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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.
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=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 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.
=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:
* 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"/>.
=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.
{| class="wikitable"
!Strategy!!Timing!!Soreness!!Weakness!!Downsides
|-
|Repeated Bout Effect|Before (days to months)|Strong evidence of reduced soreness|Some evidence of reduced weakness|None
|-
|[[Nutrient Timing| 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
|-
|[[Why compression clothes| 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<sup>a</sup>
|-
|[[Massage]]|After|Some evidence of reduced soreness|No benefit|None
|-
|[[Warmup]]|Immediately before|Some evidence of reduced soreness|No benefit|None
|-
|Light Exercise |After|Transient pain reduction |No benefit|None<sup>c</sup>
|-
|TENS|After|Transient pain reduction |No benefit|None
|-
|[[Cryotherapy| Icing]]|After|No benefit|No benefit|None<sup>b</sup>
|-
|Antioxidents|Before and/or After|Mixed evidence|Mixed evidence|Conflicting evidence of reduced endurance adaptations
|-
|[[Stretching]]|Before and/or After|No benefit|No benefit|
* [[Stretching]] temporarily weakens muscles
* Can induce DOMS
* Can lead to injury
|-
|[[NSAIDs and Running| NSAIDs]]|Before and/or After|Most evidence indicates no benefit|Most evidence indicates no benefit|Can impair recovery
|}
Notes
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"/>.
{| class="wikitable"
! Vitamin C
! Vitamin E
! Dose Period
! Result
|-
|-
|3,000mg/day||14 3 days prior and 4 days post-exercise|Vitamin C reduces reduced soreness in first 24 hours<ref name="BryerKaminski-20061992"/>
|-
|3,000mg400mg/day||3 14 days prior and 4 days post-to exercise |reduced soreness<ref name="KaminskiThompson-19922001"/>
|-
|400mg3,000mg/day||14 3 days prior to and 5 days post-exercise|reduced sorenessno effect<ref name="ThompsonConnolly-20012006"/>
|-
|31,000mg/day||3 days 2 hours prior and 5 4 days post-exercise |no effectsoreness change, but impaired strength recovery 7 and 14 days after exercise<ref name="Connolly-2006CloseAshton2006"/>
|-
|1,000mg/day||2 hours prior and 4 days post-to exercise|no soreness change, but impaired strength recovery 7 and 14 days after exerciseeffect<ref name="CloseAshton2006Thompson-2001x"/>
|-
|1,000mg400mg/day||2 hours 12 days prior to and 3 days post-exercise|no effectchange in soreness<ref name="Thompson-2001x2004"/>
|-
|400mg| 1,200 IU/day||12 30 days prior and 3 days post-to exercise|no change in sorenessNo effect<ref name="ThompsonBeaton-20042002"/>
|-
|500mg/day|1,200 IU/day|30 days prior to and 7 days post-exercise|No effectimproved muscle function but no change in soreness<ref name="BeatonShafat-20022004"/>
|-
|}
==Stretching==
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.
{| class="wikitable"
! NSAID
! Soreness
! Weakness
|-
7xNo 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"/>
8xNo 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|1xNo Effect<ref name="HyldahlKeadle2010"/>|
|-
|Acetaminophen (Paracetamol)|2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>|
|-
|Aspirin|2xImproved<ref name="Riasata-2010"/><ref name="Francis-1987"/>
2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>
|2xNo Effect<ref name="Riasata-2010"/><ref name="Francis-1987"/>
|-
|Naproxen |4xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>
1xNo Effect<ref name="Bourgeois-1999"/>
|3xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>
1xNo Effect<ref name="Bourgeois-1999"/>
|-
|Diclofenac |Possible slight reduction<ref name="DonnellyMcCormick1988"/>|
|-
|Codeine|1xNo Effect<ref name="Barlas-2000"/> |
|-
|Rofecoxib |1xNo Effect<ref name="LoramMitchell2005"/> |
|-
|Ketoprofen |1xImproved<ref name="Sayers-2001"/>|1xImproved<ref name="Sayers-2001"/>
|-
|Bromelain |1xNo Effect<ref name="Stone-2002"/>|
|}
=Mechanisms of DOMS=