What is delayed-onset muscle soreness (DOMS)?

DOMS stands for delayed-onset muscles soreness.
DOMS stands for delayed-onset muscles soreness.

Muscle fever is often referred to as delayed-onset muscle soreness (DOMS). DOMS is muscle discomfort or pain that occurs 12-72 hours of doing strenuous exercises. It usually occurs when a person is not used to the physical activity they did. It may also occur after overdoing physical activities, such as using heavyweights in a gym, walking downhill, downward motion of squats, and pushups. Heavy exercises increase the workload on the muscle fibers (myofibrils), leading to small-scale microtrauma (tears) to the myofibrils. Muscle soreness is like a temporary sign of muscle adaptation to an injury. It is a warning sign to decrease muscle activity to prevent further damage to the muscle fibers. This soreness is often interpreted as a good workout, but it is not always a good sign.

Ruptures in the myofibrils are microscopic lesions at the Z-line of the muscle sarcomere (sarcomere is the functional and contractile unit of the muscle fiber). The increased tension on the myofibrils (very fine, contractile muscle fibers) separates the actin and myosin (muscle proteins) cross-bridges before relaxation. This exerts greater pressure on the remaining active muscle units, increasing the risk of sarcomere damage. The microtrauma stimulates the pain receptors (nociceptors) in the muscle fibers, causing pain. Moreover, the calcium accumulation inside the cells following the rupture activates the enzymes (proteases and phospholipases), which break down and degenerate the muscle protein. This stimulates inflammation of the damaged area and causes pain.

What are the signs and symptoms of DOMS?

Muscle soreness is a temporary sign caused by the muscles adapting to the increased tension and force exerted to the new muscle groups or at a higher exertion than usual. Soreness is experienced when the ruptured muscle fibers are put under pressure, stretched, or contracted. The symptoms peaks during the first 12-72 hours post workout and usually disappears in a week. The main symptoms and signs include the following:

  • Dull, aching pain in the affected area
  • Hyperalgesia (muscle tenderness) or stiffness
  • Reduced range of motion
  • Decreased muscle strength
  • Muscle swelling and fatigue

What is the treatment for DOMS?

Delayed-onset muscle soreness (DOMS) usually requires no treatment. The symptoms go away on their own with time, provided the muscles are not continuously exerted. However, simple measures are suggested to ease the pain and discomfort in the affected muscles.

Massaging the sore muscles: Massage the sore muscles after high-intensity exercises using foam rollers. This will increase the blood flow to the muscles, help release the stiffness, and restore normal muscle function. Seeking the help of a professional massage therapist or physical therapist can help.

Topical analgesics: Applying menthol-based topical analgesic or pain-relief creams, balms, and patches over the affected area can help relieve pain caused by DOMS. The products should be used as per the instructions on the packaging.

Steaming hot bath: Taking a steaming hot bath after exercising would dilate the blood vessels, improve blood circulation, and help muscles relax.

Contrast water therapy: Using alternate cold and warm water therapy could contract and over-expand the blood vessels, bringing a rush of nutrients with the blood to help recover the injured tissues.

Branched-chain amino acid (BCAA) supplements: They are important for muscle repair. BCAA include leucine, isoleucine, and valine. BCAA supplements help repair the torn microscopic fibers and reduce pain.

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Is it possible to prevent DOMS?

Usually, it's impossible to prevent delayed-onset muscle soreness (DOMS). Some precautionary steps could be taken before working out or performing high-intensity activities to reduce the intensity of soreness and prevent worsening:

  • Limiting exercises to concentric or isometric contractions or limiting the length of eccentric muscle extensions during exercise
  • Doing proper warmups and cool downs before and after workouts that would reduce the risk of tissue injury
  • Wearing compression workout clothing that will keep the muscles constricted and reduce swelling
  • Staying hydrated and consuming foods rich in proteins, magnesium, omega-3 fatty acids, and antioxidants
  • Training with the help of a professional, certified trainer

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Medically Reviewed on 2/18/2021
References
Cheung, K., P. Hume, and L. Maxwell. "Delayed onset muscle soreness: Treatment strategies and performance factors." Sports Med 33.2 (2003): 145-164. <https://pubmed.ncbi.nlm.nih.gov/12617692/>.

Domonell, K. "This is why you have sore muscles two days after you work out." University of Washington. Sept. 4, 2017. <https://rightasrain.uwmedicine.org/body/exercise/delayed-onset-muscle-soreness-muscle-pain>.

Krum, N.L. "Understanding muscle soreness – How much is too much?" National Kidney Foundation. <https://www.kidney.org/content/understanding-muscle-soreness-–-how-much-too-much>.