DOMS treatments – What works and what doesn’t

Delayed onset muscle soreness, commonly known as DOMS, is that muscle pain that sets in a day or so after an intense workout. While it is not fully understood what causes it, and while there is no cure, there are some proven methods for DOMS pain relief. There are also some popular methods that don’t work. This article explains which is which. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

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In this article:

1. What is DOMS?

2. What causes DOMS?

3. DOMS pain relief

4. How we can help

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What is DOMS?

DOMS is the delayed onset muscle soreness you get after exercise – usually exercise that you're not used to. The fitter you are and the more used you are to exercise, the less likely you are to get DOMS.

DOMS doesn't start immediately – the clue is in the word “delayed”. It only starts to develop after about 24 hours, and then it often gets worse; it's usually at its worst after about two or three days. Research on people with DOMS has found that it can last for five to seven days.

I often get people telling me on social media, “Oh, I’ve had a massage and now I’ve got terrible DOMS! What can I do for it?” That is not DOMS. If you've got soreness from a massage, that is simply because your muscles have been bruised in the process.

Also, if your muscles are sore immediately or soon after exercise, it’s very likely an injury that's rearing its head and not DOMS.

What causes DOMS?

DOMS typically sets in after a heavy exercise session that involved eccentric muscle contractions. This is when you contract a muscle while it lengthens. Examples are slowly lowering a dumbbell after a bicep curl (biceps), slowly going down into a squat position (quads), and jumping and hopping (calf muscles when landing). Some runners will know that you can easily get DOMS from running downhill fast (quads and glutes).

People used to think DOMS is caused by a build-up of lactic acid in the muscles. But we now know that it definitely isn't. The lactic acid that forms in your muscles when you exercise is cleared out within an hour afterwards, even if you just go plonk yourself down on the couch without even doing a cool-down routine.

However, the people in the lab coats still haven’t quite figured out how DOMS is caused, because it's about subtle changes that happen in our bodies.

Some of the suggested explanations involve the well-understood concept of “micro-damage”.

Exercise causes micro-damage to various types of tissue in our bodies, including in our muscles, and that micro-damage is then repaired to a more robust state than before. This is how exercise makes us stronger.

Some think that DOMS happens when the micro-damage in the muscles goes just a little bit too far. Others think that DOMS might be caused by micro-damage to the fascia – the white, sinewy sheaths that envelop our muscles. And others think it may be a combination of micro-damage to the muscles and the fascia.

Personally, I think it’s a combination of the above, plus perhaps some irritation of the nerve endings in the muscles.

DOMS pain relief

First, we’ll look a things that may work, followed by things that won’t work, some of which may actually be detrimental to your recovery.

Compression garments

There is some evidence that compression may decrease the intensity of DOMS.

They're not entirely sure why yet, but it seems that compression garments can help with lymph drainage. Lymph glands help to get rid of the chemicals that build up in our muscles when there is damage.

It may also be thanks to the physical pressure of the compression garment. We know that low-level pressure can desensitise areas that feel painful.

A compression garment has to be firm, but comfortably firm. Too tight, and you get the opposite effect; too loose, and you don't really get the compression effect.

Here are some options on Amazon:

DOMS massage?

Massage is over-hyped as a silver bullet for healing many injuries, but in this instance, research has shown that it is actually quite a useful adjunct for recovery and that it can decrease DOMS.

The pain caused by DOMS means that the pain receptors in our muscles are now on high alert – it’s part of our body’s survival mechanism – and at the slightest provocation they will send alarm signals to the brain to create pain sensations.

The constant, gentle pressure from a massage (if it is done right) desensitises the pain receptors and causes them to calm down.

DOMS not only causes muscle soreness but also a decrease in muscle function, i.e. the muscle can’t contract as well as usual. Despite massage decreasing your pain, research shows that it doesn't help to restore your function more quickly. So, for instance, you can't jump better within a few hours or a few days after you’ve had a massage versus if you hadn’t had one.

What about foam rolling?

Foam rolling is basically a form of self-massage, so for the same reasons as above, foam rolling has been shown to decrease DOMS pain.

Here are some foam rolling options on Amazon:

Anti-inflammatories

There's a prevailing mindset that whenever somebody has pain, either from an injury or from DOMS, they should swallow some tablets, because the quicker they can get the pain to go down and the quicker they can get the inflammation to calm, the quicker they will recover.

Inflammation has been and is being unduly demonised. It is an important part of the healing process of any injury and of the micro-damage caused by DOMS.

If you have an injury or micro-damage, there are damaged cells that need to be absorbed and there are chemicals involved in the healing process that need to be moved around. Guess what is responsible for this? The inflammatory cells.

Excessive inflammation in a wound isn't good, but normal inflammation that is a part of the healing process and a part of DOMS is good, and it's needed. So, don’t take anti-inflammatories like Ibuprofen, Voltaren, or Naproxen for DOMS; you're messing with the healing response that repairs the micro-damage to make you stronger than before.

If you feel the DOMS pain is overwhelming, speak to your GP about other types of medication, like paracetamol.

Ice baths

We sometimes marvel at the bravery and dedication of professional athletes who immerse themselves in ice baths after a hard training session, race, or match. It is supposed to speed up their recovery.

The research into the effect of cold therapy on DOMS has produced some contradictory results, but a recent meta-analysis of the combined results of 32 studies showed that it may offer some benefit.

However, this does not mean that you should start doing ice baths after every training session. In fact, there is good evidence that if you get into that ice bath within an hour or so after you've done your exercise, you may actually deny your body the benefit of the exercise.

This is because ice, like the anti-inflammatory drugs I’ve discussed above, decreases the inflammation – at least not for as long as the medication does.

Does this mean that ice baths should be avoided? No. They can be useful (for instance if you're competing and recovery is your main aim rather than strength gains), but you have to use them with discretion. You can find more information about when and how to use ice baths here.

DOMS stretching

It’s strange, the guilt trip some people go on when they get DOMS. I’ve often had patients say, “Ah, I’m really bad. I never stretch after exercise and now I’ve got this DOMS!” But they forget that they haven't stretched after exercise for the last 20 years! So, the fact that they've now got DOMS is likely not because they've not been stretching.

The research shows that you can stretch until the cows come home, it doesn't help to decrease the pain of DOMS, and it doesn't restore your muscle function more quickly.

If stretching makes you feel more comfortable because your muscles feel stiff and you feel more flexible and mobile afterwards, by all means go for it. It's just that it doesn't help for the pain or anything else that you feel due to DOMS specifically.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References

1. Gregory E. P. Pearcey, David J. Bradbury-Squires, Jon-Erik Kawamoto, Eric J. Drinkwater, David G. Behm, Duane C. Button; Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. J Athl Train 1 January 2015; 50 (1): 5–13.

2. Guo, J., et al. (2017). "Massage alleviates delayed onset muscle soreness after strenuous exercise: a systematic review and meta-analysis." Frontiers in Physiology 8: 747.

3. Nahon, Roberto Lohn, Jaqueline Santos Silva Lopes, and Aníbal Monteiro de Magalhães Neto. "Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis." Physical Therapy in Sport 52 (2021): 1-12.