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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| 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. 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| caffeine]] and [[Massage| massage]] can also help.

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| [[Nutrient Timing| Carbohydrate and/or protein]]

| [[Cadence]]

| [[Why compression clothes| Compression Clothing]]

| [[Caffeine]]

| [[Massage]]

| [[Warmup]]

| [[Cryotherapy| Icing]]

| Conflicting evidence of reduced [[Endurance Adaptations]]

| [[Stretching]]

| # [[Stretching]] temporarily weakens muscles

| [[NSAIDs and Running| NSAIDs]]

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 I found one studies were found 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.

[[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.)

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.

Sadly, [[Cryotherapy| Icing]] does not helpwith 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.

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[[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"/>.

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. 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;"