Delayed-Onset Muscle Soreness (DOMS)

(Also called muscle fever or post-exercise muscle soreness)

DOMS can be mild (a few days of significant discomfort and disconcerting weakness is roughly the worst case scenario) or severe (DOMS can cause major loss of muscle function for several days and tenderness like a severe bruise. In such cases, the muscle is truly damaged.).

When the symptoms are more widespread, this is an unhealthy state known as rhabdomyolysis, or “protein poisoning” from myoglobin spilling out of damaged muscle cells.

Although a delay of a day is typical in DOMS, there seems to be a large natural range for just how delayed DOMS can be. 

DOMS is caused by exercise or other physical stresses outside your normal range of intensity. Even extremely well-conditioned athletes can get DOMS, when they train harder than usual.

Rhabdomyolysis is metabolic poisoning (the kidneys are poisoned by myoglobin from muscle crush injuries). This is a medical emergency. Many physical and metabolic stresses cause milder rhabdomyolysis-like states, including intense exercise, and probably even deep tissue massages. The mildest rhabdomyolysis (a comparatively benign cocktail of waste metabolites and by-products of tissue damage) is probably one of the reasons why we feel generally stiff and painful after intense physical stresses.

There is growing evidence that free radicals are involved in DOMS.

DOMS is not inflammation.

Some diseases cause excessive post-exercise soreness, often for many years before diagnosis, and without any other symptoms.

Therapists have been trying to treat exercise-induced muscle soreness since forever, mostly unsuccessfully. There is a broad consensus that nothing really decisively helps DOMS and the best way to prevent it is … just get it over with.

Anti-inflammatory drugs (NSAIDS) have been shown to modestly reduce the pain of DOMS. Only the pain is influenced, not the other symptoms such as stiffness.

Rest is the only thing that guarantees to work for DOMS.

In mild soreness only, exercise is beneficial; not in severe soreness. Caution should increase with soreness. Overdose is never good.

Massage is not very helpful.