and treat them promptly.

Symptoms of Delayed Onset Muscle Soreness (DOMS)

According to the report published by the American College of Sports Medicine, the symptoms of DOMS typically occur at least 12 to 24 hours later after extreme endurance exercise. The pain tends to peak about 1 to 3 days after the workout and should ease up after that. The most common symptoms of DOMS that a person may experience include:

  • Muscle fatigue
  • Swelling in the affected muscles
  • Short-term loss of muscle strength
  • Tenderness in muscles
  • Reduced range of motion due to stiffness
  • Aching pain in muscles when moving

It is important to note that the pain is typically only felt when a muscle is contracted, stretched, or put under pressure.

young asian woman feeling painful from knee muscle injury after workout

Causes of Delayed Onset Muscle Soreness (DOMS)

DOMS is not the same thing as muscle soreness or pain experienced during exercise or caused by an injury such as a sprain or strain. Instead, it is related to increased stress in muscle fibers when a person exerts them excessively. DOMS can also occur if a person engages in movements that their muscles are not accustomed to, such as a new exercise regimen (Hotfiel et al., 2018).

High-intensity exercise can result in tiny, microscopic tears in muscle fibers. The human body responds to this damage by increasing inflammation which may cause delayed onset of soreness in the muscles. Pretty much any high-intensity exercise, such as step aerobics, strength training, and jogging, can cause DOMS.

DOMS is mainly triggered by eccentric muscle contractions in which muscle contracts and tenses as it lengthens. For example, the controlled downward motion as one straightens their forearm after a bicep curl is an eccentric movement. Other examples include running downhill, descending stairs, lowering weights, doing squats, and lowering oneself during push-ups.

DOMS vs. Lactic Acid Buildup

In research published by The Physician and Sports Medicine, the researchers tested a hypothesis that delayed-onset muscle soreness after exercising is related to the production of lactic acid during exercise (Schwane et al., 2016).

They measured blood lactic concentration before and during 45 minutes of treadmill running. Blood lactic acid concentration and subjective sensations of muscular soreness were assessed at various intervals for 72 hours after the exercise. It was found that lactic acid concentration was increased during exercise, but there was no significant muscle soreness post-exercise. It was then concluded that lactic acid buildup is not related to exercise-induced delayed-onset muscle soreness (Schwane et al., 2016).

Who can experience Delayed Onset Muscle Soreness?

Almost everyone, from professional athletes to beginners and people who have begun working out after a long interval of time, can be affected by Delayed Onset Muscle Soreness. So, regardless of the level of a person’s fitness, DOMS may strike whenever one performs eccentric exercises, dial up the intensity of the workout, or try out a new kind of exercise that the body is not used to.

Additionally, DOMS is not an age-related problem, but a person’s age may determine the intensity of effects of DOMS on a person’s body.

Is Delayed Onset Muscle Soreness (DOMS) a sign of a good workout?

A lot of people think that unless one feels sore after every workout, they are not exercising properly or making any fitness gains. But the question remains, is there any truth to this?

The simple answer is, no. When a person begins a new exercise regimen or exerts themselves while working out, they are more likely to get sore. But as a person keeps working out consistently over a while, their body adapts to it.

For instance, a person may feel less and less sore as they keep working out, but it does not mean that they’re not exercising properly, working out hard enough, or missing out on fitness gains from these workouts.

hijab girls doing leg warm-up exercises

Tips to ease the effects of DOMS

A person may feel tempted to rest and avoid all exercise and movements when DOMS strike, but unless the effects of DOMS are severe, resting up all day only worsens the pain and stiffness instead of easing it.

It is recommended to listen to your body. If the effects of DOMS are bad, a person may need to take the day off and rest up to repair their muscles. It is also suggested to skip any kind of high-intensity cardio or weightlifting when sore. That may only worsen and delay a person’s recovery from DOMS.

It is also recommended to try out gentle movements such as gentle yoga, moderate-intensity walking, and swimming throughout the day. It may not speed up the recovery, but it is likely to lessen the soreness.

Treatments for Delayed Onset Muscle Soreness

The biology of Delayed Onset Muscle Soreness remains extremely unclear as there is neither a ‘cure’ for it and not a clear-cut way to prevent it or get through it faster. There have been many suggestions over the last few decades in the field of medical sciences, but nothing has been scientifically proven.

It is said that time is the best treatment for DOMS, but there are steps that people can take to ease the pain and stiffness as the muscles repair themselves. In other cases, DOMS can be relieved with massage, anti-inflammatory medication, and compression garments (Kim et al., 2017).

  1. Massage

In 2017, a review of several studies revealed that people who got a massage 24 to 72 hours after intense or eccentric exercise reported significantly less soreness than people who did not receive a post-exercise massage. In most cases, getting a massage after 48 hours seems to work the best. It is also recommended to try certain self-massaging techniques if getting a massage is not feasible.

A person can self-massage on their:

  • Shoulders
  • Arms
  • Calves
  • Thighs
  • Buttocks

The best technique to do a self-massage is to apply a lubricant, preferably an oil or lotion, to an area and gently shake, squeeze, and knead your muscles to help through a bad case of DOMS.

  1. Topical Analgesics

These are products meant to help relieve muscular pain. It is suggested to use menthol-based topical analgesics and those with arnica as they better help ease the pain caused by DOMS (Stefanelli et al., 2019).

These products can be applied topically to the area that’s affected. It is highly advised to follow the instructions on the packaging concerning how much and how often to use these products.

  1. Warm or Cold Bath

A 2016 review of studies revealed that cold water baths could help ease the soreness and stiffness caused by DOMS. It is suggested to do a 10 to 15 minutes full-body immersion in ice-cold water, between 10-15°C, to lessen the effects of DOMS. This method of self-treatment has recently become extremely popular amongst professional athletes.

On the other hand, if the idea of a cold bath sounds extreme, it is suggested to try a soak in warm water. A warm bath or moist heat wraps also happen to ease the pain and stiffness caused by DOMS.

  1. Anti-Inflammatory Supplements/Foods

Some research reveals that taking certain supplements with anti-inflammatory qualities or eating certain foods helps ease the pain and stiffness caused by DOMS. However, more research is needed on this as nothing so far has been proven.

  1. Can over-the-counter pain relief medication help with DOMS?

It was once believed that nonsteroidal anti-inflammatory (NSAID) medications, such as ibuprofen, helped relieve the effects of DOMS. But this has since been debunked. Over-the-counter pain relievers do not help ease DOMS pain.

When to Get Help for DOMS

In most cases, DOMS does not require going to the doctor. But in some cases, it is recommended by the American Council on Sports Medicine that a person should see a doctor if the pain caused by DOMS makes it difficult to perform normal daily activities.

It is also recommended to seek medical attention in the case of:

  • Severe swelling in affected muscles
  • DOMS lasts longer than seven days
  • Urine becomes abnormally dark

It is important to understand the difference between muscle soreness and dull aching from the extreme effects of DOMS. It is highly advised to see a doctor right away if a person feels a sharp pain, muscle spasms, tingling, and numbness in their muscles.

Can DOMS be prevented?

Avoiding DOMS altogether may not be possible, but there are a few steps that a person can take to lessen its intensity. These include:

  • It is important to stay hydrated. A study revealed that people who exercised in hot or humid temperatures had a big dip in muscle soreness when they hydrated themselves before, during, or after exercise compared to people who did not drink enough water.
  • A 5 to 10 minutes warm-up before each workout can help a lot with post-exercise muscle soreness. Switch to dynamic stretching as it allows better than static stretching.
  • A cool-down post-workout is highly recommended. A 20-minute cool down of low-intensity exercise, or walking, can help decrease soreness in muscles. It is also important to end cool down with some static stretching. It may not lessen the effects of DOMS in all cases, but it helps boost flexibility in muscles and joints.
  • It’s advised to take it slow. Taking workouts to the next level of intensity and overexerting may not be wise. It is important to take small steps at a time to help build strength and endurance to minimize the effects of DOMS.

indian man training and stretching body at home

Prevention Tips for DOMS

  • Always warm-up and cool down as it helps regulate blood flow, relieve the buildup of lactic acid, and relieve pain as well as inflammation.
  • It is important to progress reasonably, as pushing too hard or using heavy weights when you are not accustomed to them may likely do more harm to your muscles.
  • Follow the 10% rule while exercising, which means that a person should only increase their activity by 10% per week and no more than that. This means in terms of distance, time, and intensity.

It is also important to understand that DOMS is just a step in a person’s journey. Even if it is unavoidable, take steps to lessen its impact. If DOMS strikes, use self-care techniques to help ease the pain as your body heals. But most importantly, be patient. The best cure for DOMS is time, as its effects subside soon enough.

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Gulick, D. T., & Kimura, I. F. (1996). Delayed onset muscle soreness: What is it, and how do we treat it? Journal of Sport Rehabilitation, 5(3), 234–243.

Hotfiel, T., Freiwald, J., Hoppe, M. W., Lutter, C., Forst, R., Grim, C., Bloch, W., Hüttel, M., & Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletzung-Sportschaden, 32(4), 243–250.

Kim, J., Kim, J., & Lee, J. (2017). Effect of compression garments on delayed-onset muscle soreness and blood inflammatory markers after eccentric exercise: A randomized controlled trial. Journal of Exercise Rehabilitation, 13(5), 541–545.

Knochel, J. P. (1990). Catastrophic medical events with exhaustive exercise: “White-collar rhabdomyolysis.” Kidney International, 38(4), 709–719.

Schwane, J. A., Ms, B. G. W., Bs, S. R. J., Armstrong, B., Schwane, J. A., Ms, B. G. W., Bs, S. R. J., Schwane, J. A., Watrous, B. G., Johnson, S. R., & Armstrong, R. B. (2016). Is Lactic Acid Related to Delayed-Onset Muscle Soreness? 3847(July).

Stefanelli, L., Lockyer, E. J., Collins, B. W., Snow, N. J., Crocker, J., Kent, C., Power, K. E., & Button, D. C. (2019). Delayed-Onset Muscle Soreness and Topical Analgesic Alter Corticospinal Excitability of the Biceps Brachii. Medicine and Science in Sports and Exercise, 51(11), 2344–2356.