If you have ever engaged in exercise, chances are you have experienced delayed-onset muscle soreness, a.k.a. DOMs. In this article we explore how to prevent and reduce DOMs.
What is DOMs
Delayed-onset muscle soreness (DOMs) describes the tenderness and soreness that may be experienced after exercise. It normally peaks 24-72 hours after exercise and goes away after 5-7 days (1).
DOMs typically occurs after performing exercises one is not used to (i.e. unaccustomed exercise) and/or eccentric exercise (i.e. controlled lengthening of muscles) (1, 2, 3).
The most commonly cited potential causes for DOMs include lactate build-up in muscles, inflammation, muscle spasm, muscle/connective tissue damage, increased muscle temperature (1, 3).
There are other hypotheses for potential causes of DOMs involving electrolytes and neurotransmitters but we won’t go into those at this stage. As usual, it is likely that DOMs is a result of a complex interplay of factors, which makes it a difficult phenomenon to prevent and treat.
DOMs is not only unpleasant but it also leads to reduced athletic performance due to a temporary loss of strength and range of motion (3). Logically, it can also affect training, sleep and recovery.
How to prevent and reduce DOMs
There are many things that athletes do to prevent and/or reduce DOMs. Most of the commonly used strategies have some evidence behind them. However, in most cases there is no consensus when it comes to protocols: dose, timing post-exercise, duration, etc.
Most importantly, there is no consistency on how DOMs is measured. Some studies rely on reported muscle soreness, some on markers of muscle inflammation such as creatine kinase. Because inflammation is one of many physical manifestations of DOMs, in this case I think more value should be given to reported levels of soreness. Of course, this is a subjective measure that needs to be taken with a grain of salt. Moreover, there is always the chance that effects are due to placebo effect.
As seen before, caffeine can improve athletic performance thanks to its ability to reduce the perception of pain and/or effort due to its effect in blocking adenosine receptors. Likewise, caffeine consumed in the few days post-exercise at a dose of 5 mg/kg bodyweight may reduce DOMs (3).
Omega-3 fatty acids
The omega-3 fatty acids EPA and DHA have known anti-inflammatory effects and have been shown in some studies (most of them small) to reduce DOMs (3). Effective doses ranged from 1.8 to 3 grams daily (3).
The amino acid taurine may be effective in reducing DOMs either taken by itself or with BCAAs (3). Effective doses vary wildly (from 50 to 2000 mg) (3), leading me to believe there is something else going on in those positive results. For example, it could be the case that lower doses are needed for people who eat foods of animal origin, which are rich in the amino acid.
Polyphenols are chemical found in plants (i.e. phytochemicals) with antioxidant and anti-inflammatory properties (3). Polyphenols commonly used in interventions showing positive results in DOMs include pomegranate and cherry juice, however results seem to vary depending on type of exercise, dose, etc. (3).
Antioxidant supplements such as vitamin C and vitamin E are commonly used as means to prevent or treat DOMs (1, 4). However, there is currently no evidence that they actually reduce DOMs after exercise, even considering different supplementation timings post-exercise (6, 24, 48, 72 and 96 hours) (1, 4).
Even though stretching is important for reducing risk of injury, improving physical performance, etc., there is no evidence to suggest that it reduces DOMs significantly (2).
Having a massage after exercise may help prevent and reduce DOMs (5, 6, 7). It seems that the optimal time frame is 2-3 days after exercise than the day after (5, 7).
Wearing compression garments, either on the exercised limb(s) or on the whole body, may reduce DOMs and fatigue potentially by reducing swelling and oedema (i.e. fluid retention) (7).
Cold water immersion
Athletes have been using cold plunges for a while for recovery, however the popularity of this modality in the mainstream is fairly recent. To be effective, the temperature of the water should be under 15°C (7, 8), although this is difficult to control under DYI circumstances. Regardless, there is some evidence that cold water immersion can reduce DOMs, but no consensus on which protocol (i.e. timing after exercise, duration, temperature, etc.) is best (7, 8).
Contrast water therapy
This modality involves alternating cold (e.g. 8-15°C) and warm water (e.g. 38-45°C) (7, 8) to promote alternating vasoconstriction and vasodilation (7). Contrast water therapy seems to have an equivalent benefit on DOMs to cold water immersion (7, 8).
This is a tricky strategy to study, as it can look very differently depending on the athlete. The theory behind it is to perform some sort of low impact, low intensity physical activity that keeps the body moving without requiring much energy output nor muscle damage. Studies that have examined the effect of active recovery techniques on DOMs have found it can be beneficial but is not necessarily superior to other strategies (7, 8).
Although many athletes resort to traditional health modalities such as acupuncture, there is no evidence pointing at its benefits for DOMs (9).
Summary and recommendations
A number of supplement and recovery strategies can be used to prevent and reduce DOMs. Because DOMs is such a complex phenomenon, it is a good idea that athletes trial strategies separately to determine which one(s) work for them, preferably under the guidance of a sports dietitian.
- Ranchordas MK, Rogerson D, Soltani H, Costello JT. Antioxidants for preventing and reducing muscle soreness after exercise. Cochrane database Syst Rev. 2017 Dec;12(12):CD009789.
- Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane database Syst Rev. 2011 Jul;(7):CD004577.
- Kim J, Lee J. A review of nutritional intervention on delayed onset muscle soreness. Part I. J Exerc Rehabil. 2014 Dec;10(6):349–56.
- Torre MF, Martinez-Ferran M, Vallecillo N, Jiménez SL, Romero-Morales C, Pareja-Galeano H. Supplementation with Vitamins C and E and Exercise-Induced Delayed-Onset Muscle Soreness: A Systematic Review. Antioxidants (Basel, Switzerland). 2021 Feb;10(2).
- Guo J, Li L, Gong Y, Zhu R, Xu J, Zou J, et al. Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Front Physiol. 2017;8:747.
- Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. Vol. 6, BMJ open sport & exercise medicine. 2020. p. e000614.
- Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol. 2018;9:403.
- Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane database Syst Rev. 2012 Feb;2012(2):CD008262.
- Chang W-D, Chang N-J, Lin H-Y, Wu J-H. Effects of Acupuncture on Delayed-Onset Muscle Soreness: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020;2020:5864057.
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