• Arash Lavian, M.D.

What to Know about DOMS – Delayed Onset Muscle Soreness

By Arash Lavian, M.D.

As workout resolutions begin to take shape over the coming months, everyone (fitness buffs and newbies alike) needs to understand an often-felt but lesser-known condition referred to as DOMS. The acronym DOMS stands for Delayed Onset Muscle Soreness. It is a phenomenon that many athletes, fitness enthusiasts, and those just beginning to work out will face at some point (or multiple) in their lives.


The term delayed-onset muscle soreness simply refers to the normal muscle discomfort that develops 24-48 hours after vigorous physical activities to which your body is not accustomed. DOMS typically peaks approximately 1-3 days after exercising and then begins to abate gradually.


As important as knowing what DOMS is, it is also useful to understand why it happens. DOMS causes micro-tears in the muscle fibers being exercised. Such tears can be more common when a muscle has not been challenged in a while. The micro-damage from the strenuous activity causes stimulation of pain receptors within the muscle tissue and cause a sensation of pain.

Research suggests that there are some types of exercises that are more likely to result in DOMS:


- New activities or exercise programs which have not previously engaged dormant muscle groups

- Eccentric exercises – these include, but are not limited to, exercises such as squats, push-ups, and pull-ups

- High-intensity exercises – these include, but are not limited to, exercises such as burpees, mountain-climbers, and jumping jacks


Although there is variability in the sensation, DOMS is actually a good reminder for your body. Stronger pain intensity can remind your body to tone down the power and rest the body before returning to similar activity.


If the soreness is mild you can continue to run with DOMS. Though it may seem counterintuitive at first, moving and continuing exercise can actually help lessen the pain and ease the stiffness associated with DOMS. I recommend recovery runs of mild to moderate intensity and avoid sprints and high-intensity interval training (HIIT) while recovering from DOMS. However, you should rest in the case of severe pain and stick with lower impact activities like cycling, swimming, or walking instead of running during a DOMS recovery period.


DOMS is treated by what we physicians call a "tincture of time." One must allow the body to heal itself and recover over time. It is recommended that you do gentle exercises and activities to ease symptoms and avoid high-intensity movements or strenuous lifting. Though controversial, some studies support massages or foam rolling within days of intense exercising to lessen soreness associated with DOMS. Topical analgesics may also help ease symptoms associated with DOMS. These medication types include NSAID ointments applied to the skin or natural anti-inflammatory creams such as Arnica.


Elite athletes often use cold baths, commonly referred to as cryotherapy, immediately after intense games, practices, or training sessions to stave off DOMS development. However, there is no definitive proof to support as to whether cryotherapy truly helps accomplish this goal. Ideally, the best way to prevent severe DOMS is to gradually increase the intensity of whatever exercise you're performing or exercise you're engaging in over time, instead of quick, sudden, or intense changes in those exercises or activities.


Of course, it is also crucial to distinguish between pain from an orthopedic or musculoskeletal injury and DOMS. The easiest way to do this is to consider the development of pain. Was it sharp and acute after a specific movement? If the answer is yes, this might signal an injury rather than DOMS, which features a soreness delay. If there was a delay in your pain or discomfort, is pain severity improving over time? With DOMS, the pain will gradually lessen within a few days. However, with an orthopedic injury, the associated pain can often increase or remain the same over time, rather than abating. Knowing how to tell the difference is essential. So, pay close attention to your body and be sure to alert your health care provider about any pain that hasn't resolved or is worsening over time.


As we begin to plan our New Year’s fitness resolutions for 2021, take time to consult your physician about your workout regimen and how to prepare for the inevitable muscle soreness that will follow. Once you have a game plan in place, you can tackle your goals…one step at a time.


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