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What is DOMS and How Do You Deal With It?


Delayed Onset Muscle Soreness or DOMS is the pain or discomfort that occurs 24 to 72 hours after a strenuous activity. It usually results from exercise that your body isn’t used to performing. The result is pain, ache, tenderness, and stiffness on or around the muscles affected. The severity varies from individual to individual. 

What is Delayed Onset Muscle Soreness (DOMS)?

Almost everyone who has tried doing a new exercise has experienced DOMS. Some people also call it as muscle fever.  Many people often confuse it with regular soreness of the muscle.  Unlike your usual muscle soreness, DOMS is more painful and is often debilitating. Some people may also confuse it for muscle strain or an injury because of the severity of its symptoms. Normal muscle soreness happens almost immediately —  within 12 hours after exercise— and lasts for less than two days. DOMS occurs several days after the exercise, hence the name.

DOMS greatly affects the performance of muscles and could lead to permanent damage. Its diagnosis involves increased plasma enzymes, abnormal muscle swelling, and myoglobinemia. Despite numerous research and studies, there’s still no absolute preventive measure for the condition.

Common Causes of DOMS

Prolonged Physical Exertion

The soreness is due to prolonged physical exertion, which could happen during strength training exercises, walking down the hill, jogging more than usual, jumping, and even step aerobics. Anyone — regardless of fitness level — could experience it. Age, lifestyle, and muscle condition are common contributing factors.

According to an article by Clayton South, young athletes are at higher risk of experiencing DOMS because their muscles are not yet fully developed to handle intense workouts. In addition, their pro-inflammatory response system is usually over-active.  Older people are also at risk because of lower recovery responses, changes in hormonal status, and age. In addition, their inflammatory response systems have also become slower.  

Lactic Acid Buildup

Lactic acid buildup in the muscles has been associated with DOMS for many years.However, recent research showed  that it is unrelated to DOMS. According to Szymanski, the amount of lactic acid in the blood rises to considerable levels when one is involved in intense and concentric exercises. However, these levels drop to normal 30-60 minutes after the exercise. This contradicts with DOMS, which happens 24-48 hours later. At which point, the lactic acid level has already returned to normal.  

New Workout Routine

benefits of dynamic swimming warm-up

Why does DOMS happen? It often occurs after performing an exercise that you’re unaccustomed to or insufficiently prepared for.

The eccentric contractions of the muscle, also known as stretching and elongation of the muscles, lead to more muscle pain compared with concentric contractions. During the eccentric phase, the muscle contracts while it lengthens. In the concentric phase, on the other hand, the muscle contracts as it shortens. This stretching of the muscle during contraction results in pain and soreness.

A good example of eccentric contractions is the lowering phase of a bicep during an exercise that causes the thigh muscles to lengthen as the limbs try to control your body’s momentum. An example of this is jogging or running down a hill.

The extent of this soreness depends on how many times you repeated the action. Genetics could also play a role in DOMS. he sensitivity and intensity of the soreness vary from person to person. Dehydration also increases your risk of DOMS.


The symptoms of DOMS do not necessarily create a need for medical intervention. It only calls for medical attention when you start experiencing debilitating pains, your urine color changes to black, and your limbs start to swell severely.

Proposed Interventions

Although scientists have not developed specific treatments for DOMS, several interventions have been established to treat its symptoms.

  1. 1. Use of Non-steroidal anti-inflammatory drugs
  2. 2. Use of nutritional supplements
  3. 3. Performing warm up
  4. 4. Performing repeated bout effect
  5. 5. Cryotherapy

Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)


Many people believe that the only solution for DOMS is NSAIDs. NSAIDs such as ibuprofen and flurbiprofen have been used by many athletes as a treatment to reduce their DOMS symptoms. They are useful in reducing the pain in the muscles and the inflammation and swellings around these areas. However, research shows that these drugs cause stunt muscle growth and in severe cases could result in liver damage (O’connor et al, 2003).  They could also lead to gastrointestinal distress and hypertension to some users. Contradictions and conflicts among the usage of NSAIDs usually focus on their long-term effects. Because of these reasons, they have now been considered not to be an optimal choice for treatment.  

Some individuals use sitosterols, a plant-derived sterol essential in combating soreness. It also increases the CD4 activity in the body while decreasing inflammatory agents and chemicals. Additionally, sitosterols  are known to reduce cortisol levels and enhance muscle buildup.

Use of Nutritional Supplements

A 1957 study showed that protease enzyme therapy decreases muscle inflammation. Papain, bromelain, and trypsin are common protease enzymes which remove excess proteins in the blood and reduce inflammation. They also inhibit stimulants that could cause an increase in inflammatory agents in the body.

With protease enzymes, you feel less muscle pain and soreness after exercise. It also enhances your recovery and decreases the onset of DOMS. However, your body does not easily absorb these enzymes.  Your gut could also not break them up easily. This has limited the use of these enzymes. To enhance its absorption, scientists added piperine, a substance obtained from pepper. With it, the absorption rate of protease enzyme increased to 60%.

Free radicals cause inflammation ,and Vitamin C and E are known to limit the amounts we have in our bodies. According to Connolly, these nutrients are also inconsistent and should not be considered as a better treatment option for DOMS. Experts are still investigating the effects of Coenzyme Q and L-carnitine to prove if they can help with the soreness.

Performing Warm-Up

warm-up to prevent DOMS

Arguably, warm-up exercises  such as passive stretching have proven to be beneficial when it comes to preventing DOMS. You can do warm-ups in combination with other techniques such as ice massage. Massage after a strenuous exercise is comparable with electrical stimulation.  Combining these techniques  could result in less muscle tenderness, less pain, and relaxed elbow flexion.

Performing Repeated Bout Effect

Repeated bout effect refers to performing the same exercise causing the soreness thus, allowing the body to adapt to the eccentric exercise. This could help you minimize -and even avoid- muscle damage or injury.

Research shows that repeated bout effect protects muscles from secondary damage. In addition, it reduces the primary soreness by a good percentage. When repeated bouts are performed before the initial higher intensity, you lower your chances of getting DOMS. Therefore, a repeated introduction into the exercise over time is highly recommended. Szymanski in his research stated that a faster recovery and increased strength is affected if this action is carried out (McHugh, M. P., 2003).


This is one of the initial treatments that was recommended for injuries to the soft tissues. The application of ice causes the swelling to subsidize and increases metabolism thus lowering the inflammatory response.

According to research, the use of cold water or ice 15 minutes after exercise for 30 minutes is effective in reducing muscle stiffness and could result in lower plasma CK activity. Cryotherapy is also effective in reducing calcium ion levels within 48 hours after the eccentric exercise. This is more so because of lower permeability of the plasma membrane.  

Muscle soreness causes calcium to increase, triggering the inflammatory process. The increased pressure in the affected area could also cause tissue edema, which stimulates the pain receptors, causing the onset of DOMS. From this, we can clearly see that cryotherapy is essential in reducing DOMS and muscle damage after an eccentric exercise (Cheung et al,2003)

Prevention of DOMS

Prevention is essential since this soreness does not have a specific treatment. To avoid DOMS, start with your new exercise program slowly. This gives your body time to adapt to the new activity, thus minimizing the severity of the symptoms. If slow progression is not possible, consider doing recovery exercises on the succeeding days after you had the chance to rest.

Proper warm-up is essential as it prepares your muscles to handle the forces and stress that usually cause the damage. Perform your warm-up and cool down exercises 10-15 minutes before and after the activity. Hydration is also an important factor. Make sure to drink enough fluids during and after the activity. Drinking sufficient amounts of water helps hydrate your muscles and get rid of lactic acids.

There are many ways to prevent DOMS but the best one is to ensure that you know your limits. Warm-ups and slow progression to a new routine also reduce cases of soreness. In case of severe medical symptoms, it is advisable to see your doctor as soon as possible. You  should also seek medical attention pain and soreness have persisted for three days or more, or if your symptoms have gotten worse. Additionally, seek help from a medical professional if the pain is on the joints and not on the muscles.


  • – Cheung, K., Hume, P. A., & Maxwell, L. (2003). Delayed onset muscle soreness. Sports Medicine, 33(2), 145-164.
  • – Connolly, D.A.J., S.P Sayers, and M.P. McHugh. Treatment and prevention of delayed onset muscle soreness. J. Strength Cond. Res. 17(1):197-298. 2003.
  • – McHugh, M. P. (2003). Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. Scandinavian journal of medicine & science in sports, 13(2), 88-97.
  • – Nosaka K, Newton M, Sacco P. Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage. Scand J Med Sci Sports. 2002 Dec;12(6):337-46.
  • – Szymanski, D.J. Recommendations for the avoidance of delayed-onset muscle soreness. J. Strength Cond. Res. 23(4): 7-13. 2001
  • – A. Trappe, F. White, C. P. Lambert, D. Cesar, M. Hellerstein, and W. J. Evans. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J PhysiolEndocrinolMetab 282: E551-E556, 2002