Delayed Onset Muscle Soreness; Cause, Symptom, Treatment

Delayed Onset Muscle Soreness (DOMS) is a muscle-related pain that occurs due to excessive exercising. Simultaneous contraction and lengthening of the muscles, in most cases, is the underlying cause of this condition. Running downhill, squatting, plyometric exercises are typical examples. Such microtraumas may cause an imbalance between the electrolyte as well as intramuscular fluids present in the body. This affects the muscle’s capacity to absorb shocks, maintain coordination and their ability to contract. This condition typically affects the athletes and is considered to be the body’s natural way to adapt to the change in physical activity. In most people, it is an occasional phenomenon, but in others DOMS can be chronic.

Mechanism of Delayed Onset Muscle Soreness

The mechanism of delayed onset muscle soreness is not completely understood, but the pain is ultimately thought to be a result of microtrauma – mechanical damage at a very small scale – to the muscles being exercised.

DOMS was first described in 1902 by Theodore Hough,[rx] who concluded that this kind of soreness is “fundamentally the result of ruptures within the muscle”.[rx] According to this “muscle damage” theory of DOMS, these ruptures are microscopic lesions at the Z-line of the muscle sarcomere.[rx] The soreness has been attributed to the increased tension force and muscle lengthening from eccentric exercise. This may cause the actin and myosin cross-bridges to separate prior to relaxation, ultimately causing greater tension on the remaining active motor units.[rx] This increases the risk of broadening, smearing, and damage to the sarcomere. When microtrauma occurs to these structures, nociceptors (pain receptors) within the muscle’s connective tissues are stimulated and cause a sensation of pain.[rx]

Another explanation for the pain associated with DOMS is the “enzyme efflux” theory. Following microtrauma, calcium that is normally stored in the sarcoplasmic reticulum accumulates in the damaged muscles. Cellular respiration is inhibited and ATP needed to actively transport calcium back into the sarcoplasmic reticulum is also slowed. This accumulation of calcium may activate proteases and phospholipases which in turn break down and degenerate muscle protein.[rx] This causes inflammation, and in turn pain due to the accumulation of histamines, prostaglandins, and potassium.

An earlier theory posited that DOMS is connected to the build-up of lactic acid in the blood, which was thought to continue being produced following exercise. This build-up of lactic acid was thought to be a toxic metabolic waste product that caused the perception of pain at a delayed stage. This theory has been largely rejected, as concentric contractions which also produce lactic acid have been unable to cause DOMS.[rx] Additionally, lactic acid is known from multiple studies to return to normal levels within one hour of exercise and therefore cannot cause the pain that occurs much later.[rx]

Causes of Delayed Onset Muscle Soreness

  • Myofibril tears or muscular strain
  • Excessive exercising
  • Performing an exercise that the body is not accustomed to
  • Presence of biochemical markers such as lactic dehydrogenase leads to disruption of the muscle fibers
  • Younger athletes are more susceptible to DOMS because their bodies are not yet conditioned for rigorous exercise regimes
  • Enzyme efflux- microtrauma to the muscle fibers leads to accumulation of calcium in the muscles leading to the breakdown of cellular respiration and consequent degeneration of muscle proteins
  • Sudden change in intensity of the exercise

Symptoms of Delayed Onset Muscle Soreness

  • A dull muscular pain may occur within 24-48 hours of exercise
  • Tenderness and stiffness in muscles around the joint
  • Localized pain and discomfort
  • Range of motion may be affected
  • Swelling
  • Increased pain while walking down the stairs
  • Pain may subside with rest and reoccur if the activity is resumed

Diagnosis of Delayed Onset Muscle Soreness

  • A thorough physical check by an orthopedic doctor or a physical therapist
  • Ultrasound may be used to check for muscle tears
  • Range of motion of the affected part may be tested
  • Ultrasound
  • Diffuse, well-defined hyperechoic regions within the muscle
  • Increased muscle size
  • Minimal hyperemia

Treatment of Delayed Onset Muscle Soreness

  • The doctor may recommend adequate rest to allow the muscles to settle down
  • Anti-inflammatory medicines and muscle relaxants may be prescribed
  • Application of ice packs
  • Heat pads may be helpful in reducing muscle pain
  • Muscle strengthening exercises should be avoided
  • Ultrasound Therapy
  • Warmup or light exercise, “working it out
  • Glutamine and arginine supplements, mostly underwhelming, but here’s one weakly positive study
  • Stretching
  • Icing (not just ineffective, but possibly even harmful
  • Transcutaneous electrical nerve stimulation (TENS)
  • Epsom salts
  • Drinking extra water
  • Cherry juice it’s the antioxidants,
  • Compression garments (tight elastic sleeves)
  • It is important to cool down and warm up after and before an exercise to prevent reoccurrence of DOMS
  • Mild stretching, walking, swimming, and cycling may help to alleviate muscle soreness
  • Prescription of some enzyme-based medicines may reduce inflammation
  • The doctor may ask the patient to increase the intake of vitamin C
  • Medical grade compression garments such as socks or calf sleeves may provide support to the muscles and prevent muscle strains
  • The soreness usually disappears within about 72 hours after appearing. If treatment is desired, any measure that increases blood flow to the muscle, such as low-intensity activity, massage, nerve mobilization,[rx] hot baths, or a sauna visit may help somewhat.[rx]
  • Immersion in cool or icy water, an occasionally recommended remedy, was found to be ineffective in alleviating DOMS in one 2011 study,[rx] but effective in another.[rx] There is also insufficient evidence to determine whether whole-body cryotherapy – compared with passive rest or no whole-body cryotherapy – reduces DOMS, or improves subjective recovery, after exercise.[rx]
  • Counterintuitively, continued exercise may temporarily suppress the soreness. Exercise increases pain thresholds and pain tolerance. This effect, called exercise-induced analgesia, is known to occur in endurance training (running, cycling, swimming), but little is known about whether it also occurs in resistance training. There are claims in the literature that exercising sore muscles appears to be the best way to reduce or eliminate the soreness, but this has not yet been systematically investigated.[rx]

And then there are some marginally more promising treatment options that still fall well short of actually being “proven” or practical. They are only somewhat promising at best. Each of these is covered in more detail below:

Generally speaking, there is a broad consensus that nothing really decisively helps DOMS, and the best way to prevent it just gets it over with. In other words, only DOMS prevents DOMS! Except maybe Indian food. And heat. And maybe sunshine and fish. Or Vitamin I. The next few sections are devoted to a few of the slightly more promising options.


To minimize the development of DOMS the following suggestions need to be followed:

  • Take it slow and gradually build up the amount of exercise you do in your program – remember that Rome wasn’t built in a day.
  • Only increase your sets, reps, and weights by more than 10% per week.
  • Be aware of the amount of eccentric exercise you are including in your workouts.
  • Ensure you do a thorough cool down following your workout – many of us would have seen sportspeople doing gentle running and cool down drills after their games – this is one of the reasons why.
  • Long-distance runners should incorporate eccentric quadriceps training into their training.


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Delayed Onset Muscle Soreness

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