No Pain, No Gain

From the average gym goer to professional athletes, anyone can experience delayed onset muscle soreness, or DOMS. It strikes 24 to 72 hours after a period of reduced activity or when introduced to new exercises. The symptoms range from mild muscle tenderness to debilittating pain. If you’ve ever experienced this, you know the struggle of walking up and down the stairs and putting on pants in the morning. Your muscles feel stiff and are sore to the touch. To understand the types of activities that cause more severe and frequent soreness you need to know the different types of muscle contractions. There are isotonic contractions which generate force by changing the length of the muscle and isometric contractions which generate force without changing the length of the muscle. The two different types of isotonic contractions are concentric and eccentric contractions. Concentric contractions cause the muscle to shorten and generate force whereas eccentric contractions cause the muscle to elongate in response to a greater opposing force. Eccentric activities create the most intense soreness because they induce micro-injury more frequently than any other type of contraction.

Figure 1: Eccentric contraction

Many people look to the internet for ways to prevent and reduce the symptoms of their soreness. Some common ways people prevent soreness is by performing a cardio-based warm up or static stretching. Once the soreness kicks in, common ways people reduce their symptoms are non-steroidal anti-inflammatory drugs, massaging, cryotherapy, stretching, homeopathy, ultrasound, and electrical current modalities. Without any background knowledge, people might be wasting their time trying techniques that have no proven evidence of preventing or reducing soreness. What really is the best treatment to alleviate the symptoms of DOMS or is time your only option?

One study looked at the effects of stretching before and after exercise on muscle soreness. They did a systematic review of five different studies which all included young healthy adults as their participants. The participants stretched from 300 to 600 seconds between the studies and muscle soreness was measured at 24, 42, and 72 hours after exercise. They found that stretching before or after exercise has no effect on delayed onset muscle soreness.

Another study was performed that looked at if a warm-up or cool-down reduces delayed onset muscle soreness. They randomly assigned 52 healthy adults to four groups: a warm-up and cool-down group, a warm-up only group, a cool-down only group, and neither warm-up nor cool-down group. The warm-up and cool-down was 10 minutes of walking and the eccentric exercise was 30 minutes of walking backwards downhill on a treadmill inclined at 13 degrees at 35 steps per minute. The participants were asked to record their muscle soreness 10 minutes after exercise as well as 24, 48, and 72 hours after. The results showed that a cool-down had no effect on soreness and a warm-up produces a small reduction in muscle soreness.

It’s a day after your hard workout and you can’t walk. What do you do? A study in Sports Medicine found that cryotherapy, stretching, homeopathy, ultrasound, and electrical current modalities all have no effect on DOMS. They found that massage could have an effect based on the timing of the massage and the technique used. This data was also supported by a study done by Nicole Nelson, who found massages to be a promising result in reducing soreness.

While there are a lot of studies done on DOMS, there are several limiatinos. One problem is that there are multiple ways to measure muscle soreness, so it can be hard to compare studies to each other. Some studies used a visual analogue scale and some used a 0-10 measurement. The mechanism for what causes delayed onset muscle soreness is still unknown, which makes it difficult to prescribe an accurate treatment. In one study, walking was the warm-up as well as the exercise to induce the muscle soreness. They didn’t look at if having a walking warm-up would still be effective if squats was the exercise inducing the muscle soreness. For some of the studies, the outcome measures were all self-reports so the participants could have mis-reported.

From my own personal experience, I experience delayed onset muscle soreness whenever I try out a new workout or increase the intensity of an old one. Usually, I just let the soreness runs its course and don’t do anything to reduce the symptoms. From the literature, it seems like the best thing to do is wait. To prevent DOMS you can try and ease into the exercise rather than performing it at full intensity the first time. Cryotherapy, stretching, homeopathy, ultrasound, and electrical current modalities all had no effect on muscle soreness. Warming up before exercise seemed to have a small effect, but won’t drastically reduce the severity of DOMS. There still needs to be a lot of research done on the mechanism of DOMS in order to find out the appropriate treatment.

Questions and Comments

Are there any other methods of prevention or treatment that work for you?

Have you tried any of the treatment options above and have they helped alleviate your soreness?

Please leave any comments or questions about DOMS below!


Recommended Further Reading

No Pain, No Gain? Five Myths About Muscle Soreness 


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7 thoughts on “No Pain, No Gain

  1. This was really interesting for me to read because I have always struggled with soreness after tough workouts in the gym. There are many times that I miss the gym for weeks at a time and that first workout back causes so much pain I am almost immobilized. I remember one time after my first leg day in 6 months I couldn’t walk for a few days. I find that stretching works as a temporary solution but the pain comes back after about 20-30 minutes. I find that diet is incredibly important and that my soreness is reduced if I eat ample protein and carbs during the days after a workout. I also find that using the sore muscle the next day helps more than full rest. I find that it helps to do light-weight exercises with the sore muscle in order to increase blood flow to the muscle. Is this what homeopathy is referring to?

    • Thanks for sharing your personal experience. Homeopathy is using natural remedies to alleviate your soreness. A common supplement people try for muscle soreness is called Rhus toxicodendron. It is supposed to relieve the pain in your joints and muscles. From the literature, it was not proven that homeopathy is an effective method of relieving soreness. It was found that exercise is the most effective way to temporarily alleviate DOMS, so the light-weight exercises are good to keep doing when your are sore.

  2. I felt the same way as Malcolm, I have been trying to find the best way for myself to recover from soreness after workouts. I also found that stretching helps temporarily, and that eating right after your workout and keep your (sore) muscles moving rather than completely resting help the best to recover. I am still not really sure if it is actually “better” for you to ease into exercises if you haven’t done them in a while or if you might as well just go for it and be sore for a week (I usually go for the last option since I am very impatient and don’t like to accept that I am not as strong or fit as I might have been earlier)

    • Thanks for sharing! If you don’t mind being really sore, than jumping into a workout is fine. When you do experience intense DOMS, it causes a reduction in joint range of motion and shock attenuation. This may affect you athletic performance, so if you have a big game coming up it might not be the best idea to jump right back into an eccentric exercise.

  3. It’s somewhat surprising that all of these studies show no improvement for DOMS with movement-based techniques – I usually stretch after a workout with the idea that it will relieve some pain in the future (at least my legs). It would likely be useful to examine the pain mechanism behind DOMS, which a quick search gives in two hypotheses. The first is that the microtrauma associated with eccentric movements and the damage it causes to the sarcomeres causes intramuscular pain receptors to be stimulated. The other is that microtrauma causes calcium accumulation in the damaged muscles, causing inflammation, and in turn pain due to a buildup of histamines, prostaglandins, and potassium.

    It sounds like more effective ways of minimizing DOMS would be to facilitate rapid muscle rebuilding (lots of protein & carbs) and reduce inflammation (anti-oxidant-rich foods, clean diet/lifestyle). Proper sleep likely greatly influences both of these and could be a topic of future studies on DOMS.

    • Steven, you bring up good points about two common hypotheses related to the mechanism of DOMS. I would challenge the assumption that reduced inflammation is beneficial. In fact, some literature shows that administration of COX-inhibitors (NSAIDs) reduces muscle hypertrophy. We’ll learn more about NSAIDs in a future Research Says blog post, but from my own research experiences, inflammation should not be considered inherently “bad.” Instead, it is often an important, natural component of the healing process, and efforts to eliminate inflammation can have negative consequences on healing. Certain aspects of inflammation, particularly increased duration (inflammation that does not resolve on a typical time course), could be damaging. So perhaps the issue lies in the timing of inflammation. If research shows that DOMS exhibits unresolved inflammation, then perhaps efforts to reduce the later stages of inflammations could be explored. I do also want to point out that “inflammation” is a very broad term used to encompass a variety of molecular processes that span minutes to days in duration… with chronic inflammation lasting weeks/months.

  4. It is really surprising to me that the scientific community still does not really know the best way to help soreness. As you mentioned, it is difficult to quantify soreness as it truly does vary person-to-person. In the studies you looked at, did they specify their mechanism of cryotherapy? I wonder if there is any proven difference between simply placing an icepack on your sore muscles and going to a facility with walk-in cold chambers.

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