Author: Sonja Squires
We’ve all been there—enduring the debilitating soreness and stiffness that comes with walking around after a tough workout, usually accompanied by the all-too-familiar “waddle” used as an attempt to reduce the tenderness of tired muscles. This phenomenon is known in the science world as “delayed-onset muscle soreness”, or “DOMS” for short. It was given this title because research has consistently shown that this painful sensation begins approximately 24 to 72 hours following a particularly strenuous workout, making the “onset” of the pain “delayed”. Despite the general population having such a strong familiarity with this experience—whether you’re an athlete with a strict training plan, or you exercise recreationally—the world really doesn’t know as much about DOMS as you’d think .
What we do currently know is that DOMS can be, in most cases, induced by three main types of strain to the muscles. First is continued muscle lengthening contractions, called eccentric contractions. Lengthening contractions happen when a force is applied by the muscle when it is still extending, which causes more strain because the contracting force is in the opposite direction of the muscle movement. Examples of this include running downhill or lowering a heavy weight with your arms or legs. Strain on the muscles also occurs when an individual does a new kind of exercise.1 During new, unfamiliar exercises, the muscles involved have not yet been “trained” to do them, resulting in extra muscle strain.1 A third type of strain that your muscles can experience can result from an increase in exercise frequency. When you subject your muscles to a greater number of exercise bouts than what they’re used to over a certain period of time, you are keeping them from getting a critical period of recovery time that would normally act to prevent delayed-onset muscle soreness.1
We also know the main physiological responses to these types of exercises—an inflammatory response produced by the muscles subjected to the exercise. This inflammatory response results in the symptoms we are familiar with, including a decrease in force production and capacity, muscle soreness, stiffness, minor swelling, and even intramuscular edema.1 But what is happening on the microscopic level of our muscle tissue that causes all of these undesirable outcomes? Scientists have come up with several hypotheses about what the true source of DOMS actually is, but no research that has been conducted thus far has found any find any strong causes of this familiar, yet mysterious condition. The one you might be most familiar with is the “lactic acid buildup” hypothesis, which claims that as lactic acid—a toxic byproduct of exercise—sits in the muscles after a bout of exercise, it can cause an unpleasant stimulus by activating the pain receptors in your muscles. This theory has, in fact, been rejected by scientists because lactic acid buildup returns to baseline levels after just one hour post-exercise.2 Keeping in mind that the symptoms of DOMS appear 24 to 72 hours post-exercise—way beyond the window where lactic acid is present in the tissues—it wouldn’t make sense for this toxic byproduct to be the culprit behind muscle soreness. A few other theories present in scientific literature that try to explain DOMS include how muscle damage and connective tissue damage could directly affect the soreness experienced in DOMS, but as stated previously, the research done on each of these theories have not been able to successfully pinpoint a specific cause behind the condition. It’s reasonable to predict that DOMS could be a result of the combination of several of these current theories, but we just can’t be too sure as of right now.
Even without knowing the origins of this condition, people have developed and used a wide assortment of preventative techniques to try to avoid DOMS after their workouts. Sometimes, avoiding painful symptoms doesn’t work regardless of which preventative measures are taken, so preventative techniques turn into treatment techniques for DOMS. Many different treatment options have been developed over the years, and it’s likely that you’ve heard of—or have used—some of these techniques with foam rolling, ice-bathing, stretching, supplementation, and acupuncture being among the most popular of the myriad of options. But does research support the use of any of these to control the symptoms of DOMS? Let’s take a deeper look into some of these mechanisms that are thought to control DOMS to find out.
The first treatment technique that you may be thinking of is proper stretching before and after working out. Believe it or not, a review done by Heiss et al. exclaims that there just isn’t enough a lot of evidence that supports the use of stretching to prevent soreness.2 They even found that excessive stretching may even lead to muscle soreness on its own—without any exercise to induce it! Why is stretching so heavily emphasized as part of the pre and post-workout routine, then? Instead of preventing DOMS, stretching is used mainly to try and prevent injuries.
Another treatment option that many people are familiar with is foam-rolling. Here, we also see some inconsistencies from research. Overall, foam rolling (along with other forms of massage therapy) seems to be one of the most effective ways to decrease the severity of DOMS, but even still, it’s important to keep in mind that we still aren’t super confident in this method of treatment.4 One specific method of foam rolling is mentioned in a study where researchers found some supporting evidence that foam rolling for 20 minutes a day for 3 days could possibly lead to a decrease in the symptoms of DOMS.3
Ice-bathing is another common treatment to exercise-induced muscle soreness and is referred to as “cold water immersion” therapy, or CWI therapy in research literature. The logic behind exposing the muscles to a cold environment is to reduce the inflammation that we know accompanies the symptoms associated with DOMS. Dipping into that frigid tub of ice water is already dreaded by so many, but are these polar plunges actually working to speed up the recovery from DOMS? Studies say that using CWI has a slight significant impact on muscle recovery.1,4 The reason for this is because that even though varied results were found, there were some consistencies that showed an improvement of soreness when the water used was 15°C and below—the chillier, the better!1,4
At its core, the studies that have been conducted just don’t seem to provide us with solid evidence that today’s treatment plans can effectively reduce the symptoms of DOMS or supply the population with preventative measures which we can use to ensure that we don’t get DOMS after we workout. Whether it’s because different research parameters can lead to different outcomes of DOMS, or whether the regulation of these parameters is difficult to control, it seems that until we know more about why we experience muscle pain 24 to 72 hours post exercise, we will have to deal with the lack of confident ways to avoid and treat this obnoxious condition. Once in a while, we’re just going to have to deal with the temporary discomfort that DOMS brings. At the very least, if you want to reduce your risk of inducing DOMS, building slowly into strenuous exercises over the course of several days can help to keep your muscles from experiencing the sudden strain responsible for DOMS. Luckily, it seems that the incidence DOMS can also be reduced once you’ve already experienced DOMS before. Basically, once you experience DOMS, the threshold to experience it again increases because you’ve built up a resistance to the condition through adaptation.
So, whether you are a trained athlete or you just love to move your body and push yourself physically, the best way to approach the inevitable pain from sore muscles is to experiment with different kinds of prevention measures and treatments to see what your body best responds to, and to keep on enjoying the exercise that you do !
 Heiss R, Lutter C, Freiwald J, et al. Advances in Delayed-Onset Muscle Soreness (DOMS) – Part II: Treatment and Prevention. Sportverletz Sportschaden. 2019;33(1):21-29. doi:10.1055/a-0810-3516
 Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-164. doi:10.2165/00007256-200333020-00005
 Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13. doi:10.4085/1062-6050-50.1.01
 Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. 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. Front Physiol. 2018;9:403. Published 2018 Apr 26. doi:10.3389/fphys.2018.00403