Why Do Muscles Hurt More a Day After Exercise? DOMS Explained: Causes, Symptoms, How Long It Lasts and What Actually Helps Recovery

Reviewed by Dr. Mandeep Achar, Sports Medicine Resident at SRM, Chennai

Delayed onset muscle soreness (DOMS) is a common condition involving your muscles that causes muscle pain, stiffness, and tenderness appearing 12-24 hours post exercise. The physical symptoms usually peak at 24-72 hours and resolve within 3-7 days. 

DOMS is triggered by strenuous or unfamiliar activity to the body, like going to the gym, playing football, or moving heavy boxes while shifting, generally during the eccentric portion of an exercise. It affects everyone regardless of their fitness level.

It’s formally classified under the Munich Consensus Statement muscle injury classification as a Type 1b, fatigue-induced, delayed-onset muscle disorder.

 It’s also known as “muscle fever” even though there is no fever associated with it. This term was used to describe how uncomfortable and widespread it can feel. 

DOMS is one of the most common musculoskeletal complaints among both recreational exercisers and competitive athletes. It occurs to everyone irrespective of their fitness level, from beginners to Olympic athletes.

The most common triggers are strenuous exercise after a long break from exercising, or hiking or playing a new sport.

Most people wonder whether it is a normal process during recovery or whether it is an injury, but most of the data points towards it being a natural physiological process of recovery that takes place after 12-24 hours and lasts for 3-7 days. The symptoms peak around 24-72 hours after exercise, with the timing varying subjectively depending on the individual’s fitness level and the type of exercise.

What Causes DOMS?

There isn’t a single agreed upon mechanism to explain the phenomenon among researchers, and many theories have been proposed.

Eccentric contractions or exercises (muscle lengthening under tension) like downhill running, lowering phase of a squat/curl, and plyometrics produce the most significant number of microtears in the muscle fiber, thereby leading to soreness.

Other factors that contribute include: speed of contraction, joint angle during contraction, fatigue level, and prior conditioning.

Muscles have a unique ability called the “the repeated bout” effect, where the muscle adapts after first exposure to an exercise and this leads to less soreness on subsequent similar sessions. This is the reason why someone going to the gym consistently experiences a significantly lower level of soreness compared to someone who goes inconsistently.

What Happens in the Muscles During DOMS?

The most accepted theory states that exercise leads to microtears in the muscle fiber, which trigger an inflammatory response, releasing inflammatory mediators like prostaglandin E2, and leukotrienes, making nerve endings more sensitive and more susceptible to pain and swelling. Newer research shows that damage to the connective tissue/fascia also contributes to the soreness.

On a microscopic level, histologically, there is myofibrillar disruption and interstitial fluid accumulation, which begins on day 3 and gets repaired by day 7.

The most common symptoms are : 

• Muscle stiffness

• Pain on movement/ contraction/ stretching

• Tenderness to touch

• Mild swelling

• Temporary reduction in strength 

• Temporary reduction in range of motion

Pain is usually dull and diffuse in character, is not present at rest and gets worse on movement or palpation. The pain felt is generally widespread over the whole volume of the muscle. It isn’t a pinpoint or sharp type of pain, which is one of the key differentiators between it and muscle injury.

“In sports medicine and clinical practice, the role of a sports medicine physician is to differentiate benign and self-limiting biological adaptation from structural failure. The challenge occurs when athletes mistake structural tear or systemic exertional collapse for soreness. An acute muscle strain presents with a distinct popping and tearing sensation during rapid eccentric deceleration, followed by an immediate focal hematoma, asymmetrical ecchymosis and loss of terminal load bearing capacity. When severe muscular pain is associated with rigid swelling, tea-colored/dark urine and systemic malaise, it should raise suspicion for an exertional rhabdomyolysis with acute kidney injury, hence requiring an immediate work up and renal protective strategy, not a foam-roller”, says Dr. Mandeep Achar, Sports Medicine Resident, SRM, Chennai.

DOMS normally doesn't require any attention from a doctor, but it’s important to know when to seek professional help in rare cases.

DOMS vs Muscle Strain or Tear

• Onset - immediate or sudden at the moment of the activity

• Location - sharp pain at a specific point

• Its aggravated more during concentric contractions or stretching at the specific injury site

• Has 3 different grades : 

  Grade 1 : pain without functional loss 

  Grade 2: strength + ROM loss 

  Grade 3: complete tear/rupture 

• DOMS causes only mild, non-graded functional reduction in movement

• Progression - doesn’t improve with time like DOMS. It's a persistent, worsening type of pain

DOMS vs Rhabdomyolysis: Warning Signs to Watch For

• Associated with dark, tea-colored urine appearing 1–3 days after exercise

• Important red-flag differential for DOMS

• Symptoms are more severe, with disproportionate muscle pain, marked swelling, reduced urine output, and nausea

• Higher risk when associated with dehydration, extreme heat/humidity, hypokalemia, sickle cell trait, exercise-induced asthma, and pre-exertion fatigue   

• Occurs most often in untrained individuals attempting unaccustomed intense exercise 

• Acute kidney injury develops in ~10–30% of cases if unrecognized 

Other conditions that can mimic DOMS are compartment syndrome (if pain is severe, disproportionate, and associated with neurovascular symptoms) and myositis or myopathies (if soreness is unusually prolonged or unrelated to exertion)

When Should You See a Doctor for Muscle Pain? 

“At the end of the day, if your strength and range of motion seem normal, you can press on through the pain that comes along with muscle or tendon soreness. But, if you have localized pain that is sharp, limits your mobility, changes your gait, affects your range of motion or is accompanied by significant weakness, it could be a sign of a serious injury that needs treatment.” says Dr. Scott Rand, a Sports Medicine doctor at Houston Methodist.

The general principle for the management of DOMS is supportive and not curative.

There are various ways to manage DOMS supportively and aid recovery.

Does Massage or Foam Rolling Help DOMS?

Meta-analyses involving 11 studies among 504 participants on DOMS have shown that getting a professional or amateur massage after an intense workout can help reduce soreness and aid performance recovery.

Foam rolling is another alternative and doesn’t require anybody. It leads to self-myofascial release, where pressure application on the muscle relieves tension and promotes blood flow. A 2017 review in the International Journal of Sports Physical Therapy stated that self-myofascial release reduces pain and muscle tightness after exercise.

Foam rolling and massages speed up recovery by reducing how long muscle tone and stiffness stay elevated after DOMS. Foam rolling is also shown to improve muscle elasticity, compared to resting, according to the Journal of Functional Morphology and Kinesiology (JFMK).

Does Cold Water Immersion Help DOMS?

Full body cold water immersion at 11-15°C (51.8–59°F) for 11–15 minutes is the optimal time to reap all the benefits, being better than doing nothing at all. The effect is small, but it’s slightly better than doing nothing.

It’s not entirely useful after strength building workouts, as regular submerging leads to temporary reduction in soreness or perceived fatigue, but it doesn’t necessarily make muscles recover substantially faster. Therefore, it should be used as a tool amongst many mentioned in the article and spaced out during the week.

Cold water immersion is useful to reduce the perception of soreness, but subjective pain relief should not be interpreted as restoration of muscle function.

Does Heat Therapy Help DOMS?

Heat therapy shows better results compared to cold water immersion only if the timing is followed diligently.

A small study involving 60 participants examined the effects of applying a heat wrap for 8 hours at different intervals post-exercise. The participants who applied it immediately post-exercise reported less soreness and stiffness. The ones that applied it 24 hours post-exercise reported less soreness and stiffness. The ones that applied it 24 hours post exercise reported that it was not much effective. The timing of application matters, which allows the heat to increase tissue flexibility and blood flow to the muscle, which helps reduce soreness. Early application helps provide temporary relief in terms of early soreness by improving comfort, but there’s no evidence that it accelerates recovery from DOMS.

Do Supplements Help DOMS Recovery?

They play a supportive role along with the main pillars of recovery mentioned above. 

Curcumin may reduce inflammation and possibly delayed onset muscle soreness (DOMS) whereas BCAAs are supportive for protein synthesis and recovery, according to the Journal of the International Society of Sports Nutrition. BCAAs require a large dosage and a longer supplementation period to produce better results. Supplements have a secondary, supportive role compared with the adequate whole-food nutrition, hydration and sleep. Therefore, people shouldn’t rely on just supplements to boost their recovery.

Do Pain Relievers Help DOMS?

Topical NSAIDs (Non-steroidal anti-inflammatory drugs) like diclofenac and ketoprofen gels have shown that they can reduce pain by about 50% in some cases. They are preferred over oral use of NSAIDs as topical application has fewer systemic side-effects and has shown to be effective, whereas oral NSAIDs may cause systemic side effects in a handful of people, mainly in the gastrointestinal system. All of the data is according to the Cochrane review conducted by Sheena Derry, R Andrew Moore, Helen Gaskell, Mairead Mcintyre, and Philip J Wiffen.

Continuous use of NSAIDs has been shown to negatively impact performance and recovery because it causes blunted muscle adaptation over time.

Do Warm-Ups and Cooldowns Prevent DOMS?

Warm-ups and cooldowns do a great job of preparing your body for a particular workout/exercise. Warming up prepares your nervous system and adds more value in reducing injury-risk and improving performance. Dynamic/static stretching may improve the range of motion by activating neuromuscular connections, but there is no conclusive evidence that warming up specifically reduces DOMS. The value is provided more in the area of performance.

Cooldowns may promote a subjective sense of calm for the individual. A 2018 study in a sports medicine journal stated that active cooldowns improve cardiovascular and respiratory health.

How Does Progressive Overload Help Prevent DOMS?

The best method to prevent DOMS is known as “Progressive Overload” over time. Progressive overload is gradually increasing the weight of an exercise or increasing the intensity of a workout so that there is steady progress in the exercise/activity. The key is to introduce new exercises, weights, and volumes slowly rather than going all-in right away.

An individual can do this by increasing the weight he lifts this week by a little more than he could lift last week or reducing the rest time between his/her sets or increasing the total number of sets in each exercise to increase the volume of the workout.  

Easing into new exercises reduces muscle strain and subsequent soreness, as well as being a key practical prevention strategy for soreness.

OG/VSN/MSM