Delayed Onset Muscle Soreness

Myth: If my muscles aren't sore the day after a workout , I didn't train hard enough

BUSTED: THAT IS FALSE!

You went to the gym after taking a few weeks off, or maybe you went on a run with steeper hills than your usual route. The next day you got out of bed and — ouch! Your muscles feel like someone went to town on them with a meat tenderizer. As the day goes on, rather than getting less sore, your muscles get more and more sore. What is happening? Is it time to be alarmed!?

What is muscle soreness?

Worry not, muscle soreness after a new activity, although not pleasant, is not uncommon, and is a normal physiologic response. Athletes commonly experience this type of delayed onset muscle soreness, or DOMS, at the beginning of a sport season after they have been using muscles in a way that they are not habitually accustomed to. It can also happen after you perform a new workout movement, or a particularly challenging home exercise that lights up muscles that have been ‘offline’ so to speak.

DOMS also occurs more commonly after performing eccentric exercises; ones where your muscle is working to slow down a movement. This is why running downhill can elicit this delayed soreness response. When running downhill in particular, your quads and leg muscles are working to control your rapid progression towards lower grounds, eliciting a significant physiological response.

Exercise induced muscle soreness is less immediate than other types of activity - induced soreness and peaks between 48 and 72 hours after exercise. Other signs associated with DOMS include decreased ability to forcefully contract the affected muscles, a short term decrease in muscle flexibility, and associated limitations in joint mobility. It can also be accompanied by swelling and dysfunction that are part of the inflammatory response. For more insight on the inflammatory process of tissue healing, check out this article. As someone who has tried to jog a few steps the day after a marathon or ultra event can tell you, it can also negatively impact your muscles’ ability to attenuate shock absorption.

DOMS usually occurs in both arms or both legs, depending on the exercise. If you performed an exercise that involved both limbs equally, but one limb is experiencing a degree of pain and symptoms not mirrored by the other side, your pain may be telling you something more, and may require further examination by a physical therapist. Not all pain is the same. DOMS symptoms are your body’s way of telling you to slow down and let it recover. However, other types of pain may be indicative of a different condition.

Why does it happen?

There are up to six theories regarding the physiology of muscle soreness, but the exact mechanism behind this phenomenon is unknown, and likely involves the conglomeration of multiple theories. Essentially, your muscles are breaking down in response to stress, and then rebuilding in response to that stress, which is a normal process of adaptation in response to exercise.

Does this mean if I don’t have DOMS I didn’t get a good workout in?

ABSOLUTELY NOT. Many productive forms and intensities of exercise do not elicit a DOMS response. The intention of the exercise matters here. If you are going on an easy jog between workouts, where the intention is to both recover and build your aerobic capacity and improve your running economy, you aren’t and shouldn’t be pushing to the point of causing muscle soreness. Similarly, if you are performing a higher intensity workout, the absence of delayed soreness doesn’t mean the workout was a wash. As long as the exercise is challenging and or varied enough to initiate a stress adaptation response, you will improve as a result of the effort, whether or not DOMS results. So, although DOMS indicates your body is responding to a new or particularly demanding stimulus, the absence of DOMS certainly does not indicate that your training session was ineffective.

I have muscle soreness, is there anything I can do to mitigate this?

Active rest is going to be the best form of recovery for you when you are experiencing DOMS. If you are a runner or cyclist, this may mean going on a walk instead of a run so your muscles are circulating blood flow, but you are asking for less out of those overworked muscles. In fact, light and appropriate exercise is considered the most effective method for decreasing DOMS induced pain short term. Additionally, preliminary research indicates that NSAIDs may be helpful in short term management of DOMS. Massage techniques have also been shown to be helpful, when appropriately timed.

However, don’t reach for the ice pack, as icing, stretching, ultrasound, and electric current modalities have not been shown to be effective in mitigating DOMS symptoms.

In addition to walking, exercises for less affected body parts can be helpful for recovery. To reduce training lost due to DOMS, introducing new or eccentric exercises slowly and progressively over the course of a few weeks is the best approach.

At Zenith, we have a variety of tools at our disposal to aid you with your training journey. This can mean providing manual therapy to mitigate DOMS when it does happen, as well as the knowledge to guide you in gradually ramping up your training. We can also help you distinguish between DOMS, and other types of pain that may be related to injury rather than the natural process of tissue adaptation. To learn more and work with the physiotherapy experts at Zenith, check us out here.

Hotfiel T, Freiwald J, Hoppe MW, Lutter C, Forst R, Grim C, Bloch W, Hüttel M, Heiss R. Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletz Sportschaden. 2018 Dec;32(4):243-250. English. doi: 10.1055/a-0753-1884. Epub 2018 Dec 11. PMID: 30537791.

Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64. doi: 10.2165/00007256-200333020-00005. PMID: 12617692.