Brace Yourself – DOMS is Coming

In the health and wellness field, jargon tends to be thrown around frequently.  While jargon can be a good thing because it can help professionals discuss topics quickly, jargon can be alienating for the common man.  So, what does it mean that “DOMS are coming?”  

First of all, DOMS stands for delayed-onset muscle soreness.  It typically is experienced after increased physical activity.  Personally, I recently resumed weightlifting and taught my significant other how to do squats, deadlifts, overhead press, cleans, and bench press.  I was pretty bummed about how much my lifting tolerance had decreased, but it was a good session.  The next morning though, my low back let me know that DOMS had come.  By the afternoon, I had problems sitting down due to soreness in my quads (front thigh muscles).  The next day, I ended up looking pretty odd as I would flop down on the couch to avoid using my low back or quads.

DOMS is different from acute soreness, which is pain that occurs during the actual activity.  My lifting session felt great. The next three days did not.  DOMS typically starts 12-24 hours, and the most pain can occur 24-72 hours AFTER the original workout.  This was definitely true for me!  The next evening, I had to walk down stairs (which normally uses the quads), and I was doing it in heels; this was so much WORSE.  On a side note, I looked up the physics behind heels, and the “long legged look” that heels create decreases the natural propulsion given by the achilles tendon and leg muscles.  Instead, the knees, thighs, hips, and buttocks pick up the slack.  Hence, the reason why stairs in heels were my worst enemy.

The good news is that DOMS is a normal physiological response to increased physical activity.  ADOMS_Memes much as I related to Fry as I hobbled down the stairs, I wasn’t really dying.  DOMS can occur not matter your fitness level.  Typical symptoms of DOMS include: temporary strength loss, increased pain, muscle tenderness, muscle stiffness, and swelling.

So how does DOMS occur?  For years, researchers thought it was due to the buildup of lactate, a by-product of using energy, in the muscles.  However, this is not the case.  While lactate levels do increase during exercises, they return to normal about 30-60 minutes after exercise.  Instead, DOMS usually occurs after eccentric exercise like downhill running, plyometrics, and resistance training.  The current theory is that eccentric exercise starts an inflammation response that produces metabolic waste.  The waste acts as a chemical stimulus and attracts white blood cells to the “injured” tissue.  The white blood cells produce free radicals which can further exacerbate the issue.

So how long do you have to deal with DOMS?  Pain and tenderness peaks about 1-3 days post workout and are usually completely gone in a week.  Stiffness and swelling peaks 3-4 days post workout and are usually gone in 10 days.  However, these symptoms don’t always present at the same time because they aren’t dependent on one another.

But, can DOMS be treated?  I found a pretty interesting research article that discussed it.

  • One common method suggested is using NSAIDs (ie. aspirin) to reduce DOMS symptoms.  However, NSAIDs actually interfere with inflammation, which is a necessary part of healing; inflammation helps with muscle remodeling and regeneration.  Overuse of NSAIDs can also lead to serious issues such as stomach ulcers, liver damage, and kidney failure.
  • Some researchers recommend light exercise after DOMS occurs that focuses more on concentric muscle actions.  This only provides temporary relief and does not appear to improve long-term recovery.  One study showed that yoga training can help in reducing DOMS, but the mechanism is unknown.  Current research does not have enough evidence or limited evidence to support the use of homeopathy, warm-up, stretching, TENS, laser therapy, ultrasound, nutritional supplements, or acupuncture.
  • Massage and cryotherapy (ice) to target inflammation and swelling haven’t been proven effective in several studies.  However, a compression sleeve worn for 5 day period post eccentric exercise was shown to reduce DOMS at the arm.  Yet, more research is needed in this area.

The conclusion of the article is that instead of trying to treat DOMS, to consider how to PREVENT DOMS.  The authors suggest that gradually increasing the eccentric workload could be used to prevent DOMS.  There is evidence that supports the repeat bout effect: less muscle damage and soreness occurs after the second instance of the same eccentric exercise.  In fact, this phenomenon can occur with as few as 6 eccentric muscle repetitions and intensity as low as 50% of your personal max.  It is quite likely that I “overdid” the lifting session that I mentioned earlier, and I plan to consider what I have learned when I go to the gym tonight.

What are your experience with DOMS?  Do you have any questions?  Feel free to comment below!



Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In late May, I plan to attend Smart Success PT Live, a business, marketing, and branding course by some of the  top PT entrepreneurs in the field.


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