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Delayed Onset Muscle Soreness

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== What is DOMS? ==
Delayed Onset Muscle Soreness (DOMS) generally occurs between 24 and 72 hours after unusual or severe exercise, such as racing a marathon. 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. [[Downhill Running]] is much more eccentric than flat or uphill running.
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== What are the symptoms of DOMS? ==
The soreness of DOMS is different to a 'pulled' muscle. With DOMS, large areas of the muscle are very tender to the tough, and the pain is very unpleasant. With a pulled muscle, 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. This is often described as 'loosening' up.
== Why is DOMS important? ==
DOMS can prevent continued running, due to weakness and soreness. 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="Z1"/>. If you've ever run a long, steep decent (the latter part of Iron Mountain or Mount Mitchell Challenge spring to mind), you'll know the strange feeling of weak numbness that pervades your quads as the effect of the downhill builds up. 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. It is 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.
== How to treat DOMS? ==
Do if you do get DOMS, what can you do?
* There is good evidence that [[Why compression clothes|Graduated Compression Clothing]] mitigates DOMS.
* [[NSAIDs and Running|NSAIDS]] (Ibuprofen, Acetaminophen/Paracetamol, etc.) have been shown to increase the pain of DOMS, though they may delay its onset<ref name="DomsNsaids"/>, and NSAIDS may also impair healing<ref name="um"/>.
* The evidence for anti-oxidants is scant, but Vitamin C, D and E might help.
* The evidenced for massage, stretching and ice is ambiguous <ref name="X2"/>. In fact, short periods of [[Cryotherapy| icing]] can make DOMS worse<ref name="TsengLee2012"/>.* Light exercise has been shown to relieve DOMS <ref name="X3"/>.
My personal experience is that a small amount of easy running, while painful, can speed up recovery. I have found no benefit to ice, massage, or Ibuprofen.
== Tangent - DOMS and Lactic acid ==DOMS is not caused by lactic acid; a full discussion will have to wait until I blog write an entry on 'the lactic acid myth', but suffice to say, lactic acid is your friend, not your enemy.
==See Also==
* [[Downhill Running]]
* [[Downhill Intervals]]
== References ==
<references>
<ref name="TsengLee2012">{{cite journal|last1=Tseng|first1=Ching-Yu|last2=Lee|first2=Jo-Ping|last3=Tsai|first3=Yung-Shen|last4=Lee|first4=Shin-Da|last5=Kao|first5=Chung-Lan|last6=Liu|first6=Te-Chih|last7=Lai|first7=Cheng-Shou|last8=Harris|first8=M. Brennan|last9=Kuo|first9=Chia-Hua|title=Topical Cooling (Icing) Delays Recovery from Eccentric Exercise-Induced Muscle Damage|journal=Journal of Strength and Conditioning Research|year=2012|pages=1|issn=1064-8011|doi=10.1519/JSC.0b013e318267a22c}}</ref>
<ref name="X1">Caffeine Attenuates Delayed-Onset Muscle Pain and Force Loss Following Eccentric Exercise
http://www.nowfoods.com/idc/groups/public/documents/digital_asset/074390.pdf </ref>