Amazingly our musculature posses a remarkable ability to protect itself from a repeated bout of exercise that brings about soreness and losses to performance. Welcome to post 69 of S&C for therapists. In this post we’re going to look at the dreaded DOMS and the amazing phenomenon that can protect us. We all know that DOMS can be a real obstacle to patients and clients sticking with exercises and rehab, particularly if they’re new to exercise. So here goes: how to avoid DOMS; the repeated bout effect.
DOMS: Delayed-Onset Muscle Soreness
Okay, so we all know what DOMS id. Even if you’re not familiar with the acronym, you’ll be familiar with that sore feeling in your muscles after you’ve done some new exercise. This could be commencing resistance training following a period of rest (or never having done it before), ramping up your exercise intensity or duration, or even doing something unaccustomed – low back and hamstring discomfort following gardening is great example of that!
We generally don’t feel the discomfort soreness whilst we’re performing the activity, but we do once the the exercise has ceased. Typically this delayed-onset muscle soreness (DOMS) peaks between 24h-48h following the activity. We’re often aware of this when we get up in the morning and wishing you lived in a bungalow as you descend the stairs – for the lower limbs at least.
Exercise-Induced Muscle Damage
Skeletal muscle is susceptible to ultrastructural damage following unaccustomed and, or, high-intensity – exercise. This damage is predominantly caused by eccentric muscle activity whereby the muscle lengthens whilst under load, such as downhill running or the lowering phase during resistance exercise, and it is called ‘Exercise-Induced Muscle Damage’ (EIMD) This is not to be confused with acute muscle fatigue, see here for more information on that. EIMD is not something that should be avoided though as the repair process is important to build strength and resilience.
EIMD can be separated into two phases. The first results from the exercise-induced mechanical and metabolic stress. From a mechanical perspective, the inciting high-force and, or, novel lengthening (eccentric) activations of muscle means the weaker less resilient sarcomeres become progressively overstretched and damaged. This leads of pockets of ‘damage’ throughout the exercised muscle that physically disrupts the contractile performance of the myofibril, and the associated membrane damage disrupts the contractile environment of the cells.
The second phase occurs post-exercise and is due to the subsequent inflammatory response. A series of processes occur in response to the mechanical disruption; these are thought to be really important in repair and remodelling – and the ability to tolerate the same stresses subsequently.
Consequences of Exercise-Induced Muscle Damage
It’s important to note that it’s not just the DOMS that might be of concern – though we’ll get to that shortly as this is most definitely important in patient populations. EIMD can involve major consequences to performance; this includes detrimental effects on:
- Muscle Strength
- Rate of Force Development
- Muscle Power
- Proprioceptive Acuity
- Electromechanical Delay
- Range of Motion
The remodelling process is pretty spectacular though, so we only really need to be aware of this acutely post-exercise, for a few days, or a couple of weeks if the exercise was exceptionally harsh.
Markus et al (2021) produced a great figure that summarise the processes of EIMD:
The Repeated-Bout Effect
Clearly, we don’t experience these decrements to performance or suffer DOMS forever, the musculature remodels and adapts. What’s remarkable is that the remodelling process means that if you were to repeat the exact same bout of exercise a few days or weeks later, the consequences would be attenuated. The soreness would be less, so would the losses to strength, and performance. This is called the Repeated-Bout Effect (RBE).
So, what happens to protect us from the consequences of this repeated bout? There are multiple processes that work independently or in with interaction each other. It’s complex and has been the focus of exciting research for nearly 20 years since the first paper by McHugh (2003). Here are just a few of the adaptive responses:
- Rightward shift of the Length-Tension Relationship. Meaning the musculature is stronger at longer muscle lengths (potentially caused by addition of sarcomeres), however this mechanism cannot entirely explain the RBE as the shift doesn’t always last for the duration of the RBE.
- Tendon Adaptation: Changes in muscle fascicle length post EIMD suggest the tendon may become more compliant, offsetting the forces through the contractile tissue, and which could also partially explain the above adaptation.
- Neural Adaptation. Still under investigation, but it is assumed that the central nervous system adjusts the motoneuron pool to protect the muscle from further damage by distributing mechanical constraint over a greater motor unit sample, when submaximal eccentric exercise is repeated
Is DOMS Bad?
It depends on how you look at it. My first response is no. Whilst not perfectly aligned with peak impairments to muscle function, DOMS can help be a to cue reduced activity if needed. For example, it might be wise to avoid unpredictable situations with high joint loading if muscle performance capabilities are significantly impaired. Loss of proprioceptive acuity, strength and RFD may offer the opportunity got increased risk of injury, perhaps.
In patient populations, particularly with those who are unfamiliar with exercise, DOMS can be a negative experience. I’m sure that you’ve experience this yourself – patients or clients worrying about exercise because it’s made them sore or even worse, disengaging completely because they think that they’ve injured themselves.
How to Avoid DOMS; The Repeated Bout Effect
Okay, so let’s get to the nitty gritty, how to avoid DOMS. Can we attenuate the DOMS response of novel, and or, high intensity exercise?
Originally the RBE was studied in the context of damage-inducing eccentric (lengthening) contractions, whereby a second bout of damage-inducing eccentric contractions performed within several weeks of an initial bout, would result in attenuation of functional declines post-exercise. Clearly this defeats the object; we’re trying to minimise DOMS, so by damaging the muscle significantly in the first episode we’re likely to induce significant DOMS.
The good news is that you don’t have to create DOMS or damage to initiate the protective effect.
Research is now clearly showing that non-damaging muscle contractions can convey a protective effect. Whilst it might be more short-lived, we’re now seeing a range of interventions from maximal isometric, low level eccentric and low level isometric contractions even conveying a protective effect. Let’s look at just one study.
Lin et al. (2015) sought to investigate the effects of an initial episode of 3 sets x 10 reps eccentric contractions at only 10% MVIC (10% of max isometric strength) of the knee flexors & knee extensors un untrained young men per group on the responses to a second bout of 3 sets x 10 reps maximal eccentric contractions.
There were several groups as the investigators wanted to evaluate how long the protective effect, if it existed, lasted for. Thus the initial bout of exercise was performed 2-days, 1-week, 2-weeks and 3-weeks prior to the second bout of maximal eccentric exercise
Above you can see the soreness and strength changes in the knee flexors in all groups following the maximal eccentric exercise. See the key for the different conditions – the open circles represent the control condition where no initial bout was performed.
So it’s really clear to note from the figure on the left that the peak soreness response occurred 2 days after the second bout of exercise. This is what we’d typically see in the knee flexors (it occurs slightly earlier in the knee extensors). But you can also see that the peak soreness is much less in the groups that performed the initial bout of exercise (remember only 10% MVIC) 2 days and 1-week prior. The protective effect was diminished after that. That is to say no protective effect on attenuating DOMS was observed when the initial bout of low level exercise was performed 2-weeks prior to the second bout.
The panel on the right shows the strength data, more specifically losses to concentric strength. You can clearly see, as indicated by the red arrow, that there was a significant decrease in strength up to 25% following the second bout of exercise. However, what’s also notable is the losses to strength and the profile of recovery is are better in the groups that performed the initial bout of exercise 2 days and 1-week prior. That is to say the loss to strength was less and accordingly recovery was complete by 5 days, which wasn’t the case for the other groups.
So, what does all of this mean?
1. Well, novel exercise of high intensity, extended duration, predominantly eccentric in nature can cause acute micro trauma to the associated musculature. This results in losses to muscle function an inflammatory response and a delayed onset soreness that peaks a day to 2-days following exercise.
2. The repeated-bout effect describes the phenomenon whereby the remodelling process attenuate the negative responses to a repeated bout of damaging exercise.
3. WHigh intensity eccentric exercise will convey a protective effect for longer. But low level muscle contractions of different modalities performed a few days prior to a second bout of high intensity eccentric exercise can attenuate the negative consequences. This may offer a useful strategy to use in rehabilitation prior to ramping up exercise to mitigate the DOMS response and seek to maximise adherence
- McHugh (2003). Scand. J. Med. Sci. Sports. 2003; 13(2):88–97.
- Markus et al (2021). Eur J Appl Physiol 121(4):969-992 (abst)
- Lin et al. (2015). Appl. Physiol. Nutr. Metab. 40: 1004–1011 (link to full paper)
5 New Masterclasses on topics like this coming in November!
How athletes can prevent DOMS? ›
One way to avoid DOMS from happening is having a cool down phase after each workout. Finish your training sessions with a 10-minute light cardio session, and then do some dynamic stretching like lunges, squats, or arm circles.What is the best way to get rid of DOMS? ›
- Painkillers. ...
- Ice pack. ...
- Self-massage, foam rolling or gentle sports massage. ...
- Compression clothing. ...
- Hot baths. ...
- Contrast heat and cold treatments.
The repeated bout effect refers to the adaptation whereby a single bout of eccentric exercise protects against muscle damage from subsequent eccentric bouts. While the mechanism for this adaptation is poorly understood there have been significant recent advances in the understanding of this phenomenon.What is the most common cause of DOMS? ›
Microscopic tears in the muscle, or a breakdown in muscle tissue, likely causes DOMS after a workout. Trying a new type of exercise or increasing the intensity can increase how sore you are in the days following a workout. Over time, though, your muscles become resilient to that exercise.Why do I get DOMS so easily? ›
Though the exact cause of DOMS hasn't been nailed down yet, researchers have found that it may come from one or more of a few factors: Performing an unaccustomed movement during your workout. Doing a completely new kind of workout. Increased intensity in your workout.Does drinking water reduce DOMS? ›
While reducing lactic acid build up during a workout will not prevent post workout soreness (DOMS), it will help you work harder for longer which is fundamental for any athlete, whether a child or an adult, and remaining adequately hydrated will help promote faster muscle recovery so you can get back to it sooner.Do protein shakes prevent DOMS? ›
Studies have shown that supplementing with protein powders containing BCAAs can help to reduce DOMS and also reduce the damage to the muscle tissue which can cause it. This is because BCAAs can activate a signalling pathway in the body called mTOR, the main way muscles build new muscle proteins (Yoon, 2017).What is the method on how performer can reduce the effect of DOMS? ›
There are many recovery techniques that can help lessen the affects of DOMS on athletic bodies. These techniques include cryotherapy (icing/ice baths), stretching, massage, compression, and anti-inflammatory drugs.What should I eat during DOMS? ›
A well-balanced diet, including plenty of high-quality protein, wholegrains, fruits, vegetables, and healthy fats will help to support the adaptation process and alleviate the symptoms associated with DOMS.Do bananas help DOMS? ›
Bananas are also a fantastic source of potassium, which has been suggested to help reduce DOMS.
Does ice get rid of DOMS? ›
Ice pack. As mentioned earlier, Ice packs are extremely useful tools for getting rid of DOMS. They do this by reducing muscle inflammation and the cold response helps provide pain relief while also increasing oxygen delivery to the sore muscles.What causes the repeated bout effect? ›
The exact mechanisms through which the repeated bout effect occurs are not 100% clear yet. But it's likely related to the connective tissue (tissue that attaches muscle to bone) and nervous system adaptations you achieve when you train consistently.How long does the repeated bout effect last? ›
Following an initial "damage bout," a repeated bout results in reduced symptoms. This protective effect is known as the repeated bout effect (RBE) and can last up to 24 weeks between bouts.What is an example of repeated bout effect? ›
Imagine that you do an easy 1-minute pushup workout on Monday and a difficult 10-minute pushup session on Friday. The Repeated Bout Effect says that your soreness after Friday's workout will be reduced simply because you did an easy session earlier in the week.When do DOMS disappear? ›
How Long Does It Take DOMS to Go Away? DOMS is temporary — depending on how intense your exercise was, any delayed onset soreness should go away within about two to four days. During this recovery period, the goal will be to help your muscles naturally pump out excess fluid and decrease inflammation.Should you exercise with DOMS? ›
Should I workout with DOMS? Although training with DOMS pain may feel like the last thing you want to do, it can actually be good for your recovery. Low-impact cardio like swimming is a fantastic way to gently ease your body back into exercise and means you don't need to put a pause on your fitness.What helps muscles recover faster? ›
- Drink a lot of water. Hydrating after a workout is key to recovery. ...
- Get enough sleep. Getting proper rest is easily one of the most effective ways to recover from any form or degree of physical exertion. ...
- Eat nutritious food. ...
Research has shown that heat therapy can reduce delayed-onset muscle soreness (DOMS) by up to 47% just 24 hours post-exercise. Like cold therapy, heat therapy is best applied immediately after a workout.Does DOMS mean you're getting stronger? ›
The answer to this is, no. Muscle damage and DOMS may play a small part in muscle growth, but they by no means should be used as a primary gauge of growth following a workout.Does caffeine help DOMS? ›
Our meta-analysis results indicate that caffeine supplements reduce delayed-onset muscle soreness when compared to a placebo 48 h after exercise. However, at 24 h post-exercise, caffeine can reduce DOMS only in people who worked on resistant exercise.
Does Gatorade help sore muscles? ›
The sugar in Gatorade and Powerade fulfills your body's immediate energy needs during and after exercise. Consequently, amino acids help the muscles recover and rebuild more quickly after strenuous exercise.Does watermelon help DOMS? ›
Watermelon juice's reputation among athletes is getting scientific support in a new study, which found that juice from the summer favorite fruit can relieve post-exercise muscle soreness. The report in ACS' Journal of Agricultural and Food Chemistry attributes watermelon's effects to the amino acid L-citrulline.Can you build muscle without DOMS? ›
This process is often known as Delayed Onset Muscle Soreness (DOMS). Muscle soreness is related to muscle damage, which can promote, but is not required for, muscle growth. In a nutshell, unless your goal is to feel sore, then you don't need to be sore after every workout.Can you still build muscle with DOMS? ›
The answer to this is, no. Muscle damage and DOMS may play a small part in muscle growth, but they by no means should be used as a primary gauge of growth following a workout.Does DOMS go away the more you exercise? ›
Plus, your muscles will get accustomed to the exercises you do, which will reduce further DOMS. This means that once you get used to this level of training, DOMS will go away and you can make huge progress in your training without this soreness. Yes, even if you gradually increase the intensity.Should you lift weights if you have DOMS? ›
The NHS suggests that DOMS will typically last between 3 and 5 days, yet you're likely to feel your muscles loosen up after the first couple of days. Should I workout with DOMS? Although training with DOMS pain may feel like the last thing you want to do, it can actually be good for your recovery.Are DOMS a good thing? ›
It is a warning sign to decrease muscle activity to prevent further damage to the muscle fibers. This soreness is often interpreted as a good workout, but it is not always a good sign.Should you run if you have DOMS? ›
Can I Run With DOMS? You might feel stiff and sore, but you can run while experiencing DOMS—especially if the soreness is mild. “Moving and continuing exercise can actually help lessen the pain and ease the stiffness associated with DOMS,” says Trentacosta.Do professional athletes get DOMS? ›
Don't worry, it's totally normal. This can be impacted by a lot of different factors, like how heavy of weights you're lifting, how long you're exercising, or even if you're targeting the same muscle group multiple days in a row. As you can imagine, CrossFitters know a thing or two about DOMS.How long is too long for DOMS? ›
Doms can last up to five days, with the effects usually worst on day two or three, then gradually improving without treatment. It is a normal part of building muscle strength and stamina, but coach Nick Anderson warns that it could be telling you it's time to review your workout.