Delayed Onset Muscle Soreness (DOMS)

There are several topics within exercise science that are not well understood and delayed onset muscle soreness or DOMS is one of them.

DOMS is a familiar experience for athletes at every level and can be described as muscles soreness that occurs 24 - 48 hours following intense exercise. The sensation can range from mild discomfort to debilitating pain.

Delayed onset muscle soreness differs from the acute muscle soreness that can be felt during or immediately following a heavy exercise bout. This is usually attributable to an increase in hydrogen ions associated with lactic acid accumulation or edema that build up of fluid in the tissues often referred to by bodybuilders as being pumped-up.

Several theories have been proposed to explain the underlying cause of delayed onset muscle soreness, however none is universally accepted. There are also many anecdotal claims that the effects of DOMS can be reduced with various treatment modalities. Again, no method has any conclusive, empirical support; likewise for the prevention of delayed onset muscle soreness.

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Causes of Delayed Onset Muscle Soreness

Although the actual pathophysiology of DOMS is debateable, most researchers agree that it results from strenuous eccentric muscle action (1).

Stone and co-workers (2) found that static and concentric muscle actions caused little or no delayed soreness compared to the extreme soreness felt with eccentric resistance training.

Studies on endurance-based activity have found that the eccentric bias of running downhill on a treadmill results in a significantly higher level of delayed onset muscle soreness compared to running on the flat (3,4). This is a phenomenon many fell runners can testify to!

Lactic Acid
Lactic acid and its accumulation was once thought to be a major cause of DOMS, however this is not the case. Blood lactate returns to resting levels within one hour of exercise even after extremely intense bouts of work (5). The studies on downhill running (3,4) found that although it resulted in greater DOMS compared to level running, it produced significantly less blood lactate accumulation.

Tissue Breakdown
Delayed onset muscle soreness may be the result of muscle tissue breakdown. Muscle biopsies taken from marathon runners after competition or training, have highlighted considerable cell damage in these athletes muscles (7). The sarcolemma (cell membrane) may be ruptured (6) allowing the contents of the cell to seep between other muscle fibers. Damage to the contractile filaments actin and myosin as well as the z disc configuration (responsible for structural support), has also been reported (7).

Inflammatory Response
Heavy exercise of the kind that results in DOMS can often induce an immune system response. White blood cell count has been shown to increase following strenuous activity (8,9). This has led to the hypothesis that DOMS is caused by an inflammatory response in the muscles.

In an attempt to attenuate the effects of delayed onset muscle soreness, researchers have tried administering athletes with anti-inflammatory drugs. However, this approach has been unsuccessful at reducing either the occurrence or severity of soreness. More recently, it has been found that microscopic muscle damage caused by heavy exercise may indeed cause an inflammatory response in the muscles. See Tidall (10) for an in-depth discussion on the inflammatory cell response to acute muscle injury.

It seems likely that acute structural damage to muscle tissues initiates the occurrence of DOMS. This could then set up a chain of events that leads to necrosis (cell death) peaking about 48 hours after exercise. Intracellular contents and the by-products of an immuno-response then accumulate outside the cells stimulating the nerve endings of the muscle (11).

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Reducing the Effects of Delayed Onset Muscle Soreness

DOMS results in loss of maximal force and can reduce performance in a 1-repetiton maximum test for example (12). This may be due to three factors:

1) Physical damage to the muscle tissue
2) Failure of the excitation-contraction coupling
3) Loss of contractile protein

DOMS also results in a loss of range of motion and muscle recruitment patterns (18).

No method has been shown to significantly speed the recovery from delayed onset muscle soreness.

Massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. It can reduce the discomfort associated with DOMS (13,14,15) and perhaps even swelling (13) but does not seem to affect muscle function (13,14,15). Cryotherapy (ice baths or ice packs) (16,17), stretching (18), homeopathy (19), ultrasound (20) and electrical current modalities (21,22) have demonstrated no effect in clinical trials on the alleviation of muscle soreness or other DOMS related effects.

Vitamin C plays a role in repairing connective tissue and anecdotal reports suggest that antioxidant supplementation can attenuate the effects of delayed onset muscle soreness. However, this is not confirmed by clinical trials (23,24, 25). Taking vitamin C in large doses is not recommended and can, in some cases, be harmful.

Finally, a recent study by Miller and co-workers (26) demonstrated the effectiveness of a protease supplement on the prevention and recovery from DOMS...

The experimental group demonstrated significantly superior recovery of contractile function and diminished effects of delayed onset muscle soreness after downhill running when compared with a placebo group.

Although intense exercise, particularly after a prolonged layoff from activity, can cause DOMS, subsequent training sessions are less likely to result in delayed soreness (13).

References
1) McArdle WD, Katch FI and Katch VL. (2000) Essentials of Exercise Physiology: 2nd EditionPhiladelphia, PA: Lippincott Williams & Wilkins
2) Stone MH, O'Bryant H, Garhammer J. A hypothetical model for strength training. J Sports Med Phys Fitness. 1981 Dec;21(4):342-51
3) Schwane JA, Johnson SR, Vandenakker CB, Armstrong RB. Delayed-onset muscular soreness and plasma CPK and LDH activities after downhill running. Med Sci Sports Exerc. 1983;15(1):51-6
4) Schwane JA, Watrous BG, Johnson SR and Armstrong RB. Is lactic acid related to delayed-onset muscle soreness? Physician and sportsmedicine 1983 11(3) 124-131
5) Freund H, Gendry P. Lactate kinetics after short strenuous exercise in man. Eur J Appl Physiol Occup Physiol. 1978 Aug 15;39(2):123-35
6) Armstrong RB, Warren GL, Warren JA. Mechanisms of exercise-induced muscle fibre injury. Sports Med. 1991 Sep;12(3):184-207
7) Hagerman FC, Hikida RS, Staron RS, Sherman WM and Costill DL. Muscle damage in marathon runners. Physician and sportsmedicine 1984 12 39-28
8) Natale VM, Brenner IK, Moldoveanu AI, Vasiliou P, Shek P, Shephard RJ. Effects of three different types of exercise on blood leukocyte count during and following exercise. Sao Paulo Med J. 2003 Jan 2;121(1):9-14. Epub 2003 Jul 4.
9) Simonson SR, Jackson CG. Leukocytosis occurs in response to resistance exercise in men. J Strength Cond Res. 2004 May;18(2):266-71
10) Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc. 1995 Jul;27(7):1022-32
11) Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review.Med Sci Sports Exerc. 1984 Dec;16(6):529-38
12) Warren GL, Ingalls CP, Lowe DA, Armstrong RB. Excitation-contraction uncoupling: major role in contraction-induced muscle injury. Exerc Sport Sci Rev. 2001 Apr;29(2):82-7
13) Zainuddin Z, Newton M, Sacco P, Nosaka K. Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train. 2005 Jul;40(3):174-80
14) Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med. 2003 Feb;37(1):72-5
15) Ernst E Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. Br J Sports Med. 1998 Sep;32(3):212-4
16) Isabell WK, Durrant E, Myrer W, Anderson S. The Effects of Ice Massage, Ice Massage with Exercise, and Exercise on the Prevention and Treatment of Delayed Onset Muscle Soreness. J Athl Train. 1992;27(3):208-217
17) Howatson G, Van Someren KA. Ice massage. Effects on exercise-induced muscle damage. J Sports Med Phys Fitness. 2003 Dec;43(4):500-5
18) Cheung K, Hume P, Maxwell L Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64
19) Vickers AJ, Fisher P, Smith C, Wyllie SE, Lewith GT. Homoeopathy for delayed onset muscle soreness: a randomised double blind placebo controlled trial. Br J Sports Med. 1997 Dec;31(4):304-7
20) Craig JA, Bradley J, Walsh DM, Baxter GD, Allen JM. Delayed onset muscle soreness: lack of effect of therapeutic ultrasound in humans. Arch Phys Med Rehabil. 1999 Mar;80(3):318-23
21) Allen JD, Mattacola CG, Perrin DH. Effect of Microcurrent Stimulation on Delayed-Onset Muscle Soreness: A Double-Blind Comparison. J Athl Train. 1999 Oct;34(4):334-337
22) Butterfield DL, Draper DO, Ricard MD, Myrer JW, Schulthies SS, Durrant E. The Effects of High-Volt Pulsed Current Electrical Stimulation on Delayed-Onset Muscle Soreness. J Athl Train. 1997 Jan;32(1):15-20
23) Close GL, Ashton T, Cable T, Doran D, Holloway C, McArdle F, MacLaren DP. Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process. Br J Nutr. 2006 May;95(5):976-81
24) Thompson D, Bailey DM, Hill J, Hurst T, Powell JR, Williams C. Prolonged vitamin C supplementation and recovery from eccentric exercise. Eur J Appl Physiol. 2004 Jun;92(1-2):133-8. Epub 2004 Mar 13
25) Thompson D, Williams C, Garcia-Roves P, McGregor SJ, McArdle F, Jackson MJ. Post-exercise vitamin C supplementation and recovery from demanding exercise. Eur J Appl Physiol. 2003 May;89(3-4):393-400. Epub 2003 Apr 1
26) Miller PC, Bailey SP, Barnes ME, Derr SJ, Hall EE. The effects of protease supplementation on skeletal muscle function and DOMS following downhill running. J Sports Sci. 2004 Apr;22(4):365-72.