No pain, no gain
The relationship between DOMS (Delayed Onset Muscle Soreness) and muscle growth
The myth that you need to be sore after your workout for it to be effective, has long been present in the fitness industry. And the lack of muscle pain after an intense training session can truly be discouraging. The occurrence of DOMS is most present in novice trainees or after longer periods of inactivity. It is also common when a new training stimulus such as a new exercise or activity has been introduced. For example, you might be going to the gym five times a week, but you go on a 5 km run and experience the worst DOMS in your legs even though you regularly train them. However, you might have noticed that the pain associated with DOMS tend to decrease as you stick to a workout routine. This explains why we experience less and less soreness in subsequent sessions on our fitness journey. But do we need to worry about it at all? DOMS has been an extensively researched topic in exercise science, and all evidence points to the fact that DOMS are not necessary to build muscle or achieve other fitness-related goals. On the other hand, they are neither detrimental to your progress, given that your recovery and sleep is sufficient.
However, it can be beneficial to learn more about this phenomenon to better understand our bodies and its reactions to exercise. And what’s more important, instead of obsessing over DOMS, you will be able to objectively assess the effectiveness of your training sessions, thus becoming a better athlete.
What are DOMS?
Delayed onset muscle soreness (DOMS) is a feeling of discomfort/pain that occurs 1 to 2 days after training. It can start 6-8 hours after strenuous activity, but it usually peaks at 48 hours post-exercise. The soreness is most present at the muscle/tendon junction, and it spreads throughout the muscle.[1] If you have experienced DOMS, you might have experienced a wide range of symptoms. Sometimes the muscles can feel a bit tender, other times it is debilitating severe pain that inhibits daily activities such as sitting down on the toilet or walking up the stairs. There has been multiple theories and hypothesis regarding the cause of DOMS, including one that attributed DOMS to the buildup of lactic acid, but it has since been debunked. Nowadays, the scientific consensus is that DOMS are a culmination of six different mechanisms: starting with microtrauma to the muscles and the surrounding connective tissues, followed by an inflammatory process.
DOMS and athletic performance
Because the feeling of pain can trigger a series of compensatory mechanisms such as reduction in joint range of motion, or alterations of muscle sequencing and recruitment, further stress could be put on tendons and ligaments if we return to exercise too quickly. In the worst-case scenario it might even lead to a more serious injury. For this reason, treatment strategies have been thoroughly studied to restore muscle function as fast as possible and enable athletes to return to exercise quickly. It seems that apart from massage therapy, further exercise seems to alleviate the symptoms of DOMS, however, the intensity and duration should be lower than the DOMS-inducing session.[2] Obviously, as an average gym-goer you should probably take a break from intense exercise if you experience severe DOMS. Instead, go on a walk or do other light cardio activities, such as biking or swimming. If you really want to train, you can always target body parts that are less affected by DOMS, for example executing your training sessions according to an upper and lower body split.
The greater the DOMS the more muscle you’re building.
Sadly, it’s not that simple. To gain muscle, you need three components: 1. mechanical tension, metabolic stress and muscle damage. [3] Mechanical tension refers to the amount of force/tension within the muscle fibers in response to stimulus. In very simple terms, the more weight you’re lifting, the bigger the mechanical tension will be. Metabolic stress, more commonly known as “time under tension” refers to an anaerobe state in which metabolites accumulate (for example lactic acid). Lastly, muscle damage can lead to hypertrophy as a response mechanism to exercise-induced tears in the muscle tissue. Since DOMS are a result of exercise-induced muscle damage, it would make sense to seek them out in order to build muscle. However, some studies point out that progressive mechanical tension overload is considered more important in terms of muscle growth, especially when it comes to training to failure. Furthermore, DOMS can be manipulated, since it’s been shown that eccentric activities tend to cause more DOMS than concentric. Examples of eccentric activities include running of walking downhill, lowering a barbell, or the lowering phase of a pull-up.
Another study in the Strength and Conditioning Journal established that we can even experience DOMS without presenting local signs of inflammation (which is a clear sign of exercise-induced muscle damage), thus not contributing to hypertrophy. The same can be said about long distance aerobic activities such as long distance running or cycling. These activities tend to cause significant DOMS (for example running a marathon) but these activities are generally not associated with significant muscle growth.
Furthermore, Schoenfeld argues that training with DOMS might interfere with strength and as a result lead to less intensity during training. Since intensity is needed for maximizing hypertrophy, DOMS can potentially be detrimental to muscle gain.
Some studies have also pointed out that soreness after a workout is different for everybody. Some people are generally more prone to DOMS than others. I can anecdotally testify this, since I’ve trained many people in my career as a personal trainer and some clients reported to be sore after almost every workout, while other rarely experienced DOMS even if their RPE-s (rate of perceived exertion) were similar. Research shows a correlation between DOMS and the alpha-actinin-3 protein (ACTN3) gene, which determines muscle composition. This gene can be found in fast-twitch muscle fibers, which are responsible for speed and power. Fast-twitch muscle fibers are utilized in weightlifting as opposed to slow-twitch muscle fibers that are more important in endurance-based activities such as running or biking. Scientists found a connection that people that produce more ACTN3 proteins (and are better at power and speed) experience less muscle damage and consequently less DOMS. There is also some evidence that higher estrogen levels can decrease the level of DOMS one experiences, which means that female athletes might experience less DOMS than males.
Prevention and Treatment
Although DOMS are completely natural and should get less intense gradually, if the muscle damage was so significant that symptoms such as pain or swelling make everyday activities cumbersome or inhibit your sleep, you might look into prevention and treatment.
According to a 2003 study non-steroid anti-inflammatory drugs such as ibuprofen or aspirin can help with the inflammation caused by DOMS. The application of diclofenac or ketoprofen, which are dual-action NSAID-s have shown even greater potential, but they might be subject to prescriptions by a medical provider.
Regarding more conventional treatment options, passive stretching after a workout have thought to be effective in alleviating DOMS symptoms. However, the study found no conclusive evidence that proved this myth. On the other hand, warm-up and post-workout massage, including underwater jet-massage showed positive results.
The age-old questions whether to rest or do light exercise with DOMS has also been brought up by this study. A case trial showed faster strength recovery when the muscle was exercised as opposed to fully rested. Another option would be immobilization at a lengthened position (for example a fully extended knee). However, in my opinion, when it comes to DOMS, full immobilization is neither needed, nor applicable in everyday life.
Another promising area of research is nutritional supplementation as a tool to alleviate DOMS. With the growth of the supplement industry, it is no surprise that certain compounds are advertised to help with symptoms of DOMS. However, not all of them are backed by research. The study has brought up a few well-studied antioxidant therapy practices that showed positive results when it came to pain relief. Vitamin C and E have been well-researched and shown promising results when consumed before exercise, but L-carnitine has also led to decreased pain and tenderness.
Conclusions
The bottom line, when it comes to DOMS is that it is a natural occurrence and there’s no need to worry or obsess over them. Tenderness in the worked muscles post-exercise can be a good indicator that some muscle damage has been done, but it cannot be used to objectively measure the effectiveness of our workout session. A much better way of gauging our progress is progressive overload. Could you do more repetitions with the same weight than last time? Could you increase the weight on a certain exercise?
On the other hand, one should also not worry too much about DOMS. Unless pain or swelling persists for more than a week, it is not a sign of injury and there’s no need to stop exercising or seek medical care. However, it is not advised to “power through” your workouts with severe DOMS since decreased strength in the muscle can lead to unaccustomed stress on the joints and ligaments, which can lead to injury.
If you still wish to continue your training routine, or you just find that DOMS inhibit your daily activities, the following treatments can provide some relief. Foam rolling and massage, vitamin C and E supplementation before exercise and in severe cases non-steroid anti-inflammatory medication.
[1] MacIntyre DL, Reid WD, McKenzie DC. Delayed muscle soreness. The inflammatory response to muscle injury and its clinical implications. Sports Med. 1995 Jul;20(1):24-40. doi: 10.2165/00007256-199520010-00003. PMID: 7481277.
[2] Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. 2003;33(2):145-64. doi: 10.2165/00007256-200333020-00005. PMID: 12617692.
[3] Schoenfeld, Brad J. The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training. Journal of Strength and Conditioning Research 24(10):p 2857-2872, October 2010. | DOI: 10.1519/JSC.0b013e3181e840f3
