Delayed Onset Muscle Soreness (DOMS)

Delayed Onset Muscle Soreness (DOMS) is muscle soreness that occurs 12–24 hours after performing an unfamiliar exercise or exercising with increased intensity or duration. It does not cause pain during exercise.

People typically experience muscle weakness, swelling, stiffness, and tenderness 12–24 hours after exercise, lasting up to 5–7 days. Depending upon the exercise's novelty, duration, and intensity, symptoms can range from mild to moderate.

There are no tests to diagnose DOMS. A healthcare provider will instead conduct a thorough examination to rule out other possible causes of symptoms, such as rhabdomyolysis, compartment syndrome, or muscle strains. If the assessment indicates a condition other than DOMS, blood tests or imaging may be performed for further evaluation.^[1][2]

Usually, DOMS does not require medical treatment. With rest and/or lowering the intensity of exercise, symptoms should subside within 5–7 days. Acetaminophen or oral and/or topical nonsteroidal anti-inflammatory drugs may decrease soreness; however, prolonged use of these medications is not recommended.^[3][4]

Curcumin, Branched-Chain Amino Acids, Tart Cherry Juice, Fish Oil, Taurine, Vitamin C, and Beet Root may be helpful for treating the symptoms of DOMS. However, there is mixed evidence regarding the efficacy of dietary supplements for DOMS.^[5] Furthermore, because DOMS will resolve without treatment, using dietary supplements may not be worth the potential risks associated with dietary supplements, such as potential drug interactions or unlisted ingredients.

One study comparing the effects of a high and low carbohydrate meal on DOMS found no difference between the two groups.^[6] Thus, if an individual is experiencing DOMS, it is best to follow the basics of recovery from exercise (i.e., adequate fluids, calories, protein, and sleep).^[7]

Massage,^[8] compression garments,^[9] cold therapy,^[10] local heat pack therapy,^[10] vibration therapy,^[11] and intermittent compression therapy^[12] have mild to moderate effects in reducing DOMS. However, popular recovery tools such as saunas,^[10] stretching,^[13] and acupuncture^[14] have not been found to be effective in treating DOMS.

Although the exact mechanism of DOMS hasn’t been determined, DOMS tends to occur after eccentric (muscle-lengthening) or novel exercises. Other factors, such as muscle damage, neutrophil accumulation, oxidative stress, inflammatory compounds (histamine, bradykinins, and prostaglandins), and fluid accumulation may also contribute to the symptoms of DOMS.^[2] However, if a person performs an exercise that causes DOMS, they may feel less sore when they perform the same exercise during future workouts; this is known as the repeated bout effect.^[15]