Can you reduce delayed onset muscle soreness?
Delayed onset muscle soreness, or DOMS, is the scientific term to use when you experience muscle soreness following a new or unaccustomed workout with eccentric muscle actions, where eccentric muscle actions are those where the muscle lengthens under load; for example, the downward movement in a bicep curl.
Specifically, you will notice that tenderness or stiffness with movement becomes progressively more apparent in the 24-48 hour mark following an exercise session, with more extended periods of 72 hours also frequently reported (1).
DOMS has particular relevance to those just getting into a strength training routine or those who haven't been physically active for some time because their bodies are not used to the stressors strength training delivers. Therefore, the side effects will be among the highest for this population.
With this in mind, I researched and wrote this post to determine if there are any methods one can use to reduce delayed onset muscle soreness.
Methods for Reducing Delayed Onset Muscle Soreness
Many methods have been used to help alleviate and reduce muscle soreness, but do these practices hold up under scientific scrutiny? A review paper published in the sports medicine journal thoroughly reviewed the most common methods, such as cryotherapy and anti-inflammatory drugs, which I've expanded on below.
1) Cryotherapy (cold treatment)
Summary
Studies have shown little or no reduction in muscle soreness or the improvement of its condition post application.
What it is
Cryotherapy is the practice of applying ice or cold substances to the skin in an effort to increase blood flow and reduce swelling while temporarily alternating intramuscular and joint temperatures. Some common methods are ice packs, ice baths and other cold immersion strategies.
Supporting evidence
The review cites a study conducted by PaddonJones and Quigely, who, after an exercise session, placed one arm in five 20-minute ice water immersions. The results between the submerged and unsubmerged arm resulted in no significant differences in muscle soreness and strength in the arms post-recovery and the following 48 hours post-exercise (1).
2) Stretching
Summary
Stretching has no preventative effect on the sensation of muscle soreness.
What it is
Stretching, or more specifically, in the case of the supporting evidence, static stretching is holding a muscle in a set position for a period of time. It's somewhat surprising to learn that static stretching, when done intensely (> 60-second holds and multiple sets), has been shown to produce DOMS on its own!
Supporting evidence
Most studies investigating the effects of stretching before or after exercise have shown no preventative impact on the sensations of DOMS (1).
3) Anti-inflammatory drugs
Summary
Anti-inflammatory drugs are effective in relieving symptoms but not performance decreases associated with DOMS. Large doses can negatively influence muscle repair times.
What it is
Ibuprofen, aspirin and other nonsteroidal anti-inflammatory drugs help reduce the inflammatory response, relieving pressure and inflammation in the muscle, thereby reducing soreness.
Supporting evidence
Studies comparing participants taking anti-inflammatory drugs after a workout found that soreness was 25% less than controls at 48 hours post-exercise. Of note is that high doses can actually suppress the production of a protein involved in muscle repair and delay the healing process (1).
4) Massage
Summary
Massage, both passive and active, have shown mixed results in its ability to reduce muscle soreness. At best, small reductions in muscle soreness have been reported, with most studies trending towards no significant changes in soreness.
What it is
Massage has been recommended by many to reduce muscle soreness by increasing blood flow to the area, promoting healing and reducing additional damage done by the inflammation process.
Supporting evidence
Massage studies generally have the participant receive a 5-30-minute massage after a workout compared with a control group. One of the biggest issues with the inconsistency within the effectiveness of the technique is the significant variation in methods and practitioners (1).
5) Exercise
Summary
The most effective way of temporarily alleviating delayed onset muscle soreness.
What is it
Exercise or general movement has been shown to reduce muscle soreness temporarily and, in some studies, has led to a net decrease in perceived soreness at 24, 48 and 72 hours after exercise. Exercise may include active mobility drills, walking, general cardio activities or a weight training session. One of the reasons why this may be the case is that exercise breaks up the adhesions in the sore muscles and removes waste in the muscle (1).
Supporting evidence
Although some mixed findings depend on the type of exercise used, of particular note, Hasson et al. reported a significant decrease in DOMS following 6 sets x 20 reps (repetitions) of maximal leg extensions. This demonstrates that loaded resistance training may be the most efficient form of exercise in relieving DOMS, but more research is needed (1).
Final Thoughts
Although there are many proposed treatments for DOMS, very few, have been shown to offer benefits.
The combination between active recovery exercise and anti-inflammatories may be the best treatment for DOMS. Massage shows mixed results with a trend towards having no significant difference. Although they're commonly used techniques, stretching and cryotherapy do not hold up as being practical and are not recommended compared to exercise and anti-inflammatory drugs.
In-between training days, my clients have active recovery days, which are light-to-moderate exercises with an emphasis on mobility and movement to help with the sensation of DOMS and develop better movement.
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References
Cheung, K., Hume, P. A., & Maxwell, L. (2003). Delayed onset muscle soreness. Sports medicine, 33 (2), 145-164.