Revision as of 14:58, 6 January 2020

DOMS is of critical importance for runners. Unlike many other types of exercise, running requires your muscles to extend under load, absorbing your weight as you land. This extension under load, called eccentric, is a prime cause of DOMS, and while the soreness is delayed, the accompanying weakness is immediate. This eccentric stress is why marathon runners are often hobbling around the day after a race. The good news is that a bout of DOMS inducing exercise provides protection against future DOMS, and so it's a critical part of training. This "Repeated Bout Effect" (RBE) is a core aspect of training, and by intentionally inducing DOMS you can prevent the soreness that occurs after long distance races. The less obvious, but more important benefit is that you also prevent some of the weakness that occurs towards the end of longer races. This is a key benefit to Downhill Running and especially the Treadmill Descent. I believe that incorporating Treadmill Descents into my training is the reason I've completed 100-mile races with little muscle soreness.

1 Introduction

Delayed Onset Muscle Soreness (DOMS) is a familiar experience to most people who exercise. It affects people who weight train and run particularly, and DOMS can produce anything from mild muscle soreness to debilitating pain and weakness. DOMS is caused by eccentric stress, where the muscles working to resist lengthening, such as lowering a weight or absorbing the landing forces of running. Downhill Running is a particular source of eccentric stress. DOMS not only produces delayed soreness, but immediate weakness that generally lasts a similar length of time. DOMS also produces swelling, tense muscles, reduced coordination and a limited range of motion. A key benefit of DOMS inducing exercise is that a bout of DOMS can give protection against similar future exercise, and the protection lasts for months. This Repeated Bout Effect (RBE) is a critical part of endurance training. Running with the correct Cadence can help prevent DOMS, and taking protein after DOMS inducing exercise is one of the best treatments, though compression clothing, caffeine and massage can also help. It seems that Vitamin C may be critical to the RBE.

2 What is DOMS?

The soreness of DOMS generally peaks between 24 and 72 hours after unusual or severe exercise, though soreness may occur sooner after running^[1]. DOMS is particularly related to eccentric exercise, which is where the muscle works to resist becoming longer, rather than working to contract. When your muscles absorb the impact of running, this is eccentric exercise, and Downhill Running is more eccentric than flat or uphill running. The images below show the damage that occurs from eccentric exercise^[2] and marathon running^[3]:

• Muscle damage from eccentric exercise (downhill running)
• 

  Muscle before downhill running

• 

  Immediately after downhill running. Notice the disruption to the dark bands (z-bands) that are part of the muscle structure showing there is immediate damage.

• 

  One day later, the damage and disruption is worse, indicated some continued breakdown.

• 

  Muscle 14 days later, structurally recovered (other metrics do not return to pre-exercise levels at 14 days).

• Muscle damage after running a marathon
• 

  The selective pattern of damage, showing the normal upper fiber adjacent to the 'moth eaten' appearance of the damaged lower fiber.

• 

  Here you can see extreme damage, with only the Z band of the fiber remaining (marked Z). Adjacent fibers show far less damage.

3 Why is DOMS important?

Because running involves a lot of eccentric stress, DOMS is common in runners, especially after Downhill Running. The pain that occurs 24-72 hours after exercise can prevent continued training. However, the biggest issue for long distance runners is that although the pain occurs 24-72 hours after exercise, the weakness peaks after 30 minutes ^[4]/>. If you've ever run a long, steep descent, you'll know the strange feeling of weak numbness that pervades your quads as the effect of the downhill builds up. The Boston Marathon or the latter part of Mount Mitchell Challenge have descents that cause this type of weakness. If you've felt a similar weakness in the latter stages of a marathon, this may not be Glycogen depletion creating 'the wall', but eccentric muscle damage that will later manifest itself as DOMS. It is suggested that this is the reason the Boston Marathon course is relatively slow, even though it is a net decent.

4 What does DOMS mean to you?

There is some good news in all of this. While excessive eccentric exercise can cause DOMS, doing some eccentric exercise causes the muscles to adapt and to be able to handle eccentric exercise without DOMS ^[5]. There are two ways then of protecting your muscles from DOMS in running; running greater distances, or running downhill. I believe that downhill running that is greatly underutilized in training regimes. Most hill training workouts focus on the uphill segment, and relegate the downhill to recovery. While uphill can produce some benefits, it is the downhill that can provide the greatest advantage. Adding hills into your workout can make you a much stronger runner, and have benefits even on flat race courses. Don't just use the downhill to recover from the uphill, but work on the downhill.

5 Determining if you have DOMS

It's not always obvious if you have DOMS or some other problem. Here are some simple checks that can help guide you:

• As the name suggests, DOMS normally occurs a day or two after the exercise, but this is not always the case.
• The soreness of DOMS eases off with light exercise, so if the pain gets less then it's probably DOMS but if it gets worse it's probably not. The lessoning of the pain should occur after a few minutes of light exercise, such as walking or gentle running.
• The soreness of DOMS is normally quite diffuse over a large area of the muscle and the soreness is close to the surface. Often the muscles are tender to the touch and Massage is too painful. That is different to something like a muscle tear which has a sharp, localized pain, or a Trigger Point that has a painful lump in the muscle.
• DOMS also reduces the strength of the effected muscles, and this can be quite dramatic in extreme cases.
• Often a muscle with DOMS is hard to the touch, even when it's as relaxed as possible. A healthy muscle should only be firm when it's contracted.

5.1 DOMS Scale

This is a simplistic scale that I use to evaluate how bad my DOMS symptoms are. This is focused on DOMS of the quads, the most common areas noticed in runners.

5.2 Likert Scale Muscle Soreness

There is a more general scale of muscle soreness that applies to all muscles, but is not focused on DOMS^[1][6].

6 What are the symptoms of DOMS?

The soreness of DOMS is different to other forms of muscle soreness. With DOMS, large areas of the muscle are tender to the touch and painful when the muscle is used. With other forms of muscle soreness the area of tenderness is usually more localized and the pain of massage is sometimes described as a 'good pain'. The pain of DOMS will normally lessen with light exercise such as walking, which is often described as 'loosening' up. However, the soreness of DOMS is not the best indicator of the muscle damage, and similar levels of soreness can result from differing levels of muscle damage^[7]. In addition, there are other symptoms, such as:

• Reduction in strength^{[8][9][10][11]}, typically 30-60%^[12]. (Note that the reduction in strength starts immediately following the damaging exercise and increases over the next 24-48 hours^[13]. The initial reduction in strength can be as much as 40%^[12].)
• Muscle tenderness. DOMS makes the muscles tender to the touch, and the pain associated with pressure differs between DOMS and normal muscle soreness. With DOMS, the pain is extremely unpleasant and can be nauseating, where normal muscle soreness can be painful, but the pain has a sense of relief and is sometimes call a "good pain." The muscle tenderness can be measured from the "Pressure-Pain Threshold", where pressure is increased until the subject feels pain rather than pressure^[14].
• Increased passive muscle tension^[15]. A muscle suffering from DOMS will often be hard to the touch, even when relaxed as much as possible.
• Swelling of the muscle^[15], which can be seen as a lack of muscle definition in lean individuals.
• The perceptions of joint angle and force are impaired^[8], which can result in reduced coordination and a sense of clumsiness.
• A reduction in the Range of Motion^[8][9][10].
• Changes in running biomechanics, possibly as compensation for other changes^[16]. For instance, the reduction in Range of Motion can result in a reduction in stride length.
• Decreased Running Economy^[17][18].
• Impaired Glycogen repletion^[17][18], though higher carbohydrate intake partly offsets the reduction^[19]. There is some evidence that Glycogen levels continue to drop after DOMS inducing exercise^[20][21], and the deficiency in glycogen lasts for over 72 hours^[21].
• There are some studies that indicate there are possible changes in muscle fiber recruitment patterns^[22][23][24].

7 How long does DOMS last?

It seems likely that exercise characteristics (duration, intensity, etc.) will change the time to recovery^[25][26]. The soreness generally peaks between 24-72 hours after the damaging exercise, but will last at least 4 days^[26]. My personal experience is that DOMS can last for over a week, and I prefer to avoid Downhill Running in the two weeks before a race, though sometimes I will include it as close as 10 days beforehand.

8 The effect of steepness on DOMS

I have found that steeper descents produce disproportionately severe DOMS. This might be due to the angle of the knee, as most^[27][28] (but not all^[26]) studies indicate that the longer a muscle is when being stressed, the greater the DOMS. This effect is most noticeable when using a Treadmill for Downhill Running, as small changes in angle can produce a big difference in DOMS.

9 How to prevent or treat DOMS?

There are various approaches to preventing or treating DOMS. The table below is a summary of the approaches showing how likely the strategy is to prevent or treat DOMS combined with the possible significant downsides. At the top are those that are likely to help and have no downsides, then those that have no effects or downsides, then those with little benefit and significant downsides.

Notes

• ^aCaffeine can interfere with sleep
• ^b Only ever use ice in a bag, never a frozen gel pack. Gel packs start too cold and can cause skin or nerve damage.
• ^c Light exercise does not appear to speed up healing, but it does not hinder it either.

9.1 Repeated Bout Effect

The DOMS that follows an initial bout of eccentric exercise is much less on subsequent similar bouts. This is often called the Repeated Bout Effect (RBE)^[15][13]. The initial bout does not have to cause significant soreness or damage^[29]. As few as 2-10 maximal eccentric repetitions can protect against a subsequent larger bout (24-50), but the initial bout must be close to maximal effort^[30]. By contrast, eight weeks of training with 50% of the maximal eccentric load did not provide protection against a subsequent maximal bout^[31]. There is some cross-over of protection between different forms of exercise. For instance, eccentric weight training protects against soreness and weakness in subsequent downhill running^[32]. The protection from the RBE is long lived. One study showed that while the initial weakness was not reduced by the RBE, the recovery of strength was much faster for up to 9 months, and soreness was less for up to 6 months^[33]. Another study showed that 30 minutes of downhill running provides protection for between 6 and 9 weeks^[34]. There is evidence that the RBE may rapidly start to provide protection from soreness and weakness^[35], within 5 days^[36], and possibly within 24 hours^[37]. One study^[38] demonstrated a change in the length-tension curve of DOMS trained muscles. As shown on the chart below, 7 days after a bout of DOMS inducing exercise the hamstring is able to generate more force and generate it at a greater angle.

A chart of a subject before and 7 days after DOMS inducing hamstring exercise. The chart shows the angle and the torque developed, indicating that after training the hamstrings are not only stronger, but are able to generate power at significantly longer length. This may be part of the underlying mechanism for the repeated bout effect.

9.1.1 Repeated Bout and Vitamin C

I found a single study that looked at how the repeated bout effect changes with Vitamin C^[39]. As described below, most studies have found a small reduction in DOMS with Vitamin C. This 2014 study found that for the first bout, Vitamin C reduced the muscle soreness for the hamstrings, Quads, and Tibialis Anterior (shin), but the soreness of the glutes and calves were similar. However, for the second bout, not only was the soreness was reduced for the placebo, but it was further reduced with the Vitamin C. While this is just one study, it is intriguing with some profound implications. If the protective benefits of the repeated bout effect are dependent on nutritional (or other) factors, some runners may not get the benefit from their training. Personally, I've been taking ~1g/day of Vitamin C for many years due to skin condition. However, the evidence that Vitamin C impairs the adaptation to exercise caused me to take a break for about 15 months. During that break from Vitamin C, I found my ability to perform downhill running was quite impaired, and I didn't seem to be able to build up resistance from the repeated bout effect.

9.2 Carbohydrate and Protein

Main article: Nutrient Timing

The damage of DOMS requires repair, so it's not surprising that taking Protein or amino acids, which are the building blocks of the muscle fibers, helps with recovery.

• Most studies show that amino acids reduce muscle soreness^{[40][41] [42][43]}, and may^[43][41] or may not reduce weakness^[44][45][44].
• Most studies have shown that protein will reduce muscle weakness after DOMS inducing exercise^{[46][47] [48][49][50]}, with only two studies showing no improvement^[51][52].
• The effect of protein on soreness is more mixed with some studies showing improvement^{[53] [54][50]}, but others not^[46][55][52].
• Not surprisingly timing may be important, with CHO+PRO having an effect on muscle weakness directly after or 24 hours after, but not before DOMS inducing exercise^[49], as shown below.
• In addition to reducing muscle soreness, protein supplementation in military recruits also reduced illness and injury^[54].
• Taking carbohydrate alone after DOMS inducing exercise does not appear to help^[56][57].

The change in strength after DOMS inducing exercise. CON: control, PRE: protein before, POST: protein immediately after, TWENTY-FOUR: protein 24 horus after^[49].

Protein helps with recovery from DOMS^[50]. The graphs below show the impact of 100 grams of Protein taken immediately after 30 minutes of downhill running. Note that muscle soreness peaked at 72 hours, even though force and power had returned to baseline.

Peak force generated after DOMS inducing eccentric exercise. (*is significant change from baseline, double S marker indicates significant change from treatment.)

Peak power generated after DOMS inducing eccentric exercise.(*is significant change from baseline, double S marker indicates significant change from treatment.)

9.3 Cadence

Main article: Cadence

A study that looked at how changes in Cadence impacted the DOMS symptoms of downhill running showed that compared with a runner's preferred cadence, a higher cadence reduced subsequent weakness while a lower cadence increased soreness^[58]. This change in DOMS is not surprising given that an increased cadence reduces the impact forces of running^[59][60][61]. The impact forces from a lower cadence are mostly absorbed by the knee^[62], which would create greater eccentric loading of the quads. In addition, most^[27][28] (but not all^[26]) studies show that the more extended a muscle is when undergoing eccentric stress, the more likely it is to suffer from DOMS. This is likely to compound the effect of Cadence on DOMS.

9.4 Compression Clothing

Main article: Why compression clothes

Studies show that wearing Graduated Compression Clothing during the days after DOMS inducing exercise mitigates the soreness^{[63][64][65][66][67][68][69]} and weakness^[64][66][67] of DOMS. Relatively few studies showed no benefit from compression clothing^[70][71]. However, the results of compression clothing are likely to vary with the particular garment, how well it fits and therefore the pressure that is provided^[72]. I found one studies that looked at the effect of wearing compression clothing during DOMS inducing exercise on the subsequent recovery^[73]. This study used either or both graduated or uniform compression socks on hiking, a trail run, or calf exercise, with the socks also worn for the following four days. Graduated socks reduced DOMS pain on the hike compared with no compression, the only test with no compression as a control. The uniform compression reduced the pain compared with graduated on the run, and there was no difference between them on the calf exercise. This suggests to me that uniform compression might be better than graduated, or at least, it might not be worth paying extra for graduated compression.

9.5 Caffeine

Main article: Caffeine

Caffeine has shown to be effective in reducing the pain of DOMS, as well as reducing the weakness^[74]. (The reduction in weakness did not reach statistical significance in regular caffeine users^[75].) While the evidence for caffeine reducing the weakness of DOMS, this is one of the few approaches that can help offset the weakness during the damaging exercise.

9.6 Massage

Main article: Massage

Massage is widely used to prevent and treat injuries. Most meta-analysis suggest that post-exercise massage helps with the soreness of DOMS^[76][77], though the mechanisms are unclear^[78]. Studies that give massage 2-3 hours after DOMS inducing exercise showed reduced soreness^[79][80][81], but not weakness^[80][81]. One study that gave massage 2 days after exercise that resulted in reduced soreness and improved muscle function^[82], but other studies that use massage 24 hours or more after exercise showed no benefit^[83][84]. A study that used 20 minutes of foam rolling immediately following the DOMS inducing exercise, then again at 24 and 48 hours showed a significant improvement in both pain and muscular performance^[14]. Therefore it seems likely that the timing of the massage is important, though other factors, such as the style of massage and the extent of the DOMS may also change the outcome. My personal experience suggests that massage immediately after the exercise is more effective than when the massage is delayed. (All too often, the muscles are too painful under pressure to allow any form of massage.)

9.7 Warmup

Main article: Warmup

Performing a Warmup before exercise may help reduce DOMS pain^[85][86], but not all studies support this^[87].

9.8 Light Exercise

Light training in the days following DOMS inducing exercise generally accepted to be one of the most effective ways of reducing muscle soreness, but unfortunately the reduction in pain is temporary^{[88][89][15][13]}. A study that looked at running 30 minutes/day after DOMS inducing downhill running shows that the extra exercise neither helped nor hindered with soreness, weakness or Running Economy^[90]. (The study only looked at the 7 days following the downhill running, and it would be interesting to know if there are any longer-term differences.) One study used cycling at light (30%) or moderate (70%) immediately after DOMS inducing exercise^[91]. The moderate intensity cycling prevented the loss of strength, and actually increased strength on days 3 and 4. There were no differences between the control and the light exercise, nor between any of the conditions for soreness. This is an interesting suggestion that higher intensity exercise might be beneficial, but the study has a number of flaws, including the use of predicted Maximum Heart Rate to set exercise intensity.

9.9 TENS

TENS may reduce the soreness of DOMS^[92], but the effect seems to be transient^[93] and the effect is reduced if combined with icing^[94]. Not all studies show any pain reduction^[95] and none show a reduction in the weakness.

9.10 Icing

Main article: Cryotherapy

Sadly, Icing does not help with DOMS^{[96][97][98][11]}, and can make DOMS worse^[99][100]. Ice reduces pain slightly, but does not restore strength^[94]. (In my experience, ice can be extremely effective at helping heal muscle tears and non-DOMS muscle injuries, but not DOMS.)

9.11 Protracted Heat

One study looked at applying heat for 8 hours, either directly after DOMS inducing exercise or 24 hours later^[101]. The study used "ThermaCare" chemically generated heat wraps, and I suspect the study was sponsored by the company. The 60 subjects underwent 5 minutes of squats to induce DOMS, then 20 were controls, 20 had immediate heat for 8 hours and the remainder had heat applied 24 hours after exercise. The immediate heat subjects had little reduction in strength over the follow three days, where the 24-hour delayed heat was no different from the controls. The strength drop was about 24% in controls/delayed-heat, which is a meaningful improvement. There was some reduction in pain over the first two days, with the immediate heat doing better than the delayed heat, which was slightly better than the controls.

9.12 Antioxidants - Vitamin C and E

The evidence for anti-oxidants is mixed, with some studies showing a benefit but not others. Note that one study below showed an impaired recovery with vitamin C supplementation. In addition, there is mixed evidence that vitamin C and/or vitamin E reduces Endurance Adaptations from exercise^{[102][103][104]} or they do not^{[105][106] [107]}. A 2019 systematic review of 50 studies covering 1,089 subjects concluded that there was moderate quality evidence that Vitamin C reduced DOMS at 48 and 96 hours, with lower quality evidence for 6 and 24 hours, but the reduction was quite small^[108].

9.13 Stretching

Main article: Stretching

Stretching before^{[119][120] [121]}, after ^{[120][122][123]}, or both before and after^[124] exercise does not help with DOMS. In fact, stretching alone can induce DOMS^[125]. Both static and dynamic stretching are ineffective^[126].

9.14 NSAIDs

Main article: NSAIDs and Running

The most common NSAIDs (Ibuprofen, Acetaminophen/Paracetamol, and Aspirin) are unlikely to help with DOMS, but Naproxen may reduce the pain and weakness. If an NSAID is taken, it should probably be immediately after the damaging exercise rather than waiting until the soreness develops. It seems likely that taking an NSAID for DOMS will reduce the muscular growth that would normally occur as part of the recovery. In one disturbing study, rabbits treated with an NSAID (flurbiprofen) after DOMS inducing exercise initially recovered their strength after 3-7 days, but between days 7 and 28 days the rabbits became weaker while the untreated controls became stronger^[127]. I have not included other animal studies, but this is the only one that looks at how NSAIDs impact the longer term recovery from DOMS. Studies of Turmeric, which acts as a selective COX-2 NSAID^[128], are promising. Reduction in soreness is mixed, with some studies showing reduced soreness^{[129][130] [131]}, while others do not^[132][133]. However, one study shoes reduced weakness and inflammation markers^[133] and an animal study showed less subsequent reduction in running performance in mice^[134]. Several studies showed reduced markers of damage^{[135][134][133][132] [131]}. However, Turmeric should be treated like any other medication as there are safety concerns; see Turmeric as an NSAID for details.

9.15 CBD Oil

I have heard anecdotal suggestions that CBD oil may help with sleep after DOMS inducing exercise, but I've found no supporting research. Note that in 2018, World Anti-Doping Agency (WADA) removed CBD, from its 2018 prohibited substances list, but the legality of CBD is complex.

10 Menstrual Cycle

A study has shown that DOMS does not vary with menstrual cycle^[157].

11 Mechanisms of DOMS

The underlying mechanism of DOMS is thought to consist of phases; the initial damage that occurs during the exercise and then secondary damage that occurs subsequently^[13][15]:

• Primary damage. The initial damage is believed to be mechanical in nature, both on the contracting parts of the muscle (sarcomeres) and the supporting structures (primarily the z-bands). While there are some suggestions that the primary damage might be due to metabolic factors such as low blood flow, low oxygen saturation, impaired metabolite clearance, these causes are not well supported. The idea that DOMS is caused by lactic acid has been rejected^[158].
• Secondary damage. The secondary damage appears to be initiated by the disruption of the intracellular Ca²+homeostatis, which leads to further myofibrillar damage including degradation of the cell membrane.

11.1 Mechanisms for the Repeated Bout Effect

For those interested in the details, there are several possible mechanisms that might be responsible for the Repeated Bout Effect (RBE)^[159][160]:

• Neural adaptation. The RBE may be due to changes in the way muscles are recruited. While there is some direct evidence that RBE occurs without neural adaptations, it is possible that this mechanism contributes to the protection.
  • Increased recruitment of slow-twitch fibers. Fast-twitch fibers may be more susceptible to eccentric damage, so an adaptation to recruit more slow-twitch fibers might reduce DOMS.
  • Activation of more muscle fibers. Recruiting a larger number of fibers may reduce the eccentric stress on each fiber, thus reducing the damage.
• Mechanical adaptation. It is possible to consider muscle damage as similar to materials fatigue. These adaptations are in the non-contracting structures of the muscles. For instance, protection from damage could come from increased structural strength in the z-band of the muscles which get disturbed by eccentric exercise as seen above.
  • Increased dynamic muscle stiffness. Dynamic stiffness refers to how stiff the muscles are when contracted.
  • Increased passive muscle stiffness. In contrast, passive stiffness is when the muscles are relaxed. It is unclear if increased passive stiffness protects against eccentric damage or actually exacerbates it.
• Cellular adaptation. A number of changes at the cellular level may provide protection against eccentric damage.
  • Increased sarcomeres. The sarcomeres are part of the contracting mechanism of the muscles. The contraction of a muscle comes from parts of the sarcomere sliding over each other. One adaptation to eccentric exercise may be that the overlap in these sliding areas becomes larger. A study in rats suggests that the adaptation may include more sarcomeres in series, which produces a greater Range Of Motion and greater force at longer muscle lengths^[161].
  • Changed inflammation response. The delay in soreness is probably due to a delayed inflammatory response, so changes in that response could reduce the soreness. However, this would not reduce the immediate loss of strength.
  • Maintenance of Excitation-Contraction coupling. One reason for the loss of strength following eccentric exercise is that the nerve impulses (excitation) may result in less contraction. The decoupling could be due to lack of neural drive (perhaps due to pain), physical disruption of the contracting structures of the muscle, or a failure to activate those contracting structures.

12 Limitations of the current scientific studies

While there are a large number of scientific studies available on DOMS, these studies have a number of limitations.

• Most studies use a small number of subjects, limiting their ability to detect the effectiveness of treatments.
• The studies are not consistent in the level of DOMS that is provoked, with some studies having relatively mild soreness.
• Not all studies avoid the confounding effects of the Repeated Bout Effect. This can be where the study has not ensured that subjects have not performed any eccentric exercise in the recent past, or where subjects undergo multiple bouts in the study.
• The studies generally do not establish any dose/response relationship.
• Human studies are limited in their timeframe, so that the longer term effects of the treatments are unclear.
• Studies often focus on how a treatment reduces the symptoms of DOMS without looking at how the treatment might also change the adaptation process. A DOMS treatment that effectively reduces soreness and/or weakness but also prevents any adaptation to the training has limited benefit.

13 See Also

• Downhill Running
• Downhill Intervals

14 References

1. ↑ ^{1.0 1.1} Andrew J Vickers, BMC Musculoskeletal Disorders, volume 2, issue 1, 2001, pages 5, ISSN 14712474, doi 10.1186/1471-2474-2-5
2. ↑ L Feasson, D Stockholm, D Freyssenet, I Richard, S Duguez, J S Beckmann, C Denis, Molecular adaptations of neuromuscular disease-associated proteins in response to eccentric exercise in human skeletal muscle, The Journal of Physiology, volume 543, issue 1, 2002, pages 297–306, ISSN 0022-3751, doi 10.1113/jphysiol.2002.018689
3. ↑ MJ. Warhol, AJ. Siegel, WJ. Evans, LM. Silverman, Skeletal muscle injury and repair in marathon runners after competition., Am J Pathol, volume 118, issue 2, pages 331-9, Feb 1985, PMID 3970143
4. ↑ V. Marginson, AV. Rowlands, NP. Gleeson, RG. Eston, Comparison of the symptoms of exercise-induced muscle damage after an initial and repeated bout of plyometric exercise in men and boys., J Appl Physiol, volume 99, issue 3, pages 1174-81, Sep 2005, doi 10.1152/japplphysiol.01193.2004, PMID 15817716
5. ↑ Skeletal muscle damage and repair http://books.google.com/books?id=ueMh1x7kFjsC&lpg=PA195&ots=wwIhuoi0Nt&dq=Tiidus%201997&pg=PA69#v=onepage&q=Tiidus%201997&f=true
6. ↑ FM. Impellizzeri, NA. Maffiuletti, Convergent evidence for construct validity of a 7-point likert scale of lower limb muscle soreness., Clin J Sport Med, volume 17, issue 6, pages 494-6, Nov 2007, doi 10.1097/JSM.0b013e31815aed57, PMID 17993794
7. ↑ Kazunori Nosaka, Mike Newton, Paul Sacco, Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage, Scandinavian Journal of Medicine & Science in Sports, volume 12, issue 6, 2002, pages 337–346, ISSN 09057188, doi 10.1034/j.1600-0838.2002.10178.x
8. ↑ ^{8.0 8.1 8.2} JM. Saxton, PM. Clarkson, R. James, M. Miles, M. Westerfer, S. Clark, AE. Donnelly, Neuromuscular dysfunction following eccentric exercise., Med Sci Sports Exerc, volume 27, issue 8, pages 1185-93, Aug 1995, PMID 7476064
9. ↑ ^{9.0 9.1} Delayed Onset Muscle Soreness and Decreased Isokinetic Stren... : The Journal of Strength & Conditioning Research http://journals.lww.com/nsca-jscr/abstract/1988/05000/delayed_onset_muscle_soreness_and_decreased.1.aspx
10. ↑ ^{10.0 10.1} DT. Gulick, IF. Kimura, M. Sitler, A. Paolone, JD. Kelly, Various treatment techniques on signs and symptoms of delayed onset muscle soreness., J Athl Train, volume 31, issue 2, pages 145-52, Apr 1996, PMID 16558388
11. ↑ ^{11.0 11.1} DJ. Paddon-Jones, BM. Quigley, Effect of cryotherapy on muscle soreness and strength following eccentric exercise., Int J Sports Med, volume 18, issue 8, pages 588-93, Nov 1997, doi 10.1055/s-2007-972686, PMID 9443590
12. ↑ ^{12.0 12.1} A. Baldwin Lanier, Use of nonsteroidal anti-inflammatory drugs following exercise-induced muscle injury., Sports Med, volume 33, issue 3, pages 177-85, 2003, PMID 12656639
13. ↑ ^{13.0 13.1 13.2 13.3} K. Cheung, P. Hume, L. Maxwell, Delayed onset muscle soreness : treatment strategies and performance factors., Sports Med, volume 33, issue 2, pages 145-64, 2003, PMID 12617692
14. ↑ ^{14.0 14.1} GE. Pearcey, DJ. Bradbury-Squires, JE. Kawamoto, EJ. Drinkwater, DG. Behm, DC. Button, Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures., J Athl Train, volume 50, issue 1, pages 5-13, Jan 2015, doi 10.4085/1062-6050-50.1.01, PMID 25415413
15. ↑ ^{15.0 15.1 15.2 15.3 15.4} G. Howatson, KA. van Someren, The prevention and treatment of exercise-induced muscle damage., Sports Med, volume 38, issue 6, pages 483-503, 2008, PMID 18489195
16. ↑ Muscle Soreness During Running: Biomechanical and Physiological Considerations http://journals.humankinetics.com/jab-back-issues/jabvolume7issue2may/musclesorenessduringrunningbiomechanicalandphysiologicalconsiderations
17. ↑ ^{17.0 17.1} Smith LL. Causes of delayed onset muscle soreness and the impact on athletic performance: a review. J Appl Sport Sci Res 1992; 6 (3): 135-41
18. ↑ ^{18.0 18.1} WA. Braun, DJ. Dutto, The effects of a single bout of downhill running and ensuing delayed onset of muscle soreness on running economy performed 48 h later., Eur J Appl Physiol, volume 90, issue 1-2, pages 29-34, Sep 2003, doi 10.1007/s00421-003-0857-8, PMID 12783232
19. ↑ DL. Costill, DD. Pascoe, WJ. Fink, RA. Robergs, SI. Barr, D. Pearson, Impaired muscle glycogen resynthesis after eccentric exercise., J Appl Physiol, volume 69, issue 1, pages 46-50, Jul 1990, PMID 2394662
20. ↑ M. Zehnder, M. Muelli, R. Buchli, G. Kuehne, U. Boutellier, Further glycogen decrease during early recovery after eccentric exercise despite a high carbohydrate intake., Eur J Nutr, volume 43, issue 3, pages 148-59, Jun 2004, doi 10.1007/s00394-004-0453-7, PMID 15168037
21. ↑ ^{21.0 21.1} JJ. Widrick, DL. Costill, GK. McConell, DE. Anderson, DR. Pearson, JJ. Zachwieja, Time course of glycogen accumulation after eccentric exercise., J Appl Physiol, volume 72, issue 5, pages 1999-2004, May 1992, PMID 1601811
22. ↑ MP. Miles, JC. Ives, KR. Vincent, Neuromuscular control following maximal eccentric exercise., Eur J Appl Physiol Occup Physiol, volume 76, issue 4, pages 368-74, 1997, PMID 9349654
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126. ↑ Yanfei Xie, Beibei Feng, Kedi Chen, Lars L. Andersen, Phil Page, Yuling Wang, The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals, Clinical Journal of Sport Medicine, volume 28, issue 1, 2018, pages 28–36, ISSN 1050-642X, doi 10.1097/JSM.0000000000000442
127. ↑ DK. Mishra, J. Fridén, MC. Schmitz, RL. Lieber, Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function., J Bone Joint Surg Am, volume 77, issue 10, pages 1510-9, Oct 1995, PMID 7593059
128. ↑ R.S. Ramsewak, D.L. DeWitt, M.G. Nair, Cytotoxicity, antioxidant and anti-inflammatory activities of Curcumins I–III from Curcuma longa, Phytomedicine, volume 7, issue 4, 2000, pages 303–308, ISSN 09447113, doi 10.1016/S0944-7113(00)80048-3
129. ↑ ^{129.0 129.1} LM. Nicol, DS. Rowlands, R. Fazakerly, J. Kellett, Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS)., Eur J Appl Physiol, volume 115, issue 8, pages 1769-77, Aug 2015, doi 10.1007/s00421-015-3152-6, PMID 25795285
130. ↑ ^{130.0 130.1} F. Drobnic, J. Riera, G. Appendino, S. Togni, F. Franceschi, X. Valle, A. Pons, J. Tur, Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva): a randomised, placebo-controlled trial., J Int Soc Sports Nutr, volume 11, pages 31, 2014, doi 10.1186/1550-2783-11-31, PMID 24982601
131. ↑ ^{131.0 131.1} Lesley M. Nicol, David S. Rowlands, Ruth Fazakerly, John Kellett, Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS), European Journal of Applied Physiology, volume 115, issue 8, 2015, pages 1769–1777, ISSN 1439-6319, doi 10.1007/s00421-015-3152-6
132. ↑ ^{132.0 132.1 132.2} Brian K. McFarlin, Adam S. Venable, Andrea L. Henning, Jill N. Best Sampson, Kathryn Pennel, Jakob L. Vingren, David W. Hill, Reduced Inflammatory and Muscle Damage Biomarkers following Oral Supplementation with Bioavailable Curcumin, BBA Clinical, 2016, ISSN 22146474, doi 10.1016/j.bbacli.2016.02.003
133. ↑ ^{133.0 133.1 133.2 133.3 133.4} Yoko Tanabe, Seiji Maeda, Nobuhiko Akazawa, Asako Zempo-Miyaki, Youngju Choi, Song-Gyu Ra, Atsushi Imaizumi, Yoshihiko Otsuka, Kazunori Nosaka, Attenuation of indirect markers of eccentric exercise-induced muscle damage by curcumin, European Journal of Applied Physiology, volume 115, issue 9, 2015, pages 1949–1957, ISSN 1439-6319, doi 10.1007/s00421-015-3170-4
134. ↑ ^{134.0 134.1 134.2} JM. Davis, EA. Murphy, MD. Carmichael, MR. Zielinski, CM. Groschwitz, AS. Brown, JD. Gangemi, A. Ghaffar, EP. Mayer, Curcumin effects on inflammation and performance recovery following eccentric exercise-induced muscle damage., Am J Physiol Regul Integr Comp Physiol, volume 292, issue 6, pages R2168-73, Jun 2007, doi 10.1152/ajpregu.00858.2006, PMID 17332159
135. ↑ N. Kawanishi, K. Kato, M. Takahashi, T. Mizokami, Y. Otsuka, A. Imaizumi, D. Shiva, H. Yano, K. Suzuki, Curcumin attenuates oxidative stress following downhill running-induced muscle damage., Biochem Biophys Res Commun, volume 441, issue 3, pages 573-8, Nov 2013, doi 10.1016/j.bbrc.2013.10.119, PMID 24184481
136. ↑ ^{136.0 136.1} SM. Hasson, JC. Daniels, JG. Divine, BR. Niebuhr, S. Richmond, PG. Stein, JH. Williams, Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation., Med Sci Sports Exerc, volume 25, issue 1, pages 9-17, Jan 1993, PMID 8423760
137. ↑ ^{137.0 137.1} author Tokmakidis SP, Kokkinidis EA, Smilios I, Douda H, The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise., J Strength Cond Res, 2003, volume 17, issue 1, pages 53-9, PMID 12580656
138. ↑ ^{138.0 138.1} Effect of Ibuprofen Use on Delayed Onset Muscle Soreness of the Elbow Flexors http://journals.humankinetics.com/jsr-back-issues/jsrvolume4issue4november/effectofibuprofenuseondelayedonsetmusclesorenessoftheelbowflexors
139. ↑ ^{139.0 139.1} FX. Pizza, D. Cavender, A. Stockard, H. Baylies, A. Beighle, Anti-inflammatory doses of ibuprofen: effect on neutrophils and exercise-induced muscle injury., Int J Sports Med, volume 20, issue 2, pages 98-102, Feb 1999, doi 10.1055/s-2007-971100, PMID 10190769
140. ↑ ^{140.0 140.1} Joel R. Krentz, Braden Quest, Jonathan P. Farthing, Dale W. Quest, Philip D. Chilibeck, The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training, Applied Physiology, Nutrition, and Metabolism, volume 33, issue 3, 2008, pages 470–475, ISSN 1715-5312, doi 10.1139/H08-019
141. ↑ ^{141.0 141.1} Lars Arendt-Nielsen, Morten Weidner, Dorte Bartholin, Allan Rosetzsky, A Double-Blind Randomized Placebo Controlled Parallel Group Study Evaluating the Effects of Ibuprofen and Glucosamine Sulfate on Exercise Induced Muscle Soreness, Journal Of Musculoskeletal Pain, volume 15, issue 1, 2007, pages 21–28, ISSN 1058-2452, doi 10.1300/J094v15n01_04
142. ↑ ^{142.0 142.1} AE. Donnelly, RJ. Maughan, PH. Whiting, Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage., Br J Sports Med, volume 24, issue 3, pages 191-5, Sep 1990, PMID 2078806
143. ↑ ^{143.0 143.1 143.2} MB. Stone, MA. Merrick, CD. Ingersoll, JE. Edwards, Preliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness management., Clin J Sport Med, volume 12, issue 6, pages 373-8, Nov 2002, PMID 12466693
144. ↑ Robert D. Hyldahl, Justin Keadle, Pierre A. Rouzier, Dennis Pearl, Priscilla M. Clarkson, Effects of Ibuprofen Topical Gel on Muscle Soreness, Medicine & Science in Sports & Exercise, volume 42, issue 3, 2010, pages 614–621, ISSN 0195-9131, doi 10.1249/MSS.0b013e3181b95db2
145. ↑ ^{145.0 145.1 145.2} P. Barlas, JA. Craig, J. Robinson, DM. Walsh, GD. Baxter, JM. Allen, Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics., Arch Phys Med Rehabil, volume 81, issue 7, pages 966-72, Jul 2000, doi 10.1053/apmr.2000.6277, PMID 10896014
146. ↑ ^{146.0 146.1} Lucille Smith, Robert George, Thomas Chenier, Michael McCammon, Joseph Houmard, Richard Israel, R. A. Hoppmann, Susan Smith, Do over-the-counter analgesics reduce delayed onset muscle soreness and serum creatine kinase values?, Research in Sports Medicine, volume 6, issue 2, 1995, pages 81–88, ISSN 1543-8627, doi 10.1080/15438629509512039
147. ↑ ^{147.0 147.1} Riasati et al.: Aspirin and delayed onset muscle soreness ASPIRIN MAY BE AN EFFECTIVE TREATMENT FOR EXERCISE- INDUCED MUSCLE SORENESS | ResearchGate http://www.researchgate.net/publication/228091056_Riasati_et_al._Aspirin_and_delayed_onset_muscle_soreness_ASPIRIN_MAY_BE_AN_EFFECTIVE_TREATMENT_FOR_EXERCISE-_INDUCED_MUSCLE_SORENESS
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149. ↑ ^{149.0 149.1} GA. Dudley, J. Czerkawski, A. Meinrod, G. Gillis, A. Baldwin, M. Scarpone, Efficacy of naproxen sodium for exercise-induced dysfunction muscle injury and soreness., Clin J Sport Med, volume 7, issue 1, pages 3-10, Jan 1997, PMID 9117523
150. ↑ ^{150.0 150.1} AC. Baldwin, SW. Stevenson, GA. Dudley, Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals., J Gerontol A Biol Sci Med Sci, volume 56, issue 8, pages M510-3, Aug 2001, PMID 11487604
151. ↑ ^{151.0 151.1} JM. Lecomte, VJ. Lacroix, DL. Montgomery, A randomized controlled trial of the effect of naproxen on delayed onset muscle soreness and muscle strength., Clin J Sport Med, volume 8, issue 2, pages 82-7, Apr 1998, PMID 9641434
152. ↑ The Effect of Taking Naproxen Drug on the Level of Perceived Pain and Changes of CPK Serum after Eccentric Exercise - Harakat Volume: 37, Issue:, Accessed on 3 January 2013
153. ↑ ^{153.0 153.1} J. Bourgeois, D. MacDougall, J. MacDonald, M. Tarnopolsky, Naproxen does not alter indices of muscle damage in resistance-exercise trained men., Med Sci Sports Exerc, volume 31, issue 1, pages 4-9, Jan 1999, PMID 9927002
154. ↑ A E Donnelly, K McCormick, R J Maughan, P H Whiting, P M Clarkson, Effects of a non-steroidal anti-inflammatory drug on delayed onset muscle soreness and indices of damage., British Journal of Sports Medicine, volume 22, issue 1, 1988, pages 35–38, ISSN 0306-3674, doi 10.1136/bjsm.22.1.35
155. ↑ L.C. Loram, D. Mitchell, A. Fuller, Rofecoxib and tramadol do not attenuate delayed-onset muscle soreness or ischaemic pain in human volunteers, Canadian Journal of Physiology and Pharmacology, volume 83, issue 12, 2005, pages 1137–1145, ISSN 0008-4212, doi 10.1139/y05-113
156. ↑ ^{156.0 156.1} SP. Sayers, CA. Knight, PM. Clarkson, EH. Van Wegen, G. Kamen, Effect of ketoprofen on muscle function and sEMG activity after eccentric exercise., Med Sci Sports Exerc, volume 33, issue 5, pages 702-10, May 2001, PMID 11323536
157. ↑ Morgan E. Chaffin, Kris E. Berg, Jessica R. Meendering, Tamra L. Llewellyn, Jeffrey A. French, Jeremy E. Davis, Interleukin-6 and Delayed Onset Muscle Soreness Do Not Vary During the Menstrual Cycle, Research Quarterly for Exercise and Sport, volume 82, issue 4, 2011, pages 693–701, ISSN 0270-1367, doi 10.1080/02701367.2011.10599806
158. ↑ J Schwane, Is lactic acid related to delayed-onset muscle soreness., Physician & Sportsmedicin, volume 11, issue 3, pages 124-127;130-131, Mar 1983
159. ↑ MP. McHugh, Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise., Scand J Med Sci Sports, volume 13, issue 2, pages 88-97, Apr 2003, PMID 12641640
160. ↑ MP. McHugh, DA. Connolly, RG. Eston, GW. Gleim, Exercise-induced muscle damage and potential mechanisms for the repeated bout effect., Sports Med, volume 27, issue 3, pages 157-70, Mar 1999, PMID 10222539
161. ↑ R. Lynn, JA. Talbot, DL. Morgan, Differences in rat skeletal muscles after incline and decline running., J Appl Physiol (1985), volume 85, issue 1, pages 98-104, Jul 1998, PMID 9655761