Delayed-Onset Muscle Soreness


Delayed-onset muscle soreness (DOMS) is a condition in which pain, soreness, and stiffness is felt in muscles in the hours or days after performing unfamiliar or strenuous exercises, such as when a new exercise program is begun or a dramatic change is instituted in the intensity or duration of a current program. The symptoms associated with DOMS usually last from 24 to 72 hours after exercise. When DOMS occurs, usually only temporary damage has occurred within the particular muscles affected.


Also called muscle fever, DOMS is a condition caused by muscle damage from “eccentric” lengthening exercises—exercises that consist of the elongation (lengthening) of the muscles while under tension from an opposing and larger force. These types of exercises can be very strenuous to a person, and if not performed frequently, can also cause DOMS.

Medical researchers contend that mild muscle strain causes an injury related to DOMS. Extremely small-sized damage occurs to the muscle fibers, which causes pain and inflammation. Although the muscle, or muscles, has been damaged by the exercise, it normally repairs itself and the pain and soreness eventually go away.

Examples of muscles that may be involved in eccentric lengthening exercises are the biceps muscles and the triceps muscles in the arm. One example of an eccentric lengthening exercise is a bicep curl. The biceps muscle is worked as the hands hold weights (the counter force) while the elbow begins to move from being bent and near the shoulders to being straight and moved toward the upper legs, which elongates the biceps muscle. During tricep curls, the triceps muscle is exercised in the opposite manner. Running downhill, going down stairs, lowering weights, and downward motions in push-ups and squats are other examples of eccentric (lengthening contraction) exercises that can cause DOMS.


Causes and symptoms


DOMS is caused by performing an excessive number or an abnormally high intensity of any type of exercise; however, the use of eccentric contractions of muscles is the main cause of the condition. It is also caused by a person's being unaccustomed to performing such eccentric muscle contractions, which is why DOMS often occurs when people first begin to exercise. Bodybuilders and weightlifters are more prone to developing symptoms of DOMS because of the large amount of weight, repetitions, or sets they perform.

DOMS is a normal response to unusual exertion on the part of the muscles. The condition is part of the normal adaptation process that eventually causes the muscles to be able to withstand greater amounts of exercise (for greater stamina and strength).


The symptoms of DOMS are usually felt as a dull and aching pain in the affected muscles when they are stretched and placed under pressure. When touched, the muscle can be tender or feel inflamed. It can also feel stiff to the person affected by DOMS. When at rest (without exertion), the muscle feels fine, without any lingering symptoms of DOMS. DOMS symptoms show up after exercise is completed and are not associated with any symptoms that may show up during exercise.

In most situations, a person with DOMS feels the most pain and experiences the most symptoms during the first 24 hours after exercising. The intensity of symptoms can vary from individual to individual but usually peaks somewhere between 24 and 72 hours after exercise. Thereafter, the symptoms decrease in severity over the next few days.


People who initially experience DOMS will likely experience less symptoms the next time, and even fewer symptoms on the third round. Less muscle tissue is damaged on subsequent exercise periods, along with less soreness and a faster recovery time. This also coincides with the affected muscles getting stronger and better at adapting to a regular set of exercises. Thus, it is important to exercise all muscles at some point in a weekly exercise routine. A set of muscles should be exercised on one day, and the next day these muscles rested while different sets are exercised. The sets of muscles used and rested should be rotated and varied throughout the week so that all the muscle groups are exercised at some point and one particular set is not overworked. For example, work arm, chest, and leg muscles on day one, and then shoulders, abs, and back on day two.

A muscle, formally called biceps brachii, with two attachment points on the upper arm.
Concentric contraction—
Any activity of a muscle in which it shortens while under tension due to the application of a larger but opposing force.
Eccentric contraction—
Any activity of a muscle in which it lengthens while under tension due to the application of a larger but opposing force.
Isometric contraction—
Any activity of a muscle in which it neithershortens nor lengthenswhile under tension due to the application of a larger but opposing force.
Nonsteroidal anti-inflammatory drugs—
Any drug that provides fever-reducing (antipyretic) and pain-reducing (analgesic) benefits and, in high doses, anti-inflammatory effects.
A large muscle, formally called triceps brachii, with three attachment points that go from the back of the upper arm to the elbow.

Moderate soreness that does not prevent someone from continuing to exercise and perform daily activities is deemed acceptable. However, if symptoms of DOMS prevent one from going to work or to school, and accomplishing regular daily activities, then the intensity of the workout should be reduced to a more accommodating level.


Symptoms should disappear within about 72 hours on their own. If treatment is desired, there are several ways to relieve the symptoms of DOMS. For instance, cold therapy (such as ice packs, ice baths, cold water baths), hot baths, sports massage, and the use of saunas can help relieve the pain and soreness. Cold therapy is effective at reducing swelling, soreness, and pain when used immediately after exercise. In cold therapy, ice is applied to the injured tissue for the first 48 to 72 hours after the injury.


Some exercise experts, such as physiologists and athletic trainers, contend that light exercises for these muscles, such as flexibility and stretching exercises, yoga, walking, or swimming, actually relieve symptoms faster than resting them. Other medical experts contend that stretching is not an effective way to relieve muscle soreness. As of late, there is no medically or scientifically proven treatment that consistently relieves DOMS symptoms.


The discomfort that comes with DOMS is considered by physiologists to be a normal response to strenuous or new and unfamiliar exercises. DOMS is a symptom of the muscles adapting to such exercises, and it takes time for the muscles to become accustomed to them. The short-term discomfort brought by DOMS is actually a sign that the muscles are getting stronger and better at performing the exercise.

If symptoms of DOMS, especially pain, persist for more than seven days after proper treatment, patients should seek appropriate medical help through a family doctor or other such medical professional.


DOMS can be minimized, or even prevented, by beginning a new exercise program or routine slowly and increasing its intensity gradually over time. It is highly recommended to have a warm-up phase before any exercise workout and a cool-down phase after any such routine. Five to 10 minutes or more of easy exercise such as walking should also be included. Finish the warm-up and cool-down phases with gentle stretching exercises.

As a general guide, persons can follow the Ten Percent Rule, which states that the time and intensity of exercise should be increased by no more than 10% each week. Individuals prone to DOMS symptoms or those unfamiliar with the proper way to begin and perform exercises should get professional help from a personal trainer.



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American Association of Orthopaedic Surgeons, 9400 W Higgins Rd., Rosemont, IL, 60018, (847) 823-7186, (800) 626-6726, Fax: (847) 823-8125, customerservice@, .

American College of Sports Medicine, 401 W Michigan St., Indianapolis, IN, 46202-3233, (317) 6379200, Fax: (317) 634-7817, .

American Pain Society, 8735 W Higgins Rd., Ste. 300, Chicago, IL, 60631, (847) 375-4715, info@american, .

William A. Atkins, BB, BS, MBA

  This information is not a tool for self-diagnosis or a substitute for professional care.