Delayed Onset Muscle Soreness: A Runner’s Friend or Foe?


Therapeutic Associates

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The Race to Robie Creek is a Rite of Spring for runners in Boise, Idaho. The route climbs about 2000 feet in 8.5 miles and drops 1700 feet in 5 miles prompting the nickname, “the Northwest’s toughest half marathon.” About 24 hours after crossing the finish line, my quadriceps muscles cry out their agreement with this half marathon’s moniker as I descend the stairs in my house. The limping soreness increases for the next two days and then as quickly as the pain came on, it slowly improves and I am back to running normally (and surprisingly stronger) within two weeks.

Many of you have experienced similar symptoms after pushing the pace during a race, running intervals or hills or trying a new weight lifting program. This painful condition is called Delayed Onset Muscle Soreness or DOMS. The onset of DOMS is usually within 24 to 72 hours of unaccustomed exercise. Symptoms include severe muscle tenderness, mild swelling of muscle tissue and restricted range of motion.

Theoretical causes of DOMS.

While the research has not been conclusive on the causes of DOMS, there are two common theories. The first explanation is that an accumulation of the lactic acid produced during exercise causes muscle pain. Lactic acid is a by-product of our cells that can exceed normal levels with strenuous exercise and create a painful acidic environment.

Most physiological studies do not support the lactic acid theory. A majority of the excessive lactic acid is flushed from your system within 30 minutes. Hence discomfort from lactic acid should not be felt one to two days after exercise. More evidence that lactic acid is not the culprit is that similar blood levels of lactic acid in cyclists and swimmers do not produce the same symptoms that runners experience.

The more widely accepted cause for the symptoms of DOMS is that the muscle pain is due to extreme trauma to our muscle tissues. Running, at its essence, is controlled falling. We use our muscles to decelerate our joints as they absorb impact. 

These types of muscular contractions are called eccentric contractions. Eccentric muscle contractions are performed with weight bearing activities (walking, running, weightlifting ). As the muscle fibers slow down and control the rapid deceleration of a runner’s body weight (especially with a new or harder than normal workout), they tear. About 24 hours after the bout of exercise, the effects of inflammation appear as pain, swelling and stiffness. The inflammatory process basically cleans up damaged tissue and repairs and/or produces new tissue. The pain is caused from inflammatory enzymes and chemical by- products that sensitize pain receptors and cause cellular swelling. The cellular swelling can be extremely painful and can last about 72 hours. The new muscle fibers that are produced are usually more adaptable to the stress and strain of running. In other words, it is out with bad and in with the better. This is not news to many experienced runners. Tough runs and workouts make us stronger.

Running, at its essence, is controlled falling. We use our muscles to decelerate our joints as they absorb impact.

The role inflammation plays.

Traditionally, inflammation has a bad reputation. Nonsteroidal anti-inflammatories (NSAIDS) are common medications used by runners to reduce post run inflammation and pain. Some runners will even take NSAIDS prior to a run to prevent inflammation. However, studies have shown that not only are NSAIDS tough on your stomach and kidneys, but they also impair the normal healing process. So, while popping an NSAID might give you temporary relief from the pain of DOMS, it is likely leading to weaker muscle fiber formation. In fact, it could be argued that controlled inflammation is a runner’s best friend. After an abnormally long or hard run, the body has a short window of time to take advantage of the inflammatory cycle’s process of muscle fiber rebuilding and remodeling. 

Try these practices to optimize your body’s potential while your body recovers:

Soaking yourself from the hips down in a cold stream, lake or in a tub full of ice for 15-20 minutes within 30 minutes of your run reduces the painful cellular swelling produced by inflammation without affecting the healing components of the inflammatory cycle. I have found that getting in the tub first and then adding the ice is the least painful method.

Move! If you sit around during the healing process the remodeled muscle tissue will be stiff and shortened which over time leads to postural imbalance and injury. For example, prolonged sitting can result in tight hamstrings which could lead to a hamstring strain when you try to go for your first post-DOMS run. Walking, yoga class, cycling, elliptical trainer and pool running are all good options for exercise while recovering from DOMS. Try the Downward Dog stretch to address tightness in the hamstring, hip and calf muscles. See Fig.1 for instructions on this common yoga technique.

Stretching during the 24-72 period of DOMS is very different from normal stretching. The healing muscle fibers are very delicate. You do not want to overstretch and tear previously damaged muscle fibers. Take your stretches just to the threshold of discomfort and then back off a bit. Hold for up to 60 seconds. See Fig. 2-3 for instructions on how to stretch the quadriceps and hip flexor muscles.

Gentle massage or self massage using a foam roller helps increase blood flow and flexibility of healing tissues. Avoid deep tissue massage for at least a week after the onset of DOMS to avoid further traumatizing healing muscles. See Fig. 4 for directions on using a foam roll on the outer leg and hip muscles.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

As a physical therapist, I am constantly trying to make changes to patients’ bodies by prescribing exercises to improve flexibility and strength. During the short period of DOMS, the body is primed for making these types of changes in a relatively short time.

I have described running as a sport that causes countless tissue tears and profound inflammation. So why should we run? Why would I recommend such a traumatic activity? Weekly, I have patients ask me if running is bad for them or someone has told them not to run because it is too hard on their body. The human body is designed to adapt and grow stronger to the stresses we put on it. If we do not stress our tissues, they weaken and become prone to disease and injury. Proof of our nation’s current trend to avoid stressing our bodies with exercise can be observed in the health care crisis. Three of our country’s biggest health problems are heart disease, obesity and type II diabetes. We spend billions on medications for these problems when running could cure (in most cases) all three. In a society where the majority react to disease instead of being proactive in prevention, I would ask, “Why Wouldn’t You Run?!”

Are you experiencing discomfort with running or other activities?

Our physical therapists can help you return to a pain-free, active life. Our passion is to help every patient reach their goals on their journey to recovery and optimal performance.

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