Delayed Onset Muscle Soreness

Wikis > Orthopaedics > Muscle Injury > Delayed Onset Muscle Soreness

The Science of Sore – DOMS explained


Self limiting overuse disorder – occurs following unaccustomed exercise, initiation of exercise or resumption of exercise after period of not exercising – usually eccentric exercise (muscle lengthens as it creates tension)  temporary weakness, stiffness, soreness and pain. Can occur in any type of athlete – regardless of fitness level. Presence of DOMS is not indicative of a “good workout”.

Muscle damage in DOMS is similar between males and females but the inflammatory response in females is attenuated compared to males. Not related to lactic acid build up.

Three theories of pathogenesis:
1) ‘Microscopic tears’ hypothesis – soreness due to muscle damage (most likely pathology)
2) Spasm theory – production of substance-P during exercise  stimulate pain receptors  muscle spasm (not a lot of evidence for this)
3) Diffuse soreness more likely following eccentric than concentric work (must have something to do with pathogenesis)

MRI has sown oedema in muscle fibres. Tissue damage on biopsy is present at cessation of exercise, but symptoms occur up to 24hrs later.

Clinical Features:
Symptoms begin after about 12 hours and increase for 24 hours following exercise – usually, peak at 24 to 72 hours  then subsides over 3 to 7 days. Pain is usually more evident at musculotendonous junction before spreading to all of muscle. Subsequent bouts of exercise does not influence recovery time course .
Muscle strength/power is decreased and range of motion used during subsequent activity is reduced  change in lower limb biomechanics/shock absorption (increased injury risk)  no permanent impairment.
Plasma creatine kinase, carbonic anhydrase III and myoglobin levels are increased.
Need to differentiate from a low-grade muscle strain.

Low intensity and duration exercise; massage; if more severe  NSAID’s. Trial of analgesics has shown no difference when compared to placebo ; Hyperbaric oxygen therapy has been shown to not be effective . Low intensity laser therapy , ultrasound , ice ,, homoeopathy , post-exercise stretching have been shown to be ineffective. Research on use of acupuncture has reported mixed results. Most studies on massage show it be beneficial .

Most prevention revolves around gradual and systematic increases in exercise loads – avoid sudden changes in training routine.
Pre-exercise stretching has been reported as having no effect on DOMS prevention

Related Topics:
Compression Garments for Post Exercise Recovery

External Links:
Delayed onset muscle soreness (Podiatry Arena)

Comments are closed.