SaveYourself.ca • Sensible advice for aches, pains & injuries
updated 12/22/11
Delayed-onset muscle soreness (DOMS) or “muscle fever” — such a wonderfully descriptive term — is that distinctive muscle pain that nearly everyone experiences after intense or unfamiliar exercise, often peaking as much as a day or two later. Sometimes it is so severe that it is mistaken for a pulled muscle. Weakness is a symptom as much as the pain is, but only hardened competitors are likely to test their strength while feeling so sore. The nastiness starts after a bit of a delay, often after sleeping, and then continues for 24 to 72 hours. Some people don’t even notice it until the second day.
DOMS is annoying and style-cramping, particularly if you’re starting or restarting an exercise regime. When I was a Registered Massage Therapist, patients often came to me hoping for treatment, or some advice on how to avoid the condition. It was often the primary reason given for a massage appointment: “Help, I’m sore from my workout!”
Alas, there was nothing1 I could do for them. It’s a myth that DOMS can be effectively treated by massage … or anything else. Believe me, I’ve tried — my personal experimentation will be described below. Massage therapists certainly often claim to be able to do so, but without adequate evidence or justification. Like most health care myths, it’s not too loudly touted, just carelessly repeated and perpetuated (often in major publications, ahem2). But medical science cannot even explain DOMS, let alone stop it — it seems to be nature’s little tax on exercise, which everyone must pay. There are no shortcuts through it. DOMS is indomitable.
The cause of DOMS is unknown, although it is generally described as the consequence of mechanical and/or metabolic stress3 … which isn’t saying much. What else would cause DOMS? Financial stress?
Unfortunately, nothing more specific can be said about the roots of DOMS with any confidence. “Microtrauma” certainly gets said anyway, but it’s just another way of saying mechanical stress. While it does seem plausible that intense exercise could cause microtrauma specifically — and the idea is prevalent — the evidence does not strongly support this idea, and some research actually contradicts it.45
“Metabolic stress” is much less frequently brought up. The notion here is that muscle cells are like little chemical factories, and they produce some unpleasant by-products when operating at intensities they haven’t had a chance to adapt to. It seems plausible enough in general terms, but it’s a tricky concept to pin down. What constitutes metabolic stress, exactly? Researchers have spent decades identifying various obscure molecules produced by cells during exercise, but are any of these molecules necessarily a sign of painful metabolic wear and tear? Just because a cell produces a substance during exercise does not mean it is metabolically frazzled, or that you are going to hurt. In any event, no one has been able to find a link between DOMS and any specific biological markers.67
For demonstration purposes, we’ll dip into the complexity of this subject on just one point. “Free radicals” or “reactive oxygen species” are unstable, highly reactive molecules that are an unavoidable by-product of cellular metabolism. “There is growing evidence that reactive oxygen species (ROS) are involved in [DOMS].”8 Unfortunately, although free radicals have a great name, which sounds just exactly nasty enough to cause DOMS, they don’t have the decency to actually be present in great numbers when DOMS is at its worst. Instead, “the increase [of free radicals] occurred after the peak decline in muscle function and DOMS.”9 In other words, they may be involved — they probably are involved — but the relationship is indirect and unclear at best. They could even simply be a byproduct of some other, hidden culprit.
Since we don't (yet) know what causes DOMS, it’s unsurprising that anything like a cure has yet to be discovered. Even if we understood it, we still might not be able to do anything about it. Certainly nothing tried so far seems to be all that helpful. A 2003 review of the subject concluded, “Cryotherapy, stretching, homeopathy,10 ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.”11 Among other unconvincing treatments tried are:
Everyone will be pleased to know that one study (predictably European) showed some benefits to hot tubbing, specifically “warm underwater jet massage”21 — aaaah. However, it was a small and flawed piece of research — and most people know from personal experience that a soak in a hot tub may “take the edge off it,” but hardly constitutes a miracle cure for DOMS.
Adding Epsom salts will not make that hot tub any more effective for your muscle fever. I cover that topic separately, and in great detail, in a separate article all about Epsom salts. In a nutshell, using Epsoms salts is just a bit of implausible folk medicine — a claim that dissolves into nothing when scrutinized. (If that gets your hackles up, please do jump over to the big salt article for all the details before sending me cranky email.)
“Vitamin I” may be partially useful. Ibuprofen (and other anti-inflammatory drugs) have been shown to reduce the pain of DOMS,2223 although — disappointingly — they are not actually resolving it, and they definitely do not reduce the muscle weakness that goes with it. In short, they are masking the pain, not treating the condition. For instance, if you had severe DOMS in your quadriceps, taking ibuprofen would probably reduce your pain, but you would still not be able to jump as high as usual. And the value of anti-inflammatory medication as prevention for DOMS has been challenged by studies showing no benefit to that usage at all, a contradiction of an extremely prevalent athletic belief!24 Evidence even indicates that there is little or no inflammation present in DOMS.25
Generally speaking, there is a broad consensus that nothing really decisively helps DOMS,2627 and the best way to prevent it is just to get it over with. In other words, only DOMS prevents DOMS!
But what about massage therapy? We’ve got to deal with massage in more detail, because it’s the king of presumed treatments.
Massage therapists and massage enthusiasts often claim DOMS prevention and cure as a benefit of massage. Unfortunately, there is no convincing evidence to support this, and some that contradicts it — including my own extensive personal tests (see next section). It is also closely related to two other massage myths: that massage detoxifies in general, and that drinking water after massage detoxifies.
In 1998 — around the time I was starting my training as a massage therapist, actually — E. Ernst published a review of papers on this subject in the British Journal of Sports Medicine.28 Ernst concluded that, “Massage therapy may be a promising treatment for DOMS. Definitive studies are warranted.” That sounded like good news for massage therapy! However, actually reading the paper discouraged me.
Ernst found only seven studies worth considering, and most of these had “serious methodological flaws” and “very small sample sizes.” Of the seven, three are inconclusive or show no effect of massage therapy on DOMS, and four “imply a positive symptomatic effect” or a “positive trend.” I was not particularly impressed by any of those positive effects or trends — they all seemed ambiguous to me, even if you ignore the “serious methodological flaws.”
Although I can’t deny that there was some encouragement to be had from the data, it was hardly convincing. I could not come to the same optimistic-sounding conclusion that Mr. Ernst did. Since that time, I have not seen any new studies or evidence to alter my opinion.
I remain skeptical that massage therapy can prevent or reduce the intensity of DOMS for most people, most of the time.Since we don’t know much about what causes DOMS, and we don’t know much about how massage therapy works, even when it does29 and probably never will, it’s difficult to even propose how massage therapy is supposed to help. While it does seem likely that massage therapy probably has some positive effect on DOMS — a placebo, if nothing else — those effects are likely to be limited, and to vary widely depending on the therapist, the individual, and the circumstances.
Therefore, while I agree with Ernst that “definitive studies are warranted,” they have yet to appear: and so I remain skeptical that massage therapy can be claimed to generally prevent or reduce the intensity of DOMS, and massage therapy should not be promoted or purchased for this reason. Fortunately, there are other reasons to have massage therapy: see Does Massage Therapy Work?.
Purpose: To test massage-aided recovery from delayed onset (post-exercise) muscle soreness. Systemic steam heating — I have a lovely steam room at my disposal — was used as an adjunctive therapy.
Methods: I totally thrashed my biceps at the gym, deliberately pushing into the danger zone to generate wicked DOMS. It worked a charm: my guns were mighty sore by the end of the day. Soreness spiked with the slightest contraction and therefore easy to evaluate. The next morning, sensitivity was equally savage on both sides. In a toasty steam room, I massaged the crap out of my left upper arm for several minutes, using strong deep palm stroking, which was super unpleasant. The things I do for science! Then I compared soreness at regular intervals by flexing simultaneously.
Results: Soreness in my biceps was identical at all testing points after massage: 5 and 20 minutes later, and about 1, 6, 12, 24, 36, 48 and 72 hours later. The soreness was extremely intense from 24 to 48 hours, fading quickly after that — the usual pattern of recovery. And entirely symmetrical.
Conclusion: Neither strong massage or heat produced any effect on DOMS in this little guinea pig.
Losing sleep is a major factor in pain, muscle pain in particular, and probably DOMS as well. There is no direct scientific evidence of this that I am aware of. However, anyone who has ever been severely sleep deprived will tell you that it causes a distinctive and unpleasant feeling of “fragility” which seems quite likely to make one more vulnerable to DOMS.
Ultimate is an intense Frisbee sport that can make almost anyone wicked sore.
I have an example of sleep-deprivation induced DOMS from the laboratory of me.
The first ultimates games of the season have always been an ordeal. They are followed by 3-5 days of harsh DOMS. But in 2011 I started the season in unusually good physical condition, thanks to months of sprint intervals and strength training. For the first time ever I was not sore after my first games of the summer. And my DOMS-immunity continued in week two, so it didn’t seem to be a fluke.
That was then followed by some nasty sleep deprivation and jet lag. I suffered a great of it for two weeks — before, during and after a holiday to Amsterdam. When I returned to Vancouver and played ultimate again, I was really blasted sore. Quite extreme.
Coincidence? I think not!
BACK TO TEXT Comments: From the abstract: “The myofibrillar and cytoskeletal alterations observed in delayed onset muscle soreness (DOMS) caused by eccentric exercise are generally considered to represent damage. By contrast our recent immunohistochemical studies suggested that the alterations reflect myofibrillar remodeling (Yu and Thornell 2002; Yu et al. 2003).” In other words, these researchers found evidence that what previously looked like microtearing of muscle tissue is actually probably just muscle tissue doing microscopic renovations — an adaptive process, not a repair process, and probably not painful in and of itself. BACK TO TEXT Comments: From the abstract: “Eccentric physical exercise (downhill running) did not result in skeletal muscle inflammation 48 h post exercise, despite DOMS and increased CK.” Inflammation is the hallmark of tissue damage, so this evidence tends to suggest that muscles are not damaged by hard, unfamiliar exercise. BACK TO TEXT BACK TO TEXT BACK TO TEXT Comments: From the abstract: “Increased muscle temperature [by ultrasound] failed to provide significant prophylactic effects on the symptoms of DOMS.” BACK TO TEXT Comments: Although the title sounds positive about massage, the article is actually much less optimistic: results were equivocal, showing that the treatment regimen had some benefits, but was conspicuously ineffective when it came to, for instance, reducing pain. “DOMS on pressure ... did not differ between the groups.” Although it’s nice to see that this combination of therapies probably had some beneficial effect, it’s hardly persuasive if they didn’t reduce the pain of DOMS. I think it’s reasonably safe to assume that none of them alone are definitely effective. BACK TO TEXT Comments: From the abstract: “There was no difference in the reported variables between experiments one and two. It is concluded that passive stretching did not have any significant influence on increased plasma-CK, muscle pain, muscle strength and the PCr/P(i) ratio, indicating that passive stretching after eccentric exercise cannot prevent secondary pathological alterations.” BACK TO TEXT Comments: Does stretching help either before or after exercise to reduce soreness? Nope. This large review of many scientific studies concluded with a clear thumbs down: “The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.” BACK TO TEXT BACK TO TEXT Comments: From the abstract: “… analysis indicated no statistically significant differences between massage, microcurrent electrical stimulation, upper body ergometry, and control groups.” BACK TO TEXT BACK TO TEXT Comments: From the abstract: “These data indicate that a prophylactic dosage of ibuprofen does not prevent CK release from muscle, but does decrease muscle soreness perception and may assist in restoring muscle function.” BACK TO TEXT Comments: From the abstract: “The results of this study reveal that intake of ibuprofen can decrease muscle soreness induced after eccentric exercise but cannot assist in restoring muscle function.” BACK TO TEXT Comments: Although this research concludes that anterior-posterior lumbar spinal fusion is an effective treatment for chronic low back pain, in my opinion the methodology is poor and the results are unconvincing. My own interpretation is quite different: the surgical procedure may have been irrelevant to the observed improvement in symptoms, which could have occurred without the surgery. However, the results do serve to demonstrate another important point: that the spine is not fragile and it is possible for people who’ve had chronic low back pain to experience an improvement in symptoms in spite of spinal fusion. BACK TO TEXT Comments: Experimenters tortured sprinters’ muscles with a savage workout, and the painful results were identical with or without an anti-inflammatory medication. “In conclusion,” they wrote, “the aetiology of the DOMS induced in the trained subjects in this study seems to be independent of inflammatory processes ….” BACK TO TEXT Comments: This is a review. From the abstract: “To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.” BACK TO TEXT Comments: From the article: “An effective treatment has been sought for many years … to date, none of these approaches has been fully convincing.”BACK TO TEXT