Injury Prevention

Delayed-Onset Muscle Soreness (DOMS) Symptoms, Treatment And Prevention

Delayed-onset muscle soreness can be intense. Learn what’s normal and how to minimize the pain.

Delayed-onset muscle soreness can be intense. Learn what’s normal and how to minimize the pain.

The Symptoms

General muscle soreness, especially the day after an intense workout or starting a new activity. However, delayed-onset muscle soreness, a specific and serious condition, can be incredibly painful.

What’s Going On In There?

When muscle tissue is injured by exercise, the fibers tear. Ideally, in a day or two the fibers repair themselves and are stronger than before. This is the basis of building muscle, and normal muscle soreness after a workout—especially during the first few weeks of intensified activity—is to be expected.

If your muscle soreness is intense and doesn’t begin until 24 to 48 hours after the muscle injury, however, you may have a serious condition called delayed-onset muscle soreness (DOMS). It can happen when you apply an excessive loading force to muscle cells. It’s important to distinguish the symptoms of DOMS from the everyday aches and pains that come after hard exercise. This pain can
 be severe.

Why is DOMS serious? When muscle tissue is injured, a process called rhabdomyolysis causes it to release a protein called myoglobin. We all have a bit of myoglobin released after hard athletic events, and some of it is processed by the kidneys. Several studies that looked at healthy athletes after marathons found mild to moderate amounts of myoglobin in their urine, a condition called myoglobinuria. When the muscle injury is more serious, however, the amount
 of myoglobin can be quite large. The urine can be a dark color,
 and in some cases kidney damage and even kidney failure can result.

RELATED: The End Of Injury

Fix It

Normal postworkout soreness:
Hydrate, fuel up, sleep well. Give your body the best opportunity to repair muscle damage and come back strong. Drink fluids until your urine is clear, eat smart, and get a great night’s sleep. The best restoration and recovery happen while you sleep.

Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help alleviate soreness.

Delayed-onset muscle soreness:
Hydrate and see your doctor. If you suspect you have DOMS, start drinking lots of fluids and call your doctor. A sports doctor is a better 
bet than a primary care physician because he or she will have more experience identifying DOMS.

Prevent It

Hydrate. Proper hydration before engaging in any exercise or athletic event can help ease common post-exercise muscle soreness and, more important, prevent DOMS. Factors to consider: temperature and humidity level (Vegas versus Seattle), the intensity of effort you plan on reaching (race versus easy run), and your overall health during the previous week (even a mild stomach bug or case of diarrhea can dehydrate you). Drink enough fluids to keep your urine running clear.

RELATED: Muscle Cramping 101

When To Call A Doctor

If your muscle pain and soreness are severe
 and seemed to come on 24 to 48 hours after hard activity, and your urine is dark, see your doctor immediately.

Your doctor will do a urinalysis to check your myoglobin level and, 
if necessary, perform blood tests to determine if there’s been any kidney damage.

DOMS is much more common than most athletes realize. Why some athletes experience DOMS and others don’t is not yet understood, but one of the most important factors is dehydration before, during and after intense activity. However, regardless of their hydration status, some athletes just seem prone to developing DOMS and get it often, probably because of biological and genetic factors affecting their muscle tissue.

The good news: DOMS is usually preventable with education and smart pre-exercise behavior.

More injury prevention advice.

New York City sports medicine specialist Jordan D. Metzl, M.D. is a 29-time marathon finisher and 10-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.