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Upon waking the next morning rolling out of bed can be a struggle, let alone walking, climbing stairs or even the thought of partaking in another strenuous session. Everyday activities such as steering a car, shaking a hand at a prospective meeting or reaching up toward a high shelf become painfully avoided activities. This generalised muscle ache can vary in degrees of pain, stiffness and activity impairment and is referred to as Delayed Onset Muscle Soreness (DOMS).

There are various theories circulating regarding the pathophysiology behind DOMS. Some of these include lactic acid accumulation, muscle spasm, intra-muscular inflammation and micro-damage to muscle fibre structure. Many studies have highlighted the presence of proteins associated with muscle fibre degradation, in subjects with symptoms of DOMS. Therefore the ‘muscle fibre breakdown’ theory seems most plausible. DOMS usually begins 24 hours post exercise bout and can peak anywhere up until 72 hours. Symptoms generally subside after this period.

Resistance training that focuses on eccentric muscle actions is the most common foundation for the production of DOMS. Eccentric muscle contraction involves microscopic muscle fibre contraction while the muscle is lengthening. The simplest example of this is the lowering phase of a squat; gluteals and quadriceps must contract eccentrically to prevent the collapse of the hip and knee against gravity. Eccentric induced muscle fibre damage can be thought of as a protective mechanism by the human body, in that damage initiates repair into a stronger more load resistant tissue. A gym workout that focuses on negative work or a slow eccentric phase has been shown to maximally recruit type 2 fast twitch fibres and although hypertrophy (muscle bulk) will be maximised, DOMS is a certainty.

So how do we overcome the potentially crippling effects of the dreaded DOMS? There are plenty of interventions that are common practice for DOMS, with very few of them supported in the literature. Cryotherapy (ice therapy), contrast baths (hot/cold) ultrasound and stretching have shown no effect on DOMS. Flushing massage has given some positive results, however depends on timing in the DOMS cycle. This may give credence to the lactic acid theory as mentioned above. Application of compression garments and gentle non-aggravating exercise such as pool walking or gentle bike have showed promising results. Atypical elite level recovery program will generally consist of flushing massage, compression garments and hydrotherapy based exercise to flush any by-products produced from muscle breakdown into the lymphatic system.

The easiest way to deal with DOMS is to not let it happen in the first place! As long as a sensible, gradual and progressive exercise program is implemented from the get go, avoidance of DOMS is quite possible. Progressing slowly and cautiously into heavy eccentric exercise should ensure safety. This might occur over a 4-6 week period. In some instances, DOMS can be a favourable outcome. I encounter patients daily who explain their DOMS experience as 'good pain', 'feels like I'm actually working'. For those of us who want to increase a shirt size, controlled DOMS, is a critical component. We want to damage those fibres so they come back bigger and stronger. Training the same muscle groups during the DOMS period can actually be deleterious to muscle tissue. This is why it is important to avoid overloading a DOMS muscle with further eccentric insult. This timeframe can be variable and depends of the intensity of the instigating session and the strength/endurance/eccentric capability of the individual. The gradual, progressive strategy applies not only for resistance training but also for other athletic events and team sports. Training of the specific movement patterns for your chosen sport over a specified period of time, will not only facilitate improved athletic performance and prevent stress related injuries, but it will minimise the inevitable loss of function that is associated with a severe case of DOMS.
  

Shane O’Sullivan
Sports Physiotherapist
Prahran Sports Medicine Centre