Delayed Onset Muscles Soreness (DOMS) is one of the enigmas of the Physiotherapy world. Just what exactly is it? We’ve all been there for sure. Maybe you’ve played football for the first time in a year. Perhaps you’ve gone for it too much in the gym. Or the ultimate. Having to walk backwards down the stairs after a marathon! But what exactly is this mysterious DOMS and how do avoid getting it?

When Do You Get DOMS?

You get DOMS basically when you have done more than your muscles can deal with in one go. Effectively you are not suitably conditioned for what you have done and DOMS is part of your muscles recovering. To say whether the muscles are damaged by the training is a bone of contention.

DOMS is a great one for making you feel old. Not only do you feel like an old man / lady at the time but the amount of “delay” before the soreness comes on changes with age. In our formative years DOMS usually starts within 24 hours. As we gain in maturity (get old!) this moves more to 48 hours and sometimes beyond.

It’s not only age that is a factor. It’s you! Everyone is different. There seems to be some genetic factor in how quickly you feel it. I personally have always been within 24 hours kind of guy. At the ripe old age of 41 this has yet to change. I’d like to say that’s due to my excellent conditioning… but that would be a lie! Maybe a lifetime in average level sport means I’ve never truly got completely unfit – maybe this helps in terms of timing of the soreness. But it’s still sore!

Should I Be Worried By DOMS?

In a word no. Whilst DOMS is not fully understood (see below) it is thought to simply be part of the process of your muscles recovering from doing more than they are used to. That said is you are still struggling 3 or 4 days after the offending exercise then you might need to “review” the situation. Especially if the soreness that is not going away is asymmetrical i.e. more on one side.

It may also be of mild concern if you have DOMS in muscles you didn’t exercise. Let’s just say for the sake of argument you had done lots of calf raises in the gym and not only you calves were sore your quads were sore too. This would suggest that your quads were compensating for a weakness in your calves. Not a national emergency but it might be movement pattern worth ironing out to reduce the risk of injury in the future.

What Is Causing DOMS?

Firstly it is not lactic acid. This is one of the biggest myths going and has been out there for years. This one was fairly easy to refute simply by assessing blood lactate levels post exercise. Most lactic acid has been removed from muscles within 2 hours of exercise and all of it within 24 hours. Lactic acid is a normal by product of anaerobic respiration i.e. when your muscles work without enough oxygen. It’s not as efficient but it gets the job done.

That’s not to say this process doesn’t have any effect on DOMS. It’s just not the lactic acid that causes the pain. A more widely held theory is that it is micro-trauma the muscle fibres. If you want to get technical it’s thought to be temporary damage to the z-lines within the actin and myosin. These are the molecules that makes the muscles fibres contract.

There’s also some evidence to suggest that Free Radicals have a role to play in the pain that we feel after intense exercise. For those without a chemistry degree and want to know what free radicals are there’s a great simple article here that you don’t need a brain the size of a planet to understand.

What Are The Prescribed Remedies?

The following is a list of remedies commonly believed to have a positive effect on the symptoms of DOMS. Whatever it is the symptoms are caused by!

• Stretching before and after intense exercise
• Ice bath post intense exercise
• Warm up and cool down before and after exercise
• Taking anti-oxidant supplements
• Massage – especially deep tissue and Sports Massage

Is There Any Evidence For The Prescribed Remedies?

Sadly many of the prescribed remedies only have anecdotal evidence. Sadly even my beloved massage! I will of course give the case for the defence shortly. But here’s a brief overview of what has been shown to work and what has been shown not to.

Sadly stretching before and after exercise has minimal impact on DOMS as per this article here. It’s interesting as we all do a lot of stretching, or at least feel we should, but there’s very little evidence to say it helps much for anything. That said. It does make you feel good afterwards and it must do something as gymnasts and ballerinas wouldn’t be so bendy otherwise!

Ice baths are still all the rage post exercise especially in elite level sport. They’re the only ones deranged enough to try it! I recall Paul Radcliffe swearing by them. Sadly this piece of research here suggests there is absolutely no affect at all in reducing the post exercise soreness.

There’s slightly better news for post exercise warm down from this article. I think most sports club worth their salt include a warm down these days. Rather than a pint in the pub. So that backs things up nicely. From my own experience in club swimming I find the longer my swim down the quicker my recovery. Not only in terms of DOMS but also in terms of post exercise lethargy – especially when getting out of bed the following morning!

It would appear that anti-oxidants help. This ties in nicely with the theory that some of the pain is caused by the free radicals produced as a by product of intense exercise. Anti-oxidants are thought to help the body dispose of these free radicals. There are a variety of papers along these lines but the one that seems to be the most in depth and useful in terms of telling you what kinds of supplements to take is here.

I’d also like to throw my two pence in. Admittedly this is the definition of anecdotal evidence but I do have a lot of anecdotes having been in the physiotherapy world for over 12 years now. Firstly massage can work. Gentle pressure massage increasing the pressure as the sensitivity of the muscles reduces does work in most cases. The cases where it doesn’t work are when people have really gone for it in terms of overdoing the exercise. This positive effect can be made even better by what I call increasing bio-mechanical efficiency. This is probably easiest explained by way of an example.

Take yours truly. User of true gentleman’s bio-mechanics that we call quad dominance. Basically if I try and do any movement in my body the first muscle that wants to work is the quads. This is why I look like Mr Muscle on my top half and Arnold Schwarzenegger on my legs… in relative terms at least! This is in part due to my hip flexors not doing as much as they should. So let’s say we release the hips flexors and the DOMS in my quads starts to dissipate. Especially then after some massage on the quads to complement the release.

I have prepared some evidence which kind of backs this up. Or at least gets us thinking. The article here explains how muscles that haven’t been exercised that are innervated from the same nerve root can get sore also. Maybe this works the other way round too and may in part explain some of the improvements I have seen in the clinic.

We could further expand this idea to a myofascial model. For the non regular readers that simply means how muscle and connective tissue are related and effect each other. In this example we could consider the hip flexors’ (psoas and iliacus) continuation into the adductors on Anatomy Trains’ Deep Front Line. Click here for a visual. Meaning we can release the soreness in the adductors using the same hip flexor release. I’ve seen this approach work countless times.

Conclusion

So the jury is out. Just as with most Physiotherapy research! What the research has done is dispel some old fashioned myths. No DOMS is not lactic acid! The research suggests that massage does not help. However, research rarely comes down in the favour of massage as it’s personal to each therapist. I have seen shifts in peoples’ DOMS from massage treatment. In fact I would suggest that is the norm. But there are cases of DOMS that no amount of Sports Massage will shift!

What I would suggest if you’re someone who regularly suffers from DOMS is a multi faceted approach. Firstly get your bio-mechanics as optimal as possible. Make sure that all the muscles are firing as optimally as they can and not putting unnecessary load on compensatory muscles. That is of course something we can help you out with.

Next consider your training programme. Build up to things gradually. If you’ve been off running / the gym or whatever sport drop your expectations for a few sessions and take it easy. You can soon ramp things up, adaptations happen surprisingly quickly. If you’ve never done a sport before and getting back to it after years out. Take your time. Run / walk training programmes are a great option for getting into running without excessive pain.

From the research above make sure you include a warm down. You may also wish to investigate supplementing you diet with extra anti-oxidants including vitamin C. Finally you could try a Sports Massage. See if you think the research is right or wrong? Personally I’m always sceptical of research regarding massage because it always seems to say it makes no difference and in my experience it always seems to make a profound difference. Regular readers will know I like to contradict research where possible!

So that’s the best advice I can give you on the enigma that is DOMS. Follow that little lot and hopefully you’ll see a significant improvement. I’d suggest not just in post exercise soreness but also in your predisposition to injury. Of course if you’re the kind of person who feels like DOMS means you’ve worked hard and has learnt to enjoy the sensation. Ignore all of the advice above, our number is top right, we’ll be seeing you soon!