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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.
=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"/>:
* 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?=
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.
|[[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.)]]
|}
==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.
==Caffeine==
{{Main| Caffeine}}
{{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.
==Warmup==
{{Main| Warmup}}
* '''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<ref name="Schwane-1983"/>.
* '''Secondary damage'''. The secondary damage appears to be initiated by the disruption of the intracellular Ca<sup>2</sup>+homeostatis, which leads to further myofibrillar damage including degradation of the cell membrane.
For those interested in the details, there are several possible mechanisms that might be responsible for the Repeated Bout Effect (RBE)<ref name="McHugh-2003"/><ref name="McHugh-1999"/>:
* '''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.