DOMS: What You Can do with Post-Exercise Pain.

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DOMS stands for Delayed Onset Muscle Soreness. Any Tom, Dom and Blossom can experience DOMS… that stiffness and soreness of muscles after performing some exercise you haven’t done for a while/ever, or heavy eccentric exercise. Besides the obvious discomfort, it can impede athletic performance by reducing both strength and range of motion at joints. In fact, it’s been found to be the MAIN cause of impedance amongst athletes and casual exercisers. So…  what can you do about it?

Key Points:

  1. DOMS is caused by doing intense eccentric contractions or just doing heavier exercise than your muscles are adapted to.
  2. DOMS won’t usually cause soreness during exercise, but it will increase afterwards and peak around 24-48 hours, before gradually subsiding
  3. An effective strategy to manage DOMS will target the complex inflammatory processes that damaged muscle undergoes. Massage (+/- stretching) may be one of the most effective ways to recover from DOMS once you have it. Active recovery, use of compression and cold techniques, and some nutritional tweaks may also help. 
  4. Increasing your workloads by increments of up to 10% (whether in reps, weight or time), and sticking with that until you’ve adapted, is a sensible way to go to make sure DOMS isn’t excessive. Recovery days matter. 

DOMS is delayed because the symptoms ramp up after exercise, with peak soreness usually occurring between 24 and 48 hours. Soreness then starts to subside and may last into the 3rd day after the physical training, according to research. (On rare occasions where I’ve performed training I’m very unaccustomed to, I’ve had residual soreness and stiffness beyond that… )

What causes DOMS?

At the crux of DOMS is microscopic muscle damage that occurs from exercise overload (working at a level your body is not adapted to). This damage has been witnessed in microscopic studies of muscle fibres, and increased blood levels of creatine kinase (an enzyme released from damaged muscle cells). This microscopic damage triggers a spike in the inflammatory molecules bradykinin, prostaglandins and leukotrienes, which have a range of impacts:

The swelling within muscles can also put pressure on the nerve fibres that send pain signals to the brain.

Managing DOMS

You actually wouldn’t be able to attain strength or muscle mass gains without microscopic muscle damage, but in DOMS the damage is exaggerated. Repair and recovery is essential. 

This isn’t groundbreaking, but adequate rest and recovery is critical to managing DOMS & muscle health in general. Unceasing overload will only lead to accumulated damage. Some general rules of thumb are to give a muscle group at least one recovery day between consecutive resistance training sessions, and when you increase your workload, do by no more than 10%. 

The premise of recovery methods is generally to reduce the space available for muscle swelling and oedema formation and enhancing the removal of metabolics/neutrophils/damaged proteins from the muscle to the blood 

Massage for DOMS

A 2018 review pegged massage as the most beneficial tool for recovery. Another review from 2017 showed that massage after strenuous exercise reduced ratings of soreness and blood creatine kinase levels. It also seems to increase joint mobility in the acute post-exercise stage, whereas there is mixed evidence regarding any improvement in  muscle performance or power. 

Subjective effects of massage are relief of muscle soreness, tension and stiffness, and *feeling* more relaxed psychologically.

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There are a number of proposed mechanisms for its effect, but we are not certain. The action of massage may help clear creatine kinase and other waste products via the lymphatic system and an increase in blood flow. Perhaps the increase in skin and muscle temperature, or an increase in relaxing parasympathetic nervous system activity contribute.  

When massage was combined with stretching, reduced perceived fatigue has also been reported.

Eating for DOMS

  • Caffeine may reduce DOMS after exercise. Some studies have shown that 5mg caffeine/kilogram of body weight before and/or after exercise is effective. However, it is not clear whether before or after is more effective. Nor is the mechanism clear, however it may be related to its effect on the central nervous system.
  • Omega-3 fatty acids contain eicosanoids EPA & DHA, which can reduce DOMS by regulating the inflammatory response to exercise.That is, they reduce production of pro-inflammatories including thromboxane, leukotriene, and prostaglandin; plus interleukin-6 (IL-6), and tumor necrosis factor-α. The definite dosage, how often and for how long omega 3 intake is required for benefit is not clear, but available studies (up to 2014) have shown 1.8-3g/day to be of benefit. 

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  • Small studies have suggested ingestion of the amino acid taurine may reduce oxidative stress & DOMS

Active Recovery and DOMS

Light exercise enhances blood circulation and the removal of waste products, which may reduce muscle damage and pain. The systematic review with meta-analysis from 2018 showed it was a somewhat effective strategy. You should aim to keep moving gently through as great a range of motion as is possible without excess pain.

A systematic review with meta-analysis from 2018 showed that active recovery, massage, compression garments, immersion, contrast water therapy, and cryotherapy induced a small to large decrease, whereas electromyostimulation, hyperbaric therapy and stretching alone did not have any effect on DOMS or fatigue, although some changes in inflammatory markers were seen

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Other strategies:

  • Compression garments. Perceived fatigue can be effectively managed using compression techniques, such as compression garments,
  • Water immersion Reduced inflammation and fatigue has been observed with immersion in water <15°C. 
  • Similarly, Cryotherapy, and Contrast water therapy (where the body/parts thereof are alternately exposed to hot and cold water) also seem to improve DOMS.

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The Verdict

It seems the most effective way to manage a bad case of DOMS is to have a massage, and possibly stretch out those sore, tired muscles too. Other potentially useful strategies are light exercise for “active recovery”, use of compression garments, cryotherapy and cold or contrast water therapy, and enhancing the diet with omega-3 fatty acids, polyphenols from fruit and vegetables and foods containing the amino-acid taurine. These have the common effect of reducing the inflammation that is central to DOMS. Caffeine use may also help alleviate the central nervous system fatigue element of DOMS. Because the evidence is mixed, it might be worth experimenting yourself to see what works for you. After all, most of them can’t hurt you (with the exception of caffeine overdose and the possible unpleasantness of cold therapies)- and even in the worst case scenario where there’s no significant impact on DOMS, most will have other health benefits. 

What techniques have helped you recover from DOMS? Have you found anything that works other than what we’ve outlined? 

References

Jianmin, G., Linjin, L., Yuxiang, G., Rong, Z., Jiake, X., Jun, Z., and Xi, C (2017). Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 8.     DOI=10.3389/fphys.2017.00747  

Kim, J., and Lee, J. (2014). A review of nutritional intervention on delayed onset muscle soreness. Part I  Journal of Exercise Rehabilitation, 10(6): 349-356.

Olivier, D., Wafa, D., Dimitri, T., Laurent, B., and Benoit, D. (2018). An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology, 9. DOI=10.3389/fphys.2018.00403    


Murase, S., Terazawa, E., Queme, F. et al. (2010). Bradykinin and Nerve Growth Factor Play Pivotal Roles in Muscular Mechanical Hyperalgesia after Exercise (Delayed-Onset Muscle Soreness). Journal of Neuroscience. 30(10): 3752-3761. DOI:10.1523/JNEUROSCI.3803-09.2010.  

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