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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.
{{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"/>. Both static and dynamic stretching are ineffective<ref name="XieFeng2018"/>.
==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. (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" style="margin-left: auto; margin-right: auto; border: none;"
! NSAID
| 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"/>.
<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="TufanoBrown2012">James J. Tufano, Lee E. Brown, Jared W. Coburn, Kavin K.W. Tsang, Vanessa L. Cazas, Joe W. LaPorta, Effect of Aerobic Recovery Intensity on Delayed-Onset Muscle Soreness and Strength, Journal of Strength and Conditioning Research, volume 26, issue 10, 2012, pages 2777–2782, ISSN [http://www.worldcat.org/issn/1064-8011 1064-8011], doi [http://dx.doi.org/10.1519/JSC.0b013e3182651c06 10.1519/JSC.0b013e3182651c06]</ref>
<ref name="RanchordasRogerson2018">Mayur K Ranchordas, David Rogerson, Hora Soltani, Joseph T Costello, Antioxidants for preventing and reducing muscle soreness after exercise: a Cochrane systematic review, British Journal of Sports Medicine, 2018, pages bjsports-2018-099599, ISSN [http://www.worldcat.org/issn/0306-3674 0306-3674], doi [http://dx.doi.org/10.1136/bjsports-2018-099599 10.1136/bjsports-2018-099599]</ref>
<ref name="AbumradRathmacher2011">Naji N Abumrad, John A Rathmacher, Exercise-Induced Muscle Damage is Not Attenuated by Maximuscle β-Hydroxy-β-Methylbutyrate-1000™ Supplementation, Journal of Strength and Conditioning Research, date July 2011, volume 25, issue 7, pages 1–2, ISSN [http://www.worldcat.org/issn/1064-8011 1064-8011], doi [http://dx.doi.org/10.1519/JSC.0b013e3181f7c3a8 10.1519/JSC.0b013e3181f7c3a8], PMID [http://www.ncbi.nlm.nih.gov/pubmed/21555959 21555959]</ref>
<ref name="HeHockemeyer2015">F. He, J. Hockemeyer, D. Sedlock, Does Combined Antioxidant Vitamin Supplementation Blunt Repeated Bout Effect?, International Journal of Sports Medicine, volume 36, issue 05, 2015, pages 407–413, ISSN [http://www.worldcat.org/issn/0172-4622 0172-4622], doi [http://dx.doi.org/10.1055/s-0034-1395630 10.1055/s-0034-1395630]</ref>
<ref name="van SomerenEdwardsHowatson2005">Ken A. van Someren, Adam J. Edwards, Glyn Howatson, Supplementation with β-Hydroxy- β-Methylbutyrate (HMB) and α-Ketoisocaproic Acid (KIC) Reduces Signs and Symptoms of Exercise-Induced Muscle Damage in Man, International Journal of Sport Nutrition and Exercise Metabolism, date August 2005, volume 15, issue 4, pages 413–424, ISSN [http://www.worldcat.org/issn/1526-484X 1526-484X], 1543-2742 !!eissn!!, doi [http://dx.doi.org/10.1123/ijsnem.15.4.413 10.1123/ijsnem.15.4.413], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16286672 16286672]</ref>
<ref name="NunanHowatsonvanSomeren2010">David Nunan, Glyn Howatson, Ken A van Someren, Exercise-Induced Muscle Damage Is Not Attenuated by β-Hydroxy-β-Methylbutyrate and α-Ketoisocaproic Acid Supplementation, Journal of Strength and Conditioning Research, date February 2010, volume 24, issue 2, pages 531–537, ISSN [http://www.worldcat.org/issn/1064-8011 1064-8011], doi [http://dx.doi.org/10.1519/JSC.0b013e3181c4d370 10.1519/JSC.0b013e3181c4d370], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20072045 20072045]</ref>
<ref name="KnitterPantonRathmacher2000">A. E. Knitter, L. Panton, J. A. Rathmacher, A. Petersen, R. Sharp, Effects of β-hydroxy-β-methylbutyrate on muscle damage after a prolonged run, Journal of Applied Physiology, date 1 October 2000, volume 89, issue 4, pages 1340–1344, ISSN [http://www.worldcat.org/issn/8750-7587 8750-7587], 1522-1601 !!eissn!!, doi [http://dx.doi.org/10.1152/jappl.2000.89.4.1340 10.1152/jappl.2000.89.4.1340], PMID [http://www.ncbi.nlm.nih.gov/pubmed/11007567 11007567]</ref>
<ref name="NunanHowatsonvanSomeren2011Ack">David Nunan, Glyn Howatson, Ken van Someren, Exercise-induced muscle damage is not attenuated by β-hydroxy-β-methylbutyrate and α-ketoisocaproic acid supplementation'., Journal of Strength and Conditioning Research, date July 2011, volume 25, issue 7, page 2, ISSN [http://www.worldcat.org/issn/1064-8011 1064-8011], doi [http://dx.doi.org/10.1097/01.JSC.0000399726.36961.6c 10.1097/01.JSC.0000399726.36961.6c]</ref>
<ref name="Anthony Macartney Peoples 2021 pp. 143–153">Ryan Anthony, Michael J. Macartney, Gregory E. Peoples, The Influence of Long-Chain Omega-3 Fatty Acids on Eccentric Exercise-Induced Delayed Muscle Soreness: Reported Outcomes Are Compromised by Study Design Issues, International Journal of Sport Nutrition and Exercise Metabolism, volume 31, issue 2, date 2021-03-01, ISSN [http://www.worldcat.org/issn/1526-484X 1526-484X], doi [http://dx.doi.org/10.1123/ijsnem.2020-0238 10.1123/ijsnem.2020-0238], pages 143–153</ref>
<ref name="Thielecke Blannin 2020 p. 3712">Frank Thielecke, Andrew Blannin, Omega-3 Fatty Acids for Sport Performance—Are They Equally Beneficial for Athletes and Amateurs? A Narrative Review, Nutrients, volume 12, issue 12, date 2020-11-30, ISSN [http://www.worldcat.org/issn/2072-6643 2072-6643], PMID [http://www.ncbi.nlm.nih.gov/pubmed/33266318 33266318], 7760705 !!pmc!!, doi [http://dx.doi.org/10.3390/nu12123712 10.3390/nu12123712], free !!doi-access!!, page 3712</ref>
<ref name="Dalli Winkler Colas Arnardottir 2013 pp. 188–201">Jesmond Dalli, Jeremy W. Winkler, Romain A. Colas, Hildur Arnardottir, Chien-Yee C. Cheng, Nan Chiang, Nicos A. Petasis, Charles N. Serhan, Resolvin D3 and Aspirin-Triggered Resolvin D3 Are Potent Immunoresolvents, Chemistry & Biology, volume 20, issue 2, date 2013, PMID [http://www.ncbi.nlm.nih.gov/pubmed/23438748 23438748], 3583372 !!pmc!!, doi [http://dx.doi.org/10.1016/j.chembiol.2012.11.010 10.1016/j.chembiol.2012.11.010], pages 188–201</ref>
<ref name="Gilligan Gartung Sulciner Norris 2019 pp. 6292–6297">Molly M. Gilligan, Allison Gartung, Megan L. Sulciner, Paul C. Norris, Vikas P. Sukhatme, Diane R. Bielenberg, Sui Huang, Mark W. Kieran, Charles N. Serhan, Dipak Panigrahy, Aspirin-triggered proresolving mediators stimulate resolution in cancer, Proceedings of the National Academy of Sciences, volume 116, issue 13, date 2019-03-26, ISSN [http://www.worldcat.org/issn/0027-8424 0027-8424], PMID [http://www.ncbi.nlm.nih.gov/pubmed/30862734 30862734], 6442621 !!pmc!!, doi [http://dx.doi.org/10.1073/pnas.1804000116 10.1073/pnas.1804000116], pages 6292–6297</ref>
<ref name="Chiang Bermudez Ridker Hurwitz 2004 pp. 15178–15183">Nan Chiang, Edmund A. Bermudez, Paul M. Ridker, Shelley Hurwitz, Charles N. Serhan, Aspirin triggers antiinflammatory 15-epi-lipoxin A 4 and inhibits thromboxane in a randomized human trial, Proceedings of the National Academy of Sciences, volume 101, issue 42, date 2004-10-19, ISSN [http://www.worldcat.org/issn/0027-8424 0027-8424], PMID [http://www.ncbi.nlm.nih.gov/pubmed/15471991 15471991], 523452 !!pmc!!, doi [http://dx.doi.org/10.1073/pnas.0405445101 10.1073/pnas.0405445101], pages 15178–15183</ref>
<ref name="Markworth Maddipati Cameron-Smith 2016 pp. 110–134">James F. Markworth, Krishna Rao Maddipati, David Cameron-Smith, Emerging roles of pro-resolving lipid mediators in immunological and adaptive responses to exercise-induced muscle injury, Exercise Immunology Review, volume 22, date 2016, ISSN [http://www.worldcat.org/issn/1077-5552 1077-5552], PMID [http://www.ncbi.nlm.nih.gov/pubmed/26853678 26853678], pages 110–134</ref>
<ref name="Markworth Maddipati Cameron-Smith 2016 pp. 110–134">James F. Markworth, Krishna Rao Maddipati, David Cameron-Smith, Emerging roles of pro-resolving lipid mediators in immunological and adaptive responses to exercise-induced muscle injury, Exercise Immunology Review, volume 22, date 2016, ISSN [http://www.worldcat.org/issn/1077-5552 1077-5552], PMID [http://www.ncbi.nlm.nih.gov/pubmed/26853678 26853678], pages 110–134</ref>
</references>