Muscle Soreness

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    Louie Neri

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    Rachel Hathcock, Jeremy A. Alland
    Last Updated: October 13, 2024

    Muscle soreness refers to the percieved soreness or tender state of muscle tissue following physical exercise, usually manifesting after a short delay (and hence its common name of 'delayed onset muscle soreness' or DOMS).

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    What is DOMS?

    Delayed Onset Muscle Soreness (DOMS) is muscle soreness that occurs 12–24 hours after performing an unfamiliar exercise or exercising with increased intensity or duration. It does not cause pain during exercise.

    Is DOMS dangerous?

    Is it safe to exercise while experiencing DOMS?

    What are the main signs and symptoms of DOMS?

    People typically experience muscle weakness, swelling, stiffness, and tenderness 12–24 hours after exercise, lasting up to 5–7 days. Depending upon the exercise's novelty, duration, and intensity, symptoms can range from mild to moderate.

    How is DOMS diagnosed?

    There are no tests to diagnose DOMS. A healthcare provider will instead conduct a thorough examination to rule out other possible causes of symptoms, such as rhabdomyolysis, compartment syndrome, or muscle strains. If the assessment indicates a condition other than DOMS, blood tests or imaging may be performed for further evaluation.[2][4]

    What are some of the main medical treatments for DOMS?

    Usually, DOMS does not require medical treatment. With rest and/or lowering the intensity of exercise, symptoms should subside within 5–7 days. Acetaminophen or oral and/or topical nonsteroidal anti-inflammatory drugs may decrease soreness; however, prolonged use of these medications is not recommended.[5][6]

    Is there a way to prevent DOMS?

    Have any supplements been studied for DOMS?

    Curcumin, Branched-Chain Amino Acids, Tart Cherry Juice, Fish Oil, Taurine, Vitamin C, and Beetroot may be helpful for treating the symptoms of DOMS. However, there is mixed evidence regarding the efficacy of dietary supplements for DOMS.[9] Furthermore, because DOMS will resolve without treatment, using dietary supplements may not be worth the potential risks associated with dietary supplements, such as potential drug interactions or unlisted ingredients.

    How could diet affect DOMS?

    One study comparing the effects of a high and low carbohydrate meal on DOMS found no difference between the two groups.[10] Thus, if an individual is experiencing DOMS, it is best to follow the basics of recovery from exercise (i.e., adequate fluids, calories, protein, and sleep).[11]

    Are there any other treatments for DOMS?

    Massage,[12] compression garments,[13] cold therapy,[14] local heat pack therapy,[14] vibration therapy,[15], foam rolling,[3] and intermittent compression therapy[16] have mild to moderate effects in reducing DOMS. However, popular recovery tools such as saunas,[14] stretching,[17] and acupuncture[18] have not been found to be effective in treating DOMS.

    What causes DOMS?

    Although the exact mechanism of DOMS hasn’t been determined, DOMS tends to occur after eccentric (muscle-lengthening) or novel exercises. Other factors, such as muscle damage, neutrophil accumulation, oxidative stress, inflammatory compounds (histamine, bradykinins, and prostaglandins), and fluid accumulation may also contribute to the symptoms of DOMS.[4] However, if a person performs an exercise that causes DOMS, they may feel less sore when they perform the same exercise during future workouts; this is known as the repeated bout effect.[8]

    Does lactic acid build-up cause muscle soreness?

    Examine Database: Muscle Soreness

    Research FeedRead all studies

    Frequently asked questions

    What is DOMS?

    Delayed Onset Muscle Soreness (DOMS) is muscle soreness that occurs 12–24 hours after performing an unfamiliar exercise or exercising with increased intensity or duration. It does not cause pain during exercise.

    Is DOMS dangerous?

    DOMS is not dangerous. It may feel uncomfortable, but the discomfort should subside within a week.

    However, when experiencing DOMS, it is important to monitor your symptoms for signs of a more serious condition (e.g., rhabdomyolysis, muscle strains/sprains, or exertional compartment syndrome). If you are concerned about your symptoms, a consultation with a medical provider is advised. In addition, if the pain is moderate to severe, the recommendation is to be evaluated to rule out a more serious condition.

    For example, if you are experiencing DOMS in conjunction with red/brown urine output, you may have rhabdomyolysis and should seek medical attention immediately. Rhabdomyolysis occurs when damaged muscle releases its intracellular contents into the bloodstream, causing kidney damage and electrolyte imbalances (which could result in cardiac arrhythmias).[1]

    Is it safe to exercise while experiencing DOMS?

    Yes, if an individual is experiencing mild soreness and can move comfortably, exercising is safe. In cases where the individual is experiencing debilitating soreness, extreme weakness, and fatigue, it is best to wait until the symptoms subside, as exercising in this state can increase the risk of injury.[2] There is also some evidence that exercise may alleviate DOMS pain, but this relief is typically short-lived, and the discomfort will return after the exercise is finished.[3]

    What are the main signs and symptoms of DOMS?

    People typically experience muscle weakness, swelling, stiffness, and tenderness 12–24 hours after exercise, lasting up to 5–7 days. Depending upon the exercise's novelty, duration, and intensity, symptoms can range from mild to moderate.

    How is DOMS diagnosed?

    There are no tests to diagnose DOMS. A healthcare provider will instead conduct a thorough examination to rule out other possible causes of symptoms, such as rhabdomyolysis, compartment syndrome, or muscle strains. If the assessment indicates a condition other than DOMS, blood tests or imaging may be performed for further evaluation.[2][4]

    What are some of the main medical treatments for DOMS?

    Usually, DOMS does not require medical treatment. With rest and/or lowering the intensity of exercise, symptoms should subside within 5–7 days. Acetaminophen or oral and/or topical nonsteroidal anti-inflammatory drugs may decrease soreness; however, prolonged use of these medications is not recommended.[5][6]

    Is there a way to prevent DOMS?

    Some dietary supplements and treatments show a mild to moderate effect in preventing DOMS. Unfortunately, there is no guaranteed way to prevent DOMS. The best bet for preventing and/or reducing DOMS is to gradually increase exercise intensity while adhering to fundamental recovery principles (e.g., optimal sleep, adequate hydration, and proper nutrition).[7]

    Performing the same exercise routine in subsequent workouts can reduce soreness, a phenomenon known as the repeated bout effect. Repeated exposure to the exercise or movement triggers physiological adaptations that result in less muscle damage and soreness in future workouts.[8]

    Have any supplements been studied for DOMS?

    Curcumin, Branched-Chain Amino Acids, Tart Cherry Juice, Fish Oil, Taurine, Vitamin C, and Beetroot may be helpful for treating the symptoms of DOMS. However, there is mixed evidence regarding the efficacy of dietary supplements for DOMS.[9] Furthermore, because DOMS will resolve without treatment, using dietary supplements may not be worth the potential risks associated with dietary supplements, such as potential drug interactions or unlisted ingredients.

    How could diet affect DOMS?

    One study comparing the effects of a high and low carbohydrate meal on DOMS found no difference between the two groups.[10] Thus, if an individual is experiencing DOMS, it is best to follow the basics of recovery from exercise (i.e., adequate fluids, calories, protein, and sleep).[11]

    Are there any other treatments for DOMS?

    Massage,[12] compression garments,[13] cold therapy,[14] local heat pack therapy,[14] vibration therapy,[15], foam rolling,[3] and intermittent compression therapy[16] have mild to moderate effects in reducing DOMS. However, popular recovery tools such as saunas,[14] stretching,[17] and acupuncture[18] have not been found to be effective in treating DOMS.

    What causes DOMS?

    Although the exact mechanism of DOMS hasn’t been determined, DOMS tends to occur after eccentric (muscle-lengthening) or novel exercises. Other factors, such as muscle damage, neutrophil accumulation, oxidative stress, inflammatory compounds (histamine, bradykinins, and prostaglandins), and fluid accumulation may also contribute to the symptoms of DOMS.[4] However, if a person performs an exercise that causes DOMS, they may feel less sore when they perform the same exercise during future workouts; this is known as the repeated bout effect.[8]

    Does lactic acid build-up cause muscle soreness?

    Lactic acid is commonly thought to build up during anaerobic exercise and induce muscle soreness, but this is not correct. Lactate, not lactic acid, is generated during exercise,[19] and lactate is not a waste product of anaerobic metabolism. Rather, lactate is created under both aerobic and anaerobic conditions by the conversion of pyruvate to lactate via the enzyme lactate dehydrogenase. This process involves the consumption of a proton and thus acts as a buffer against acidosis. Once created, lactate is used as a fuel source for the body; it may even act as a cell signaling molecule during exercise. Given these roles, it is unlikely that lactate contributes to muscle soreness.[20] Moreover, although lactate levels do increase during exercise, they decrease to pre-exercise levels within one hour, which is well before the onset of DOMS.[21]

    Examine Database References

    1. Blueberry - McLeay Y, Barnes MJ, Mundel T, Hurst SM, Hurst RD, Stannard SREffect of New Zealand blueberry consumption on recovery from eccentric exercise-induced muscle damageJ Int Soc Sports Nutr.(2012 Jul 11)
    2. Bromelain - A F Walker, R Bundy, S M Hicks, R W MiddletonBromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adultsPhytomedicine.(2002 Dec)
    3. Citrulline - Andrew J Chappell, Daniel M Allwood, Trevor N SimperCitrulline Malate Fails to Improve German Volume Training Performance in Healthy Young Men and WomenJ Diet Suppl.(2020)
    4. L-Carnitine - M A Giamberardino, L Dragani, R Valente, F Di Lisa, R Saggini, L VecchietEffects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effortInt J Sports Med.(1996 Jul)
    5. HMB - Hoffman JR, Cooper J, Wendell M, Im J, Kang JEffects of beta-hydroxy beta-methylbutyrate on power performance and indices of muscle damage and stress during high-intensity trainingJ Strength Cond Res.(2004 Nov)
    6. Leucic Acid - Antti A Mero, Tuomo Ojala, Juha J Hulmi, Risto Puurtinen, Tuomo AM Karila, and Timo SeppäläEffects of alfa-hydroxy-isocaproic acid on body composition, DOMS and performance in athletesJISSN.()
    7. Ginger - Black CD, Oconnor PJAcute effects of dietary ginger on quadriceps muscle pain during moderate-intensity cycling exerciseInt J Sport Nutr Exerc Metab.(2008 Dec)
    8. HMB - Nunan D, Howatson G, van Someren KAExercise-induced muscle damage is not attenuated by beta-hydroxy-beta-methylbutyrate and alpha-ketoisocaproic acid supplementationJ Strength Cond Res.(2010 Feb)
    9. Ashwagandha - Ziegenfuss TN, Kedia AW, Sandrock JE, Raub BJ, Kerksick CM, Lopez HLEffects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR TrialNutrients.(2018 Nov 20)
    10. MSM - Kalman DS, Feldman S, Scheinberg AR, Krieger DR, Bloomer RJInfluence of methylsulfonylmethane on markers of exercise recovery and performance in healthy men: a pilot studyJ Int Soc Sports Nutr.(2012 Sep 27)
    11. Anatabine - Jenkins ND, Housh TJ, Johnson GO, Traylor DA, Bergstrom HC, Cochrane KC, Lewis RW Jr, Schmidt RJ, Cramer JTThe effects of anatabine on non-invasive indicators of muscle damage: a randomized, double-blind, placebo-controlled, crossover studyJ Int Soc Sports Nutr.(2013 Jul 22)
    12. Citrulline - da Silva DK, Jacinto JL, de Andrade WB, Roveratti MC, Estoche JM, Balvedi MCW, de Oliveira DB, da Silva RA, Aguiar AFCitrulline Malate Does Not Improve Muscle Recovery after Resistance Exercise in Untrained Young Adult MenNutrients.(2017 Oct 18)
    13. L-Carnitine - Volek JS, Kraemer WJ, Rubin MR, Gómez AL, Ratamess NA, Gaynor PL-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stressAm J Physiol Endocrinol Metab.(2002 Feb)
    14. Vitamin C - Bryer SC, Goldfarb AHEffect of high dose vitamin C supplementation on muscle soreness, damage, function, and oxidative stress to eccentric exerciseInt J Sport Nutr Exerc Metab.(2006 Jun)
    15. Taurine - Ra SG, Miyazaki T, Ishikura K, Nagayama H, Suzuki T, Maeda S, Ito M, Matsuzaki Y, Ohmori HAdditional effects of taurine on the benefits of BCAA intake for the delayed-onset muscle soreness and muscle damage induced by high-intensity eccentric exerciseAdv Exp Med Biol.(2013)
    16. Fish Oil - Tartibian B, Maleki BH, Abbasi AThe effects of ingestion of omega-3 fatty acids on perceived pain and external symptoms of delayed onset muscle soreness in untrained menClin J Sport Med.(2009 Mar)
    17. Phosphatidylserine - Kingsley MI, Kilduff LP, McEneny J, Dietzig RE, Benton DPhosphatidylserine supplementation and recovery following downhill runningMed Sci Sports Exerc.(2006 Sep)
    18. Branched-Chain Amino Acids - Shimizu M, Miyagawa K, Iwashita S, Noda T, Hamada K, Genno H, Nose HEnergy expenditure during 2-day trail walking in the mountains (2,857 m) and the effects of amino acid supplementation in older men and womenEur J Appl Physiol.(2012 Mar)
    19. Rhodiola Rosea - Shanely RA, Nieman DC, Zwetsloot KA, Knab AM, Imagita H, Luo B, Davis B, Zubeldia JMEvaluation of Rhodiola rosea supplementation on skeletal muscle damage and inflammation in runners following a competitive marathonBrain Behav Immun.(2014 Jul)
    20. Saffron - Meamarbashi A, Rajabi APreventive effects of 10-day supplementation with saffron and indomethacin on the delayed-onset muscle sorenessClin J Sport Med.(2015 Mar)
    21. Panax Ginseng (Korean Ginseng) - Gislaine Cristina-Souza, Ana C Santos-Mariano, Adriano E Lima-Silva, Poliana L Costa, Pablo R Domingos, Sandro F Silva, Wilson C Abreu, Fernando R De-Oliveira, Raul OsieckiPanax ginseng Supplementation Increases Muscle Recruitment, Attenuates Perceived Effort, and Accelerates Muscle Force Recovery After an Eccentric-Based Exercise in AthletesJ Strength Cond Res.(2020 Apr 29)
    22. Ginger - Black CD, Herring MP, Hurley DJ, O'Connor PJGinger (Zingiber officinale) reduces muscle pain caused by eccentric exerciseJ Pain.(2010 Sep)
    23. Branched-Chain Amino Acids - Shimomura Y, Inaguma A, Watanabe S, Yamamoto Y, Muramatsu Y, Bajotto G, Sato J, Shimomura N, Kobayashi H, Mawatari KBranched-chain amino acid supplementation before squat exercise and delayed-onset muscle sorenessInt J Sport Nutr Exerc Metab.(2010 Jun)
    24. L-Carnitine - Barry A Spiering, William J Kraemer, Jakob L Vingren, Disa L Hatfield, Maren S Fragala, Jen-Yu Ho, Carl M Maresh, Jeffrey M Anderson, Jeff S VolekResponses of criterion variables to different supplemental doses of L-carnitine L-tartrateJ Strength Cond Res.(2007 Feb)
    25. Bromelain - Stone MB, Merrick MA, Ingersoll CD, Edwards JEPreliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness managementClin J Sport Med.(2002 Nov)
    26. Citrulline - Pérez-Guisado J, Jakeman PMCitrulline malate enhances athletic anaerobic performance and relieves muscle sorenessJ Strength Cond Res.(2010 May)
    27. Spirulina - Aggelos Pappas, Athanasios Tsiokanos, Ioannis G Fatouros, Athanasios Poulios, Dimitris Kouretas, Nikos Goutzourelas, Giannis Giakas, Athanasios Z JamurtasThe Effects of Spirulina Supplementation on Redox Status and Performance Following a Muscle Damaging ProtocolInt J Mol Sci.(2021 Mar 30)
    28. Betaine - Hoffman JR, Ratamess NA, Kang J, Rashti SL, Faigenbaum ADEffect of betaine supplementation on power performance and fatigueJ Int Soc Sports Nutr.(2009 Feb 27)
    29. Fish Oil - Lenn J, Uhl T, Mattacola C, Boissonneault G, Yates J, Ibrahim W, Bruckner GThe effects of fish oil and isoflavones on delayed onset muscle sorenessMed Sci Sports Exerc.(2002 Oct)
    30. Green Tea Extract - Kerksick CM, Kreider RB, Willoughby DSIntramuscular adaptations to eccentric exercise and antioxidant supplementationAmino Acids.(2010 Jun)
    31. Fish Oil - Bloomer RJ, Larson DE, Fisher-Wellman KH, Galpin AJ, Schilling BKEffect of eicosapentaenoic and docosahexaenoic acid on resting and exercise-induced inflammatory and oxidative stress biomarkers: a randomized, placebo controlled, cross-over studyLipids Health Dis.(2009 Aug 19)
    32. Theaflavins - Arent SM, Senso M, Golem DL, McKeever KHThe effects of theaflavin-enriched black tea extract on muscle soreness, oxidative stress, inflammation, and endocrine responses to acute anaerobic interval training: a randomized, double-blind, crossover studyJ Int Soc Sports Nutr.(2010 Feb 23)
    33. L-Carnitine - Ho JY, Kraemer WJ, Volek JS, Fragala MS, Thomas GA, Dunn-Lewis C, Coday M, Häkkinen K, Maresh CMl-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and womenMetabolism.(2010 Aug)
    34. Tart Cherry Juice - Bell PG, Stevenson E, Davison GW, Howatson GThe Effects of Montmorency Tart Cherry Concentrate Supplementation on Recovery Following Prolonged, Intermittent ExerciseNutrients.(2016 Jul 22)
    35. Tart Cherry Juice - McCormick R, Peeling P, Binnie M, Dawson B, Sim MEffect of tart cherry juice on recovery and next day performance in well-trained Water Polo players.J Int Soc Sports Nutr.(2016)
    36. Tart Cherry Juice - Morehen JC, Clarke J, Batsford J, Barrow S, Brown AD, Stewart CE, Morton JP, Close GLMontmorency tart cherry juice does not reduce markers of muscle soreness, function and inflammation following professional male rugby League match-play.Eur J Sport Sci.(2021-Jul)
    37. Tart Cherry Juice - Meghan A Brown, Emma J Stevenson, Glyn HowatsonMontmorency tart cherry (Prunus cerasus L.) supplementation accelerates recovery from exercise-induced muscle damage in femalesEur J Sport Sci.(2019 Feb)
    38. Tart Cherry Juice - Phillip G Bell, Ian H Walshe, Gareth W Davison, Emma J Stevenson, Glyn HowatsonRecovery facilitation with Montmorency cherries following high-intensity, metabolically challenging exerciseAppl Physiol Nutr Metab.(2015 Apr)
    39. Tart Cherry Juice - Bowtell JL, Sumners DP, Dyer A, Fox P, Mileva KNMontmorency cherry juice reduces muscle damage caused by intensive strength exerciseMed Sci Sports Exerc.(2011 Aug)
    40. Tart Cherry Juice - Quinlan R, Hill JAThe Efficacy of Tart Cherry Juice in Aiding Recovery After Intermittent Exercise.Int J Sports Physiol Perform.(2019-Oct-15)
    41. Tart Cherry Juice - Drummer DJ, Many GM, Pritchett K, Young M, Connor KR, Tesfaye J, Dondji B, Pritchett RCMontmorency Cherry Juice Consumption does not Improve Muscle Soreness or Inhibit Pro-inflammatory Monocyte Responses Following an Acute Bout of Whole-body Resistance Training.Int J Exerc Sci.(2022)
    42. Tart Cherry Juice - Abbott W, Brashill C, Brett A, Clifford TTart Cherry Juice: No Effect on Muscle Function Loss or Muscle Soreness in Professional Soccer Players After a Match.Int J Sports Physiol Perform.(2020-Feb-01)
    43. Tart Cherry Juice - Kupusarevic J, McShane K, Clifford TCherry Gel Supplementation Does Not Attenuate Subjective Muscle Soreness or Alter Wellbeing Following a Match in a Team of Professional Rugby Union players: A Pilot Study.Sports (Basel).(2019-Apr-05)
    44. Tart Cherry Juice - Wangdi JT, O'Leary MF, Kelly VG, Jackman SR, Tang JCY, Dutton J, Bowtell JLTart Cherry Supplement Enhances Skeletal Muscle Glutathione Peroxidase Expression and Functional Recovery after Muscle Damage.Med Sci Sports Exerc.(2022-Apr-01)
    45. Tart Cherry Juice - Lamb KL, Ranchordas MK, Johnson E, Denning J, Downing F, Lynn ANo Effect of Tart Cherry Juice or Pomegranate Juice on Recovery from Exercise-Induced Muscle Damage in Non-Resistance Trained Men.Nutrients.(2019-Jul-14)
    46. Magnesium - Reno AM, Green M, Killen LG, O'Neal EK, Pritchett K, Hanson ZEffects of Magnesium Supplementation on Muscle Soreness and Performance.J Strength Cond Res.(2022-Aug-01)
    47. Magnesium - Steward CJ, Zhou Y, Keane G, Cook MD, Liu Y, Cullen TOne week of magnesium supplementation lowers IL-6, muscle soreness and increases post-exercise blood glucose in response to downhill running.Eur J Appl Physiol.(2019-Dec)
    48. Creatine - Kenji Doma, Akhilesh Kumar Ramachandran, Daniel Boullosa, Jonathan ConnorThe Paradoxical Effect of Creatine Monohydrate on Muscle Damage Markers: A Systematic Review and Meta-AnalysisSports Med.(2022 Feb 26)
    49. Creatine - Bethany Northeast, Tom CliffordThe Effect of Creatine Supplementation on Markers of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Human Intervention TrialsInt J Sport Nutr Exerc Metab.(2021 Feb 24)
    50. Red Light Therapy - Nampo FK, Cavalheri V, Ramos Sde P, Camargo EAEffect of low-level phototherapy on delayed onset muscle soreness: a systematic review and meta-analysis.Lasers Med Sci.(2016-Jan)
    51. Collagen - Bischof K, Moitzi AM, Stafilidis S, König DImpact of Collagen Peptide Supplementation in Combination with Long-Term Physical Training on Strength, Musculotendinous Remodeling, Functional Recovery, and Body Composition in Healthy Adults: A Systematic Review with Meta-analysis.Sports Med.(2024 Jul 26)
    52. Curcumin - Liu X, Lin L, Hu GMeta-analysis of the effect of curcumin supplementation on skeletal muscle damage status.PLoS One.(2024)