Dealing with Delayed Onset Muscle Soreness (DOMS)


by Roy Stevenson, MS, Exercise Physiologist

Muscle soreness and inflammation are some of the biggest nuisances for distance runners and unfortunately, many of the dubious treatments of these symptoms are based on all sorts of witchery and myth. Some of the treatments even exacerbate the soreness and prolong recovery. Runners can be a superstitious lot, and many continue to swear by certain ineffective treatments.

Since 1902, over 2,000 research studies have been conducted on various aspects of muscle damage, muscle soreness, inflammation and potential recovery treatments for these afflictions. You’d think that with this impressive pile of studies we’d be closer to figuring out some sort of effective therapy for the symptoms, or better yet, some sort of preventative measures that would minimize or eliminate them. Well, take heart, sore runners, because we are getting closer to answering these important questions. First, let’s look at what causes delayed onset muscle soreness (known as DOMS), what the symptoms of muscle soreness and inflammation are, and the recommended treatments for reducing the pain from this affliction. I’ll finish with some recommendations on how to prevent or minimize your chances of being reduced to hobbling around like a stiff-legged duck, based on some promising recent research.

Causes of DOMS

It is very common for out-of-condition or beginning runners to experience DOMS. Its severity depends on how much and how intensely we exercise, and whether we have performed that exercise before. But it’s not just beginning runners who are susceptible to DOMS – even well-conditioned runners who’ve been training consistently for several years can experience DOMS after a race or vigorous training session, especially a lengthy downhill-running workout.

What specifically triggers muscle soreness are the high force eccentric contractions we experience when we take up unaccustomed exercise, run harder than usual, or downhill. Our leg muscles lengthen under high load or impact, while trying to contract or shorten – a lethal combination! Recent research shows that some people are high responders to eccentric exercise, meaning that their muscle damage and inflammatory markers remain excessively high for several days after running.

The effects of DOMS on muscle tissue look formidable when seen through an electron microscope. Traumatized muscle is a war zone! Your leg muscles are under siege after repeated eccentric contractions and the descriptions of the damage sound horrifying. Here are some of the main protagonists: disruption to the muscle sarcomere; breaching of cell membranes; swollen muscle fibers; wear and tear on connective tissues (ligaments and tendons); calcium spillage from muscle tubules; cell inflammation and increased production of superoxide free radicals;

We’ve all experienced the nasty symptoms of DOMS: dull, aching pain, soreness, tenderness, stiffness of muscles and joints, swelling, loss of strength, and reduced range of motion. Typically, symptoms appear 24 – 48 hours after we run, and peak between 24 and 72 hours. After five to seven days, DOMS has usually abated.

Over the years many treatments and interventions for muscle damage repair have been proposed and tried. Some “work” and some don’t, and you’ll be surprised at what the research shows.

What Doesn’t Reduce DOMS Symptoms

Stretching Surprisingly, the majority of studies that looked at the effects of stretching on DOMS have found that stretching before or after exercise does not alleviate DOMS, or that its effect is so small that it is not worth the time. My recommendation here would be that if you try stretching, make the stretches mild, and hold them for only a few seconds. If they aggravate your soreness, discontinue them.

Massage therapy Research suggests that massage is either ineffective or has only limited influence on DOMS, muscle repair and swelling. Its effects are minor or transitory.

Ultrasound Using ultrasound in physical therapy was found ineffective in reducing DOMS (Tiidus et al 1999).

Heat Above all, resist the temptation to apply heat in any form immediately after an ultramarathon or intense training session. Heat vasodilates (widens) the capillaries and arterioles, hastening the release of inflammatory substances into the muscle, thereby increasing swelling and inflammation. Sitting in a hot tub after a long run, no matter how tempting, exacerbates muscle damage.

What Might Reduce DOMS Symptoms

Much research into the hot topics of antioxidants and natural supplements is underway. Some substances being looked at are alpha-Tocopherol (vitamin E), Beta-Carotene, Ubiquinone, flavanoids, bromelain, Genistein, alpha-Lipoleic acid, Vitamin C, Vitamin D, Glutathione, and Cysteine. In addition, there are enough kitchen ingredients thought to decrease inflammation to make a good curry: sage, black cumin, cinnamon, capsaicin, quercetin, turmeric, and ginger.

Most of these substances have no effect on DOMS, but a glimmer of hope shines through for vitamin C, D and E. Before you rush off to buy these supplements, consider the modest findings first. Although vitamin E has shown a reduction in cell leakage, thus far it shows no alleviation of DOMS symptoms. A Vitamin D supplement of 2,000 IU, twice daily, has been shown to alleviate muscle soreness, but only if Vitamin D levels are lower than 75 nmol/L. The Vitamin D Council has some interesting anecdotal evidence of its effectiveness, although this source is hardly likely to be objective.

Several promising research papers support the practice of ingesting a solution of mixed carbohydrate and protein immediately after our training and racing efforts to rebuild our muscle tissue.

What about homeopathic remedies? A natural anti-inflammatory preparation comprised of plant and mineral substances including St. John’s Wort, echinacea, belladonna, arnica, and chamomile, under the brand name Traumeel ©, was found in one study by Peter et al (2009) to reduce certain anti-inflammatory markers after running downhill on a treadmill for 90 minutes on a -6% gradient, but no mention in this study was made of perceived pain relief.

What Does Reduce DOMS Symptoms

Warm-up One study found that a ten-minute warm-up reduced DOMS a small amount 48 hours post-exercise, while a cool-down performed after strenuous eccentric exercise, surprisingly had no effect at all.

NSAIDs and other drug therapies Nonsteroidal anti-inflammatory drugs (NSAIDs) have the benefit of relieving DOMS pain by blocking the production of prostaglandins, a compound that activates the inflammatory response in damaged muscle. However, bear in mind that several studies show that by doing this, NSAIDs actually delay the recovery process by impairing protein synthesis and muscle cell regeneration.

Currently, we think it is necessary for inflammatory cells to invade the injured muscle to control the tissue damage, so the muscle tissue can then be repaired. This needs to take place for the muscle to bounce back stronger and be more resistant to future encounters with DOMS.

However, if you are in extreme pain and hobbling around like the walking wounded, NSAIDs may be just what the doctor ordered. Thus, short-term use of NSAIDs or painkillers when the pain and soreness is unbearable may well be recommended, but the prudent runner will discuss this therapy with a sports medicine physician before popping NSAID pills like candy, especially in light of what I’m about to say about their side effects.

There is strong evidence that long-term use of NSAIDs can cause gastro-intestinal bleeding, stomach upset, ulcers, kidney problems, impaired blood clotting, and possible death with long term (greater than 90 days) use of NSAIDs. So if you must use them, take them with meals and monitor yourself for sharp stomach pain and distress that could indicate ulceration. And never, ever take NSAIDs before competition or training! They can mask pain signals and reduce blood flow to the kidneys, which is definitely not what you need during a race.

RICE (Rest, Ice, Compression, Elevation)

Rest, then light mobilization Temporary rest during the most acute phase of inflammation is indicated if the athlete is in severe pain. However, this is not an invitation for complete bed rest until the soreness has dissipated. Mobilization, or light exercise using the affected area, has been shown to reduce soreness to some extent. Some physical therapists recommend that when the pain has subsided to a manageable level, light exercise – such as walking on a soft surface (sawdust, dirt trails, or grass) will help disperse residual waste products. Then you can progress to several days of slow, easy running on soft surfaces. Use your own subjective pain and soreness to help decide when to resume normal training intensity and duration, somewhere around two to four weeks.

Ice. Cryotherapy (application of ice) has been found effective in pain reduction and limiting inflammation, presumably by limiting swelling through vasoconstriction of the capillaries and arterioles in the affected area. Ice also temporarily deadens the nerve endings, bringing temporary pain relief. Ice is most effective when the ice pack or “cold cup” is gently rubbed back and forth over the affected area for no longer than ten minutes; cold-water baths or showers can also be helpful.

Compression One study found that compression bandaging of the legs was more effective than massage. Moderate pressure bandaging of the calf and quadriceps muscle groups, with frequent bandage release to encourage blood to circulate, may help prevent swelling and pain.

How to Prevent DOMS in Distance Running Training Apart from using the modalities recommended above as preventative methods (warm-up, ice, compression, some antioxidants, and post-training carbohydrate/protein mixtures), stimulating DOMS to a minor degree in training will prepare the runner better for DOMS muscle trauma.

The Repeated Bout Effect This effect occurs when a bout of unaccustomed exercise (such as running downhill) gives a protective effect in subsequent running sessions of the same nature. This explains why, after recovering from muscle damage and soreness from a race or hard session, you recover faster, and experience less soreness and pain in subsequent workouts.

What can we learn from this to implement in our training programs? Start slowly and gradually allow your muscles time to adapt.

When beginning running, or coming back from a layoff, avoid strenuous eccentric muscle movements such as downhill running, until your muscles are ready for it.

After a month or two of steady running, while slowly increasing your distance and pace, include an occasional faster, more intense effort. Then hit it hard again after allowing yourself time to recover and adapt. Every two to four weeks, do a strenuous high-intensity or downhill workout again.

Studies indicate that higher intensity eccentric workouts designated for the repeated-bout effect do not even need to be maximal in quantity or quality, and can progress in small increments over more than two weeks. The repeated bout effect lasts from two weeks to ten weeks, so runners should include hard, long or downhill running sessions at least once or twice every month to retain the effects of this training phenomenon. By gradually increasing the intensity and duration of higher intensity workouts, you should avoid that painful zombie walk that accompanies severe DOMS.

Incorporate resistance training into your program. Using a different mode of eccentric exercise (such as weight-training) confers the repeated-bout effect. Thus runners, especially beginners, benefit greatly from a basic resistance-training program that starts several weeks before beginning a running program. The resistance-training program should involve the major muscle groups used in running: quadriceps group, calf muscle complex, and hamstring group.

Recovery after repeated-bout workouts You will need to determine how easily you run after these intense workouts by how you feel. It is unwise to set a prescribed workout schedule and stick rigidly to it because your body may need extra time for the inflammation and repair process to take place. The days following repeated bout workouts, either take the day off, or run very slowly, for a short period of time.

Warm up Perform five – ten minutes of general aerobic activity, such as jogging or cycling.

Run on soft surfaces as much as possible. Harder surfaces impart a higher impact, causing more muscle damage than running on soft surfaces.

Consider some form of cross-training at least once a week to give your leg muscles a break from impact. Cycling, swimming, deep-water running, elliptical trainer, Stairmaster or similar modes are ideal.

Roy Stevenson has a master’s degree in exercise physiology and coaching from Ohio University. He teaches exercise science at Seattle University in Washington State and has coached hundreds of serious and recreational runners and triathletes in the Seattle area. As a freelance writer, Roy has over 200 articles on running, triathlons, sports, fitness and health published in over fifty regional, national and international magazines in the U.S.A, Canada, England, Scotland, Ireland, South Africa, Australia and New Zealand.



  1. blueenigma on

    You offer inconsistent advice.

    First you wrote, “Above all, resist the temptation to apply heat in any form immediately after an ultramarathon or intense training session. Heat vasodilates the capillaries and arterioles, hastening the release of inflammatory substances into the muscle, thereby increasing swelling and inflammation. Sitting in a hot tub after a long run…exacerbates muscle damage.”

    You subsequently offer a complete contradiction with, “Currently, we think it is necessary for inflammatory cells to invade the injured muscle to control the tissue damage, so the muscle tissue can… be repaired. This needs to take place for the muscle to bounce back stronger and be more resistant…”

    Certainly you see the problem with this.