Wednesday 29th September, 2021

How to treat DOMS (Delayed Onset Muscle Soreness)

Massage therapist helping with muscle soreness
In this article we share the scientifically proven ways to help reduce DOMS

DOMS (Delayed onset muscle soreness) is soreness normally felt in muscles for a few days after strenuous exercise. According to scientific studies the two best therapies to prevent and treat DOMS are 1) manual massage performed by manual therapists, and 2) vibration massage. Several other therapies such as Ice/cold, contrast baths, compression garments and active recovery can help, but the benefits are small and inconsistent. Also, to recover properly you need adequate sleep, rest, hydration and nutrition.

In this article we will briefly discuss why you get DOMS, what your muscles need to recover, and how each of these therapies can help. We’ll then show you how to combine these to effectively reduce your own DOMS.

CONTENTS

Why you get DOMS after sports or a workout
What your muscles need to do to help recover faster
The basic things you need to do to help reduce DOMS
The therapies you can use to help your muscles recover
Summary and recommendations
Professionals
References

Why you get DOMS after sports or a workout

The microscopic structure of muscles
With strenuous exercise these fine fibres are damaged, plus you get a build up of metabolites and other chemicals from the breakdown

As this diagram shows your muscles are made up of microscopic fibres. Strenuous exercise will damage some of these fibres, and you will also get a build up of metabolic wastes and chemicals that result from the breakdown of damaged tissues. You’ve probably noticed too that your muscles tend to tighten after exercise. This causes tension on the damaged fibres and puts pressure on blood vessels restricting blood flow. It’s a combination of fibre damage, the build up of wastes and break down products, plus the reduction of blood flow that causes the soreness.

Other issues

As well as soreness the strength and endurance of your muscles will be limited until fully recovered.

What your muscles need to do to help recover faster

Knowing why your muscle get sore, it's easy to see what any therapies need to do to help them recover. Anything you do to help reduce DOMS should do one or more of the following.

  • Help the microscopic damage heal
  • help remove the metabolic wastes and break down products
  • help relieve the tension off the muscles

Now, lets look at the things you can do that help do that.

  1. The basic things you need to do
  2. The extra therapies you can use to help

The basic things you need to do to help reduce DOMS

Warmup and preparation

Before sport or strenuous exercise is advisable to warm up properly using light exercises and stretching. This helps prepare your muscles for exertion and will reduce the risk of injury

Sleep and rest

Your muscles need adequate sleep and rest to recover.

Diet and hydration

There’s a lot of advertising and editorial about dietary supplements to help recovery. It’s big business. We are not experts in supplements, but the basics principles of physiology and biochemistry tells us that the levels of those things in your body is regulated by a principle called homeostasis. I'll give a couple of examples, but because of this we make the following recommendations.

  • After exercise drink a bit more than enough water to replace fluids you may have lost, then drink a few glasses of water throughout the day.
  • Make sure you have a healthy diet that supplies your nutritional needs.
Kidney function
Your kidneys play a major part in homeostasis, including regulating fluid levels

Homeostasis and fluid levels

Homeostasis is your body’s inbuilt mechanisms to regulate it’s internal environment. As an example, if you are slightly dehydrated your body will reduce fluid loss, but if you have too much fluid your kidneys will expel it. This is why we recommend you replace fluids with slightly more than you need.

Protein supplements
If it is more than you need your body will convert these into expensive urine

Homeostasis and protein levels

In general, your body will take what it needs and expel the rest. In the case of proteins, these are first broken down into basic amino acids. If the body has too much of an amino acid it further breaks it down, salvaging the usable part. The part that is broken off is actually toxic for your body, so must be expelled. While there may be some short term gain by overloading with some supplement, homeostatis says that any excess will be converted to expensive urine.

The therapies you can use to help your muscles recover

As we mentioned at the start there are two therapies that clinical trials have shown to be excellent at helping reduce post exercise soreness and speeding recovery. These are:

  1. manual massage performed by a professional therapist, and
  2. vibration massage.

In addition there are several therapies that may help a bit, plus one that has no benefit at all. Lets look at these therapies.

The two therapies that give excellent results

  • Manual massage performed by a professional therapist
  • Vibration massage
Sports massage
Massage by professional therapist is effective at reducing post exercise soreness and speeding recovery

Manual massage performed by a professional therapist

Manual massage therapy has been shown in clinical trials to give good results in reducing post exercise soreness and speeding recovery (1–5)⁠. Likely the main benefit would be from the squeezing and mechanical pumping effects of the massage increasing blood flow, flushing wastes and bringing in fresh nutrients and oxygen.

Massage ball (roller)
Self massage using balls and rollers is no where near as effective and safe as professional massage

This does not include the use of foam rollers
As discussed in our article on foam rollers, these are generally far less effective than professional massage therapy, and the results of using them in clinical trials is no where near as good. There are a host of reasons, but in summary professional massage therapy is performed by skilled knowledgeable therapists, usually on a client relaxed lying on a table. On the other hand foam rolling is usually done by people without this level of skill and knowledge, and muscles are often tightened in an attempt to adopt the correct position.

Vibration massage

Like manual massage, vibration massage is also shown to give very worthwhile reductions in pain and to speed recovery (1,5–13) . Science shows that vibration massage relaxes muscles and increases blood flow, plus in addition it has some quite remarkable additional effects.

  • Speeding the growth of muscle fibres
  • reducing the amount of scar tissue formed
  • causes and increase in the body’s production of growth hormones

For more details on these effects please see our article The scientifically proven effects of vibration massage- with clinical applications.

Self massage with a vibration massager
Vibration massage can easily be self applied with no special skills

Self massage using vibration massagers
The big advantage of vibration massage is that it can easily be self applied. There is no special skill needed. Whereas self applied manual massage (such as foam rollers) requires skill and knowledge, all one needs to do is to place the vibrating pad of a massager over the muscle and let the vibrations penetrate. Without needing the physical pressure and penetration vibration massage is also much safer.

Percussion vs vibration massage

Percussion massagers such as massage guns are not vibration massagers
The use of percussion massagers such as massage guns have become a fad. However, as discussed in our article Should I get a percussion massager (massage gun) percussion massage is different to vibration massage, with less benefits and greater risks.

Therapies with marginal benefits

Clinical trials have shown that each of the following has only marginal or inconsistent benefits. The first three can involve considerable effort, discomfort or expense for their little benefit. However, the last (active recovery) is easy to do and if done properly should help.

  • Cold/ice
  • Contrast baths
  • Compression garments
  • Active recovery

Cold/Ice therapy

Cold/Ice therapy is cooling the body down after exercise, such as using an ice bath. It is said to reduce swelling and inflammation. Clinical trials have only shown that this therapy gives a small and inconsistent reduction in post exercise soreness (2–4,14)⁠.

Contrast (hot/cold) baths

Contrast baths involve alternating between hot and cold baths. Clinical trials have shown these to produce a small decrease in post exercise pain (3)⁠. It is a fundamental principle of physics that things expand and contract with changes of temperature, so contrast baths would produce some sort of pumping action in the fluids in the muscles. However, it is hard to imagine this effect to be anywhere near that of the increased blood flow caused by manual or vibration massage.

Compression garments

Compression garments are garments that exert pressure on the muscles. They are presumed to cause a reduction in swelling. Clinical trials show that these garments can give a small decrease in post exercise pain (3)⁠.

Active recovery

Active recovery is the use of light or moderate exercise during the recovery phase. If we refer back to the cause of post exercise soreness and the needs for recovery we see that such exercise could have both positive and negative effects.

Positive effects of active recovery

  • help stretch and relax muscles
  • help stimulate blood flow

Negative effects of active recovery

  • can damage healing muscle fibres

Because of this clinical trials have only shown inconsistent short term pain relief (3,4,14–16)⁠. Active recovery can help relax muscles and increase blood flow, but if overdone it will damage healing muscle fibres. Our recommendation would be to include active recovery in your recovery program, but take it easy and do things in moderation to reduce the risk of causing damage.

Therapies with no proven benefits

Electrotherapies

Lastly we mention one commonly used therapy that has been shown to have no benefits: electrotherapies
(16)⁠. These are electrical stimulation devices such as TENS machines.

Summary and recommendation

The following are our simple guidelines to reduce post exercise soreness and speed recovery. Keep in mind that this is for general information only. For specific advice consult a professional familiar with your own needs.

Warmup and preparation

Before sport or strenuous exercise is advisable to warm up properly using light exercises and stretching. This helps prepare your muscles for exertion and will reduce the risk of injury

Sleep, rest, hydration and diet

  • Make sure you get adequate sleep and rest
  • After exercise drink more than enough to replace fluids lost, and supplement with several glasses of water each day
  • Make sure you have an adequate diet. Supplements may provide some advantage, but the principles of homeostasis tell us that your body will get rid of any excesses it doesn’t need, so there is the potential for supplements to be converted to very expensive urine.

Massage or vibration massage

These therapies have proved to be beneficial when done before exercise, after exercise, and during the recovery phase. An effective program may be to use either therapy before, after and each day during recovery. A professional sports person with therapy provided will probably have this done by professional massage therapists. However, for most this will need to be self applied. As discussed, the use of foam rollers and percussion massagers (massage guns) is not that effective, so the best alternative is to use a good vibration massager. We have a lot of information about this elsewhere on our website, but the following would be a great place to start.

Video: How to choose a massager
Article: Percussion vs vibration massage
How to use your massager: Instructions page
Video: Our very effective vibration massager

Active recovery

As discussed above, active recovery has potential positive effects and detriment. We recommend that light exercise be done conservatively to minimise the risk of injuring healing muscle fibres.

Professional at desk
Professionals: click image to find out more and possibly trial vibration massage

Professionals

DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

References

  1. Imtiyaz S, Veqar Z, Shareef MY. To compare the effect of vibration therapy and massage in prevention of delayed onset muscle soreness (DOMS). J Clin Diagnostic Res. 2014;
  2. Naderi A, Aminian-Far A, Gholami F, Mousavi SH, Saghari M, Howatson G. Massage enhances recovery following exercise-induced muscle damage in older adults. Scand J Med Sci Sport. 2021;31(3):623–32.
  3. Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol. 2018;9(APR):1–15.
  4. Bishop PA, Jones E, Woods AK. Recovery from training: A brief review. Journal of Strength and Conditioning Research. 2008.
  5. Ntshangase S, Peters-Futre E. The efficacy of manual versus local vibratory massage in promoting recovery from post-exercise muscle damage – A systematic review. J Sci Med Sport. 2017;20(February):e42.
  6. Veqar Z, Imtiyaz S. Vibration therapy in management of delayed onset muscle soreness. J Clin Diagnostic Res. 2014;8(6):10–3.
  7. Lau WY, Nosaka K. Effect of vibration treatment on symptoms associated with eccentric exercise-induced muscle damage. Am J Phys Med Rehabil. 2011;
  8. Bakhtiary AH, Safavi-Farokhi Z, Aminian-Far A. Influence of vibration on delayed onset of muscle soreness following eccentric exercise. Br J Sports Med. 2007;
  9. von Stengel S, Teschler M, Weissenfels A, Willert S, Kemmler W. Effect of deep oscillation as a recovery method after fatiguing soccer training: A randomized cross-over study. J Exerc Sci Fit. 2018;16(3):112–7.
  10. Timon R. Effects of whole-body vibration after eccentric exercise on muscle soreness and muscle strength recovery. J Phys Ther Sci. 2016;28:1781–5.
  11. Kamandani R, Ghazalian F, Ebrahim K, Ghassembaglou N, Shiri Piraghaj M, Khorram A. The Effect of Acute Vibration Training on Delayed Onset Muscle Soreness in Young Non-Athlete Women. Heal Scope. 2015;2(3):119–24.
  12. Lu X, Wang Y, Lu J, You Y, Zhang L, Zhu D. Does vibration benefit delayed-onset muscle soreness ?: a meta-analysis and systematic review. 2019;
  13. Koeda T. A trial to evaluate experimentally induced delayed onset muscle soreness and its modulation by vibration. Environ Med. 2003;47:26–30.
  14. Kinugasa T, Kilding AE. A comparison of post-match recovery strategies in youth soccer players. J Strength Cond Res. 2009;23(5):1402–7.
  15. Toubekis AG, Smilios I, Bogdanis GC, Mavridis G, Tokmakidis SP. Effect of different intensities of active recovery on sprint swimming performance. Appl Physiol Nutr Metab. 2006;31(6):709–16.
  16. Cortis C. Effects of post-exercise recovery interventions on physiological, psychological and performance parameters. Int J Sports Med. 2010;31:327–35.

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more



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