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Delayed-Onset Muscle Soreness (DOMS)

Delayed-Onset Muscle Soreness (DOMS) is an activity or exercise-related muscle pain, which happens after:

  • excessive (too much, too fast, too far) training and / or 
  • unaccustomed exercise
  • exercise / activity has eccentric muscle resistance

Eccentric muscle resistance is when the muscle is resisted in extending. If you can visualize doing a bicep barbell curl, that's your biceps muscle contracting ie resistance with shortening of the muscle. Eccentric is the reverse of it, where you extend your elbow using the reverse motion of the biceps, with resistance.

Other examples of eccentric contractions are:

  • downhill running or jogging
  • long distance running
  • plyometric exercises

What Causes Delayed-Onset Muscle Soreness (DOMS)?

DOMS are a type of muscle strain, where there are micro-tears of the muscle fibers, and these micro-trauma causes an inflammatory response where you will feel the aches and pains. 

In a nutshell -- exercising, competing or training too hard, too fast, too long, overstrains the muscles causing mild muscle fiber tears or disruption is what that causes DOMS.

Many patients actually like and enjoy a mild version of this, because it feels like they have "done a good workout" where the body has a little ache.

Research shows that people who are experiencing the symptoms of delayed onset muscle soreness does show biochemical markers such as creatine kinase and lactic dehydrogenase in their blood, which confirms and is consistent with muscle fiber injuries.

In moderate to severe situations, patients may experienced 

  • swelling
  • inconsistent or altered muscle firing patterns
  • pain
  • movement impairment

What are the common Symptoms of Delayed-Onset Muscle Soreness (DOMS)?

The classic tell-tale sign of DOMS is the general stiffness and dull muscle ache that typically develops 1-2 days after the exercise, training or competition. 

It's more often than not very localized first to the primary involved muscles and the supporting joints and muscles. Patients experience lots of muscle stiffness, ache and tenderness at the main used muscle groups.

Ironically, patients and individuals often will think they "need to stretch" but unfortunately passive stretching will only serve to worsen the DOMS symptoms.

Patients who are suffering from delayed onset muscle soreness often report short term issues of

  • decreased muscle strength, muscle activation
  • decreased range of motion
  • sense of tiredness and sleepiness
  • swelling in the affected muscle group
  • tenderness of the affected muscles

The good news is that

  1. DOMS is typically short termed - majority of DOMS patients recover fully
  2. once you start moving around / moving the affected muscles, they will start to feel less painful...but the soreness and pain will take some time to recover fully

How do we diagnose Delayed-Onset Muscle Soreness (DOMS)?

We specialize in bone, muscle, joint, tendon and ligament injury diagnosis and treatment. 

When we see you for the first time, we dedicate time deep dive assess and determine what is the actual diagnosis and rule out potential similar injuries such as

  • muscle tears / ruptures
  • ligament / tendon strains
  • fractures

Going for an imaging ultrasound scan is not reliable to diagnose DOMS (because it isn't able to) but may be able to pick up more substantial injuries such as fractures or muscle tears.

What is Delayed-Onset Muscle Soreness (DOMS) Treatment?

We recommend that DOMS be treated first with

  1. rest
  2. drinking lots of fluid
  3. heat therapy
  4. cold showers
  5. gentle exercises and activities such as walks and light jogs

We dont recommend taking any painkillers or medicine for pain, but if you really want, then you can consider some of the natural anti-inflammatory supplements we have listed in our shop.

Gentle massages are also useful to accelerate healing and recovery from delayed onset muscle soreness BUUUUUUUT not within the first 24-48 hours. Doing so during this window can cause the pains and soreness to get worse. 

Also avoid muscle stretching as well as aggressive sports or exercise in the first 48 hours as well. The reason is that your muscle already has micro-trauma and strained, so their ability to

  • absorb shock
  • coordinate
  • activate muscle fibers
  • decreased strength and control

can all cause higher risk of injuries and accidents.

Exercises you may consider during this time include

  1. swimming
  2. walks
  3. light jogs

Can we ever Prevent ourselves from suffering from Delayed-Onset Muscle Soreness (DOMS)?

We have a few recommendations for our patients:

  1. Respect the 10% per week rule for all training - only increase 10% of repetitions OR distance OR duration OR intensity. Gradual and progressive training is the best way to prevent DOMS and even overuse injuries such as tennis elbow, shin splints or stress fractures.

  2. Warm up proper AND cool down proper. Stretch immediately AFTER each sessions.

  3. If you're active in sports, remember to alternate sports / form training with complimentary strengthening which will help to prevent overuse injuries and even improve your muscle-game performance.

  4. Hydrate with rehydration drinks and salts.

  5. Heat treatments are useful when combined with cold showers.

What is the chance of full recovery if we get or suffer from Delayed-Onset Muscle Soreness (DOMS)?

The best good news for you is that majority / most of DOMS cases gradually recovers with no long term effects, within 2 to 5 days max. 

That being said...

  1. if your aches and pains in your muscles and joints have been around for more than 2 days without improving
  2. if your pain happened DURING the exercise, training or competition and NOT after the session
  3. pain is specific and located in or around the joints, not just muscle
  4. a lot of swelling, instability or discomfort

then you must make an appointment with our physiotherapist or hand therapist to assess to find out if you have any muscle tears, ligament or tendon injury, fractures or any other injuries that need immediate physio or medical attention.