Latest revision as of 06:44, 21 April 2024

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
2 What is DOMS?
3 Why is DOMS important?
4 What does DOMS mean to you?
5 Determining if you have DOMS
- 5.1 DOMS Scale
- 5.2 Likert Scale Muscle Soreness
6 What are the symptoms of DOMS?
7 How long does DOMS last?
8 The effect of steepness on DOMS
9 How to prevent or treat DOMS?
10 Menstrual Cycle
11 Mechanisms of DOMS
- 11.1 Mechanisms for the Repeated Bout Effect
12 Limitations of the current scientific studies
13 See Also
14 References

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.

DOMS Scale	Stair Test
0	You can walk down stairs without discomfort.
1	You can walk down stairs with some pain, but there's no need to hold on to the handrail.
2	You can walk down stairs with some pain, but you only need to hold on to the handrail for balance.
3	You need to put some of your weight on the handrail to descend stairs.
4	You need to put nearly all of your weight on the handrail to descend stairs.
5	Your quads cannot lower any weight and descending stairs it tricky. Descending stairs involves standing opposite the handrail and locking the leg that is opposite the handrail. Your body is then tilted towards the handrail, using your arms to lower your weight. The leg nearest the handrail is locked straight and once your body is lowered, it takes the weight. Repeat for each step. (Or avoid stairs.)

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].

Scale	Description
0	An absence of soreness
1	A light pain felt only when touched / a vague ache
2	A moderate pain felt only when touched / a slight persistent pain
3	A light pain when walking up or down stairs
4	A light pain when walking on a flat surface / painful
5	A moderate pain, stiffness or weakness when walking / very painful
6	A severe pain that limits my ability to move

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.

Strategy	Timing	Soreness	Weakness	Downsides
Repeated Bout Effect	Before (days to months)	Strong evidence of reduced soreness	Some evidence of reduced weakness	None
Carbohydrate and/or protein	After	Some evidence of reduced soreness	Strong evidence of reduced weakness	None
Cadence	During	Some evidence of reduced soreness	Some evidence of reduced soreness	None
Compression Clothing	After	Some evidence of reduced soreness	Some evidence of reduced weakness	None
Caffeine	After	Some evidence of reduced soreness	Some evidence of reduced weakness	None^a
Massage	After	Some evidence of reduced soreness	Some evidence of reduced weakness	None
Warmup	Immediately before	Some evidence of reduced soreness	No benefit	None
Light Exercise	After	Transient pain reduction	No benefit	None^c
TENS	After	Transient pain reduction	No benefit	None
Icing	After	No benefit	No benefit	None^b
Antioxidents	Before and/or After	Mixed evidence	Mixed evidence	Conflicting evidence of reduced Endurance Adaptations
Stretching	Before and/or After	No benefit	No benefit	# Stretchingtemporarily weakens muscles Can induce DOMS Can lead to injury
NSAIDs	Before and/or After	Most evidence indicates no benefit	Most evidence indicates no benefit	Can impair recovery

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].

Vitamin C	Vitamin E	Dose Period	Result
3,000mg/day		14 days prior and 4 days post-exercise	Vitamin C reduces soreness in first 24 hours^[109]
3,000mg/day		3 days prior and 4 days post-exercise	reduced soreness^[110]
400mg/day		14 days prior to exercise	reduced soreness^[111]
3,000mg/day		3 days prior and 5 days post-exercise	no effect^[112]
1,000mg/day		2 hours prior and 4 days post-exercise	no soreness change, but impaired strength recovery 7 and 14 days after exercise^[113]
1,000mg		2 hours prior to exercise	no effect^[114]
400mg/day		12 days prior and 3 days post-exercise	no change in soreness^[115]
	1,200 IU/day	30 days prior to exercise	No effect^[116]
500mg/day	1,200 IU/day	30 days prior and 7 days post-exercise	improved muscle function but no change in soreness^[117]
1,000mg/day	300 mg/d	6 weeks prior to exercise	no change in function^[118]

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/Pain Relief

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. (See below for notes on Aspirin and resolvins.) 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. There's an emerging belief that NSAIDs suppress inflammation, without actually resolving it^[128]. Studies of Turmeric, which acts as a selective COX-2 NSAID^[129], are promising. Reduction in soreness is mixed, with some studies showing reduced soreness^[130]^[131] ^[132], while others do not^[133]^[134]. However, one study shoes reduced weakness and inflammation markers^[134] and an animal study showed less subsequent reduction in running performance in mice^[135]. Several studies showed reduced markers of damage^[136]^[135]^[134]^[133] ^[132]. However, Turmeric should be treated like any other medication as there are safety concerns; see Turmeric as an NSAID for details.

NSAID	Soreness	Weakness
Ibuprofen	2xImproved^[137]^[138] 7xNo Effect^[139]^[140]^[86] ^[141]^[142]^[143]^[144]	1xMaybe^[137] 8xNo Effect^[139]^[140]^[86] ^[141]^[142]^[143]^[138]^[144]
Ibuprofen Gel	1xNo Effect^[145]
Acetaminophen (Paracetamol)	2xNo Effect^[146]^[147]
Aspirin	2xImproved^[148]^[149] 2xNo Effect^[146]^[147]	2xNo Effect^[148]^[149]
Naproxen	4xImproved^[150]^[151]^[152]^[153] 1xNo Effect^[154]	3xImproved^[150]^[151]^[152] 1xNo Effect^[154]
Diclofenac	Possible slight reduction^[155]
Codeine	1xNo Effect^[146]
Rofecoxib	1xNo Effect^[156]
Ketoprofen	1xImproved^[157]	1xImproved^[157]
Bromelain	1xNo Effect^[144]
Turmeric	2xImproved^[130]^[131] 2xNo Effect^[133]^[134]	2xImproved^[134]^[135]

9.15 HMB (β-hydroxy-β-methylbutyrate)

There's limited research on HMB and DOMS which suggests HMB might help reduce DOMS^[158]^[159]^[160]. The research isn't great, and the results aren't huge, but given the other benefits of HMB For Runners, I think it's worthwhile. (As an aside, I was amazed to find one study on HMB and DOMS didn't actually use a product containing HMB^[161]^[162]!)

9.16 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.

9.17 Omega-3

There's some limited evidence that Omega-3 oils might help with DOMS^[163]. The Omega-3 oils need to be long chain, such as fish oil, and include EPA and DHA. There's some evidence that athletes may need more Omega-3, with up to 5g/day of EPA/DHA being recommended^[164].

9.18 Omega-3, Aspirin, and Resolvins

One interesting possibility is the combination of Omega-3 and low dose Aspirin, because Aspirin triggers the conversion of DHA to resolvins^[165]. As the name suggests, these resolvins cause the resolution of inflammation rather than simply suppressing inflammation. (Resolvins are not immunosuppressive^[166].) While there's no studies on how resolvins interact with DOMS, there's a compelling hypothesis^[128] and some initial research into general muscle recovery from injury^[128]. The typical dose used to study aspirin triggered resolvins is 81mg after a study comparing 81/325/650mg doses found that 325mg had a negligible improvement over 81mg^[167]. It's unclear if less than 81mg might be effective, as I couldn't find any research into lower doses. (Anecdotally, a medical researcher suggested to me that much lower doses might be sufficient.)

The time course of inflammation.

10 Menstrual Cycle

A study has shown that DOMS does not vary with menstrual cycle^[168].

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^[169].
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)^[170]^[171]:

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^[172].
- 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

14 References

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@@ Line 1: / Line 1: @@
-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| 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. [[Nutrient_Timing| Taking protein]] after DOMS inducing exercise is one of the best treatments, though [[Why_compression_clothes| compression clothing]], [[Caffeine| caffeine]] and [[Massage| massage]] can also help.
+{{DISPLAYTITLE:Delayed Onset Muscle Soreness (DOMS) for Runners}}
+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.
+=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| 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 [[Nutrient Timing| taking protein after DOMS inducing exercise]] is one of the best treatments, though [[Why compression clothes| compression clothing]], [[caffeine]] and [[massage]] can also help. It seems that [[Vitamin C]] may be critical to the RBE.
 =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<ref name="Vickers2001"/>. DOMS is particularly related to eccentric exercise, which is where the muscle works to resist becoming longer, rather than working to contract. When you 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<ref name="FeassonStockholm2002"/> and marathon running<ref name="Warhol-1985"/>:
+The soreness of DOMS generally peaks between 24 and 72 hours after unusual or severe exercise, though soreness may occur sooner after running<ref name="Vickers2001"/>. 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<ref name="FeassonStockholm2002"/> and marathon running<ref name="Warhol-1985"/>:
 <gallery widths=300px heights=200px caption="Muscle damage from eccentric exercise (downhill running)">
 File:EccentricA.JPG|Muscle before downhill running
@@ Line 12: / Line 15: @@
 File:MarathonFiberDamage2.jpg|Here you can see extreme damage, with only the Z band of the fiber remaining (marked Z). Adjacent fibers show far less damage.
 </gallery>
+=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 <ref name=<ref name="Marginson-2005"/>. 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.
+=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 <ref name="Y1"/>. 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.
+=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 Points| 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.
+==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.
+{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
+! DOMS Scale
+! Stair Test
+|-
+| 0
+| You can walk down stairs without discomfort.
+|-
+| 1
+| You can walk down stairs with some pain, but there's no need to hold on to the handrail.
+|-
+| 2
+| You can walk down stairs with some pain, but you only need to hold on to the handrail for balance.
+|-
+| 3
+| You need to put some of your weight on the handrail to descend stairs.
+|-
+| 4
+| You need to put nearly all of your weight on the handrail to descend stairs.
+|-
+| 5
+| Your quads cannot lower any weight and descending stairs it tricky. Descending stairs involves standing opposite the handrail and locking the leg that is opposite the handrail. Your body is then tilted towards the handrail, using your arms to lower your weight. The leg nearest the handrail is locked straight and once your body is lowered, it takes the weight. Repeat for each step. (Or avoid stairs.)
+|}
+==Likert Scale Muscle Soreness==
+There is a more general scale of muscle soreness that applies to all muscles, but is not focused on DOMS<ref name="Vickers2001"/><ref name="Impellizzeri-2007"/>.
+{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
+! Scale
+! Description
+|-
+| 0
+| An absence of soreness
+|-
+| 1
+| A light pain felt only when touched / a vague ache
+|-
+| 2
+| A moderate pain felt only when touched / a slight persistent pain
+|-
+| 3
+| A light pain when walking up or down stairs
+|-
+| 4
+| A light pain when walking on a flat surface / painful
+|-
+| 5
+| A moderate pain, stiffness or weakness when walking / very painful
+|-
+| 6
+| A severe pain that limits my ability to move
+|}
 =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.  In addition, there are other symptoms, such as:
+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<ref name="NosakaNewton2002"/>. In addition, there are other symptoms, such as:
 * Reduction in strength<ref name="Saxton-1995"/><ref name="domsiso"/><ref name="Gulick-1996"/><ref name="Paddon-Jones-1997"/>, typically 30-60%<ref name="Baldwin Lanier-2003"/>. (Note that the reduction in strength starts immediately following the damaging exercise and increases over the next 24-48 hours<ref name="Cheung-2003"/>. The initial reduction in strength can be as much as 40%<ref name="Baldwin Lanier-2003"/>.)
+* 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<ref name="Pearcey-2015"/>.
 * Increased passive muscle tension<ref name="Howatson-2008"/>. A muscle suffering from DOMS will often be hard to the touch, even when relaxed as much as possible.
 * Swelling of the muscle<ref name="Howatson-2008"/>, which can be seen as a lack of muscle definition in lean individuals.
@@ Line 23: / Line 89: @@
 * Impaired [[Glycogen]] repletion<ref name="Smith-1992"/><ref name="Braun-2003"/>, though higher carbohydrate intake partly offsets the reduction<ref name="Costill-1990"/>. There is some evidence that Glycogen levels continue to drop after DOMS inducing exercise<ref name="Zehnder-2004"/><ref name="Widrick-1992"/>, and the deficiency in glycogen lasts for over 72 hours<ref name="Widrick-1992"/>.
 * There are some studies that indicate there are possible changes in muscle fiber recruitment patterns<ref name="Miles-1997"/><ref name="Zhou-1998"/><ref name="Zhou-1996"/>.
-=Why is DOMS important?=
+=How long does DOMS last?=
-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 <ref name=<ref name="Marginson-2005"/>/>. 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.
+It seems likely that exercise characteristics (duration, intensity, etc.) will change the time to recovery<ref name="Vickers-2001"/><ref name="Paschalis-2005"/>. The soreness generally peaks between 24-72 hours after the damaging exercise, but will last at least 4 days<ref name="Paschalis-2005"/>. 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.
-=What does DOMS mean to you?=
+=The effect of steepness on DOMS=
-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 <ref name="Y1"/>. 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.
+I have found that steeper descents produce disproportionately severe DOMS. This might be due to the angle of the knee, as most<ref name="Jones-1989"/><ref name="Child-1998"/> (but not all<ref name="Paschalis-2005"/>) 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.
 =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 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.
+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.
-{| class="wikitable"
+{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
-!Strategy!!Timing!!Soreness!!Weakness!!Downsides
+! '''Strategy '''
+! '''Timing '''
+! '''Soreness '''
+! '''Weakness '''
+! '''Downsides '''
+|-
+| Repeated Bout Effect
+| Before (days to months)
+| Strong evidence of reduced soreness
+| Some evidence of reduced weakness
+| None
 |-
-|Repeated Bout Effect
+| [[Nutrient Timing| Carbohydrate and/or protein]]
-|Before (days to months)
+| After
-|Strong evidence of reduced soreness
+| Some evidence of reduced soreness
-|Some evidence of reduced weakness
+| Strong evidence of reduced weakness
-|None
+| None
 |-
-|Carbohydrate and/or protein
+| [[Cadence]]
-|After
+| During
-|Some evidence of reduced soreness
+| Some evidence of reduced soreness
-|Strong evidence of reduced weakness
+| Some evidence of reduced soreness
-|None
+| None
 |-
-|Compression Clothing
+| [[Why compression clothes| Compression Clothing]]
-|After
+| After
-|Some evidence of reduced soreness
+| Some evidence of reduced soreness
-|Some evidence of reduced weakness
+| Some evidence of reduced weakness
-|None
+| None
 |-
-|Caffeine
+| [[Caffeine]]
-|After
+| After
-|Some evidence of reduced soreness
+| Some evidence of reduced soreness
-|Some evidence of reduced weakness
+| Some evidence of reduced weakness
-|None
+| None<sup>a</sup>
 |-
-|Massage
+| [[Massage]]
-|After
+| After
-|Some evidence of reduced soreness
+| Some evidence of reduced soreness
-|No benefit
+| Some evidence of reduced weakness
-|None
+| None
 |-
-|Warmup
+| [[Warmup]]
-|Immediately before
+| Immediately before
-|Some evidence of reduced soreness
+| Some evidence of reduced soreness
-|No benefit
+| No benefit
-|None
+| None
 |-
-|Light Exercise
+| Light Exercise
-|After
+| After
-|Transient pain reduction
+| Transient pain reduction
-|No benefit
+| No benefit
-|None
+| None<sup>c</sup>
 |-
-|TENS
+| TENS
-|After
+| After
-|Transient pain reduction
+| Transient pain reduction
-|No benefit
+| No benefit
-|None
+| None
 |-
-|Icing
+| [[Cryotherapy| Icing]]
-|After
+| After
-|No benefit
+| No benefit
-|No benefit
+| No benefit
-|None
+| None<sup>b</sup>
 |-
-|Antioxidents
+| Antioxidents
-|Before and/or After
+| Before and/or After
-|Mixed evidence
+| Mixed evidence
-|Mixed evidence
+| Mixed evidence
-|Conflicting evidence of reduced endurance adaptations
+| Conflicting evidence of reduced [[Endurance Adaptations]]
 |-
-|Stretching
+| [[Stretching]]
-|Before and/or After
+| Before and/or After
-|No benefit
+| No benefit
-|No benefit
+| No benefit
-|
+| # [[Stretching]]temporarily weakens muscles
-* [[Stretching]] temporarily weakens muscles
+# Can induce DOMS
-* Can induce DOMS
+# Can lead to injury
-* Can lead to injury
 |-
-|NSAIDs
+| [[NSAIDs and Running| NSAIDs]]
-|Before and/or After
+| Before and/or After
-|Most evidence indicates no benefit
+| Most evidence indicates no benefit
-|Most evidence indicates no benefit
+| Most evidence indicates no benefit
-|Can impair recovery
+| Can impair recovery
 |}
+Notes
+* <sup>a</sup>Caffeine can interfere with sleep
+* <sup>b</sup> Only ever use ice in a bag, never a frozen gel pack. Gel packs start too cold and can cause skin or nerve damage.
+* <sup>c</sup> Light exercise does not appear to speed up healing, but it does not hinder it either.
 ==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)<ref name="Howatson-2008"/><ref name="Cheung-2003"/>. The initial bout does not have to cause significant soreness or damage<ref name="Clarkson-1987"/>. 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<ref name="Brown-1997"/>. By contrast, eight weeks of training with 50% of the maximal eccentric load did not provide protection against a subsequent maximal bout<ref name="Nosaka-2002"/>. 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<ref name="Eston-1996"/>. 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<ref name="Nosaka-2001"/>. Another study showed that 30 minutes of downhill running provides protection for between 6 and 9 weeks<ref name="Byrnes-1985"/>. There is evidence that the RBE may rapidly start to provide protection from soreness and weakness<ref name="Mair-1995"/>, possibly as soon as 24 hours post exercise<ref name="Chen-2001"/>.
+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)<ref name="Howatson-2008"/><ref name="Cheung-2003"/>. The initial bout does not have to cause significant soreness or damage<ref name="Clarkson-1987"/>. 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<ref name="Brown-1997"/>. By contrast, eight weeks of training with 50% of the maximal eccentric load did not provide protection against a subsequent maximal bout<ref name="Nosaka-2002"/>. 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<ref name="Eston-1996"/>. 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<ref name="Nosaka-2001"/>. Another study showed that 30 minutes of downhill running provides protection for between 6 and 9 weeks<ref name="Byrnes-1985"/>. There is evidence that the RBE may rapidly start to provide protection from soreness and weakness<ref name="Mair-1995"/>, within 5 days<ref name="Ebbeling-1989"/>, and possibly within 24 hours<ref name="Chen-2001"/>. One study<ref name="Brockett-2001"/> 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.
+[[File:Length Tension Curve and DOMS.jpg|none|thumb|500px|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.]]
+===Repeated Bout and Vitamin C===
+I found a single study that looked at how the repeated bout effect changes with [[Vitamin C]]<ref name="HeHockemeyer2015"/>. 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 [[Epidermolysis Bullosa| 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.
+[[File:Does Combined Antioxidant Vitamin Supplementation Blunt Repeated Bout Effect.jpg|center|thumb|500px|]]
 ==Carbohydrate and Protein==
 {{Main| 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.
+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<ref name="HowatsonHoad2012"/><ref name="Greer-2007"/> <ref name="Matsumoto-2009"/><ref name="Shimomura-2010"/>, and may<ref name="Shimomura-2010"/><ref name="Greer-2007"/>   or may not reduce weakness<ref name="Jackman-2010"/><ref name="Nosaka-2006"/><ref name="Jackman-2010"/>.
-* Most studies have shown that protein will reduce muscle weakness after DOMS inducing exercise<ref name="CockburnHayes2008"/><ref name="Valentine-2008"/> <ref name="CookeRybalka2010"/><ref name="Cockburn-2010"/><ref name="Etheridge-2008"/>, with only two studies showing no improvement<span style='color:#FF0000'><ref name="Wojcik-2001"/><ref name="Green-2008"/></span>.
+* Most studies have shown that protein will reduce muscle weakness after DOMS inducing exercise<ref name="CockburnHayes2008"/><ref name="Valentine-2008"/> <ref name="CookeRybalka2010"/><ref name="Cockburn-2010"/><ref name="Etheridge-2008"/>, with only two studies showing no improvement<ref name="Wojcik-2001"/><ref name="Green-2008"/>.
 * The effect of protein on soreness is more mixed with some studies showing improvement<ref name="Luden-2007"/> <ref name="Flakoll-2004"/><ref name="Etheridge-2008"/>, but others not<ref name="CockburnHayes2008"/><ref name="Samadi-2012"/><ref name="Green-2008"/>.
 * Not surprisingly [[Nutrient Timing| 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<ref name="Cockburn-2010"/>, as shown below.
@@ Line 125: / Line 208: @@
 |[[File:DOMS Protein Power.jpg|none|thumb|300px|Peak power generated after DOMS inducing eccentric exercise.(*is significant change from baseline, double S marker indicates significant change from treatment.)]]
 |}
+==Cadence==
+{{Main|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<ref name="RowlandsEston2001"/>. This change in DOMS is not surprising given that an increased cadence reduces the impact forces of running<ref name="Mercer-2003"/><ref name="Hamill-1995"/><ref name="Clarke-1985"/>. The impact forces from a lower cadence are mostly absorbed by the knee<ref name="Derrick-1998"/>, which would create greater eccentric loading of the quads. In addition, most<ref name="Jones-1989"/><ref name="Child-1998"/> (but not all<ref name="Paschalis-2005"/>) 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.
 ==Compression Clothing ==
 {{Main| Why compression clothes}}
-Studies show that wearing [[Why compression clothes| Graduated Compression Clothing]] during the days after DOMS inducing exercise mitigates the soreness<ref name="DaviesThompson2009"/><ref name="Kraemer-2001"/><ref name="Kraemer-2001b"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/><ref name="Davies-2009"/><ref name="DuffieldPortus2007"/> and weakness<ref name="Kraemer-2001"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/> of DOMS. Relatively few studies showed no benefit from compression clothing<ref name="CarlingFrancis1995"/><ref name="Pearce-2009"/>. 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<ref name="MacRae-2011"/>.  No studies were found that looked at the effect of wearing compression clothing during DOMS inducing exercise on the subsequent recovery.
+Studies show that wearing [[Why compression clothes| Graduated Compression Clothing]] during the days after DOMS inducing exercise mitigates the soreness<ref name="DaviesThompson2009"/><ref name="Kraemer-2001"/><ref name="Kraemer-2001b"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/><ref name="Davies-2009"/><ref name="DuffieldPortus2007"/> and weakness<ref name="Kraemer-2001"/><ref name="KraemerFlanagan2010"/><ref name="Jakeman-2010"/> of DOMS. Relatively few studies showed no benefit from compression clothing<ref name="CarlingFrancis1995"/><ref name="Pearce-2009"/>. 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<ref name="MacRae-2011"/>.  I found one studies that looked at the effect of wearing compression clothing during DOMS inducing exercise on the subsequent recovery<ref name="McDonnellCooper2018"/>. 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.
 ==Caffeine==
 {{Main| Caffeine}}
@@ Line 133: / Line 219: @@
 ==Massage==
 {{Main| Massage}}
-Massage is widely used to prevent and treat injuries. Most meta-analysis suggest that post-exercise massage helps with the soreness of DOMS<ref name="Ernst-1998"/><ref name="Moraska-2005"/>, though the mechanisms are unclear<ref name="Tiidus-1997"/>. Studies that give massage 2-3 hours after DOMS inducing exercise showed reduced soreness<ref name="Smith-1994"/><ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>, but not weakness<ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>. One study that gave massage 2 days after exercise that resulted in reduced soreness and improved muscle function<ref name="MancinelliDavis2006"/>, but other studies that use massage 24 hours or more after exercise showed no benefit<ref name="Hart-"/><ref name="Dawson-2004"/>. 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.
+[[Massage]] is widely used to prevent and treat injuries. Most meta-analysis suggest that post-exercise massage helps with the soreness of DOMS<ref name="Ernst-1998"/><ref name="Moraska-2005"/>, though the mechanisms are unclear<ref name="Tiidus-1997"/>. Studies that give massage 2-3 hours after DOMS inducing exercise showed reduced soreness<ref name="Smith-1994"/><ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>, but not weakness<ref name="Zainuddin-2005"/><ref name="Hilbert2003"/>. One study that gave massage 2 days after exercise that resulted in reduced soreness and improved muscle function<ref name="MancinelliDavis2006"/>, but other studies that use massage 24 hours or more after exercise showed no benefit<ref name="Hart-"/><ref name="Dawson-2004"/>. 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<ref name="Pearcey-2015"/>. 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.)
 ==Warmup==
 {{Main| Warmup}}
 Performing a [[Warmup]] before exercise may help reduce DOMS pain<ref name="Law-2007"/><ref name="RahnamaRahmani-Nia2005"/>, but not all studies support this<ref name="Evans-2002"/>.
 ==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<ref name="Armstrong-1984"/><ref name="Zainuddin-2006"/><ref name="Howatson-2008"/><ref name="Cheung-2003"/>.
+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<ref name="Armstrong-1984"/><ref name="Zainuddin-2006"/><ref name="Howatson-2008"/><ref name="Cheung-2003"/>. 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]]<ref name="ChenNosaka2008"/>. (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<ref name="TufanoBrown2012"/>. 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.
 ==TENS==
 TENS may reduce the soreness of DOMS<ref name="Denegar-1989"/>, but the effect seems to be transient<ref name="Denegar"/> and the effect is reduced if combined with icing<ref name="Denegar-1992"/>. Not all studies show any pain reduction<ref name="Bonacci-1997"/> and none show a reduction in the weakness.
 ==Icing==
 {{Main| Cryotherapy}}
-[[Cryotherapy| Icing]] does not help<ref name="Yackzan-"/><ref name="Shunsuke-2004"/><ref name="Gulick-17"/><ref name="Paddon-Jones-1997"/>, and can make DOMS worse<ref name="TsengLee2012"/><ref name="Isabell-1992"/>. Ice reduces pain slightly, but does not restore strength<ref name="Denegar-1992"/>
+Sadly, [[Cryotherapy| Icing]] does not help with DOMS<ref name="Yackzan-"/><ref name="Shunsuke-2004"/><ref name="Gulick-17"/><ref name="Paddon-Jones-1997"/>, and can make DOMS worse<ref name="TsengLee2012"/><ref name="Isabell-1992"/>. Ice reduces pain slightly, but does not restore strength<ref name="Denegar-1992"/>. (In my experience, ice can be extremely effective at helping heal muscle tears and non-DOMS muscle injuries, but not DOMS.)
+==Protracted Heat==
+One study looked at applying heat for 8 hours, either directly after DOMS inducing exercise or 24 hours later<ref name="PetrofskyBerk2017"/>. 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.
 ==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<ref name="Gomez-Cabrera-2008"/><ref name="RistowZarse2009"/><ref name="Strobel-2011"/> or they do not<ref name="Wadley-2010"/><ref name="Higashida-2011"/> <ref name="YfantiAkerstrom2009"/>.
+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<ref name="Gomez-Cabrera-2008"/><ref name="RistowZarse2009"/><ref name="Strobel-2011"/> or they do not<ref name="Wadley-2010"/><ref name="Higashida-2011"/> <ref name="YfantiAkerstrom2009"/>. 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<ref name="RanchordasRogerson2018"/>.
-{| class="wikitable"
+{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
-|-
+! Vitamin C
-!Vitamin C!!Vitamin E!!Dose Period!!Result
+! Vitamin E
+! Dose Period
+! Result
 |-
-|3,000mg/day
+| 3,000mg/day
 |
-|14 days prior and 4 days post-exercise
+| 14 days prior and 4 days post-exercise
-|Vitamin C reduces soreness in first 24 hours<ref name="Bryer-2006"/>
+| Vitamin C reduces soreness in first 24 hours<ref name="Bryer-2006"/>
 |-
-|3,000mg/day
+| 3,000mg/day
 |
-|3 days prior and 4 days post-exercise
+| 3 days prior and 4 days post-exercise
-|reduced soreness<ref name="Kaminski-1992"/>
+| reduced soreness<ref name="Kaminski-1992"/>
 |-
-|400mg/day
+| 400mg/day
 |
-|14 days prior to exercise
+| 14 days prior to exercise
-|reduced soreness<ref name="Thompson-2001"/>
+| reduced soreness<ref name="Thompson-2001"/>
 |-
-|3,000mg/day
+| 3,000mg/day
 |
-|3 days prior and 5 days post-exercise
+| 3 days prior and 5 days post-exercise
-|no effect<ref name="Connolly-2006"/>
+| no effect<ref name="Connolly-2006"/>
 |-
-|1,000mg/day
+| 1,000mg/day
 |
-|2 hours prior and 4 days post-exercise
+| 2 hours prior and 4 days post-exercise
-|no soreness change, but impaired strength recovery 7 and 14 days after exercise<ref name="CloseAshton2006"/>
+| no soreness change, but impaired strength recovery 7 and 14 days after exercise<ref name="CloseAshton2006"/>
 |-
-|1,000mg
+| 1,000mg
 |
-|2 hours prior to exercise
+| 2 hours prior to exercise
-|no effect<ref name="Thompson-2001x"/>
+| no effect<ref name="Thompson-2001x"/>
 |-
-|400mg/day
+| 400mg/day
 |
-|12 days prior and 3 days post-exercise
+| 12 days prior and 3 days post-exercise
-|no change in soreness<ref name="Thompson-2004"/>
+| no change in soreness<ref name="Thompson-2004"/>
 |-
 |
-|1,200 IU/day
+| 1,200 IU/day
-|30 days prior to exercise
+| 30 days prior to exercise
-|No effect<ref name="Beaton-2002"/>
+| No effect<ref name="Beaton-2002"/>
 |-
-|500mg/day
+| 500mg/day
-|1,200 IU/day
+| 1,200 IU/day
-|30 days prior and 7 days post-exercise
+| 30 days prior and 7 days post-exercise
-|improved muscle function but no change in soreness<ref name="Shafat-2004"/>
+| improved muscle function but no change in soreness<ref name="Shafat-2004"/>
 |-
-|1,000mg/day
+| 1,000mg/day
-|300 mg/d
+| 300 mg/d
-|6 weeks prior to exercise
+| 6 weeks prior to exercise
-|no change in function<ref name="Mastaloudis-2006"/>
+| no change in function<ref name="Mastaloudis-2006"/>
 |}
 ==Stretching==
 {{Main| Stretching}}
-Stretching before<ref name="High-1989"/><ref name="Johansson-1999"/> <ref name="Wessel-1994"/>, after <ref name="Johansson-1999"/><ref name="Buroker-1989"/><ref name="Herbert-2007"/>, or both before and after<ref name="Lund-1998"/> exercise does not help with DOMS. In fact, stretching alone can induce DOMS<ref name="Smith-1993"/>.
+[[Stretching]] before<ref name="High-1989"/><ref name="Johansson-1999"/> <ref name="Wessel-1994"/>, after <ref name="Johansson-1999"/><ref name="Buroker-1989"/><ref name="Herbert-2007"/>, or both before and after<ref name="Lund-1998"/> exercise does not help with DOMS. In fact, stretching alone can induce DOMS<ref name="Smith-1993"/>. Both static and dynamic stretching are ineffective<ref name="XieFeng2018"/>.
-==NSAIDs==
+==NSAIDs/Pain Relief==
 {{Main|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<ref name="Mishra-1995"/>.  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.
+The most common NSAIDs (Ibuprofen, Acetaminophen/Paracetamol, and Aspirin) are unlikely to help with DOMS, but Naproxen may reduce the pain and weakness. (See below for notes on Aspirin and resolvins.) 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<ref name="Mishra-1995"/>.  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. There's an emerging belief that NSAIDs suppress inflammation, without actually resolving it<ref name="Markworth Maddipati Cameron-Smith 2016 pp. 110–134"/>. Studies of Turmeric, which acts as a selective COX-2 NSAID<ref name="RamsewakDeWitt2000"/>, are promising. Reduction in soreness is mixed, with some studies showing reduced soreness<ref name="Nicol-2015"/><ref name="Drobnic-2014"/> <ref name="NicolRowlands2015"/>, while others do not<ref name="McFarlinVenable2016"/><ref name="TanabeMaeda2015"/>. However, one study shoes reduced weakness and inflammation markers<ref name="TanabeMaeda2015"/> and an animal study showed less subsequent reduction in running performance in mice<ref name="Davis-2007"/>. Several studies showed reduced markers of damage<ref name="Kawanishi-2013"/><ref name="Davis-2007"/><ref name="TanabeMaeda2015"/><ref name="McFarlinVenable2016"/> <ref name="NicolRowlands2015"/>. However, Turmeric should be treated like any other medication as there are safety concerns; see [[NSAIDs_and_Running#Turmeric_as_an_NSAID| Turmeric as an NSAID]] for details.
-{| class="wikitable"
+{| class="wikitable" style="margin-left: auto; margin-right: auto; border: none;"
+! NSAID
+! Soreness
+! Weakness
 |-
-!NSAID!!Soreness!!Weakness
+| Ibuprofen
-|-
+| 2xImproved<ref name="Hasson-1993"/><ref name="pmid12580656"/>
-|Ibuprofen
-|2xImproved<ref name="Hasson-1993"/><ref name="pmid12580656"/>
 xNo Effect<ref name="Grossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="Stone-2002"/>
-|1xMaybe<ref name="Hasson-1993"/>
+| 1xMaybe<ref name="Hasson-1993"/>
 xNo Effect<ref name="Grossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="pmid12580656"/><ref name="Stone-2002"/>
 |-
-|Ibuprofen Gel
+| Ibuprofen Gel
-|1xNo Effect<ref name="HyldahlKeadle2010"/>
+| 1xNo Effect<ref name="HyldahlKeadle2010"/>
 |
 |-
-|Acetaminophen (Paracetamol)
+| Acetaminophen (Paracetamol)
-|2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>
+| 2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>
 |
 |-
-|Aspirin
+| Aspirin
-|2xImproved<ref name="Riasata-2010"/><ref name="Francis-1987"/>
+| 2xImproved<ref name="Riasata-2010"/><ref name="Francis-1987"/>
 xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>
-|2xNo Effect<ref name="Riasata-2010"/><ref name="Francis-1987"/>
+| 2xNo Effect<ref name="Riasata-2010"/><ref name="Francis-1987"/>
 |-
-|Naproxen
+| Naproxen
-|4xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>
+| 4xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>
 xNo Effect<ref name="Bourgeois-1999"/>
-|3xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>
+| 3xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>
 xNo Effect<ref name="Bourgeois-1999"/>
 |-
-|Diclofenac
+| Diclofenac
-|Possible slight reduction<ref name="DonnellyMcCormick1988"/>
+| Possible slight reduction<ref name="DonnellyMcCormick1988"/>
 |
+|-
+| Codeine
+| 1xNo Effect<ref name="Barlas-2000"/>
+|
 |-
-|Codeine
+| Rofecoxib
-|1xNo Effect<ref name="Barlas-2000"/>
+| 1xNo Effect<ref name="LoramMitchell2005"/>
 |
 |-
-|Rofecoxib
+| Ketoprofen
-|1xNo Effect<ref name="LoramMitchell2005"/>
+| 1xImproved<ref name="Sayers-2001"/>
-|
+| 1xImproved<ref name="Sayers-2001"/>
 |-
-|Ketoprofen
+| Bromelain
-|1xImproved<ref name="Sayers-2001"/>
+| 1xNo Effect<ref name="Stone-2002"/>
-|1xImproved<ref name="Sayers-2001"/>
+|
 |-
-|Bromelain
+| Turmeric
-|1xNo Effect<ref name="Stone-2002"/>
+| 2xImproved<ref name="Nicol-2015"/><ref name="Drobnic-2014"/>
-|
+xNo Effect<ref name="McFarlinVenable2016"/><ref name="TanabeMaeda2015"/>
+| 2xImproved<ref name="TanabeMaeda2015"/><ref name="Davis-2007"/>
 |}
+==HMB (β-hydroxy-β-methylbutyrate)==
+There's limited research on HMB and DOMS which suggests HMB might help reduce DOMS<ref name="van SomerenEdwardsHowatson2005"/><ref name="NunanHowatsonvanSomeren2010"/><ref name="KnitterPantonRathmacher2000"/>. The research isn't great, and the results aren't huge, but given the other benefits of [[HMB|HMB For Runners]], I think it's worthwhile. (As an aside, I was amazed to find one study on HMB and DOMS didn't actually use a product containing HMB<ref name="AbumradRathmacher2011"/><ref name="NunanHowatsonvanSomeren2011Ack"/>!)
+==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.
+==Omega-3==
+There's some limited evidence that Omega-3 oils might help with DOMS<ref name="Anthony Macartney Peoples 2021 pp. 143–153"/>. The Omega-3 oils need to be long chain, such as fish oil, and include EPA and DHA. There's some evidence that athletes may need more Omega-3, with up to 5g/day of EPA/DHA being recommended<ref name="Thielecke Blannin 2020 p. 3712"/>.
+==Omega-3, Aspirin, and Resolvins ==
+One interesting possibility is the combination of Omega-3 and low dose Aspirin, because Aspirin triggers the conversion of DHA to resolvins<ref name="Dalli Winkler Colas Arnardottir 2013 pp. 188–201"/>. As the name suggests, these resolvins cause the resolution of inflammation rather than simply suppressing inflammation. (Resolvins are not immunosuppressive<ref name="Gilligan Gartung Sulciner Norris 2019 pp. 6292–6297"/>.) While there's no studies on how resolvins interact with DOMS, there's a compelling hypothesis<ref name="Markworth Maddipati Cameron-Smith 2016 pp. 110–134"/> and some initial research into general muscle recovery from injury<ref name="Markworth Maddipati Cameron-Smith 2016 pp. 110–134"/>. The typical dose used to study aspirin triggered resolvins is 81mg after a study comparing 81/325/650mg doses found that 325mg had a negligible improvement over 81mg<ref name="Chiang Bermudez Ridker Hurwitz 2004 pp. 15178–15183"/>. It's unclear if less than 81mg might be effective, as I couldn't find any research into lower doses. (Anecdotally, a medical researcher suggested to me that much lower doses might be sufficient.)
+[[File:Resolvins .jpg|400px|thumb|center|The time course of inflammation.]]
+=Menstrual Cycle=
+A study has shown that DOMS does not vary with menstrual cycle<ref name="ChaffinBerg2011"/>.
 =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<ref name="Cheung-2003"/><ref name="Howatson-2008"/>:
@@ Line 268: / Line 375: @@
 ** '''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.
+** '''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<ref name="Lynn-1998"/>.
 ** '''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.
+=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.
 =See Also=
 * [[Downhill Running]]
@@ Line 276: / Line 391: @@
 =References=
 <references>
+<ref name="Paschalis-2005">V. Paschalis, Y. Koutedakis, AZ. Jamurtas, V. Mougios, V. Baltzopoulos, Equal volumes of high and low intensity of eccentric exercise in relation to muscle damage and performance., J Strength Cond Res, volume 19, issue 1, pages 184-8, Feb 2005, doi [http://dx.doi.org/10.1519/R-14763.1 10.1519/R-14763.1], PMID [http://www.ncbi.nlm.nih.gov/pubmed/15705032 15705032]</ref>
+<ref name="ChaffinBerg2011">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 [http://www.worldcat.org/issn/0270-1367 0270-1367], doi [http://dx.doi.org/10.1080/02701367.2011.10599806 10.1080/02701367.2011.10599806]</ref>
+<ref name="ChenNosaka2008">Trevor C. Chen, Kazunori Nosaka, Chia-Ching Wu, Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy, Journal of Science and Medicine in Sport, volume 11, issue 3, 2008, pages 271–279, ISSN [http://www.worldcat.org/issn/14402440 14402440], doi [http://dx.doi.org/10.1016/j.jsams.2007.02.015 10.1016/j.jsams.2007.02.015]</ref>
+<ref name="Child-1998"> RB. Child, JM. Saxton, AE. Donnelly, Comparison of eccentric knee extensor muscle actions at two muscle lengths on indices of damage and angle-specific force production in humans., J Sports Sci, volume 16, issue 4, pages 301-8, May 1998, doi [http://dx.doi.org/10.1080/02640419808559358 10.1080/02640419808559358], PMID [http://www.ncbi.nlm.nih.gov/pubmed/9663954 9663954]</ref>
+<ref name="Jones-1989"> DA. Jones, DJ. Newham, C. Torgan, Mechanical influences on long-lasting human muscle fatigue and delayed-onset pain., J Physiol, volume 412, pages 415-27, May 1989, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2600839 2600839]</ref>
+<ref name="Hamill-1995"> Hamill, J., T. R. Derrick, and K. G. Holt. "Shock attenuation and stride frequency during running." Human Movement Science 14.1 (1995): 45-60.</ref>
+<ref name="Mercer-2003"> JA. Mercer, P. Devita, TR. Derrick, BT. Bates, Individual effects of stride length and frequency on shock attenuation during running., Med Sci Sports Exerc, volume 35, issue 2, pages 307-13, Feb 2003, doi [http://dx.doi.org/10.1249/01.MSS.0000048837.81430.E7 10.1249/01.MSS.0000048837.81430.E7], PMID [http://www.ncbi.nlm.nih.gov/pubmed/12569221 12569221]</ref>
 <ref name="Pearce-2009">Pearce, Alan J., et al. "Wearing a sports compression garment on the performance of visuomotor tracking following eccentric exercise: A pilot study." Journal of science and medicine in sport 12.4 (2009): 500-502.</ref>
-<ref name="CarlingFrancis1995">{{cite journal|last1=Carling|first1=Jon|last2=Francis|first2=Kennon|last3=Lorish|first3=Christopher|title=The effects of continuous external compression on delayed-onset muscle soreness (DOMS)|journal=International Journal of Rehabilitation and Health|volume=1|issue=4|year=1995|pages=223–235|issn=1068-9591|doi=10.1007/BF02214641}}</ref>
+<ref name="CarlingFrancis1995">Jon Carling, Kennon Francis, Christopher Lorish, The effects of continuous external compression on delayed-onset muscle soreness (DOMS), International Journal of Rehabilitation and Health, volume 1, issue 4, 1995, pages 223–235, ISSN [http://www.worldcat.org/issn/1068-9591 1068-9591], doi [http://dx.doi.org/10.1007/BF02214641 10.1007/BF02214641]</ref>
-<ref name="DuffieldPortus2007">{{cite journal|last1=Duffield|first1=R.|last2=Portus|first2=M.|last3=Edge|first3=J.|title=Comparison of three types of full-body compression garments on throwing and repeat-sprint performance in cricket players * COMMENTARY|journal=British Journal of Sports Medicine|volume=41|issue=7|year=2007|pages=409–414|issn=0306-3674|doi=10.1136/bjsm.2006.033753}}</ref>
+<ref name="DuffieldPortus2007">R. Duffield, M. Portus, J. Edge, Comparison of three types of full-body compression garments on throwing and repeat-sprint performance in cricket players * COMMENTARY, British Journal of Sports Medicine, volume 41, issue 7, 2007, pages 409–414, ISSN [http://www.worldcat.org/issn/0306-3674 0306-3674], doi [http://dx.doi.org/10.1136/bjsm.2006.033753 10.1136/bjsm.2006.033753]</ref>
-<ref name="Davies-2009"> {{Cite journal  | last1 = Davies | first1 = V. | last2 = Thompson | first2 = KG. | last3 = Cooper | first3 = SM. | title = The effects of compression garments on recovery. | journal = J Strength Cond Res | volume = 23 | issue = 6 | pages = 1786-94 | month = Sep | year = 2009 | doi = 10.1519/JSC.0b013e3181b42589 | PMID = 19675482 }}</ref>
+<ref name="Davies-2009"> V. Davies, KG. Thompson, SM. Cooper, The effects of compression garments on recovery., J Strength Cond Res, volume 23, issue 6, pages 1786-94, Sep 2009, doi [http://dx.doi.org/10.1519/JSC.0b013e3181b42589 10.1519/JSC.0b013e3181b42589], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19675482 19675482]</ref>
-<ref name="Jakeman-2010"> {{Cite journal  | last1 = Jakeman | first1 = JR. | last2 = Byrne | first2 = C. | last3 = Eston | first3 = RG. | title = Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. | journal = Eur J Appl Physiol | volume = 109 | issue = 6 | pages = 1137-44 | month = Aug | year = 2010 | doi = 10.1007/s00421-010-1464-0 | PMID = 20376479 }}</ref>
+<ref name="Jakeman-2010"> JR. Jakeman, C. Byrne, RG. Eston, Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females., Eur J Appl Physiol, volume 109, issue 6, pages 1137-44, Aug 2010, doi [http://dx.doi.org/10.1007/s00421-010-1464-0 10.1007/s00421-010-1464-0], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20376479 20376479]</ref>
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+<ref name="Mair-1995"> J. Mair, M. Mayr, E. Müller, A. Koller, C. Haid, E. Artner-Dworzak, C. Calzolari, C. Larue, B. Puschendorf, Rapid adaptation to eccentric exercise-induced muscle damage., Int J Sports Med, volume 16, issue 6, pages 352-6, Aug 1995, doi [http://dx.doi.org/10.1055/s-2007-973019 10.1055/s-2007-973019], PMID [http://www.ncbi.nlm.nih.gov/pubmed/7591384 7591384]</ref>
-<ref name="Dawson-2004"> {{Cite journal  | last1 = Dawson | first1 = LG. | last2 = Dawson | first2 = PM. | last3 = Tiidus | first3 = PM. | title = Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon. | journal = J Sports Sci Med | pages = 37-43 | month =  | year =  2004 | doi =  | PMID =  }}</ref>
+<ref name="Dawson-2004"> LG. Dawson, PM. Dawson, PM. Tiidus, Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon., J Sports Sci Med, pages 37-43,  2004</ref>
-<ref name="Hart-"> {{Cite journal  | last1 = Hart | first1 = JM. | last2 = Swanik | first2 = CB. | last3 = Tierney | first3 = RT. | title = Effects of sport massage on limb girth and discomfort associated with eccentric exercise. | journal = J Athl Train | volume = 40 | issue = 3 | pages = 181-5 | month =  | year =  | doi =  | PMID = 16284638 }}</ref>
+<ref name="Hart-"> JM. Hart, CB. Swanik, RT. Tierney, Effects of sport massage on limb girth and discomfort associated with eccentric exercise., J Athl Train, volume 40, issue 3, pages 181-5, PMID [http://www.ncbi.nlm.nih.gov/pubmed/16284638 16284638]</ref>
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+<ref name="Moraska-2005"> A. Moraska, Sports massage. A comprehensive review., J Sports Med Phys Fitness, volume 45, issue 3, pages 370-80, Sep 2005, PMID [http://www.ncbi.nlm.nih.gov/pubmed/16230990 16230990]</ref>
-<ref name="Ernst-1998"> {{Cite journal  | last1 = Ernst | first1 = E. | title = Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. | journal = Br J Sports Med | volume = 32 | issue = 3 | pages = 212-4 | month = Sep | year = 1998 | doi =  | PMID = 9773168 }}</ref>
+<ref name="Ernst-1998"> E. Ernst, Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review., Br J Sports Med, volume 32, issue 3, pages 212-4, Sep 1998, PMID [http://www.ncbi.nlm.nih.gov/pubmed/9773168 9773168]</ref>
-<ref name="Hilbert2003">{{cite journal|last1=Hilbert|first1=J E|title=The effects of massage on delayed onset muscle soreness|journal=British Journal of Sports Medicine|volume=37|issue=1|year=2003|pages=72–75|issn=03063674|doi=10.1136/bjsm.37.1.72}}</ref> <ref name="MancinelliDavis2006">{{cite journal|last1=Mancinelli|first1=Corrie A.|last2=Davis|first2=D. Scott|last3=Aboulhosn|first3=Leila|last4=Brady|first4=Misty|last5=Eisenhofer|first5=Justin|last6=Foutty|first6=Stephanie|title=The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes|journal=Physical Therapy in Sport|volume=7|issue=1|year=2006|pages=5–13|issn=1466853X|doi=10.1016/j.ptsp.2005.10.004}}</ref>
+<ref name="Hilbert2003">J E Hilbert, The effects of massage on delayed onset muscle soreness, British Journal of Sports Medicine, volume 37, issue 1, 2003, pages 72–75, ISSN [http://www.worldcat.org/issn/03063674 03063674], doi [http://dx.doi.org/10.1136/bjsm.37.1.72 10.1136/bjsm.37.1.72]</ref>
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+<ref name="MancinelliDavis2006">Corrie A. Mancinelli, D. Scott Davis, Leila Aboulhosn, Misty Brady, Justin Eisenhofer, Stephanie Foutty, The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes, Physical Therapy in Sport, volume 7, issue 1, 2006, pages 5–13, ISSN [http://www.worldcat.org/issn/1466853X 1466853X], doi [http://dx.doi.org/10.1016/j.ptsp.2005.10.004 10.1016/j.ptsp.2005.10.004]</ref>
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 </references>

Difference between revisions of "Delayed Onset Muscle Soreness"