Delayed Onset Muscle Soreness (DOMS)

Big Facts w/ Nat

Getting back into the swing of going to the gym can be tough, especially when you’re battling soreness after a good workout. Soreness can limit range of motion or negative impacts on performance. So let’s dive into what is most effective in relieving soreness and getting you back to feeling your best!

After exercise, sometimes we can experience delayed onset muscle soreness (DOMS). Usually, this is a response to vigorous or unfamiliar activity. This could be starting a new training block or returning to an exercise program after a prolonged exodus. DOMS manifests 8to 72 hours after the performance of intense exercise, but timelines and intensity will vary by the individual. Contrary to outdated opinions, I want to address that lactate (also called lactic acid) buildup is not responsible for DOMS following strenuous exercise sessions. Despite decades of extensive research, the precise mechanisms that cause DOMS still need to be determined. However, research examining lactate levels immediately after exercise demonstrates little correlation with the extent of muscle soreness felt a few days later. This, we know.


The issue with DOMS, is that it can interfere with exercise, as excessive soreness can hinder our ability to train optimally. Soreness can also decrease our training motivation, impair subsequent strength capacity, and negatively impact specific adaptations. The symptoms we experience may correspond with a reduced range of motion, weakness, and stiffness. We should be aware of DOMS, as high levels or prolonged soreness can indicate exceeding the capacity for the muscle to repair itself efficiently. If this is a consistent issue, it should be examined further.

Consequently, as an attempt to treat symptoms of DOMS, a variety of interventions are widely used. Some are effective in literature, and some are not. With many products available, it is essential to examine the evidence. The most common methods include cold and heat application, active recovery, vibration, ultrasound, foam rolling, massage, compression garments, acupuncture, Kinesio taping, foam roller, elongation, electro-stimulation techniques, and even anti-inflammatory drugs. These interventions intend to alleviate DOMS post-exercise, assist with muscle damage, and aim to restore functional capacity. The overarching goal is to decrease symptoms and return to regular training in the shortest possible time. But most people wonder, do they work?

Summary of recommendations:

  • Consider massage, active recovery. heat therapy, and compression to alleviate DOMS
  • Cold therapies may negatively affect anabolic processes
  • Anti-inflammatory drugs may delay recovery responses
  • Ensure slow progression into a new exercise program, increasing training frequency, and adhering to the same exercise selection to minimize DOMS

We will start with the first intervention, cold and heat application. Current evidence indicates that applying cold and heat therapy is effective for DOMS treatment. Specifically, if placed within 60 minutes after intense exercise, pain and discomfort can be reduced for 24 hours. Hot packs show the best effect and have proven to aid in the recovery of DOMS. However, a word of caution, it is well established that cold water can decrease the rate of muscle growth. While reducing DOMS can benefit performance, cold therapies may interfere with processes beneficial to muscle development. Evidence shows that cold treatments can negatively affect anabolic processes and appears to be detrimental to long-term muscle development. Therefore, we should stay cautious when deciding whether to use a cold therapy recovery strategy when hypertrophy is also a goal. That is not to say that cold therapy does not have its place in a treatment setting, but we should always consider the potential costs versus benefits before introducing specific interventions. 

Next, we have massage, another proven effective recovery technique from DOMS. There is strong, current evidence that massage can significantly improve perceived pain and reduce fatigue. Results may be explained due to the increase of muscle blood flow and reduction of muscle edema. When considering application, a ~20-minute massage performed right after exercise and up 2 hours after can effectively reduce DOMS for 24 hours. However, additional findings have demonstrated that massage can decrease DOMS up to 96 hours after exercise. In addition to pain management and recovery, when tested against many interventions, massage was also the most effective technique to reduce perceived fatigue.

Compression garments have also demonstrated a decrease in perceived fatigue after heavy resistance training. Effects are likely explained by reduced swelling from compression to the applied limb. With various garments available, individuals choose from leggings, socks, t-shirts, and other items, and should be worn a short time after their session. Compared to massage, compression garments have shown a significant and positive impact on DOMS and perceived fatigue but have a less pronounced effect. With one of the most robust effects, there is evidence that desirable results are present quickly, then up to 96 hours after exercise. 

Conversely, when examining research surrounding active recovery, we know that the results are only meaningful for a short period of time after exercise. Still, research shows that active recovery significantly decreases DOMS but has no impact on perceived fatigue. Typically, a short period of time (for example, 20 minutes) of post-exercise active recovery will involve the same muscles that were active during the fatiguing exercise. So if we trained the lower body, then a lower body active recovery session would be appropriate. These results may be explained by increased blood flow in muscle tissue, which can facilitate the removal of metabolic waste.

Then, we have alternative interventions, such as vibration and ultrasound, which have shown to be more effective than no intervention for DOMS treatment. However, most of these studies are considered weak evidence. We should interpret these findings skeptically, although it’s important to understand that vibration and ultrasound interventions will not delay recovery or other adaptations. More research will be necessary to trust these results. 

Although a widely used tool, foam rolling has little evidence demonstrating its effectiveness in reducing DOMS to alleviate muscle tenderness. Also, although stretching is a familiar post-exercise ritual, it does not significantly influence DOMS or fatigue. Less common alternative interventions, including acupuncture, Kinesio taping, and electro-stimulation techniques, have not demonstrated statistically significant effects in the literature. And lastly, anti-inflammatory drugs do appear to reduce DOMS; however, they may slow the ability of the muscle to repair the damage. This may negatively affect muscle function in the weeks following vigorous exercise. With stronger and more effective evidence, we should initially encourage proven interventions such as active recovery, massage, heat application, and compression garments for individuals before suggesting alternative treatments.

Also, consider individual preferences, responses, and circumstances when considering any treatment. For example, when interpreting research on this topic, a potential issue is the possibility that findings are due to a placebo effect. In other words, if a particular intervention appears to assist an individual, and if it is not detrimental to their progress, there is no concern or harm to incorporate into their program. Further, one type of treatment may be more accessible and feasible.

Aside from interventions, we can discuss common strategies to minimize DOMS in the future. We should take caution to slowly progress into a new exercise program, increase training adherence by promoting more frequency, and adhere to the same exercise selection for a given period. Other methods include performing concentric-only exercises (eccentric exercise can contribute to DOMS) and exercises that stress short muscle lengths that can reduce DOMS while maintaining a training program when needed. Again, warming up and stretching has not been shown to reduce DOMS.

Another critical topic is gaining training experience, as training status will affect the extent of DOMS. It is well established in the literature that novice lifters are at a greater risk of experiencing DOMS after resistance training. We know that soreness dissipates when a muscle group is subjected to subsequent bouts of the same exercise stimulus. This is called the repeated bout effect, and as it occurs, recovery is faster. We are less likely to see significant drop-offs in strength and technique due to damage and subsequent soreness. In summary, DOMS will become less frequent and improve with time, experience, recovery, and safe progressions.



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