“No Pain, No Gain?” - An Explanation of Delayed Onset Muscle Soreness and How to (Possibly) Avoid It
We’ve all been there- you get in a really good workout and you feel great right after but you think to yourself, “I’m definitely going to feel that later…” and a couple of days later BOY do you feel it. Every step on the stairs is torture and your legs feel like they are in a vice grip. No one is immune, not even certified personal trainers such as myself (but there are ways to try to avoid it which I’ll outline below).
This phenomenon is known as delayed onset muscle soreness (DOMS) or muscle fever, and it is believed to be the result of the muscle repair process after muscle lengthening (also known as eccentric) exercise with the addition of applied force, low energy availability, inflammation, or quite possibly even injury. Eccentric muscle contractions can result in microscopic tears in your muscle fibers which leads to inflammation which may lead to the muscular soreness. This inflammation is actually a part of the process for muscle repair and building stronger muscle tissue. The inflammatory response in the body causes the release of the hormones leukotriene and prostaglandin E2, which contribute to pain and swelling. Eccentric muscle contractions cause more tearing to the structural elements of the muscle and connective tissue than concentric (think flexing type motions) muscle contractions; during these exercises, a muscle both contracts and lengthens simultaneously.
Delayed onset muscle soreness also specifically occurs after activities which our body is not yet accustomed to—aka we’ve never done them before, nor with such rigorous intensity. Some activities which cause this type of soreness include: strength training exercises, walking or jogging downhill, jumping, or step aerobics. DOMS will typically happen in varying intensity from 12-72 hours after the exercise session, though typically it will last for about 4 days. In some cases, symptoms can last for up to a week.
There are a variety of symptoms which are characteristic of delayed onset muscle soreness. These symptoms include, but are not limited to the following: stiffness of affected joints which may result in limited range of motion temporarily (this is where the torture on the stairs comes in), sensitivity to touch, swelling in affected limbs, and temporary decrease in strength of affected muscles.
The good news: there may be a way to prevent delayed onset muscle soreness. The more accustomed your body is to a specific exercise, the less likely it is that you will experience this soreness. In terms of prevention, this means that if we ease our way into a new exercise program, we may be able to avoid this type of muscular soreness. This goes for both the novice and the seasoned athlete. If you haven’t engaged in sporadic physical activity in some time, or you are attempting to engage in a new exercise regimen, you’ll likely face the same resulting soreness. Proper rest for exercised muscles is also a method of prevention as they require ample time to repair properly—this means we should not perform the same exercises on the same muscles on consecutive days.
Fueling yourself properly both before and after exercise can also help to stave off delayed onset muscle repair or at least decrease the intensity of the soreness. To adequately fuel muscle and tissue repair, we need to ensure we consume enough protein and carbohydrates. Research suggests that eating 20-30 grams of complete protein with the addition of carbohydrates following exercise facilitates faster recovery than consumption of protein or carbohydrate alone. Proper hydration after exercise can also aid in the process of muscular repair as electrolytes are lost during exercise and thus must be replenished after a bout of exercise.
Following intense exercise, you may also wish to use a foam roller to reduce muscle stiffness and improve range of motion. It is recommended that you use the roller for 90-120 seconds for each sore muscle. In addition to the use of a foam roller, you may consider getting a massage to reduce DOMS symptoms. A meta-analysis reported that a massage within 2 hours of intense exercise that lasts for 20-30 minutes successfully decreased the effects of delayed onset muscle soreness for up to 96 hours. This is believed to occur as a result of improving the blood flow in the muscles which have been decreased as a result exercise.
If you do encounter delayed onset muscle soreness after exercise: FEAR NOT! It is a totally normal part of the muscle repair process. However, if you experience pain levels which become incapacitating, your urine becomes darkly colored, your limbs begin to experience heavy swelling, or you experience DOMS for longer than 7 days, medical attention is advised as these may be signs of something more. Experiencing DOMS after an intense bout of exercise, you may wish to take non-steroidal anti-inflammatory drugs (NSAIDs). You may wish to put off taking these medications until at least a few hours after you have exercised as the initial inflammation is a necessary part of the repair process. Topical methanol-based analgesics such as Icy-Hot or similar products may also be used to reduce soreness; similarly you may also use heat or ice packs to target specific areas of soreness. Another method for reducing the severity of the symptoms of DOMS includes taking either a hot or cold bath—either has the ability to help reduce soreness (much in the way the Icy-Hot may help).
Gentle movements rather than avoiding activity altogether may help reduce the effects of delayed onset muscle soreness, though high-intensity workouts may want to be avoided so as to not worsen soreness or delay recovery. Stretching both prior to and after exercise may also help to reduce the effects of DOMS, though it likely will not speed up your recovery.
The takeaway: no one is immune to delayed onset muscle soreness. That being said, the best way to prevent it is to approach each new exercise program by taking things slowly and going into exercise fueled and hydrated properly.
