Understanding and Preventing Delayed Onset Muscle Soreness (DOMS)

DOMS Featured

Every single person who has ever endeavored to take on a new exercise program learned what delayed onset muscle soreness (DOMS) feels like, even if they don’t understand why it occurs. Even conditioned athletes and seasoned fitness enthusiasts are likely to experience DOMS on the regular. Personal trainers may come to find that some clients are affected more than others, as are different muscle groups, or perhaps different kinds of activities prove to elicit more or less DOMS. What is really happening when we feel sore for several days after a workout and is there anything we can do to recover more quickly or mitigate this sometimes unpleasant experience?

What is DOMS?

Delayed onset muscle soreness is the experience of tenderness or pain in a muscle that was challenged or taxed occurring within 12 to 96 hours of an activity. While this is a temporary condition, it can often be debilitating for some people, and certainly can discourage beginners from returning to a workout when they quite literally cannot walk the next day.

For most people, DOMS is most likely to occur when:

  • Beginning a new exercise program
  • Re-starting a program after an extended break
  • Incorporating a brand new movement into your routine with which your body is unaccustomed
  • When focusing on eccentric lifts, which are known to result in more soreness
  • Engaging in an endurance activity longer than normal

This baffling experience is actually not fully understood by scientists. What they do know is that a number of clinical measurements are affected during the experience of DOMS. These include “elevations in plasma enzymes, creatine kinase, myoglobinemia (condition in which myoglobin–an oxygen-binding iron protein–is present in higher than normal amounts), and abnormal muscle histology and ultrastructure; exertional rhabdomyolysis appears to be the extreme form of DOMS,” 1.

The theories of what may be happening include:

1) Structural damage: The high tension created as in the lengthening of a muscle under resistance (such as in the eccentric phase of a contraction) creates tears in the muscle fibers that, similar to other injuries, need to be repaired and hence, protected from further injury2. The experience of pain itself signals to our bodies that we need to protect that area or body part to prevent further injury. This makes sense since we know muscle recovery is important for muscle growth, and soreness may be a necessary signal allowing that recovery to take place.

2) Muscle fiber necrosis and metabolic damage: The damage to the muscle cell membrane damage leads to disruption of Ca++ homeostasis in the injured fibers; cell death will then peak about two days post-exercise. How might this explain pain? We need calcium ions for muscle contraction. If calcium can’t enter the cell because of membrane damage, and the cell dies.2 Simply, when a cell dies, an inflammatory response is triggered in order to promote healing. While this is also a mysterious, not-well-understood process, suffice it to say the body sends out “danger signals” when inflammation occurs. Pain is one of those signals.

This is not to say that inflammation itself is the cause of the pain. On the contrary, the inflammation is occurring in response to the “something” that caused the pain and is a protective mechanism. This is why taking any anti-inflammatory drugs while effective in reducing the experience of pain, may also slow the important work of muscle recovery.

3) Nerve irritation: Without getting too technical, the byproducts of post-exercise repair activity accumulate in the interstitium (the space between cells and tissue), which then irritate free nerve endings of the muscle’s sensory neurons. This can potentially contribute to the experience of DOMS.

Stretching Principles

Why might some people experience more DOMS than others?


The gene alpha-actinin-3 or ACTN3 is present in all of us, but has three different variations (of which you will have one). One of those variations fails to produce the ACTN3 protein that is linked to speed, power, and strength, and instead produces more ACTN2 protein that is linked to muscle endurance activities. It’s hypothesized that those in the latter group will have a harder time building and recovering muscle tissue, and hence, may experience DOMS more severely than the ACTN3 protein synthesizers.

Another gene, Myosin Light Chain Kinase gene, is expressed in one of two forms—homozygote CC or heterozygote CA, the former of which was found to be linked in decreased muscle power following a marathon. Researchers hypothesized that decreased muscle power was indicative of more muscle damage, supported by the higher levels of creatine kinase in their blood. Subjective scores were not taken, but DOMS was inferred to be higher because of the increased creatine kinase.


Women have higher levels of estrogen and subsequently lower levels of creatine kinase. The research is mixed but some have concluded that women with high estrogen will not experience the same degree of muscle damage, and therefore experience less soreness.3 However, others postulate that they actually do experience as much muscle damage but just recover more quickly.

What can we do about soreness?

Like anything else with unsettled science, the ideas and answers here vary, and I advocate for trying it all to see what works. Some of the suggested approaches include:

What doesn’t work:

  • not moving at all (tempting, but you will likely reduce blood flow, slow healing, and feel more sore and stiff)
  • going right back at it like nothing (see gentle active recovery above!)
  • stretching (that’s right, static stretching will not make the pain go away)
  • fixating and fearing it (mind over matter—trust your body will heal and focus on what you can do)

Advising clients

Firstly, being properly prepared for the possibility of DOMS and working out smart ensures your clients don’t overdo it.

With first-time clients especially, encourage them to be well hydrated the day before their first workout. Don’t try to “wow” them with what a tough trainer you are the very first session and scare them away from exercise forever. Ease them into an introductory workout in the muscle endurance training phase, beginning with a proper warm-up and ending with an adequate cool-down (to includes foam-rolling, found to be especially helpful in reducing DOMS when performed post-workout)4,5.

Of all the suggested techniques, foam-rolling appears to have the most merit and efficacy. A 2015 study took a very close look at this and experimented with athletes who served as their own controls. They found that foam rolling significantly reduce soreness and improved speed, power, and muscular endurance scores when employed post-exercise.

Above all, encourage clients who are scared or put off by the experience, and contrarily, remind them they don’t always have to be sore to know they got a good workout. While eccentric motions are more likely to produce DOMS and also build strength more efficiently, the degree of soreness one experiences does not have a linear relationship with strength and muscle growth.

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1. Cheung, K., Hume, P.A. & Maxwell, L. Delayed Onset Muscle Soreness. Sports Med 33, 145–164 (2003). https://doi.org/10.2165/00007256-200333020-00005

2. Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529-38. PMID: 6392811.www.ncbi.nlm.nih.gov/pmc/articles/PMC3094097/

3. Carter, A., J. Dibridge, and AC Hackney. “Influence of estrogen on markers of muscle tissue damage following eccentric exercise.” (n.d.): n. pag. PubMed. Web. 10 May 2017.

4. Pearcey, G. E., Bradbury-Squires, D. J., Kawamoto, J. E., Drinkwater, E. J., Behm, D. G., & Button, D. C. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of athletic training50(1), 5-13.

5. Healey, K.C., Hatfield, D.L., Blanpied, P., Dorfman, L.R., and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research. 28(1). 61–68


NFPT Publisher Michele Rogers, MA, NFPT-CPT, manages and coordinates educational blogs and social media content for NFPT. She’s been a personal trainer for 20 years with a lifetime passion for all things health and fitness. Her mission is to raise kinesthetic awareness and nurture a mind-body connection. After battling chronic lower back pain and becoming a parent, Michele aims her training approach to emphasize corrective exercise and pain resolution. She holds a master’s degree in applied health psychology from Northern Arizona University. Follow Michele on Instagram.