Delayed onset muscle soreness is the aching muscle pain you might experience a day or two after a workout. DOMS can cause muscle tenderness or severe excruciating pain.¹ It can make even the most intrepid athlete turn into a couch potato, whether an elite athlete, a weekend warrior, or an older adult exercising as a tried-and-true strategy for age management.

DOMS is more common when you start a new activity, a new season, or an exercise program. Eccentric muscle contractions (lengthening while contracting) are more likely to cause microscopic muscle tears than concentric ones, and compensating for another injury can cause abnormal muscle stress, which increases muscle soreness.^1,2 The underlying cause of DOMS is not completely understood. It is likely due to microtrauma and inflammation.³

Muscle soreness is not a sign of a good workout. You may experience muscle soreness as your muscles adapt to the stresses put on them. But as they become conditioned, the soreness should decrease.

Exercise and stressing muscles are essential to improving performance and reshaping body composition. If your muscle soreness is severe, persistent, not related to exercise, or is accompanied by dark urine or muscle swelling, see your doctor to see if there is an underlying medical cause. Otherwise, many at-home DOMS treatment options can relieve sore muscles fast and get you back in the game.

Hydrate Properly

Up to 60% of your body weight is water. It is essential to carry nutrients to your muscle cells, flush out wastes and provide an optimal environment for metabolism. Staying hydrated helps your muscles operate at peak performance.

When you don’t exercise, your kidneys adjust urine production to match fluid intake. However, when you exercise, especially in warm, humid environments, sweat production to release the heat generated during metabolism can reach 3-4 liters per hour in some well-trained people. Many athletes do not replace fluids at the same rate as they are lost, leading to dehydration by the end of the event. Experts believe that losing over 2% of body weight because of dehydration affects performance.

The easiest way to monitor your hydration status is to look for signs of dehydration, such as:

• Dry mouth and tongue
• Concentrated urine
• Headaches
• Dizziness
• Muscle cramps
• Fatigue
• Faster heartbeat
• Lack of energy
• Constipation
• Weight decreasing by more than 2% after exercise

If you notice these signs of dehydration, make it a practice to drink water more intentionally throughout the day. Let thirst be your guide and go into every exercise session well-hydrated. Staying hydrated can help prevent sore muscles after exercise.

Sleep Well

Sleep is critical to physical, mental, and emotional recovery. Aim for 8 to 10 hours of quality sleep during periods of heavier training. Otherwise, aim for 7 to 9 hours of quality sleep each night. In one study, athletes who slept less than 8 hours per night for two weeks were 1.7 times more likely to have an injury than athletes who got enough sleep.^4,5 In another study, runners who slept less were slower and felt like they were working harder when compared to runners who got at least 7 hours of sleep. 

Sleep habits to follow: 

• Set an alarm one hour before bedtime to turn off all screens and prepare for sleep.
• Choose a consistent bedtime and wake-up time.
• Limit exposure to blue light, especially in the evening.
• Sleep in a cool, dark room.
• Avoid caffeine and other stimulants after noon.
• Avoid alcohol and large meals before bedtime.
• Monitor how exercise timing affects sleep.

Warm Up Before Exercise

Warming muscles by doing aerobic exercise before exercise can improve muscle metabolism, increase blood flow, and stretch the muscle and connective tissues. Aerobic cool-down can reduce the extent of muscle damage, increase preparedness, improve blood flow after exercise, and flush waste products from muscle.⁶

In one study, warming up decreased DOMS, but cooling down did not have an effect.⁷ Warming up may not impact DOMS, but it prepares your cardiovascular system for exercise.

Before exercising, gradually increase your walking pace over 5 to 7 minutes. Learn the correct movement technique for your sport so your muscles are appropriately stretched and ready. Warming up is a key part of training that should never be skipped.

Stretch Appropriately

Stretching has traditionally been recommended for the cool-down phase of exercise under the premise that it increases recovery.⁸ However, in a small study, researchers investigated whether stretching reduces DOMS and found little to no effect.⁹ In a systematic review of the literature, researchers found no evidence that stretching improved recovery when compared to rest, cycling, or cold-water immersion. There was also no evidence that it impaired recovery.⁸ Stretching after a workout increases flexibility and joint range of motion and may have other benefits. More research is needed.¹⁰

To increase flexibility, perform stretching exercises after each physical activity. Muscles should be warm and supple before stretching. For example, try jogging and biking before stretching. Stretching exercises should be tailored to the sport.

Exercise Appropriately

Advancing your exercise routine too quickly increases your risk for DOMS, especially eccentric muscle exercises. DOMS is more likely to occur after a hard, strenuous workout. If DOMS is limiting your ability to exercise or advance in your fitness:

• Check your form to ensure you are stressing your muscles correctly.
• Give yourself active recovery days in between strenuous workouts.
• Advance your workouts slowly.
• Keep your workouts consistent. Weekend warriors are more likely to experience DOMS than people who exercise daily.

Rest Appropriately

When muscles become inflamed and swollen, they need rest to recover. Recovery days are as important as training days for performance gains. Recovery days decrease the risk of injuries by allowing time for the body to repair and strengthen muscles.¹¹

If your muscles are very sore, they may need complete rest. Otherwise, light activity on a rest day can help you recover more quickly. Go for a walk, swim, or bike ride. Keep the intensity light and give your body time to repair muscle damage and refuel.

Eat Strategically

Nutrition before and after a workout is important. Choosing your nutrition wisely will restore muscle and liver glycogen stores, replace fluids and electrolytes lost in sweat, promote faster muscle repair, and support the immune system. 

When planning your daily nutrition, choose a nutrient-dense, whole-food diet high in micronutrients. When planning your nutrition, consider the following: 

• Calories
• Macronutrient ratios (fats, carbohydrates, and proteins)
• Meal and snack timing
• Vitamins and minerals
• Hydration

According to the Dietary Guidelines for Americans 2020-2025, the optimal percentages of macronutrients for adults are: 

• Carbohydrates: 45-65% of daily calories
• Protein: 10- 35% of daily calories
• Fat: 20-35% of daily calories

An endurance athlete would increase their carbohydrate percentage, and a strength athlete may increase their percentage of proteins.

According to International Sports Sciences Association (ISSA): 

• Endurance athletes should eat 8 to 10 grams of carbohydrates per kilogram (kg) of body weight per day. On the higher range, if the event lasts 4 hours or more. 
• Power athletes should consume around 4 to 5 grams of carbohydrates per kilogram of body weight per day. 

Other recommendations from Dietary Guidelines for Americans and ISSA: 

• Limit added sugars, saturated fats, sodium, and alcoholic beverages
• Fill half your plate with fruits and vegetables
• Make half your grains whole grains
• Choose healthy sources of protein
• Choose low fat or fat-free milk or yogurt
• Choose complex carbohydrates or naturally occurring sugars (not processed or refined sugars)
• Consume around 0.8 grams/kg/day of protein. 

Use Heat And Cold

A systematic review of 32 studies showed that heat and cold treatments could reduce or prevent DOMS. Applying cold therapy within one hour after exercise reduced pain at 24 hours. Applying heat within one hour reduced the pain even longer. Cold therapy is typically used for its pain-relieving benefits in the first 24 hours, followed by heat therapy. However, both may be equally effective. Researchers used cold water immersion at 51-59 degrees Fahrenheit for 11 to 15 minutes.^3,12 Another option is to use ice massage on muscles until they become numb.

Ice should never be applied directly to the skin due to the risk of frostbite. Never apply cold compresses to an open wound or if you have vascular disease or a nerve problem that affects blood flow. Cold therapy should be used with caution in people with high blood pressure or decreased sensation and not at all in people with cold hypersensitivity, cold intolerance, Raynaud’s disease, or blood vessel disease. 

Cold therapy is used for about 10 to 15 minutes and can be repeated every 1 to 2 hours. Applying cold therapy for too long increases the risk of frostbite.

Hot packs or heating pads should be applied for 15-20 minutes with a towel between the heat source and the skin to protect it from burning.³

Heat can help warm muscle tissue and relieve cramping and spasms. However, heat should never be applied to an open wound, inflamed skin, or areas with decreased sensation.

Try Foam Rolling

Foam rolling provides many of the same benefits as massage or massage guns. It releases tension on the muscle’s connective tissue (myofascial release) and reduces DOMS. During foam rolling, you use your body weight on a foam roller to exert pressure on muscle tissue.

Foam rolling:¹³

• Stretches muscle tissue
• Reduces muscle soreness after exercise
• Decreases swelling
• Increases post-exercise range-of-motion
• Stabilizes muscle performance

For sore muscle relief, try foam rolling after exercise, especially on larger muscles like the quadriceps.

Review Your Medications

Non-steroidal anti-inflammatory medications do not seem to help DOMS and have unwanted side effects, especially if used regularly. Certain medications, such as statins and some blood pressure medications, cause muscle pain (myalgias). Check with your pharmacist to see if any of your medications have this side effect.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64. doi:10.2165/00007256-200333020-00005

2. Hody S, Croisier J-L, Bury T, Rogister B, Leprince P. Eccentric Muscle Contractions: Risks and Benefits. Review. Frontiers in Physiology. 2019-May-03 2019;10doi:10.3389/fphys.2019.00536

3. Wang Y, Li S, Zhang Y, et al. Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Phys Ther Sport. Mar 2021;48:177-187. doi:10.1016/j.ptsp.2021.01.004

4. Huang K, Ihm J. Sleep and Injury Risk. Curr Sports Med Rep. Jun 1 2021;20(6):286-290. doi:10.1249/jsr.0000000000000849

5. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. Mar 2014;34(2):129-33. doi:10.1097/bpo.0000000000000151

6. Olsen O, Sjøhaug M, van Beekvelt M, Mork PJ. The effect of warm-up and cool-down exercise on delayed onset muscle soreness in the quadriceps muscle: a randomized controlled trial. J Hum Kinet. Dec 2012;35:59-68. doi:10.2478/v10078-012-0079-4

7.  Law RY, Herbert RD. Warm-up reduces delayed onset muscle soreness but cool-down does not: a randomised controlled trial. Aust J Physiother. 2007;53(2):91-5. doi:10.1016/s0004-9514(07)70041-7

8. Afonso J, Clemente FM, Nakamura FY, et al. The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Physiol. 2021;12:677581. doi:10.3389/fphys.2021.677581

9. Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev. Jul 6 2011;(7):Cd004577. doi:10.1002/14651858.CD004577.pub3

10. Apostolopoulos N, Metsios GS, Flouris AD, Koutedakis Y, Wyon MA. The relevance of stretch intensity and position-a systematic review. Front Psychol. 2015;6:1128. doi:10.3389/fpsyg.2015.01128

11.  Menzies P, Menzies C, McIntyre L, Paterson P, Wilson J, Kemi OJ. Blood lactate clearance during active recovery after an intense running bout depends on the intensity of the active recovery. Journal of Sports Sciences. 2010/07/01 2010;28(9):975-982. doi:10.1080/02640414.2010.481721

12.   Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews. 2012;doi:10.1002/14651858.cd008262.pub2

13. Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. Jan 2015;50(1):5-13. doi:10.4085/1062-6050-50.1.01

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