Delayed onset muscle soreness. The inevitable outcome of an occasional workout.
Sometimes it shows up with the first step out of bed. As you stand from your bed, pain and stiffness fill your quads and glutes, waking you up faster than jumping in an ice bath.
Or, you take a shower, reach your arm up to wash your pit, brush your pec with your loofa (err…bar of soap), and scream from the soreness in your chest.
Then again, maybe you sneeze, and every muscle fiber in your abs aches with pain.
Welcome to a day with DOMS . . . Delayed Onset Muscle Soreness. The good news is, it doesn’t last forever.
However, like paying taxes on a portion of your income, DOMS is the inevitable effect of some of your best training sessions.
When people face DOMS for the first time, they often ask:
- “Did I do something wrong?”
- “How can I make this go away?”
As we often remind clients:
What Is Delayed Onset Muscle Soreness?
Delayed onset muscle soreness (DOMS) is the pain, stiffness, and slight swelling you feel in the hours or days following an intense exercise session.
Most of the time, it’s triggered by:
- Starting a new training program after a prolonged absence or when you’re brand new to exercise
- Starting a new block of strength training or changing training style, especially when rep ranges exceed eight reps per set and the volume is higher than average
- Eccentric or ballistic training (weights, downhill running, plyometrics, etc.)
You might get a little sore from walking or running, but in most cases, the soreness comes from strength-based movements like squats, lunges, presses, jumps, etc. Even body weight exercise, like in boot camp classes, can leave you feeling pretty sore the next few days.
DOMS is classified as a type I muscle strain injury and presents with tenderness or stiffness to palpation and/or movement.”Cheung K et al. Delayed Onset Muscle Soreness. 2012
Don’t let the word “injury” lead you into believing your muscle soreness should prevent you from physical activity, though. Activity and exercise actually lessen the soreness, whereas remaining sedentary can make things worse.
DOMS slows you down, but it’s not debilitating.
The faster you work through it, the sooner you can get back to high-intensity training. As you’ll see, there’s much you can do to speed through the recovery process.
Soreness appears anywhere from a half day to a day and a half later, and lasts for two to four days. However, in those new to exercise, the tenderness can last a little longer.
What Causes Delayed Onset Muscle Soreness?
You might think scientists today have our bodies all figured out. That’s hardly the case. When it comes to DOMS, they’ve come up with six theories as to what causes it.
I’ll briefly cover the theories here. However, I’m not trying to put you to sleep, so I’ll avoid getting too technical.
1. Lactic Acid Accumulation
The burning sensation of lactate accumulation during exercise often precedes DOMS, so sports scientists have long believed lactic acid accumulation played a role in DOMS.
However, this theory seems to be debunked, since concentric exercise can create significant lactic acid accumulation, but rarely causes DOMS. Also, lactic acid is removed within an hour following exercise, and DOMS doesn’t even show up for many hours after.
2. Muscle Spasm
The muscle spasm theory suggests that following intense eccentric training, your muscle cells go into a minor spasm.
It isn’t like when you get a cramp in your calf where you can see it and feel it. The microscopic spasms are small, but significant enough to trigger nerves and cause pain, which causes the muscles to spasm even more. Research on this theory is inconclusive.
3. Connective Tissue Damage
Connective tissue wraps your muscle fibers.
The theory here is that muscle contraction stretches the connective tissue enough to cause microscopic injury, triggering the soreness.
This theory is difficult to prove. You can measure urine levels of hydroxyproline (HP) and hydroxylysine (HL) to identify collagen breakdown.
However, urine levels increase when you build new collagen as well as when you’ve broken it down due to injury, so it’s difficult to know what’s causing elevated HP and HL levels, new collagen development or old collagen breakdown.
4. Muscle Damage
The muscle damage theory is the most-accepted of the six theories, but it probably isn’t the only factor causing muscle soreness.
Following intense muscle contraction, components of muscle fibers get damaged. The damage causes an immune response and an increase in enzymes like creatine kinase (CK).
Anytime there is injury in the body, inflammation follows as part of the immune response and recovery process.
Proteolytic enzymes break down the damaged tissue, and other compounds and cells are sent to the site of the injury, including bradykinin, histamine, prostaglandins, monocytes, and neutrophils. All these inflammatory compounds draw fluid into the muscle, causing inflammation.
The inflammation from a training session is short-term, though, so it wouldn’t account for the longer duration of muscle soreness related to DOMS on its own.
6. Enzyme Efflux
Following damage to the muscle cell, calcium escapes from the damaged sarcoplasmic reticulum, which activates proteases and phospholipases, or proteolytic enzymes. This theory suggests the proteolytic enzymes cause further damage to the area and stimulate pain-related nerves.
In reality, it’s probably a combination of all these theories and then some.
You probably don’t care about the technical stuff anyway.
I only covered it because many people with very little knowledge of exercise science speak as though they know the cause of muscle soreness. Yet, the smartest researchers in this area of science don’t know the exact cause, so you and I don’t either.
In the following sections, I’ll review what doesn’t work, what might work, and what does work for minimizing delayed onset muscle soreness.
How To Relieve Delayed Onset Muscle Soreness: What Doesn’t Work
Why am I including stuff that doesn’t work?
Because it’s inevitable that when this article get shared, people will chime in with what they’ve heard is helpful for dealing with aches and pains in muscles, and include some of the stuff that doesn’t actually work.
I figured I’d address those now to minimize the sharing of misinformation.
When it comes specifically to reducing delayed onset muscle soreness, whole body cryotherapy does not seem to be effective.
That’s not to say cryotherapy can’t enhance recovery through other means, such as stimulating growth hormone production.
It’s just that at this point, research has shown it doesn’t decrease the level of, or time with, muscle soreness compared to not doing cryotherapy.
I also see cryo as a valuable way to enhance recovery following more serious injury or trauma.
As a matter of fact, ice and ice baths don’t reduce DOMS either, although they’re still recommended for acute injuries like sprains, breaks, and significant swelling.
This might come as even more of a surprise than the fact cold therapy not working.
Even most fitness professionals would probably tell you to stretch when you express how sore you are. It doesn’t help.
Ballistic stretching could even prolong the DOMS by exacerbating the muscle damage.
Ultrasound uses sound waves to help heat up muscle tissue. Cold doesn’t work, and unfortunately, this type of “heat treatment” has mixed results in research as well.
Some studies have shown that it does, some that it doesn’t.
If you have ultrasound equipment readily available, give it a try. But don’t go out of your way for an ultrasound treatment just to deal with your DOMS.
How To Relieve Delayed Onset Muscle Soreness: What Might Work
The following therapies and tools might be helpful. If they’re easily accessible, or you have the extra money to invest in them, they might help, and they definitely won’t make things worse.
Electrical Stimulation (eStim) or Transcutaneous Electrical Nerve Stimulation (TENS)
Though it hasn’t proven to be effective in all cases, electrical stimulation seems to be more effective than other technologies for minimizing muscle soreness and speeding recovery. Logically, it makes sense.
Electrical stimulation causes your muscle fibers to create low levels of contraction. Just as light exercise or movement (which I’ll get to shortly) enhance recovery, electrical stimulation seems to as well.
Massage helps increase blood flow to your sore muscles.
The research on its effectiveness is mixed. Some shows it helps, some shows it doesn’t. In my opinion, it depends on the experience of the therapist as well.
If you choose this option, work with someone who’s worked on athletes.
Oh, and when he or she first starts massaging the sore area, avoid punching the therapist, because you’re going to want to.
Compression gear has been shown to reduce muscle pain after training, even if it doesn’t enhance performance or speed recovery. The compression gear may also minimize muscle damage, as measured by creatine kinase levels.
The interesting thing, though, is that the compression gear seems to work its magic after your training session and over the next couple of days, but most people wear it during their training session, when it doesn’t have much of an effect.
That said, not all research has shown compression gear to be effective, so compression tights wouldn’t be near the top of my list for tools to minimize muscle soreness.
The benefits of fish oil are numerous. One of its most well-known benefits are that it supports normal inflammatory levels.* Though inflammation isn’t the only factor in DOMS, it likely plays a partial role.
Though I do not recommend foam-rolling pre-exercise, it may provide benefit after exercise, or even at home in the hours or days following a training session.
Foam rollers range from inexpensive, actual “foam” rollers, to higher-end tools like the Thera-Gun.
Just be warned…when you’ve got significant DOMS, using it can be painful enough to bring you to tears or yell out a few PG-13 words.
Magnesium is the second-most common nutrient deficiency, which is why it’s included in our Foundational Five, the best supplements to support health.
Low magnesium levels may make you more sensitive to pain, so if you’re among the many with low levels, its possible you’ll feel more sore than necessary.
Magnesium also plays important roles in muscle function, and helps improve sleep quality, making it an important part of your recovery plan.
How To Relieve Delayed Onset Muscle Soreness: What Works
Start with this list (except for the NSAIDs if you don’t need them). If you want to speed up the recovery process and get rid of the muscle pain faster, this is how to do it.
1. Increase Protein And/Or Amino Acid Intake
To rebuild muscle efficiently, which is made mainly of protein, you need to eat more protein. If you’re training hard, but not eating enough protein, you’ll consistently experience more DOMS than you should.
Not only that, but you won’t see strength or body composition improvements as quickly, and you’ll have a much harder time recovering in general.
While supplementing with essential amino acids is helpful, you can’t make up for shorting yourself on whole protein by using only amino acids.
Eat one gram of protein per pound ideal body weight every day, then add on the amino acids.
2. Sleep At Least Seven Hours Every Night
Your body repairs and rebuilds while you sleep. You secrete your highest levels of growth hormone during deep sleep, which occurs in the first third of the night, as long as you’re getting enough consistent quality sleep.
If you choose to not eat enough protein or get enough sleep, the rest of the items on this list might not have much of an effect.
3. Continue to Exercise
Muscle strength is reduced while you have DOMS. The extent depends on the level of your soreness as well as your training experience.
Your tolerance for muscle soreness depends on your pain threshold. If the most pain you’ve experienced is a stubbed toe or a paper cut, slight amounts of DOMS could feel excruciating.
The more you’ve experienced muscle soreness, the more likely it is you’ll be able to train hard while feeling some soreness. However, you will have less strength in a working muscle that’s still significantly sore from the previous training session.
Going for a PR while you’re dealing with DOMS is a bad idea.
A novice exerciser might fear training with the small amount of soreness they feel, when exercising would be good for him or her. An experienced athlete might train through a significant amount of soreness to his or her detriment.
Here are a few recommendations regarding exercising with DOMs:
- DOMS changes your motor recruitment pattern, and makes eccentric movement more difficult. I wouldn’t recommend running downhill, jumping, or agility work.
- DOMS also decreases range of motion, which could increase the risk of injury from sprints or ballistic movements.
- The greatest injury risk isn’t in the sore muscles, but in the muscles used to compensate if you train at intensities beyond what you should while you’re sore. For example, if you sprint while your hamstrings are extremely sore, your decreased hamstring range of motion may cause you to compensate by increasing rotation in your hips and back. This unusual amount of work in the spine could cause injuries there.
An “average Joe” or “average Jane” might be content to sit around and wait for the soreness to go away. However, those who are committed to optimal fitness know that the fewer days they train, the less fitness they’ll develop. They also know that in order to train, they first have to recover properly.
So, instead of waiting for the soreness to go away, they look for supplements, treatments, and other bio-hacks to speed up the recovery process. You might need to reduce the weight you use for your sets, but one of the best things you can do is to continue training.
4. Apply Topical Menthol
Menthol is an over-the-counter analgesic drug, or pain reliever. Menthol can be made synthetically, or it’s found in the essential oils of corn mint, peppermint, and other mints.
Because it stimulates the cold receptors, some research indicates it could have a performance-enhancing effect when exercising in heat. Not only that, but the scent is stimulating, like when I walk out the door of our Minnesota home in January with shorts and a t-shirt on. The coolness wakes you up, which is perfect before a training session.
Menthol is a vasodilator, which increases vessel size, but at the same time, reduces arterial blood flow. Though it’s helpful for post exercise muscle soreness, it’s also used for joint pain, strains, and injuries. Doctors also recommend it for those with migraines, neuropathy, and to relieve pain from other joint conditions like arthritis.
5. Take Curcumin
Curcumin is a constituent of turmeric, the spice that gives curry its yellow color. It’s the subject of more than 3000 research papers, and has been used for more than 5000 years.
Research shows curcumin positively affects numerous aspects of health. It’s one of the supplements I use every day.
One of the problems of curcumin is its absorption. When taken alone, it tends to pass through the digestive tract with most of it unabsorbed.
A specific form called Curcumin Phytosome, sold under the brand name Meriva® wraps the curcumin in a fatty acid, dramatically improving its absorption. Turmeric oil is another form of well-absorbed curcumin.
Caffeine is well-known to dull pain. It is also one of the most proven ergogenic aids.
For a two hundred pound person, that would be about 500 mg of caffeine, or the amount in two tall Pike Place coffees from Starbucks.
It’s one of the many examples of why coffee is good for you.
Or, you could use a caffeine pill, but what would be the fun in that?
7. Non-Steroidal Anti-Inflammatories (NSAIDs)
Ibuprofen, aspirin, and other NSAIDs do provide relief from delayed onset muscle soreness, but only under certain conditions, and at a cost.
They don’t relieve pain if you take them after the muscle soreness shows up. To be effective, you need to take them before and following training, continuing for about three days.
Under this condition, doses of 400 mg, three times per day of ibuprofen has been shown to reduce DOMS.
Interestingly, higher doses have almost no effect on muscle soreness, which brings me to the potential cost of using NSAIDs.
Non-steroidal anti-inflammatories interfere with protein synthesis and actually delay tissue healing. In fact, creatine kinase (CK) and urea, both markers of protein breakdown, were higher in those using high-dose NSAIDs than those who didn’t use any at all.
Building a stronger, healthier, fitter body causes frequent discomfort, periodic soreness, and occasional pain. Of course, so does living a sedentary lifestyle if you give it enough time.
Delayed onset muscle soreness is an inevitable effect of a new or tough training session. It won’t last forever, and you can do a lot to minimize the muscle soreness, including:
- Increase your protein and/or amino acid intake
- Sleep at least seven hours every night
- Continue to exercise
- Apply topical menthol
- Take curcumin
- Use caffeine or drink coffee
Asmussen E. Observations on experimental muscle soreness. Acta Rheumatol Scand. 1956;2:109-116.
Bobbert MH, Hollander AP, Huijing PA. Factors in delayed onset muscular soreness of man. Med Sci Sports Exerc. 1986;18(1):75-81.
Cheatham SW, Kolber MJ, Cain M, Lee M. The Effects of Self-Myofascial Release Using A Foam Roll Or Roller Massager On Joint Range Of Motion, Muscle Recovery, And Performance: A Systematic Review. Int J Sports Phys Ther. 2015;10(6):827-838.
Cheung K, Hume P, Maxwell L. Delayed Onset Muscle Soreness. Sport Med. 2012;33(2):145-164.
Cooper SM. The Effects of Compression Garments on Recovery. J Strength Cond Res. 2009;23(6):1786-1794.
Costerllo JT, Algar LA, Donnelly AE. Effects of whole-body cryotherapy (-110 ºC) on proprioception and indices of muscle damage. Scan J Med Sci Sport. 2012;22(2):190-198.
de Vries HA, Electromyographic observations of the effects of static stretching upon muscular distress. Res Q. 1961;32:468-479.
Drobnic F, Riera J, Appendino G, et al. Reduction of delayed onset muscle soreness by a novel delivery system (Meriva®): a randomised, placebo-controlled trial. J Int Soc Sports Nutr. 2014;11:31.
Erten YT, Sahinkaya T, Dine E, Kilinc BE, Bayraktar B. The effects of compression garments and electrostimulation on athletes’ muscle soreness and recovery. J Exerc Rehab. 2016;12(4):308-313.
Gulick DT, Kimura IF, Sitler M, et al. Various treatment techniques on signs and symptoms of delayed muscle soreness. J Athletic Train. 1996;31(2):145-152.
Hasson SM, Daniels JC, Divine JG, et al. Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. Med Sci Sports Exerc. 1993;25(1):9-17.
Hewlings SJ, Kalman DS. Curcumin: A Review of Its’ Effect on Human Health. Foods. 2017;6(10):92.
Hurley CF, Hatfield DL, Riebe DA. The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Str Cond Res. 2013;27(11):3101-3109.
Johar P, Grover V, Topp R, Behm DG. A comparison of Topical Menthol To Ice on Pain, Evoked Tetanic and Voluntary Force During Delayed Onset Muscle Soreness. Int J Sports Phys Ther. 2012;7(3):314:322.
Kim J, Lee J. A review of nutritional intervention on delayed onset muscle soreness. Part I. J Exerc Rehab. 2014;10(6):349-356.
Kloth L. Electrotherapeutic alternative for the treatment of pain. In: Gersh M, editor. Electrotherapy in rehabilitation. Philadelphia (PA): Davis, 1992:197-217.
Lambert MI, Marcus P, Burgess T, et al. Electro-membrane micro current therapy reduces signs and symptoms of muscle damage. Med Sci Sports Exerc. 2002;34(4):602-607.
Na HS, Ryu JH, Do SH. The role of magnesium in pain. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011.
Nicoletta G, Mannelli DC, Lorenzo DCM, Gabriela M, et al. Menthol: a natural analgesic compound. Neuroscience Letters. 2002;322(3).
NIH U.S. National Library of Medicine. Menthol. Acquired March 10 2019. Menthol | C10H20O – PubChem
Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, et al. Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. J Athl Train. 2015;50(1):5-13.
Schmitz RJ, Martin DE, Perrin DH, et al. Effect of interferential current on perceived pain and serum cortisol associated with delayed onset muscle soreness. J Sport Rehabil. 1997;6:30-37.
Schwane JA, Hatrous BG, Johnson SR, et al. Is lactic acid related to delayed-onset muscle soreness? Phys Sports Med. 1983;11(3):124-127, 130-131.
Stevens C, Best R. Menthol: A Fresh Ergogenic Aid For Athletic Performance. Sport Med. 2016;47(6).
Tanabe Y, Maeda S, Akazawa N, et al. Attentuation of indirect markers of eccentric exercise-induced muscle damage by curcumin. Eur J Appl Physiol. 2015;115(9):1949-1957.