Delayed Onset Muscle Soreness (DOMS)

Athletes and gym goers alike are quite familiar with that feeling of ache and stiffness that creeps in a couple days after a new workout. This exercise induced soreness is known as a delayed onset muscle soreness (DOMS).

Symptoms associated with DOMS include pain, tenderness, swelling, and loss of strength.

Those suffering from DOMS would describe difficulty going up stairs or getting up from a chair after a leg day workout.

Although it is often associated with fitness or athletics, DOMS can affect anyone performing strenuous physical activity. This could also happen after shoveling snow, moving furniture, or going for a long walk.

What Causes Delayed Onset Muscle Soreness?

Delayed onset muscle soreness is characterized by an ache that sets in about 24-48 hours after performing an unaccustomed, commonly eccentric, exercise.

Exercise physiologist aren’t able to explain the causes of DOMS with certainty, however it is thought to be the result of micro-trauma to muscles occurring after doing certain exercises.

DOMS is often, mistakenly, blamed on lactic acid accumulation. However, research has proven otherwise. Some people experience the delayed muscle ache without having elevated levels of lactic acid.

Further, evidence is pointing to acute inflammation as the culprit for this exercise induced muscle soreness.

Treatments Used To Reduce Delayed Onset Muscle Soreness?

There is no hard and fast rule for getting rid of DOMS, however there are many treatments frequently used with limited supporting evidence.


Anecdotally, stretching could possibly be the most commonly reported way to prevent or reduce DOMS. However, there is limited support in the literature to support this practice.

  • High et al. concluded that static stretching did not reduce DOMS after a stepping exercise to exhaustion.
  • Wessel et al. suggested that stretching was ineffective at reducing DOMS either before or after an eccentric hamstring exercise.
  • Also, Lund et al. determined that passive stretching had no effect on secondary pathological alterations associated with DOMS.

Cold Application

Treatments using cold or ice is thought to have pain reducing properties and is often considered as part of the management of DOMS.

  • Sellwood et al. challenge the widely used ice-water immersion for athletes and determined that this treatment is ineffective at minimizing markers of DOMS.
  • However, Fonseca et al. found that cold water immersion was beneficial for jiu-jitsu athletes for reducing muscle soreness after training.
  • Ascensao et al. found similar supporting evidence with soccer athletes.

Heat Application

Similarly to cold, heat is often used to reduce pain associated with DOMS.

  • The use of ultrasound to increase muscle temperature was found by Symons et al. to be ineffective at significantly preventing delayed onset muscle soreness.
  • Interestingly, Petrofsky et al. argued that heating modalities applied for only 5 to 20 minutes had little to no effect on deep tissue heating. The group discovered that moist heat applied for 2 hours immediately after the exercise offered the best results for delayed pain and muscle activity.


There is some research that support the use of massage to reduce pain and inflammation triggered by exercise.

  • Zainuddin et al. suggest that massage is able to decrease DOMS by 30% and reduce swelling, but offered no benefit to restore muscle function.
  • Further, Hilbert et al. stated that massage conducted within 2 hours of exercise induced muscle injury could reduce soreness after 48 hours.
  • Moreover, Smith et al. proposed that the effects of a 30 minute sports massage at 2 hours was related to the disruption of Neutrophil accumulation that would likely lead to subsequent DOMS.


Pain medications and non-steroidal anti-inflammatory drugs (NSAIDs) could intuitively impact the effects of DOMS, however we need to understand if the risks outweigh the benefits.

  • Tramadol and Rofecoxib were evaluated by Loram et al., and found to not produce any significant effect on the pressure pain threshold for downhill runners.
  • After a systematic review of the literature, Stone et al. opined that routine use of NSAIDs to treat DOMS was not warranted due to inconclusive evidence and potential adverse effects.
  • Finally, Grossman et al. concluded that 2400 mg/day of Ibuprofen taken before and after eccentric elbow flexion exercise, offered no additional benefits for DOMS over a placebo.

How Do We Reduce Or Avoid Delayed Onset Muscle Soreness?

There doesn’t appear to be enough convincing evidence to provide sound rationale for consistent use of common DOMS treatments.

One thing that most DOMS studies have in common is that they all emphasize the need for further research. This could be researcher job security or proof that we really don’t know enough about DOMS yet.

The best and most reliable way to avoid delayed onset muscle soreness is to gradually introduce unaccustomed eccentric exercises in a workout regimen. The repeated bout effect (RBE) results in less tissue damage and subsequent soreness when we repeat similar eccentric exercises.

Therefore, if you perform eccentric exercises repeatedly at progressive intensities, you will minimize the likelihood of suffering from delayed onset muscle soreness.


Delayed Onset Muscle Soreness (DOMS) is a commonly experienced phenomenon among athletes and fitness enthusiasts, however its effects doesn’t discriminate the average population as well.

Although there are many types of treatment that are widely used to treat DOMS, few are evidenced by convincing evidence.

Despite the lack of evidence for stretching to treat DOMS, it is likely still important to include in your workouts to promote better mobility and flexibility. Check out this article to make sure you are getting the maximum benefit from your stretching routine:

5 Quick Tips For Better Stretching

We are unable to reach consistent evidence for cold or heat therapies. Further, the articles supporting cold water immersion or moist heating for over 2 hours seem impractical for the general public.

Similarly, not many people would regularly have access to a 30 minute sport massage within 2 hours of their physical activity. This may only be a consistent option for affluent professional athletes.

Lastly, pharmacological intervention failed to yield consistently reliable results and frankly the side effects may not be worth it.

At this time, your best option for managing DOMS is to take advantage of the repeated bout effect and gradually introduce new eccentric exercises over the course of multiple workouts.

How To Avoid Delayed Onset Muscle Soreness (DOMS)
DOMS infographic

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