If you have ever started a new class, gone back to the gym after a break or run further than usual, you probably know the feeling: legs that are fine the next morning, then stiff and tender the day after. This is delayed onset muscle soreness, or DOMS. It is uncomfortable, but it is normal and it usually settles on its own. Knowing what it is, and what actually helps, makes it easier to keep training.

This article is general information, not a diagnosis. If you are unsure whether your pain is soreness or an injury, see your GP.

What Is DOMS?

DOMS is the aching, tender, stiff feeling in muscles that builds up in the days after exercise your body is not used to. It typically starts within a day, peaks somewhere between 24 and 72 hours, and settles within about a week [1]. Sore muscles may feel weaker and move through a smaller range for a few days, which is worth keeping in mind before your next hard session [1].

The exact cause is still debated. Researchers now think it comes from a mix of small-scale strain in the muscle and the surrounding connective tissue, and the body's normal inflammatory and repair response that follows [1].

Why New Exercise Makes You Sore

Lengthening movements. Soreness is most likely after eccentric work, where a muscle is working while it lengthens: lowering a weight, walking or running downhill, or the lowering phase of a squat [1].

Doing more than usual. A jump in intensity or duration, a new type of exercise, or returning after time off are common triggers [1].

Your body adapts. After one bout of a new exercise, the same exercise usually causes less muscle damage and soreness the next time. This is known as the repeated bout effect, and it is one reason gradual progression works so well [2].

Soreness or Injury? Knowing the Difference

DOMS usually feels like a dull, general ache across a muscle, on both sides if you trained both sides, and it eases as you warm up and move. An injury tends to be different: pain that started suddenly during exercise, is sharp or focused in one spot, comes with swelling or bruising, or stops you using the limb normally. If your pain sounds more like the second description, get it checked rather than training through it.

What Does the Evidence Say About Recovery?

Many recovery methods are promoted, but the research behind them varies a great deal. Here is an honest summary.

  • Massage. Across several reviews, massage has the most consistent evidence for reducing how sore people feel after hard exercise [3][4]. However, the benefit is modest, the studies are mostly small and varied, and the largest review found massage did not improve strength, sprint, jump or endurance performance [5]. It may help you feel better; it is not a shortcut to fitness.
  • Active recovery. Light, easy movement on sore days showed a benefit for soreness in pooled research [3], and exercise itself can ease DOMS pain, although that relief tends to be temporary [1].
  • Stretching. A Cochrane review found that stretching before or after exercise makes only a very small difference to later soreness, too small to matter for most people [6]. Stretch if you enjoy it or it helps your mobility, but do not count on it to prevent DOMS.
  • Cupping. Some trials in athletes report less pain and better movement, but most were at high or unclear risk of bias, and the reviewers concluded no firm recommendation for or against cupping could be made [7].
  • Sleep, food and rest days. Good sleep, regular meals and planned easier days are the everyday foundations of recovery, and they cost nothing.

How Hands-On Treatment Can Fit In

The best-supported way to reduce DOMS over time is the simplest: build up gradually, so your body adapts between sessions [2]. Hands-on treatment can sit alongside that. Many people find it eases tightness and helps them feel ready to train again.

  • Sports massage focuses on the muscles you use most in your training, and can be timed around your sessions or events.
  • Deep tissue massage uses firmer, sustained pressure for tightness that has built up over weeks of training.
  • Cupping therapy is sometimes used alongside massage. Some people enjoy how it feels, though the research is still limited [7].
  • Training and load advice. Our therapist's background in exercise and sports science means you can talk through how to progress your training sensibly. You can read more about her qualifications.

Practical Tips

  • Increase gradually. Add weight, distance or new exercises a little at a time, especially lowering and downhill work [1][2].
  • Keep moving gently. A walk, an easy ride or a light swim on sore days often feels better than complete rest [3].
  • Ease off for a day or two. If you are very sore, lower the intensity rather than pushing through, as sore muscles may not work at their usual level [1].
  • Look after the basics. Sleep, eat regularly and drink enough water, particularly in hot weather.

When to See a Doctor First

Ordinary DOMS does not need medical care, but some symptoms do. See your GP promptly if you have:

  • sudden, sharp pain or a "pop" during exercise;
  • significant swelling or bruising;
  • trouble bearing weight or using the limb;
  • pain that keeps getting worse after 72 hours, or lasts beyond about a week.

Seek urgent medical care, or call 000, if you notice very dark, cola-coloured urine, or extreme muscle pain, swelling or weakness after unusually hard exercise. These can be signs of rhabdomyolysis, a rare but serious breakdown of muscle that can affect the kidneys [8].

What to Expect at Your First Appointment

Your first session starts with a conversation about your training, your symptoms and your health history, followed by a check of how you move. Treatment is tailored to what we find, and you will leave with practical ideas for managing your training load between sessions.

Remedial and sports massage may be claimable through your private health fund extras cover, and we offer on-the-spot claiming with HICAPS. Have a question first? Visit our FAQ, or when you are ready, book online.

References

  1. Cheung K, Hume PA, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine. 2003;33(2):145–164. doi:10.2165/00007256-200333020-00005
  2. McHugh MP. Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. Scandinavian Journal of Medicine & Science in Sports. 2003;13(2):88–97. doi:10.1034/j.1600-0838.2003.02477.x
  3. Dupuy O, Douzi W, Theurot D, et al. 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. Frontiers in Physiology. 2018;9:403. doi:10.3389/fphys.2018.00403
  4. Guo J, Li L, Gong Y, et al. Massage alleviates delayed onset muscle soreness after strenuous exercise: a systematic review and meta-analysis. Frontiers in Physiology. 2017;8:747. doi:10.3389/fphys.2017.00747
  5. Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine. 2020;6(1):e000614. doi:10.1136/bmjsem-2019-000614
  6. Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews. 2011;(7):CD004577. doi:10.1002/14651858.CD004577.pub3
  7. Bridgett R, Klose P, Duffield R, et al. Effects of cupping therapy in amateur and professional athletes: systematic review of randomized controlled trials. Journal of Alternative and Complementary Medicine. 2018;24(3):208–219. doi:10.1089/acm.2017.0191
  8. Kim J, Lee J, Kim S, et al. Exercise-induced rhabdomyolysis mechanisms and prevention: a literature review. Journal of Sport and Health Science. 2016;5(3):324–333. doi:10.1016/j.jshs.2015.01.012