DOMS - Delayed Onset Muscle Soreness
by Kiran Sawhney

What are the causes and symptoms of DOMS?

Symptoms of DOMS can include pain, muscle soreness, stiffness, swelling and loss of strength. Pain and tenderness usually hit the high point one to three days after exercise and subside within seven days. Stiffness and swelling can peak three to four days after exercise and generally resolve within ten days. Strength loss typically peaks within 48 hours after exercise. Full recovery can take as long as five days. These symptoms are not dependent on each other and do not always occur together.

Delayed onset muscle soreness (DOMS) is not a new phenomenon; research investigating the cause of delayed onset muscle soreness (DOMS) dates back to the early 1900s and several theories have been put forward to explain the underlying cause. Probably one of the most popular explanations is the accumulation of lactic acid in the muscles. Popular yes, correct, no. Blood and muscle lactate levels typically return to normal values after 30-60 minutes of recovery. Eccentric exercise produces the most severe muscle soreness but requires relatively low energy expenditure (even less than needed for concentric exercise). Therefore if lactic acid were to cause delayed onset muscle soreness (DOMS), then muscle soreness would be expected to be greater after exercise with a higher metabolic cost (concentric activity). In addition, we know from bitter experience that the pain associated with delayed onset muscle soreness (DOMS) peaks after 24-72 hours. When we consider that lactate concentrations return to pre-exercise levels within 60 minutes it seem ludicrous to suggest that the two are somehow related. Subsequent research has suggested that damage to the muscle ultra structure and connective tissue may be responsible for delayed onset muscle soreness (DOMS). It is suggested that a sequence of events starting with exercise causes muscle damage and then muscle protein breakdown, resulting in cell inflammation and increased local muscle temperature. As a result pain receptors are activated, causing the sensation of delayed onset muscle soreness (DOMS). Further research suggests that muscle damage alone may not be the best explanation for the cause of delayed onset muscle soreness (DOMS). Inflammation and swelling should also be considered as they also activate and sensitise pain sensors around the muscle fibres.

While each of these theories, and others which I have not discussed, do explain some of the aspects of DOMS, none of them can explain the entire process. The following is a quick run down of what we do know about DOMS.

1. The pain of DOMS is said to occur within the first 24 to 48 hours following exercise. Peak intensity of discomfort occurs somewhere between 24 to 72 hours following exercise. The soreness usually subsides within seven to ten days after the initial damage has occurred.
2. Of the three types of muscle in our bodies, cardiac (heart muscle), smooth (which lines our blood vessels) and skeletal (which is attached to our skeletons, for example, you’re biceps muscle). DOMS effects only skeletal muscle. What is more, DOMS can occur in any skeletal muscle in the body and can occur regardless of the person’s fitness level.
3. DOMS is not caused by lactic acid in the muscle. Lactic acid is a by product of burning sugars for energy during intense physical exercise. Within an hour after exercise, most, if not all, of the lactic acid produced in the muscles is removed and degraded. This misconception of lactic acid and DOMS probably got started by that fact that lactic acid is in fact produced in the muscles during intense exercise and does cause muscles to fatigue. The key point to remember is that muscle fatigue and DOMS are two different processes and just because they sometimes seem to go hand in hand, they are not related in any way.
4. DOMS does not result in any long term damage to muscle. This makes sense; if it did, we would expect to see great declines in the abilities of professional athletes during the course of their careers.
5. Studies have shown that the vast majority of damage associated with DOMS is attributed to eccentric muscle contractions, in which the muscle fibers are lengthened as force is applied to them.

What are the physical ways to decrease soreness?

While DOMS is common and annoying, it is not a necessary part of getting into shape. There are many things you can do to prevent, avoid and shorten DOMS. Here are a few tips:

1. Perform a general warm up: Try a five minute general warm up using an activity such as low intensity calisthenics, cycling, jogging or stair climbing. This will increase your core body temperature and you will be ready for an exercise containing eccentric component.
2. Perform a specific warm up: a specific warm up will increase local muscle temperature to improve mechanical efficiency in the muscles to be used in a given activity. The duration of a specific warm up will depend on your fitness level and workout intensity. Activities might include glute squeeze, kicks, lunges, squats, some specific stretches. But as a general rule, a specific warm up will incorporate just those muscles that will be used in upcoming activity.
3. Gradually introduce new exercises: when trying new activities, avoid those that involve intense eccentric contractions, such as plyometric, downhill running, advanced and challenging increase in the weights, repetitions or sets. Also avoid intense eccentric contractions when you are just beginning resistance training.
4. Take advantage of repeated bout effect: gradually increase your fitness level by increasing the exercise intensity and duration over1 to 6 weeks by modestly incorporating eccentric multijoint exercises such as downward phase of a squat, downhill running. A pattern of consistent progress will adapt the trained muscles to increased mechanical stress, minimizing the incidence and severity of DOMS. Complete additional bouts of the exercise that originally caused delayed onset muscle soreness (DOMS) - for instance, if DOMS was sustained during downhill running, additional downhill running within one to six weeks will help alleviate the problem.

Dealing with soreness

Initially, you should avoid any vigorous activity that increases pain, though you may work the unaffected areas of your body. By exercising unaffected areas or by performing low-impact aerobic activities such as biking or walking at a moderate pace, blood flow can be increased to the affected muscles, which may help diminish soreness. Finally, you should allow the soreness, weakness, and stiffness to subside thoroughly before vigorously exercising the affected muscles again.
Other measures include applying ice, gently stretching the affected muscles, which may be helpful for some people and poses little risk if done sensibly.

While for the moment, there is no magic bullet which can seek out and stop the pain associated with DOMS, there are some things you can keep in mind to deal with DOMS.

1. Nonsteroidal anti-inflammatory drugs (NSAIDS) – such as aspirin and ibuprofen were long considered a way to alleviate the symptoms of DOMS, since they were thought to combat the inflammation that occurs with exercise induced muscle damage. However, because of inconsistencies in the research on NSAIDS and the possible side effects of their use, such as gastrointestinal distress and hypertension, these drugs no longer appear to be the best choice for treating this condition. Hence, don't bother to reach for the medicine cabinet prior to a match or workout. No research supports the use if anti-inflammatory drugs, antioxidant supplements, ointments or creams in the prevention of delayed onset muscle soreness (DOMS).
2. Look into vitamin C, as one study, which is almost 40 years old, found that vitamin C supplements did in fact lessen the pain associated with DOMS. While this study has been criticized by some researchers (and to my knowledge, hasn't been reevaluated in the laboratory), it makes some sense that vitamin C would seem to help because vitamin C is involved in making new connective tissue - and connective tissue is damaged in DOMS. If you are going to experiment with vitamin C for DOMS, consider taking it in quantities of 250 milligrams (mg) or less. The body absorbs vitamin C best in this range. Anything more than this will may be lost in the urine.
3. Conflicting evidence surrounds the use of post-exercise massage.

That’s about it. Now that you know more about DOMS than you probably ever wanted to know, go out and have a pain free workout, and remember, it’s not the quantity of exercise you do, it’s the quality.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Kiran Sawhney is a personal fitness trainer in New Delhi, India. You can learn more about Kiran by visiting her website at www.fitnesolution.com or sending an e-mail to Kiran@fitnesolution.com.