Delayed Onset Muscle Soreness and Recovery

Oh the DOMS. As a runner, we’ve all experienced delayed onset muscles soreness (DOMS), the soreness that occurs a day or two after exercise. It’s a normal part of training and racing and, despite being painful, we somewhat secretly enjoy it.

DOMS is different than the acute pain that occurs during exercise. The DOMS typically sets in 12-to-24 hours after physical activity, with the greatest pain usually around 24-to-72 hours post-exercise. DOMS is characterized by: swelling of the limbs, stiffness of the joints, muscle tenderness to the touch, reduction in muscle strength, and elevated creatine kinase (CK) enzyme in the blood (a signal of muscle damage).

So, what causes the pain associated with the DOMS? Why do we experience more soreness two days after exercise?

The main cause of the DOMS is microscopic tears in the muscle fibers. As the muscle fibers slide against each other to produce tension, tearing can occur, especially during lengthening (eccentric) contractions. Think of running downhill. The muscles are lengthening, but still producing tension. This causes greater tearing of the muscle fibers, resulting in more soreness post-exercise. Tearing the muscle fibers, or sarcomeres, sounds like something bad but really it’s how muscular strength improves. To get stronger, the muscle fibers need stress placed on them to the point where they start to break down. Then, in response to the damage, the muscle fibers are repaired and built back up stronger than they were before the damage. So, although muscle damage sounds like a bad thing, it’s an important part of how we improve our fitness. Post-exercise, the muscle damage sets off an inflammatory response, resulting in swelling and tenderness in the area. Most of the symptoms of the DOMS are a result of the inflammatory response, not the actual muscle damage itself.

Colorado’s Hope Pass is an infamous DOMS instigator.

One common misconception is that muscle soreness is due to remaining lactic acid in the muscles. This is not true. Although lactate levels rise during intense exercise and lactate accumulation is associated with fatigue during exercise, lactate levels return to normal within 60-minutes post-exercise. The DOMS peaks around 24-to-48 hours post-exercise and is not a result of lactic acid in the muscles.

A few years ago I ran the TransRockies Run, a six-day stage race covering 120 miles in the Colorado Rockies. Much of the trail is rocky singletrack through the mountains, meaning lots of ascending and descending. Since I’d never done a stage race before and running downhill tends to beat me up a bit, I reviewed some (read: A LOT) scientific journal articles on the DOMS. As I dove further into the research literature, I learned that besides rest and time, there really isn’t much I could do to speed up the healing process. What I did learn, though, is that there are several treatment modalities that can reduce the symptoms (i.e. pain) associated with the DOMS. Before I go into these treatments, I do want to point out that by reducing that pain and swelling associated with the DOMS, you are in essence delaying the healing of the muscle fibers. It’s kind of like when your body has a fever. It’s sometimes best to let the fever it run its course to naturally kill off any viruses inside the body. The same with treating the symptoms of the DOMS: by reducing the pain and swelling associated with inflammation, the repair of the torn muscle fibers is delayed.

This begs the question, in terms of racing and training, is reducing muscle soreness or allowing the muscle fibers to heal the better alternative? I think the answer depends. For me, when I was racing TransRockies, I wanted my legs to feel better since I had multiple days of racing. I chose to treat the symptoms of the DOMS knowing that I might be delaying the full healing process. I think, in that type of scenario, I probably raced better each day, even if it was all in my head. Getting to the starting line a little less sore each day a little was beneficial and gave me confidence going into the day’s race.

Treatment Modalities for the DOMS

From my review of the current literature, there are many treatment modalities for post-exercise muscle soreness. Most of the studies evaluated one or two types of treatment on objective markers of muscle damage, such as creatine kinase and muscle function, as well as subjective feelings of muscle soreness. The most common treatments identified were: ice, compression, massage, non-steroidal anti-inflammatory drugs, and active recovery. Although none of these treatments can actually speed up the healing process, they can potentially alleviate the symptoms. A lot of the recommendations for these treatment modalities are from anecdotal evidence. Personally, after each stage at the TransRockies Run (TRR), I did a bit of each. Here is what I found:

Icing
Immersing in an ice bath or cold body of water for 15 to 20 minutes after muscle-damaging exercise has been thought to reduce soft-tissue swelling and soreness. Many elite athletes use ice baths after hard workouts to help reduce pain and prevent DOMS in the days following. At TRR, after I had taken care of my post-race re-fueling, I would find the nearest creek or lake to ice my legs. Up in the mountains, most of the streams are from snow runoff and are ice cold. I would slowly lower myself into the stream and try to spend 15 minutes with my legs fully immersed. Sometimes it was so cold that I couldn’t stay in that long. There aren’t further benefits from icing longer than 15 to 20 minutes, so if you stay in for longer, well then you’re just crazy.

Even if it gets you odd looks, an ice bath is still useful.

Compression
Wearing tight compression garments after exercise is popular among athletes for recovery. Most of the studies on compression tights/socks doesn’t show any real benefit in terms of muscle soreness and healing. I agree with this. However, I do like the feeling of tight compression socks or tights after I just barreled down a mountain for a couple hours. They make my legs feel better. After icing at TRR, I would stiffly make my way to my tent and put on compression wear. The effect of compression may be all in my head, but if it helps in any way, there is no harm in trying it. One cautionary note is, if the compression is too tight, it may impede blood flow, which can cause more damage.

Massage
A light massage following exercise can get the fluids moving and bring blood flow to the damaged muscles and tissues, helping to reduce soreness. Many athletes use massage in the days following a hard workout or a race to reduce the pain and tenderness and help facilitate recovery. The best part of TRR is that massage therapists travel from stage to stage with the runners. I got a massage every day and it was awesome! I usually only received 15 minutes, but it always made me feel a bit better. Like the other treatments, most studies don’t show a benefit of massage in reducing markers of muscle damage. However, there is a lot of anecdotal evidence pointing to the effectiveness of massage in relieving post-exercise muscle soreness. Another personal experience I recently had with massage was late last fall. I had injured my hip after being hit by a car while riding my bike. As part of my therapy months later, I was getting some soft tissue massage work. Since it was my left hip that was hurt, they typically only massaged my left leg. Once day in the fall, I ran up a mountain in Bend called South Sister. Not a huge endeavor, but it involves a couple miles of hard hiking/running up and some steep downhill running. Since I was just back from injury I hadn’t been running much, which resulted in my legs being very sore afterwards. Since I was still getting physical therapy, I went in a couple days later and got massage on my left leg. And yep, the next couple days, the pain in my left leg was so much less than my right leg. It felt really bizarre, but also showed me that massage really can make a difference in soreness. Self-massage tools, such as foam rollers, can also be used if you aren’t lucky enough to have a massage therapist travel with you.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Better known as Advil or ibuprofen, NSAIDs can also be used to help relieve some of the swelling and pain associated with muscles soreness. I tend to use this as my last resort or when I’m not planning to run. Although it appears that taking NSAIDs is safe to use acutely, there is some concern over long-term use or use after extreme muscle damage. NSAIDs definitely reduce swelling and inflammation, but I usually try to exhaust the other recovery options before resorting to them. There have been times a day or two after racing that I’ve needed to take NSAIDs so I could return to work. Once I had to teach a CPR class on a Monday following a weekend 50-miler. I definitely took Advil so I was able to demonstrate CPR on a manikin without looking like an 80-year-old man.

Active Recovery

Active recovery is just like it sounds, it’s getting your butt off the couch and moving. Sometimes the best treatment is actually more running. It’s usually pretty painful to start, but after a few minutes, when the blood gets flowing and the muscles get warmed up, it feels a bit better. When I’m really sore from running, I like to walk instead. At TRR, I always felt a bit better (muscle soreness-wise anyway) after the first 10 to 15 minutes. Up until then, I was stiff and every movement hurt. Once I got going, my legs loosened up and felt much better. With extreme muscle damage, however, active recovery can be too much. If you feel pain other than soreness, it can mean that the muscles are not ready yet. Rest is probably the better alternative.

It’s best to be gentle during active recovery!

Again, these are just some of the more popular treatment modalities for the DOMS. Most of them have some scientific evidence supporting their effectiveness for reducing symptoms associated with muscle damage, but not for improving muscle healing. Many of these treatment modalities have a lot of anecdotal evidence showing their effectiveness. I think the best way to determine what works is to try a handful of them post-exercise. See what you like best.

The best treatment for the DOMS is probably prevention. This can be accomplished by gradual progression of volume and/or intensity while running. Right. Most runners I know don’t do this. I’m guilty of going out for a two or three-hour run the moment the weather turns nice. It’s generally not the smartest move since I usually can’t walk the next day, but I enjoy the feeling. I think the key is finding a balance and knowing how much your body can handle. It’s fine to do something crazy every once in awhile as long as you take proper care of yourself after. The DOMS are a normal part of life for an ultrarunner and sometimes it feels good to embrace the pain. That’s probably not normal, but again, neither are we.

Call for Comments (from Meghan)

  • Okay, let’s hear your best DOMS stories. When have you been absolutely crippled by a long run or race? We’re talking walk-down-the-stairs-backward pain here.
  • For those of you with extended experiences with the DOMS and preventing it, what modalities discussed by Stephanie have you found to be most effective in relieving your pain?
Stephanie Howe: , a coach and nutrition consultant at REP Lab in Bend, Oregon, started competing as a nordic skier and migrated to running in college. Stephanie now balances her schedule competing as an elite runner for The North Face, working at REP Lab and teaching at Oregon State University - Cascades in their Exercise Physiology program. You can learn more about Stephanie at REPoregon.com.

View Comments (39)

  • umm...SPAM anyone?!

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    • Silly muggle. You know so little.

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      • c'mon now, how am I supposed to answer that? Unless theres a hidden reference to the DOMS encrypted in that message....

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    • Hey Sarah,

      We've got two levels of automatic spam protection (that do a remarkable job), but this one got through .... before we were up and at 'em today. We're vigilant about removing spam from iRunFar's comments. :-)

      Happy trails,

      Bryon

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  • Sarah and Johnny,

    Spam removed. Thanks!

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  • Hi Steph,

    Good stuff.

    Devil's advocate comment: Might the soreness in the right leg (but not the left) after the Sister's run have been due to an altered gait? Perhaps in an effort to spare the left hip, the body overcompensated with the right leg and made it do the lions share of the work. I have definitely experienced this with my frequent shin splints. On the downhills, my left leg (bad side) will use a shorter/weaker stride and the right will take all the pounding and be more sore.

    I do think massage is critical for an ultra runner. Not to diminish DOMS, but to return proper tension and functionality to the damaged tissues.

    Thanks for sharing,

    Jeremy

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  • Good summary, thanks Steph!

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  • " As the muscle fibers slide against each other to produce tension, tearing can occur, especially during lngthening (eccentric) contractions. Think of running downhill. The muscles are lengthening, but still producing tension. This causes greater tearing of the muscle fibers, resulting in more soreness post-exercise."

    Just more proof to this slow runner that if you want to do well in ultras, train the downhills... Especially if you want to finish/PB in long races...

    And it seems to me, from reading this post and others, that downhill work is an area where a lot of us see improvement relatively quickly. (and where that improvement can REALLY improve times).

    It sounds sexy to go hammer the climbs -- but it sound like the smart move is to practice those descents.

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  • Now that the spam was removed, my original comment makes no sense.

    Anyways, I've always thought that if you ate a ton of protein, it would help to reduce DOMS recovery time. I know you say all those treatment modalities are anecdotal and don't necessarily speed up the healing process. But what do you say about using nutrition to speed up recovery?

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    • I think it depends what you mean by "a ton". I'm unaware of any study that's found a benefit to consumption beyond 1.8g/kg, and most settle between 1.2 and 1.6/g/kg as an optimal range for endurance athletes. It's also necessary to view protein in the context of the whole diet. Adequate protein with inadequate consumption of carbs and fats will be of limited utility.

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  • Nice write up Steph, I'm feeling the effects from a Saturday double Bachelor. Monday's workout was horrible but I suspect todays will feel that much better because I was active post work out.

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  • I have DOMS-squared after taxing efforts. Delayed Onset Muscle Soreness + Delayed Outrageous Mood Sourness....

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  • I personally disagree with the use of NSAID's. I believe that acute inflammation is your body's natural defender and the pain we feel tells us it's not ok to run.. NSAID's negate this and many folks run too soon and actually do more damage.

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    • NSAIDS actually reduce the amount of macrophages at the site of injury and since proper "cleanup" can't happen increase the amount of time it takes to actually heal. Icing is similar, any artificial reduction in minor inflammation is really circumventing the healing process.

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  • Protein immediately after as in Muscle Milk or the Cliff Protein bar (although I find both disgusting). I usually then try and get in a cold tub/pool what ever for 15/20min. From there I begin to roll with either the stick or foam roller. The next day regardless if I'm tired/sore or not I run or walk, this usually helps the most, active recovery.

    The downs are killing me lately though with IT and Shin Splints on my right leg, I agree with Dean G train for the downs...which I'm now paying that price.

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    • And oh yes I NEVER touch NSAID's, I see that and running much like Tylenol and a hangover, I put myself in this spot of hurting, now suck it up and live through it. Compression wear I at least think I'm getting benefit from, but it's not proven.

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    • Awesome.

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  • Did my first 50 miler, and took the kids sledging the next day (family pressure, i'd of liked to stay in the chair) Then felt fine.

    Did my second, stayed in the chair and could hardly walk.

    Just anecdotal.

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  • What's wrong with looking like an 80 year old man?

    Seriously, I have had such severe DOMS (backward up and down stairs) in the past that I have considered bringing my California King size mattress downstairs so that I wouldn't have to go upstairs to sleep for a few days post race.

    The only reason why I didn't do it is my wife refused to help move it and I didn't want to injure myself and DNS.

    Active recovery and foam rolling have been the ticket for me.

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  • When I was racing at the collegiate level, this is the method I followed (and I wasn't ever sore...it was crazy):

    1) Cross training (swimming workouts) twice per week.

    2) Ice baths after every hard training session, and many easy ones as well.

    3) L-Glutamine (amino acid) before every hard training session.

    4) compression socks during every hard effort that involved racing shoes.

    That was it. I didn't have any DOMS issues. I didn't have any IMS (immediate muscle soreness ;) ) issues. I didn't have anything. What are your thoughts on L-Glutamine? I know several years ago it was thought to have muscle-building capabilities, but I recently read something that said otherwise. I don't train all that hard any more, so I haven't personally kept up with the latest research on that particular amino acid, although I probably should.

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    • Will - It seems L-Glutamine is a bit of a grey area, with some evidence showing benefits for endurance activities.

      "By attenuating or otherwise preventing glutamine depletion in exericse lasting for more than one hour, performance may indirectly increase relative to the glutamine depleted state. This is not so much performance 'enhancement' as it is performance 'preservation'."

      From: http://examine.com/supplements/Glutamine/

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      • Thanks, Johnny. I think that's roughly the state of research a few years ago, too. I seemed to experience benefits while consistently taking it. Placebo? Possibly, but is that always a bad thing? :)

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        • Agreed. It's amazing how powerful the brain is in that it can use a placebo to push your body beyond what it otherwise would not have been able to do. So by its very nature, a placebo does work.

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  • Easy solution: Weight bearing exercise. Most runners idea of cross-training is not really training. It's "anything that's not running".

    Do some actual weight training to increase muscular strength and endurance. Squats, deadlifts, pullups, clean/jerk/press/snatch,etc..

    Then again.. if you are complaining about being sore..chances are weightlifting isn't going to be your favorite either.

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    • Spot on, but if you hit the pool and swim some hard laps for 35-40 minutes, you're going to see less soreness and see some strength and endurance gains as well. (In my experience.)

      Just an alternative of "actual training" while not being weightlifting.

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  • Re NSAIDs, I recall a friend with a PhD in exercise phys telling me years ago that NSAIDs post-workout can actually interfere with maximal muscle growth/regeneration ... Any data on this?

    As for active recovery, I'm a huge believer. Pushed myself to go hiking (well, sort of, for about 90 min) one day post my first 100 and was so much the better for it.

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  • Mm I don't think the soreness was from an altered gait because I was healed by then. It was definitely bizarre though!

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  • Hi Johnny,

    While protein is crucial for rebuilding muscle, especially after muscle damaging exercise, the "more is better" paradigm doesn't hold true. You absolutely need protein following exercise but eating a ton won't speed up recovery. Unfortunately :)

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  • I agree. I only use NSAIDs when I'm not planning to run and the pain impedes my life activities.

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