Exercise & Delayed onset muscle soreness

No pain, no gain?

Last weekend, I decided to join a beginner calisthenics class. Though I’ve been following a training program for 6 consistent months now (wow—my longest streak ever), I knew it was going to be a challenge. I’ve never been able to do a proper push up and pull up—which calisthenics is heavy on.

Photo by Edoardo Cuoghi on Unsplash

Thankfully (and surprisingly), the class wasn’t so bad. Thanks to the quality check by the coaches (shout out to The Cali Movement coaches), the class was very doable and actually fun! The next few days though….were not very fun. *Cue muscle soreness*

It was right on time, and it was a struggle to function and move around.

In the years that I have been working with (older) patients, it’s surprising to find the high number of people who didn’t or don’t know about delayed onset muscle soreness, or DOMS. (Hence my writing about this topic now.) They always would say, “why—when I was younger this didn’t used to happen?!” “It didn’t used to take this long to go away…”

So, first, let’s define our terms. DOMS manifests as an ache or pain that is felt after an intense exercise that the body is not accustomed to. Most of the time, DOMS occurs when there is a high amount of eccentric exercises in the program¹. Limitation of motion is usually observed by the second day leading to difficulty in performing seemingly “normal” tasks. I’ve observed that DOMS is at its height on the first to third days (after the intense exercise program), and it can last for up to 1 week.

Second: Ok, it seems inevitable. What can be done when we have DOMS?

A natural response would be to rest, but resting completely is not the best plan of action. Although massages, the use of massage gun, and modalities (such as ice or hot compress) may help with the subjective perception of pain, it may not help as much with regard to regaining range of motion²³. Notice that the aforementioned management are passive tools, and also notice the key word that they may help. Dietary supplements (and probably foods) that contain anti-inflammatory and antioxidant properties may also help⁴⁵. However, an aggregation of studies appear to be inconsistent with its findings regarding supplements. So, let's take that last statement with a grain of salt.

In my hunt for explicit answers in Pubmed and Google, a surprisingly low number of high-level evidence is available to explain what DOMS is and what we can do about it. The lack of evidence may possibly be due to the fact that DOMS is not usually life-threatening. Therefore, funds are allocated to “more important” research. I will not dismiss, however, the functional deficits that it can cause—be it in day-to-day tasks, at work, and/or in athletic performance.

In my physical therapy practice, I promote active range exercises, foam rolling of the affected muscles, and activation of antagonistic muscles (to help actively and carefully stretch the sore muscles). Additionally, I take note of excessive DOMS reported by my patients. It is not the only piece of information, but it is definitely useful for reassessing the dose and intensity of the exercise/s for next time.⁶

Lastly: Is DOMS a bad thing?

No—it’s a classic example of “no pain, no gain.” Muscles need to undergo this process in order to adapt, gain more length and bulk, and consequently (and simply put) to get stronger so we can do whatever we want, whenever we want or need to, for as long as we possibly can. #Longevity

For many, I have seen that DOMS can be a source of discouragement. However, I hope this article serves as a source of encouragement that muscle soreness after exercise is a natural phenomenon, that there are ways to minimize the inconveniences that it can cause, and that it is a means to a (better) end.

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Disclaimer: Information from this blog is not intended to be as a resource used for self-help or self-diagnosis. The information posted should be regarded as general information based on what Isabel Sison deems as reliable. She does not endorse this information as a substitute to formal medical consultation and treatment. Any change in the information is possible without prior notice.

1. Proske, U., & Morgan, D. L. (2001). Muscle damage from eccentric exercise: Mechanism, mechanical signs, adaptation and clinical applications. The Journal of Physiology, 537(Pt 2), 333–345. https://doi.org/10.1111/j.1469-7793.2001.00333.x

2. Wang, Y., Li, S., Zhang, Y., Chen, Y., Yan, F., Han, L., & Ma, Y. (2021). Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Physical Therapy in Sport, 48 , 177–187. https://doi.org/10.1016/j.ptsp.2021.01.004

3. Veqar, Z., & Imtiyaz, S. (2014). Vibration Therapy in Management of Delayed Onset Muscle Soreness (DOMS). Journal of Clinical and Diagnostic Research, 8 (6), LE01–LE4. https://doi.org/10.7860/JCDR/2014/7323.4434

4. Nahon, R. L., Silva Lopes, J. S., & Monteiro de Magalhães Neto, A. (2021). Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis. Physical Therapy in Sport, 52, 1–12. https://doi.org/10.1016/j.ptsp.2021.07.005

5. Tanabe, Y., Fujii, N., & Suzuki, K. (2021). Dietary Supplementation for Attenuating Exercise-Induced Muscle Damage and Delayed-Onset Muscle Soreness in Humans. Nutrients, 14(1), 70. https://doi.org/10.3390/nu14010070

6. Pearcey, G. E., Bradbury-Squires, D. J., Kawamoto, J. E., Drinkwater, E. J., Behm, D. G., & Button, D. C. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training, 50 (1), 5–13. https://doi.org/10.4085/1062-6050-50.1.01