Delayed Onset Muscle Soreness (DOMS)

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Exercising involves engaging in physical activity and increasing the heart rate beyond resting levels – it’s an important part of preserving physical and mental health. Whether engaging in lighter exercises, such as going for a walk, or high-intensity activities, such as, uphill cycling or weight training, regular exercise provides a huge range of benefits for the human body and mind. Taking part in an exercise of any intensity every day is essential for preventing a range of diseases and other health issues.

Delayed-onset muscle soreness (DOMS) is muscle pain that begins after you have finished working out. It normally begins a day or two after a workout. You will not feel DOMS during a workout, however, the pain felt during or immediately after a workout is a different kind of muscle soreness. This is known as acute muscle soreness. Acute muscle soreness is a burning sensation you suddenly feel in a muscle during a workout session due to a quick buildup of metabolites during intense exercise. It typically disappears as soon, or shortly after you stop exercising.

Generally, delayed-onset muscle soreness symptoms occur up at least 12-24 hours after an intense workout. The pain tends to peak about one to three days after your workout, and then should resolve itself thereafter. In addition, some people who exercise often think that unless you feel sore after every workout, you are not making any fitness gains. However, whenever you begin a new exercise routine or push your limits, you’re more likely to get sore; as you continue to work out, your body will adapt.

Causes & Symptoms of DOMS

The primary cause of delayed-onset muscle soreness is a combination of microscopic tears in the muscle fibers that result from a workout and the muscle’s response to repair the damage. Tiny muscle tears occur when muscles are stressed more than they are used to, or in a new way. The muscle tissue releases enzymes to repair the tears, which results in inflammation and soreness.

Also, the lactic acid buildup can cause pain during a workout, but it is not the cause of DOMS. Lactic acid builds up when the muscle does not get enough oxygen to break it down, which causes cramps and muscle fatigue.

The pain normally goes away in a few hours with enough rest and hydration, unlike delayed-onset muscle soreness which occurs later and lasts much longer. DOMS can happen to anyone, regardless of fitness levels, when the muscles are challenged in a way they are not accustomed to. Even elite athletes can also develop DOMS when they start training after a break, or when they increase their training intensity.

Any general exercise may cause delayed-onset muscle soreness when you begin a routine or increase the intensity, however, exercises that require eccentric muscles contraction, are more prone to cause this condition. Eccentric contraction is the muscle’s contraction to bear load against gravity while being lengthened. Some examples of eccentric muscle contraction include the following:

  • The downward motion in pushups.
  • The downward motion in squats.
  • Downhill running when the quads lengthen.

Concentric contraction, on the other hand, is contraction while the muscle is shortened – by contrast, eccentric contraction is a more efficient way than concentric contraction to exercise a muscle, because it uses less energy to work harder. Though beneficial, eccentric concentration is also more likely to cause delayed-onset muscle soreness because it places more stress on the muscle.

Some of the most common symptoms linked to DOMS include:

  • Pain that is aching in the affected muscle.
  • Stiffness.
  • A sudden throbbing feeling.
  • Muscle tightness.
  • A burning sensation when touching the affected muscle.

Delayed-onset muscle soreness typically affects your entire muscle. Therefore, if you feel any sharp, shooting pain in a specific joint, there may be a possibility that DOMS is being presented.

Overall, muscle soreness is commonly equated with a good workout, but DOMS is not always a good sign. Soreness indicates that the muscle has been worked, which encourages and motivates you to continue with the activity, but it is also important to be aware of how much soreness is beneficial.

If it makes you too sore to carry on with your regular activities, it is too much. Muscle strength grows with exercise even if you do not feel any soreness. Excessive or persistent soreness is detrimental to muscle recovery and can negate the benefit from exercise and affect your athletic performance. If ignored, persistent soreness can also damage the capacity of the muscle to repair and grow stronger.

Who gets DOMS?

Delayed-onset muscle soreness can affect anyone (men and women), from committed athletes to beginners, to people who have not worked out in a long time.

Therefore, no matter your fitness level, DOMS can strike whenever you increase your workout intensity, perform eccentric-only exercises, or try a new kind of exercise routine that your body is not used to coping with. Additionally, DOMS can also increase the risk for older people between the ages of 50 years old and up due to the general wear and tear of their muscles.

How Does DOMS Affect You? How Serious is it?

A few days of significant discomfort and weakness can turn delayed-onset muscle soreness into a serious problem. For instance, climbing the stairs might be unpleasant, but still manageable. In severe cases, DOMS can cause major loss of muscle function for several days and tenderness like a severe bruise. In some cases, the muscle can be completely damaged. When more damage is widespread, this indicates a chance of developing a condition known as rhabdomyolysis.

Rhabdomyolysis is a life-threatening condition caused by muscle breakdown and muscle death. This dangerous muscle damage can result from overexertion, trauma, toxic substances, or disease. As muscle cells disintegrate, they release a protein called myoglobin into the blood.

Recommended Treatment & Rehabilitation for DOMS

During a diagnosis for delayed-onset muscle soreness, a healthcare provider may order tests, such as the following below:

  • Muscle biopsy – This test is used to look for muscle tissue changes that may indicate diseases linked to severe DOMS (such as rhabdomyolysis).
  • Electromyography – Electromyography is used to help measure electrical activity in nerves and muscles.
  • Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan – This is used to look for muscle injury or damage.
  • Blood tests – to check enzyme, hormone, and electrolyte levels and test for infections.

If you have experienced mild symptoms associated with delayed-onset muscle soreness, a physiotherapist can work to assess your strengths and weaknesses. He or she can work with you to improve your performance in your sport or exercise activity.

Your physiotherapist will develop a safe, progressive exercise program to help you reach your goals and teach you ways to prevent further injuries. If you have felt pain from eccentric exercises with high intensity (thus leading to DOMS), your physiotherapist may help you recover.

These include recommended activities to help you keep your fitness, address any weaknesses or movement problems that contributed to your injury, and recommend ways to prevent further muscle soreness due to DOMS.

It may not be possible to prevent delayed-onset muscle soreness, however, you can reduce the severity by gradually increasing the intensity when you begin a new exercise routine. Warming up before, and cooling down, and stretching after an intensive workout can greatly help in relaxing the muscles and reducing soreness.

Varying your daily workout routine by cross-training with exercises that engage different groups of muscles may be another great way to handle delayed-onset muscle soreness. Cross-training allows your muscles recovery time between workouts, without disrupting your training.

Delayed-onset muscle soreness does not usually require treatment and will resolve on its own. The best recommendation for DOMS is to keep the muscles moving unless the pain is intolerable. Other great ideas that can help reduce DOMS include the following:

  • Massage – Studies have shown that people who receive a massage 24, 48, or 72 hours after an intense workout reported significantly less soreness than people who did not get a post-workout massage. Getting a massage after every workout may not be feasible, but you can try self-massage on your calves, thighs, buttocks, arms, and shoulders.
  • Foam roller – It is recommended to use a foam roller that can loosen up the knotted muscles.
  • Compression – Wearing compression clothing, which many athletes say improves blood flow and reduces pain, though there is no conclusive evidence for this.
  • Ice application – Applying ice packs can help numb the nerve endings in the muscle. Taking cold showers may help boost the recovery process due to DOMS.
  • Warm baths – Taking a warm bath or applying moist heat wraps may help ease the pain and stiffness that come with delayed-onset muscle soreness.
  • Anti-inflammatory foods – Studies have shown that eating certain foods or taking certain anti-inflammatory supplements can help improve symptoms of DOMS. However, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, do not do much to help relieve pain linked to DOMS.


In the days following your muscle soreness due to DOMS, these recovery workouts may help prevent or reduce soreness:

  • Yoga – Yoga combines deep breathing with slow stretching which will give your muscles the added boost of blood and oxygen they need.
  • Swimming – Swimming is a great way to help your muscles relax from your workout. Swimming will help you be able to have a good stretch and the water will help to gently massage out any knots.
  • Light cardio – Going for a simple walk or slow cycle will help to improve circulation, which increases the blood flow to your sore muscles.
  • Resistance bands – Use a few lightweight bands to really stretch those muscles. Resistance bands are particularly useful to stretch the muscle groups that are hard to get to, like the chest, back, and triceps.

Alternative & Homeopathic Treatment for DOMS

It is always important to know that muscle soreness can occur in both adults and kids. Depending on the severity and cause of the soreness, the situation can cause mild to extreme discomfort. Soreness of muscles normally gets healed on its own after a few days, but if it doesn’t, you can try some simple homeopathic treatments, including the following:


Epsom salts

Epsom salt is rich in magnesium sulfate and is a natural ingredient to relax sore muscles. The magnesium withdraws the fluid out of the tissue which causes pain in the muscles. A cup of Epsom salt, when mixed in a warm tub of water, works very well for the aching muscles.


Apple cider vinegar

Apple cider vinegar is also recommended for sore muscles. You can either mix a teaspoon of apple cider vinegar in water and consume it or can apply it directly to the affected area. Due to its anti-inflammatory properties, apple cider vinegar helps to reduce muscle pain and inflammation.


Essential oils

Few essential oils are also helpful for muscle pain relief. You can try lemongrass, peppermint, and lavender essential oil for DOMS.


Cherry juice

Tart cherry juice is packed with antioxidants that help reduce muscle soreness due to DOMS.

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