Delayed onset muscle soreness

Delayed onset muscle soreness (DOMS) refers to the muscular discomfort and stiffness experienced from several hours to days following unaccustomed or strenuous physical activity. The peak intensity of this soreness typically occurs between 24 to 72 hours post-exercise. DOMS is believed to result from eccentric, or lengthening, exercises that induce minor damage (microtrauma) to the muscle fibers.

Pathophysiology

DOMS arises due to microscopic damage incurred by the muscle fibers during eccentric exercise. This type of exercise places the muscles under tension as they elongate, leading to structural disruptions in the muscle tissue, known as microtrauma. The microtrauma incites an inflammatory response, which increases the muscle's sensitivity to pain and results in the characteristic symptoms of DOMS. Notably, the muscle rapidly adapts to this damage, leading to a 'repeated bout effect,' which reduces the likelihood of further damage and associated soreness from subsequent similar exercises.

Clinical Presentation

Individuals with DOMS experience a spectrum of symptoms, including muscle stiffness, tenderness, swelling, and a reduced range of motion. Symptoms can manifest in any muscle group but are most commonly observed in the ones engaged during the exercise. Notably, DOMS does not cause sharp, immediate pain that is usually associated with muscle strains or sprains.

Diagnosis

Diagnosis of DOMS is typically based on the individual's exercise history and the presentation of characteristic symptoms. As DOMS is a self-limiting condition, laboratory or imaging tests are generally unnecessary unless symptoms persist beyond the expected timeframe or if a more severe muscle injury is suspected.

Management and Treatment

Management strategies for DOMS primarily focus on symptom relief and facilitating recovery. These may include rest, gentle stretching, heat or cold application, massage, and over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs).

Prevention

Prevention strategies for DOMS include gradually increasing the intensity and duration of exercise, incorporating both eccentric and concentric (shortening) exercises into training routines, and ensuring proper rest and recovery between workouts.

References

• Hyldahl, R. D., & Hubal, M. J. (2014). Lengthening our perspective: morphological, cellular, and molecular responses to eccentric exercise. Muscle & Nerve, 49(2), 155-170.
• Cheung, K., Hume, P., & Maxwell, L. (2003). Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine, 33(2), 145-164.

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