Delayed onset muscle soreness

Delayed onset muscle soreness

Delayed onset muscle soreness (DOMS), also called muscle fever, is the pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise. The soreness is felt most strongly 24 to 72 hours after the exercise.[1] It is caused by eccentric exercise.[2] After such exercise, the muscle adapts rapidly to prevent muscle damage, and thereby soreness, if the exercise is repeated.[3]

Delayed onset muscle soreness is one symptom of exercise-induced muscle damage, the other being acute muscle soreness, which appears during and immediately after exercise.



The soreness is perceived as a dull, aching pain in the affected muscle, often combined with tenderness and stiffness. The pain is felt only when the muscle is stretched, contracted or put under pressure, not when it is at rest.[1] Although there is variance among exercises and individuals, the soreness usually increases in intensity in the first 24 hours after exercise, peaks from 24 to 72 hours, then subsides and disappears after about five to seven days after exercise.[1]


The soreness is caused by eccentric exercise, that is, exercise consisting of eccentric (lengthening) contractions. Isometric (static) exercise causes much less soreness, and concentric (shortening) exercise causes none.[1]


Delayed onset muscle soreness was first described in 1902 by Theodore Hough,[4] who concluded that this kind of soreness is "fundamentally the result of ruptures within the muscle".[1] This is still considered broadly valid, although the soreness does not appear to involve the rupture of whole muscle fibers.[2] What has been observed to accompany soreness are ultrastructural disruptions of myofilaments, especially at the Z-disc, as well as damage to the muscle's connective tissue. That tissue damage may relate most directly to soreness, as it may increase the mechanical sensitivity of the muscle nociceptors, or pain receptors, and cause pain with stretching and palpation.[1] The delayed onset of the soreness may occur because the inflammatory response process that sensitizes the nociceptors takes some time.[1] However, the relationship between damage, inflammation and soreness is not yet completely understood.[2]

Two other hypotheses that have been advanced to explain the soreness, muscle spasms and the presence of lactic acid in the muscle, are now considered unlikely to be correct, since there is evidence to refute them.[1] In particular, lactic acid is removed from the muscle within an hour of intense exercise, and cannot therefore cause the soreness which normally begins about a day later.[5]

Relation to other effects

Although delayed onset muscle soreness is a symptom associated with muscle damage, its magnitude does not necessarily reflect the magnitude of muscle damage.[6]

Soreness is one of the temporary changes caused in muscles by unaccustomed eccentric exercise. Other such changes include decreased muscle strength, reduced range of motion and muscle swelling.[7] It has been shown, however, that these changes develop independently in time from one another and that the soreness is therefore not the cause of the reduction in muscle function.[7]

Possible function as a warning sign

Soreness might conceivably serve as a warning to reduce muscle activity so as to prevent further injury. However, further activity temporarily alleviates the soreness, even though it causes more pain initially. Continued use of the sore muscle also has no adverse effect on recovery from soreness and does not exacerbate muscle damage.[8] It is therefore unlikely that soreness is in fact a warning sign not to use the affected muscle.[8]

Repeated-bout effect

After performing an unaccustomed eccentric exercise and exhibiting severe soreness, the muscle rapidly adapts to reduce further damage from the same exercise. This is called the "repeated-bout effect".[9]

As a result of this effect, not only is the soreness reduced, but other indicators of muscle damage, such as swelling, reduced strength and reduced range of motion, are also more quickly recovered from. The effect is mostly, but not wholly, specific to the exercised muscle: experiments have shown that some of the protective effect is also conferred on other muscles.[10]

The magnitude of the effect is subject to many variations, depending for instance on the time between bouts, the number and length of eccentric contractions and the exercise mode. It also varies between people and between indicators of muscle damage.[10] Generally, though, the protective effect lasts for at least several weeks. It seems to gradually decrease as time between bouts increases, and is undetectable after about one year.[11]

The first bout does not need to be as intense as the subsequent bouts in order to confer at least some protection against soreness. For instance, eccentric exercise performed at 40% of maximal strength has been shown to confer a protection of 20 to 60% from muscle damage incurred by a 100% strength exercise two to three weeks later.[12] Also, the repeated-bout effect appears even after a relatively small number of contractions, possibly as few as two. In one study, a first bout of 10, 20 or 50 contractions provided equal protection for a second bout of 50 contractions three weeks later.[11]

The reason for the protective effect is not yet understood. A number of possible mechanisms, which may complement one another, have been proposed. These include neural adaptations (improved use and control of the muscle by the nervous system), mechanical adaptations (increased muscle stiffness or muscle support tissue) and cellular adaptations (adaptation to inflammatory response and increased protein synthesis, among others).[13]


Delayed onset muscle soreness can be reduced or prevented by gradually increasing the intensity of a new exercise program,[14] thereby taking advantage of the repeated-bout effect.

Soreness can theoretically be avoided by limiting exercise to concentric and isometric contractions.[14] But eccentric contractions in some muscles are normally unavoidable during exercise, especially when muscles are fatigued.[1] Limiting the length of eccentric muscle extensions during exercise may afford some protection against soreness, but this may also not be practical depending on the mode of exercise. A study comparing arm muscle training at different starting lengths found that training at the short length reduced muscle damage indicators by about 50% compared to the long length, but this effect was not found in leg muscles.[15]

Stretching or warming up the muscles does not prevent soreness.[16][17] Overstretching can by itself cause soreness.


The soreness disappears in about 72 hours after appearing. If treatment is desired, any measure that increases blood flow to the muscle, such as low-intensity work, massage, hot baths, or a sauna visit may help somewhat.[14] Immersion in cool or icy water, an occasionally recommended remedy, was found to be ineffective in alleviating DOMS in one 2011 study,[18] but effective in another.[19]

Counterintuitively, continued exercise may temporarily suppress the soreness. Exercise increases pain thresholds and pain tolerance. This effect, called exercise-induced analgesia, is known to occur in endurance training (running, cycling, swimming), but little is known about whether it also occurs in resistance training. There are claims in the literature that exercising sore muscles appears to be the best way to reduce or eliminate the soreness, but this has not yet been systematically investigated.[20]


  1. ^ a b c d e f g h i Nosaka, 63
  2. ^ a b c Nosaka, 64
  3. ^ Nosaka, 76
  4. ^ Hough, Theodore (1902). "Ergographic studies in muscular soreness". American Journal of Physiology 1902 (7): 76–92. 
  5. ^ Kokkinos, 111
  6. ^ Nosaka, 66–67
  7. ^ a b Nosaka, 66
  8. ^ a b Nosaka, 68
  9. ^ Nosaka, 68–69
  10. ^ a b Nosaka, 69
  11. ^ a b Nosaka, 70
  12. ^ Nosaka, 73
  13. ^ Nosaka, 74
  14. ^ a b c Kokkinos, 112
  15. ^ Nosaka, 71
  16. ^ High, DM; Howley ET; Franks BD (December 1989). "The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness.". Res Q Exerc Sport. 60 (4): 357–61. PMID 2489863. 
  17. ^ Herbert, R. D.; De Noronha, M. (2007). "Stretching to prevent or reduce muscle soreness after exercise". In Herbert, Robert D. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD004577.pub2.  edit
  18. ^ Sellwood, K. L.; Brukner, P.; Williams, D.; Nicol, A.; Hinman, R. (2007). "Ice‐water immersion and delayed‐onset muscle soreness: A randomised controlled trial". British Journal of Sports Medicine 41 (6): 392–397. doi:10.1136/bjsm.2006.033985. PMC 2465319. PMID 17261562.  edit
  19. ^ Snyder, J. G.; Ambegaonkar, J. P.; Winchester, J. B.; McBride, J. M.; Andre, M. J.; Nelson, A. G. (2011). "Efficacy of Cold-Water Immersion in Treating Delayed Onset Muscle Soreness in Male Distance Runners". Medicine & Science in Sports & Exercise 43: 766. doi:10.1249/01.MSS.0000402128.66983.f7.  edit
  20. ^ Nosaka, 62–63


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