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What Causes Delayed Onset Muscle Soreness (DOMS)?

delayed onset muscle soreness

Story at-a-glance -

  • Increasing exercise intensity or load may increase your risk of developing delayed onset muscle soreness (DOMS), which may appear 12 to 36 hours after your workout
  • DOMS may be triggered by microtears in the muscles that release chemical irritants, triggering pain and discomfort in the nerve endings in your connective tissue
  • Once damaged, reducing pain using natural strategies does not mean the muscle has healed; natural strategies include ginger, astaxanthin and curcumin. You may also reduce stiffness and improve flexibility using a foam roller

By Dr. Mercola

The combination of early year resolutions and thinking about shorts and bathing suit weather may be responsible for delayed onset muscle soreness (DOMS) as you boost your exercise program or start a new one.

Research demonstrates exercise does more than tone your muscles and helps you fit into your clothes with greater ease. It also helps you build a neurological system and brain that resists shrinkage as you age, and improves your cognitive abilities.1 A long-term investment in regular exercise helps improve your mood and prevent depression.2

Exercise helps boost your metabolism, helps you to maintain your weight and prevent chronic illnesses, such as cardiovascular disease, Type 2 diabetes and high blood pressure. However, while exercise has a significant number of benefits, those benefits are not permanent.

When you stop exercising the benefits to your muscle strength and tone, neurological protection and metabolic boost slowly recede. While it is common to experience post-exercise muscle soreness after beginning a program when you have not exercised in a while, DOMS can occur even when you’ve been previously exercising. Knowing what it is, how to avoid it and how to speed up healing may discourage you from giving up your program completely when faced with muscle discomfort and stiffness.

Post-Exercise Muscle Soreness

Muscle stiffness may occur after starting a new exercise program, adding a new exercise to your current program or increasing the intensity and duration of your routine. This stiffness is often accompanied by discomfort, pain and sometimes, cramping.

Stiffness associated with exercise is not usually a cause for concern and may be treated at home. As your muscles work harder it may cause microscopic damage to muscle fibers that result in DOMS. Any movement may result in discomfort, but jogging, squats, pushups and weightlifting are more commonly associated with the condition.3

Most people who develop DOMS don’t seek medical care and assume occasional soreness is the cost of strengthening and toning muscles. However, with planning and practice you may reduce the number of occurrences and severity of the condition. Interestingly, the sensation of discomfort occurs more frequently after new eccentric physical activity.4

When your muscles move through an exercise, there is eccentric and concentric movements. During a concentric movement the load being lifted is less than the maximum. The contraction shortens the muscle, such as when you raise a weight during a bicep curl.5 Eccentric muscle contraction happens while the muscle lengthens.

In other words, as your muscle is lengthening it is also activating. During eccentric activity strengthening is greatest, the motion is physiologically common and DOMS is selectively associated with eccentric motion.6 Think of the same bicep curl, when the muscle is at once shortening and contracting. As your arm is extending, the muscle is lengthening yet is still activated or contracted to control the extension. This is eccentric motion.

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Exercise-Related Muscle Tears Related to DOMS

During eccentric motion, tiny muscle tears occur as the force is distributed over a smaller cross-sectional area of muscle than concentric movement. This increased tension may be the cause behind the structural disruption in the muscle fibers or connective tissue, muscle tears and subsequent pain and soreness.7 The pain and discomfort often occurs one to two days after your workout and is sometimes described as “muscle fever.”8

A common misconception about DOMS is that it’s triggered by a buildup of lactic acid in the muscle after a strenuous workout.9 Lactic acid is an organic compound that builds up during anaerobic activity, when there isn’t enough oxygen delivered to the muscle to break down glucose and glycogen for energy.10 The buildup may trigger a temporary burning sensation in the muscle groups being used, and if enough builds it may trigger nausea and vomiting. However, it is not responsible for DOMS.

Sensation of pain is transmitted over myelinated fibers that terminate in free nerve endings distributed in the connective tissue between muscle fibers.11 Larger group III fibers are believed to carry sharp, localized pain, while dull, diffuse pain associated with DOMS is likely carried over group IV sensory neurons. These fibers respond to a variety of stimuli, including chemical, thermal and mechanical, and are likely triggered by the chemical irritants released when microtears in the muscle occur.

A higher number of repetitions is commonly associated with the development of DOMS, so you may be able to prevent a severe case by starting a new exercise slowly with lower weight and a low number of repetitions before building to your goal level. Other than local pain or discomfort, other symptoms that are related to DOMS include:

  • Swelling and tenderness to the touch of the affected area
  • Stiffness of the joint with a reduction in range of motion
  • Temporary reduction in strength of the affected muscle and joint
  • An elevation of creatinine kinase (CK) in the blood indicating muscle damage
  • In rare cases of severe injury, elevated CK may place your kidneys at risk

Sprains and Strains Create Similar Symptoms

A strain happens when muscle fibers are stretched or torn, while a sprain is when ligaments are torn, stretched or twisted.12 Common areas affected by strains are your lower back and legs, while sprains are common in your knees, ankles, wrists and thumbs. Symptoms of strains and sprains are similar to those of DOMS, including pain, swelling and tenderness.

Additional symptoms include bruising and redness. Other medical conditions can also create muscle soreness that is unrelated to exercise or injury, including fibromyalgia, polymyalgia rheumatica, infections, medication side effects and lack of physical activity.13

DOMS causes only temporary pain and discomfort. You may experience voluntary reduced performance from the soreness and reduced muscle capacity, but there is no evidence to suggest that it may lead to permanent loss of strength or continued discomfort. The injured muscle usually completely regenerates within three weeks.14 However, the symptoms often resolve well before.

Imaging studies have found ultrasounds are not sensitive enough to detect DOMS in cross-sectional muscle areas, but ultrasounds are able to detect damage from sprains and strains, indicating the damage from DOMS is significantly less than that incurred during a sprain or muscle strain.15

Muscle edema from DOMS is evident on more sensitive imaging studies, such as magnetic resonance imaging (MRI) but these are not a necessary diagnostic tool. Researchers have found the abnormalities related to DOMS found on MRI are evident for three weeks after you no longer experience symptoms.

Recovery Happens in Baby Steps

Although you may have suffered microtears that triggered DOMS in one exercise session, recovery doesn’t happen nearly as quickly. The condition doesn’t usually require medical attention, however. You can help your body heal at home using a few simple strategies. However, if your pain is debilitating, if your limb becomes heavy and weak or your urine becomes dark despite drinking adequate amounts of water, then seeking medical attention is advisable.16

Often you’ll find the symptoms improver as you become more active, which may tempt you to return to your previous level of activity and workouts. However, your muscles will recover far quicker if you do a lighter workout in the days following. Continue this lighter workout schedule for several days until your muscle stiffness and pain are nearly gone within 24 hours of your last workout. Trying to “push past the pain” and do a difficult workout may make the situation worse.

While there are ways to help reduce the immediate pain, it is important to remember that a reduction in pain does not equal muscle repair and recovery. Ice packs, light massage and acupressure may help relieve discomfort. As your pain subsides with these measures, do not be tempted to attack your next workout believing you’ve healed or you may create a bigger problem.

Although it is unlikely you’ll be able to avoid soreness altogether, it is important to note that greater pain doesn’t equal greater gains. In fact, pain is often an indication it’s time to slow down or back off a bit until your body is fully recovered.17 Remember that pain that starts during your workout signals there is a problem with the exercise, such as poor form or a sprain or strain. Your workout should stop immediately before further muscle or joint damage occurs.

There are two valuable modalities that I regularly use that virtually eliminate DOMS and that is PEMF (pulsed electro magnetic field therapy) and PBM (photobiomodulation). I use about 20 minutes of near infrared and red PBM that reduces DOMS by over 80 percent and PEMF gets rid of the rest. I will discuss these in more detail in a later article as a detailed discussion is beyond the scope of this article.

Benefits of a Foam Roller

A foam roller implements soft tissue mobilization that can be regularly used to address pain and stiffness or as a pre-workout warmup to increase blood flow to the muscles you intend to work. Poor flexibility and mobility may impair your range of motion and movement, which may lead to DOMS as you overexert to achieve your workout goals. A foam roller benefits general fitness and addresses common pain. They are inexpensive, therapeutic tools that can:

  • Release trigger points and tight muscles, tendons and ligaments
  • Increase blood flow through your skin, fascia and muscles, thereby improving tissue quality and cellular function
  • Engage core muscles and build strength
  • Increase range of motion in your spine
  • Improve posture by strengthening your core

Warm up With a Foam Roller

Epoch Times has published a four-part series on foam rolling warmup exercises. You can find an infographic showing the basic moves for a lower leg warmup18 in their November 26, 2017, post. Below is a summary of the suggested moves. In the video above, Jill Rodriguez also demonstrates some of these foam rolling techniques, along with a few others.

Foot roll: Sit on the floor with knees bent and your feet on the roller. Prop yourself up for balance by leaning back on your arms. Roll the soles of your feet from heel to toes.

Shin roll: Position yourself on all fours. Lift your right leg, placing the roller beneath your shin. Support yourself on both hands and one knee while rolling your right shin, from your knee down to your ankle. Repeat on the left leg.

Calf roll: Start by sitting on the floor with your knees bent to your chest. Extend your right leg and place the foam roller under your right calf. Roll the entire area from your Achilles tendon to the back of your knee by supporting yourself on both hands and left foot while lifting your buttocks off the floor.

Rotate your hip inward and outward to reach the inner and outer areas of your calves. Remaining stationary, you can also rotate your calf from side to side. Alternatively, you can keep both legs outstretched on the roller, with one foot crossed over the other. This will allow you to exert more pressure. Repeat on the left leg.

Outer leg roll: Sit on the floor and place the foam roller under your knees. Bend your left leg, keeping your right leg extended. Support yourself on your arms and left leg, and lift your buttocks off the floor to roll your extended leg across the roller. Rotate your leg outward to reach the outer side of your leg.

Nutritional Factors That Can Help Prevent and Heal DOMS

Microscopic tears in your muscle release chemical irritants that may trigger pain receptors. Several nutritional factors have demonstrated usefulness in the prevention and healing of DOMS.


Ginger has a long medicinal history of use to treat digestive upset, nausea, improve cognitive function and as a natural anti-inflammatory pain reliever. Both raw and heat-treated ginger may reduce muscle pain by as much as 24 percent.19


Cherries have proven anti-inflammatory effects and can help reduce pain and discomfort associated with arthritis and gout. They may also be useful for general muscle soreness. One study demonstrated tart cherry juice significantly reduced post-exertion pain in long-distance runners.20


Astaxanthin, a naturally occurring, powerful antioxidant, boasts a wide variety of health benefits, including decreasing DOMS and speeding recovery.21


This pigment gives the spice turmeric a vibrant yellow color and is an effective anti-inflammatory agent, assisting in relieving pain, increasing mobility and reducing inflammation.22

Omega-3 fat

Animal-based omega-3 fat is highly anti-inflammatory and beneficial for your heart. The best way to get these from your diet is through wild-caught Alaskan salmon or smaller fish, in which environmental toxins are not highly accumulated, such as herring, mackerel or anchovies. When faced with immediate DOMS, try krill oil supplementation.


This homeopathic remedy has been shown to reduce muscle soreness in marathon runners but did not have an effect on cell damage.23


MSM, which is 34 percent sulfur, is known for joint health benefits, improving metabolism and reducing inflammation. It also appears to improve cell wall permeability, so it can help deliver other active ingredients. Sulfur plays a critical role in detoxification, and is the primary component your body uses to manufacture the most important native antioxidant, glutathione.


This antioxidant consists of the amino acids beta-alanine and histidine. It helps reduce muscle soreness by buffering acids in muscle tissue and reducing local inflammation. Most studies find that if you want to increase athletic performance with carnosine, your best bet is to take beta-alanine alone, since it appears to be the rate-limiting amino acid in the formation of carnosine.

As your muscles accumulate hydrogen ions, pH falls, making them more acidic. The theory is that by improving your carnosine levels, you can counteract the detrimental effect of these hydrogen ions, thereby enabling you to sustain high-intensity muscle contractions for longer periods of time without damage.