Oh the DOMS. As a runner, we’ve all experienced delayed onset muscles soreness (DOMS), the soreness that occurs a day or two after exercise. It’s a normal part of training and racing and, despite being painful, we somewhat secretly enjoy it.

DOMS is different than the acute pain that occurs during exercise. The DOMS typically sets in 12-to-24 hours after physical activity, with the greatest pain usually around 24-to-72 hours post-exercise. DOMS is characterized by: swelling of the limbs, stiffness of the joints, muscle tenderness to the touch, reduction in muscle strength, and elevated creatine kinase (CK) enzyme in the blood (a signal of muscle damage).

So, what causes the pain associated with the DOMS? Why do we experience more soreness two days after exercise?

The main cause of the DOMS is microscopic tears in the muscle fibers. As the muscle fibers slide against each other to produce tension, tearing can occur, especially during lengthening (eccentric) contractions. Think of running downhill. The muscles are lengthening, but still producing tension. This causes greater tearing of the muscle fibers, resulting in more soreness post-exercise. Tearing the muscle fibers, or sarcomeres, sounds like something bad but really it’s how muscular strength improves. To get stronger, the muscle fibers need stress placed on them to the point where they start to break down. Then, in response to the damage, the muscle fibers are repaired and built back up stronger than they were before the damage. So, although muscle damage sounds like a bad thing, it’s an important part of how we improve our fitness. Post-exercise, the muscle damage sets off an inflammatory response, resulting in swelling and tenderness in the area. Most of the symptoms of the DOMS are a result of the inflammatory response, not the actual muscle damage itself.

One common misconception is that muscle soreness is due to remaining lactic acid in the muscles. This is not true. Although lactate levels rise during intense exercise and lactate accumulation is associated with fatigue during exercise, lactate levels return to normal within 60-minutes post-exercise. The DOMS peaks around 24-to-48 hours post-exercise and is not a result of lactic acid in the muscles.

A few years ago I ran the TransRockies Run, a six-day stage race covering 120 miles in the Colorado Rockies. Much of the trail is rocky singletrack through the mountains, meaning lots of ascending and descending. Since I’d never done a stage race before and running downhill tends to beat me up a bit, I reviewed some (read: A LOT) scientific journal articles on the DOMS. As I dove further into the research literature, I learned that besides rest and time, there really isn’t much I could do to speed up the healing process. What I did learn, though, is that there are several treatment modalities that can reduce the symptoms (i.e. pain) associated with the DOMS. Before I go into these treatments, I do want to point out that by reducing that pain and swelling associated with the DOMS, you are in essence delaying the healing of the muscle fibers. It’s kind of like when your body has a fever. It’s sometimes best to let the fever it run its course to naturally kill off any viruses inside the body. The same with treating the symptoms of the DOMS: by reducing the pain and swelling associated with inflammation, the repair of the torn muscle fibers is delayed.

This begs the question, in terms of racing and training, is reducing muscle soreness or allowing the muscle fibers to heal the better alternative? I think the answer depends. For me, when I was racing TransRockies, I wanted my legs to feel better since I had multiple days of racing. I chose to treat the symptoms of the DOMS knowing that I might be delaying the full healing process. I think, in that type of scenario, I probably raced better each day, even if it was all in my head. Getting to the starting line a little less sore each day a little was beneficial and gave me confidence going into the day’s race.

Treatment Modalities for the DOMS

From my review of the current literature, there are many treatment modalities for post-exercise muscle soreness. Most of the studies evaluated one or two types of treatment on objective markers of muscle damage, such as creatine kinase and muscle function, as well as subjective feelings of muscle soreness. The most common treatments identified were: ice, compression, massage, non-steroidal anti-inflammatory drugs, and active recovery. Although none of these treatments can actually speed up the healing process, they can potentially alleviate the symptoms. A lot of the recommendations for these treatment modalities are from anecdotal evidence. Personally, after each stage at the TransRockies Run (TRR), I did a bit of each. Here is what I found:

Icing

Immersing in an ice bath or cold body of water for 15 to 20 minutes after muscle-damaging exercise has been thought to reduce soft-tissue swelling and soreness. Many elite athletes use ice baths after hard workouts to help reduce pain and prevent DOMS in the days following. At TRR, after I had taken care of my post-race re-fueling, I would find the nearest creek or lake to ice my legs. Up in the mountains, most of the streams are from snow runoff and are ice cold. I would slowly lower myself into the stream and try to spend 15 minutes with my legs fully immersed. Sometimes it was so cold that I couldn’t stay in that long. There aren’t further benefits from icing longer than 15 to 20 minutes, so if you stay in for longer, well then you’re just crazy.

Compression

Wearing tight compression garments after exercise is popular among athletes for recovery. Most of the studies on compression tights/socks doesn’t show any real benefit in terms of muscle soreness and healing. I agree with this. However, I do like the feeling of tight compression socks or tights after I just barreled down a mountain for a couple hours. They make my legs feel better. After icing at TRR, I would stiffly make my way to my tent and put on compression wear. The effect of compression may be all in my head, but if it helps in any way, there is no harm in trying it. One cautionary note is, if the compression is too tight, it may impede blood flow, which can cause more damage.

Massage

A light massage following exercise can get the fluids moving and bring blood flow to the damaged muscles and tissues, helping to reduce soreness. Many athletes use massage in the days following a hard workout or a race to reduce the pain and tenderness and help facilitate recovery. The best part of TRR is that massage therapists travel from stage to stage with the runners. I got a massage every day and it was awesome! I usually only received 15 minutes, but it always made me feel a bit better. Like the other treatments, most studies don’t show a benefit of massage in reducing markers of muscle damage. However, there is a lot of anecdotal evidence pointing to the effectiveness of massage in relieving post-exercise muscle soreness. Another personal experience I recently had with massage was late last fall. I had injured my hip after being hit by a car while riding my bike. As part of my therapy months later, I was getting some soft tissue massage work. Since it was my left hip that was hurt, they typically only massaged my left leg. Once day in the fall, I ran up a mountain in Bend called South Sister. Not a huge endeavor, but it involves a couple miles of hard hiking/running up and some steep downhill running. Since I was just back from injury I hadn’t been running much, which resulted in my legs being very sore afterwards. Since I was still getting physical therapy, I went in a couple days later and got massage on my left leg. And yep, the next couple days, the pain in my left leg was so much less than my right leg. It felt really bizarre, but also showed me that massage really can make a difference in soreness. Self-massage tools, such as foam rollers, can also be used if you aren’t lucky enough to have a massage therapist travel with you.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Better known as Advil or ibuprofen, NSAIDs can also be used to help relieve some of the swelling and pain associated with muscles soreness. I tend to use this as my last resort or when I’m not planning to run. Although it appears that taking NSAIDs is safe to use acutely, there is some concern over long-term use or use after extreme muscle damage. NSAIDs definitely reduce swelling and inflammation, but I usually try to exhaust the other recovery options before resorting to them. There have been times a day or two after racing that I’ve needed to take NSAIDs so I could return to work. Once I had to teach a CPR class on a Monday following a weekend 50-miler. I definitely took Advil so I was able to demonstrate CPR on a manikin without looking like an 80-year-old man.

Active Recovery

Active recovery is just like it sounds, it’s getting your butt off the couch and moving. Sometimes the best treatment is actually more running. It’s usually pretty painful to start, but after a few minutes, when the blood gets flowing and the muscles get warmed up, it feels a bit better. When I’m really sore from running, I like to walk instead. At TRR, I always felt a bit better (muscle soreness-wise anyway) after the first 10 to 15 minutes. Up until then, I was stiff and every movement hurt. Once I got going, my legs loosened up and felt much better. With extreme muscle damage, however, active recovery can be too much. If you feel pain other than soreness, it can mean that the muscles are not ready yet. Rest is probably the better alternative.

Again, these are just some of the more popular treatment modalities for the DOMS. Most of them have some scientific evidence supporting their effectiveness for reducing symptoms associated with muscle damage, but not for improving muscle healing. Many of these treatment modalities have a lot of anecdotal evidence showing their effectiveness. I think the best way to determine what works is to try a handful of them post-exercise. See what you like best.

The best treatment for the DOMS is probably prevention. This can be accomplished by gradual progression of volume and/or intensity while running. Right. Most runners I know don’t do this. I’m guilty of going out for a two or three-hour run the moment the weather turns nice. It’s generally not the smartest move since I usually can’t walk the next day, but I enjoy the feeling. I think the key is finding a balance and knowing how much your body can handle. It’s fine to do something crazy every once in awhile as long as you take proper care of yourself after. The DOMS are a normal part of life for an ultrarunner and sometimes it feels good to embrace the pain. That’s probably not normal, but again, neither are we.

Call for Comments (from Meghan)

Okay, let’s hear your best DOMS stories. When have you been absolutely crippled by a long run or race? We’re talking walk-down-the-stairs-backward pain here.

For those of you with extended experiences with the DOMS and preventing it, what modalities discussed by Stephanie have you found to be most effective in relieving your pain?