Seems unfair, doesn’t it?
Exercise, the best thing you can do for your health with it’s long list of impressive (and life-saving) benefits, is also notorious for it’s unpleasant after-effects. Some people even avoid exercising for this reason.
‘Delayed onset muscle soreness’ (DOMS) or ‘post exercise muscle soreness’ (PEMS) or whatever you want to call it, is that nasty muscle pain experienced the next day or two after moderate or higher intensity exercise (or any activity you’re not used to). After a good leg workout, walking down the stairs becomes a daunting task!
Luckily, this soreness usually only lasts a few days, or at most a week.
Still, it can be quite unpleasant, and it’s even capable of reducing sports performance. 1 That’s why athletes who train almost every day are constantly looking for the next best thing to alleviate the pain!
So does anything actually help? Do you have to just “suck it up”? And what’s up with that delay of a whole day or two? Let’s discuss!
What is it?
‘Post exercise muscle soreness’ (a.k.a. DOMS) is muscle pain experienced after exercise (typically occurring 24 – 48 hours later). It’s actually quite normal (unfortunately) and usually happens when you start a new exercise program or try an unfamiliar activity. The pain is often ‘bearable’ and is usually considered nothing more than an annoyance. Some people actually want it because it may signify an effective workout. However, it can be severe enough that people seek relief.
Muscle soreness is often confused with muscle strains, spasms or cramps. While muscle soreness can be quite painful, it’s usually diffuse – affecting whole muscles, many muscles, maybe even your whole body! Furthermore, you usually retain the function of your muscles – you might not want to, but you can probably exercise again.
‘Strains’ are actual muscle injuries. They usually have a more specific location, and the pain is typically more severe than that of muscle soreness. See: ‘Muscle Strains – Treatment and Recovery Guide‘. ‘Cramps’ are painful (but temporary) feelings of tightness, like a muscle not being able to relax. ‘Spasms’ are even shorter: involuntary muscle contractions that come and go quickly. With these problems, you usually lose some function – like losing some range of motion, or not being able to contract the muscle without severe pain.
See? It could always be worse!
Why and how does this happen?
There are many theories as to why muscle soreness can occur. Let’s review them and what the science has to say about each candidate:
- Lactic Acid – Nope. 2 In fact, lactic acid is an important source of fuel when exercising at a high intensity, 3 and apparently leaves muscle within a few hours after exercise anyway.
- Muscle Spasm – Nope. 2 It was once thought that minor, constant muscle spasm was the cause, but a study showing that muscles do not exhibit any change in electrical activity after exercise pretty much debunked that. 4
- Inflammation – Nope. 5 One study demonstrated that 48 hours after intense ‘eccentric’ exercise there was no evidence of inflammation while people still had DOMS and elevated blood levels of creatine kinase (CK – an indicator muscle damage). 6 Yup, damage and soreness, but no inflammation.
- Muscle damage – Yes (most likely candidate). 1 It appears that microscopic muscle damage (‘micro-tears’) is what initiates the development of muscle soreness. The word ‘damage’ may be an over-simplification though… when looking at recently exercised muscle with powerful microscopes, it looks more like “adaptive remodeling” than “damage”. 7 Pretty cool stuff! Either way, the muscle is going through some structural changes, and with that comes a lot of complicated biochemistry.
But these changes are immediate. So why does it take a day or two to start hurting? We can thank the wonderful world of biochemistry for that! While the body begins the repair and remodeling processes immediately after exercise, it appears to take a day or two before the key chemicals that cause this type of pain start causing trouble. 8
Don’t act like that’s not interesting! Science is awesome.
When does this happen?
Muscle soreness typically occurs after exercise that involves a lot of ‘eccentric contractions’. 9
An eccentric contraction occurs when a muscle is actively contracting, but instead of shortening, it’s lengthening (stretching out). It’s like resisting a stretch.
For example: you are doing the exercise ‘Calve Raises’ (see image to right). The up part is called a ‘concentric’ contraction. The down part is called ‘eccentric’.
‘Eccentric contractions’ are normal, and a part of every day movement. But when they’re involved in more demanding activities with greater forces, this type of contraction is thought to cause more microscopic muscle damage than ‘concentric’. 9 With enough intensity, however, either type of contraction can cause muscle soreness.
Basically, exercising in an intense or different way will make you “pay for it” later.
What can be done about it?
There has been a fair bit of research done on this topic. 1, 2, 9 So what does the research have to say? Well, a lot of popular methods don’t seem to help (beyond the placebo effect, perhaps). Even the things that do seem to work have pretty small effects.
So what works? Let’s go over the popular choices:
- Stretching – Nope. 10 And why would it? If the pain is caused by some obscure body chemicals, why would stretching help? And no, it doesn’t “flush” away the chemicals… if anything does, it’s walking around (contracting and relaxing the muscles). Your body has a perfectly good circulatory system for moving stuff around, and if it’s not working, you have bigger things to worry about than muscle soreness. See: ‘Stretching‘ for more research on stretching.
- Cold Therapy – Nope. 1, 2 It might feel good, killing the pain temporarily. But it doesn’t’ seem to have a lasting, significant effect. Some people swear by it, so it’s worth a try – but research indicates that it isn’t reliable for everyone. If you want to try it, see: How to ice your injury.
- Electrical Therapy (TENS, IFC, e-stim, etc.) or Ultrasound – No, and no. 1, 2, 9 Of course, there may be temporary pain relief like with cold therapy, but it has not been shown to be significant in any research so far.
- Exercise – Kinda. 2 Exercising seems to be the most effective strategy, but again, it’s temporary. However, it’s nice to know that even if walking down the stairs hurts like crazy, it doesn’t mean that going to the gym or practice is going to be brutal too. Once you warm-up, things usually become way more tolerable.
- Massage – Kinda, a little. 1, 2, 9 This may come as a surprise, but the scientific evidence that massage works to reduce muscle soreness is actually quite limited. It may have an effect (beyond placebo), but if it does, it’s nothing to get excited about. For way more in-depth review, check out Paul Ingraham’s article from his site, ‘Delayed Onset Muscle Soreness (DOMS) — nature’s little tax on exercise‘.
- Anti-oxidants – Interestingly, maybe! 2, 9 These are the super-trendy nutrients that everyone keeps talking about. If you eat lots of fruit and veggies, you are almost definitely getting enough. They seem to help reduce muscle soreness if you have been eating them in advance for a long time. Apparently, Tart Cherry Juice seems to work. 11, 12 However, it seems that the effects of anti-oxidants are less for highly trained athletes. 13 Eat your fruits and vegetables!
- Anti-inflammatories – Seems to work, yes. 1, 2, 9 The most common example is: Ibuprofen (Advil, Motrin, etc.) These over-the-counter drugs do seem to help. It does seem funny that this type of drug works to reduce muscle soreness – despite the fact that inflammation doesn’t appear to be the cause! However, drugs like these usually have many effects, some we don’t even know about. It might be one of these other reasons, and not anti-inflammation.
– They work… but there’s a catch! Taking excessive anti-inflammatories (too long or too much) can actually slow healing and even decrease the benefits of exercise! For more details, read: ‘Should I use painkillers or anti-inflammatories?‘ So what should you do? If the pain is quite severe, go ahead and take them – but not longer than the directions on the bottle (or recommended by a physician). If the pain isn’t too bad, then don’t take them.
Not much to get excited about! If you do find yourself getting very sore after starting a new exercise program, keep the following in mind:
- Muscle soreness is most prevalent at the beginning of a sports season or initiation of a new exercise regime. 2 Once you get “in shape”, muscle soreness seems to decrease after workouts – even if you keep exercising intensely. So the best “cure” for post-exercise muscle soreness is actually to keep exercising!
- For athletes who train daily, lower the intensity of your workouts for at least two days after a hard workout that causes a lot of soreness. 2 You should probably be doing this anyway to optimize your recovery.
How can we prevent, or at least reduce, the occurrence of muscle soreness?
- Ease into new exercise programs, and ease back into programs you’ve taken a break from. 2 Gradually increase the volume and intensity over the first two weeks. This should decrease the amount of soreness you experience.
- As mentioned above, eating well may decrease the amount of soreness you experience. 2, 9 This means eating lots of fruits and especially vegetables – which you should be doing anyway!
Do whatever you feel is helpful. The “damage” isn’t really a big deal (and is probably a good thing, as discussed), and it almost always goes away after 72 hours anyway. It’s not like you’re ignoring a serious infection or injury. Go ahead, “harness” that placebo effect.
Try any or all of these things:
- cold therapy.
- light exercise.
- light stretching.
- low dose of anti-inflammatories.
- rest and relaxation.
- nutritious foods.
- anything else that makes you feel better.
Until the science becomes more clear, pick the options that cost you the least time / money!
Remember, perhaps the best thing to do for muscle soreness is to survive it and exercise again! Be consistent, and always build things up gradually to allow your body time to adapt.
Hang in there! Consistently.
1. Howatson G, van Someren KA. The prevention and treatment of exercise-induced muscle damage. Sports Med. 2008;38(6):483-503. Review. PubMed PMID: 18489195.
2. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64. Review. PubMed PMID: 12617692.
3. Brooks GA. Cell-cell and intracellular lactate shuttles. J Physiol. 2009 Dec 1;587(Pt 23):5591-600. Epub 2009 Oct 5. Review. PubMed PMID: 19805739; PubMed Central PMCID: PMC2805372.
4. Bobbert MF, Hollander AP, Huijing PA. Factors in delayed onset muscular soreness of man. Med Sci Sports Exerc. 1986 Feb;18(1):75-81. PubMed PMID: 3959868.
5. Semark A, Noakes TD, St Clair Gibson A, Lambert MI. The effect of a prophylactic dose of flurbiprofen on muscle soreness and sprinting performance in trained subjects. J Sports Sci. 1999 Mar;17(3):197-203. PubMed PMID: 10362386.
6. Malm C, Sjödin TL, Sjöberg B, Lenkei R, Renström P, Lundberg IE, Ekblom B. Leukocytes, cytokines, growth factors and hormones in human skeletal muscle and blood after uphill or downhill running. J Physiol. 2004 May 1;556(Pt 3):983-1000. Epub 2004 Feb 6. PubMed PMID: 14766942; PubMed Central PMCID: PMC1664987.
7. Yu JG, Carlsson L, Thornell LE. Evidence for myofibril remodeling as opposed to myofibril damage in human muscles with DOMS: an ultrastructural and immunoelectron microscopic study. Histochem Cell Biol. 2004 Mar;121(3):219-27. Epub 2004 Feb 26. PubMed PMID: 14991331.
8. Murase S, Terazawa E, Queme F, Ota H, Matsuda T, Hirate K, Kozaki Y, Katanosaka K, Taguchi T, Urai H, Mizumura K. Bradykinin and nerve growth factor play pivotal roles in muscular mechanical hyperalgesia after exercise (delayed-onset muscle soreness). J Neurosci. 2010 Mar 10;30(10):3752-61. PubMed PMID: 20220009.
9. Connolly DA, Sayers SP, McHugh MP. Treatment and prevention of delayed onset muscle soreness. J Strength Cond Res. 2003 Feb;17(1):197-208. Review. PubMed PMID: 12580677.
10. Herbert RD, de Noronha M. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004577. Review. Update in: Cochrane Database Syst Rev. 2011;(7):CD004577. PubMed PMID: 17943822.
11. Kuehl KS, Perrier ET, Elliot DL, Chesnutt JC. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Int Soc Sports Nutr. 2010 May 7;7:17. doi: 10.1186/1550-2783-7-17. PubMed PMID: 20459662; PubMed Central PMCID: PMC2874510.
12. Connolly DA, McHugh MP, Padilla-Zakour OI, Carlson L, Sayers SP. Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med. 2006 Aug;40(8):679-83; discussion 683. Epub 2006 Jun 21. PubMed PMID: 16790484; PubMed Central PMCID: PMC2579450.
13. Bloomer RJ, Falvo MJ, Schilling BK, Smith WA. Prior exercise and antioxidant supplementation: effect on oxidative stress and muscle injury. J Int Soc Sports Nutr. 2007 Oct 3;4:9. PubMed PMID: 17915021; PubMed Central PMCID: PMC2131751.