Tuesday, July 14, 2009


This is what one of my patients who had DOMS did with his pain (cupping), hope you didn't do the same.

DOMS or delayed onset of muscle soreness is a condition where you have muscle pain, soreness or stiffness that is usually worse 2-3 days after exercise, hence the word delayed, and the pain usually subsides over the following few days.

Certain activities are more likely to cause DOMS. Those that require your muscles to forcefully contract while lengthening (eccentric contractions) seem to cause the most soreness. Ever took part in a race where there were lots of running downhill? Then you should know the feeling in your legs a couple of days later. Other examples of eccentric contractions are going down stairs or lowering your barbell slowly during weights. I've also seen patients/ athletes who had DOMS at the beginning of a new an exercise program (especially a new gym/ weight program), after a change in sports activities, or after prolonged or higher than usual intensity efforts.

DOMS is different from the muscle pain or fatigue you experience during exercise. The onset of pain from DOMS always occurs 2-3 days after the cessation of exercise. This helps differentiate it from more acute injuries such as a muscle rupture or sprain.

The soreness will go away on its own after a few days. There are a few things you can do to help. Icing or contrast baths (hot/cold) seems to help although no clear evidence proves they are effective. I had severe DOMS in my legs after my first half marathon race about 12 years ago and tried contrast baths and they didn't seem to help much. Gentle stretching of the affected muscles has also been recommended although there is again no real published evidence found.

There is some evidence that massage seems to help alleviate DOMS by about 30%, but it had no effects on muscle function.

Wanna know what seems to work? My personal experience suggest that performing reduced intensity and low volume exercise will increase blood flow to the affected muscles and often reduce pain. Pedaling on low resistance on a stationary bike is ideal as you don't have to worry about traffic (if you ride on the roads). An easy swim or just walking in waist or chest height water works well too. Wearing compression garments will help reduce it as well. These above mentioned strategies do have some support in the research.

Can you prevent it? Szymanski (2003) suggests the repeated-bout effect as a way of reducing DOMS. This is a progressive adaptation to eccentric exercise. If you perform repeated bouts of lower intensity eccentric exercise 1-6 weeks before your key event,it will help reduce DOMS and exercise induced muscle damage. Thus, a gradual introduction of eccentric exercise, over a period of weeks, is encouraged.


Herbert,RD and De Noronha, M. (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews. Issue 4. The Cochrane Collaboration.

Szymanski, D. (2003). Recommendations for the avoidance of delayed-onset muscle soreness. Strength and Conditioning Journal 23(4): 7–13.

Zainuddin, Z et al (2005).Effects of massage on delayed-onset muscle soreness, swelling and recovery of muscle function.Journal of Athletic Training.Jul-Sep;40(3):174-80.

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