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Understanding DOMS – Article by Performance Medicine

Article by Elissa Petestic – Senior Physiotherapist at Performance Medicine Sydney

Have you ever been sore the day after a rehearsal despite not remembering a moment of injury?
This may have been Delayed Onset Muscle Soreness or DOMS as it is commonly known.

What is DOMS?

Delayed Onset Muscle Soreness refers to the muscle pain and stiffness that is felt after unaccustomed or strenuous exercise. It typically peaks 1-3 days after the exercise and subsides over 5-7 days.

Unlike the burning sensation that you feel during an exercise, the sensation of DOMS is delayed. It is often described as a dull ache, heaviness, stiffness or tenderness felt in the muscles. The muscles it is felt in is usually the most used muscle group of the activity that was
performed.

DOMS is considered a normal response to exercise, particularly when there is an increase in intensity, volume or the introduction of a new movement. Think of it as a way that your muscles adapt to an increase in load.

Two examples that I have seen in the clinic are:

  • A gym goer who was unable to straighten their elbows completely after completing a chin up challenge two days prior.
  • A dancer with sore and tight quadriceps after a rehearsal when they are practicing a section on and off the floor repeatedly.

What Causes DOMS?

Despite decades of study, researchers have not been able to find the exact mechanism for DOMS. The most widely accepted theory is that damage to muscle fibres and surrounding connective tissues stimulates the body’s repair process and triggers pain receptors leading to
temporary tenderness and stiffness whilst the body repairs.

DOMS is most strongly associated with eccentric muscle contractions, this is when a muscle is lengthening whilst producing force for example running downhill, landing a jump or lowering from a chin up. Eccentric muscle contractions put more mechanical stress on muscle fibres than
a concentric muscle contraction (when the muscle shortens).

Previously it was thought that DOMS was due to a build up of lactic acid post exercise which has been disproven. Lactate levels typically return to normal within an hour after exercise which is long before DOMS begins.

Is DOMS dangerous?

In most cases, DOMS is not an injury. It is considered an adaptive response to exercise stress and should improve three days after the activity and should resolve within a few days of this. It is worth noticing that significant soreness can reduce muscle strength and range of motion which will affect performance. This could make some exercises or movements unsafe in the days that you are experiencing significant DOMS as you are at increased risk of injury.

Managing and Preventing DOMS

While DOMS is not always avoidable there are some strategies that can reduce the symptoms:

  • Load Management.
  • Gradually progress training intensity and volume to avoid spikes in activity.
  • Allowing adequate recovery between sessions – this can include active recovery with movement rather than further strain on affected muscle groups.
  • Cold Water Immersion – Immersing the muscle group in cold water (between 11-15 degrees) for 11-15 minutes has shown promising results with recovery.
  • Compression garments applied post exercise can reduce clinical symptoms and accelerate the recovery of muscle function.

Take away points

  • DOMS is a normal response to exercise when there is increased load.
  • It typically peaks 1-3 days after the exercise session and subsides over 5-7 days.
  • If your muscular pain is not related to a specific moment of injury and is not improving 4
    days after the activity then you should visit your trusted physiotherapist to see if the pain
    is not due to DOMS.

References

  1. Connoly, D. A. J., Sayers, S. E., & McHugh, M. P. (2003). Treatment and Prevention of Delayed Onset Muscle Soreness. Journal of Strength and Conditioning Research, 17(1),197–208. https://doi.org/10.1519/00124278-200302000-00030
  2. Heiss, R., Lutter, C., Freiwald, J., Hoppe, M., Grim, C., Poettgen, K., Forst, R., Bloch, W., Hüttel, M., & Hotfiel, T. (2019). Advances in Delayed-Onset Muscle Soreness (DOMS) – Part II: Treatment and Prevention. Sportverletzung · Sportschaden, 33(01), 21–29. https://doi.org/10.1055/a-0810-3516
  3. Hotfiel, T., Freiwald, J., Hoppe, M., 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(04), 243–250. https://doi.org/10.1055/a-0753-1884
  4. Mizumura, K., & Taguchi, T. (2015). Delayed onset muscle soreness: Involvement of neurotrophic factors. The Journal of Physiological Sciences, 66(1), 43–52. https://doi.org/10.1007/s12576-015-0397-0
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