Delayed Onset Muscle Soreness (DOMS)

What is Delayed Onset Muscle Soreness?

Delayed onset muscle soreness (DOMS) is exercise-related muscle pain that appears after unaccustomed or harder-than-usual activity. It is most common after exercises with a strong eccentric load, such as downhill running, long-distance running, step-down work, plyometrics and landing drills.

What Causes Delayed Onset Muscle Soreness?

DOMS occurs when your muscles experience more load than they are used to, especially during eccentric contractions where the muscle lengthens while it contracts. Eccentric loading is also a key factor in conditions such as Achilles tendinopathy and other overuse injuries. At a microscopic level, small myofibril tears and connective tissue strain lead to an inflammatory response, intramuscular fluid shifts and local swelling.

In people with DOMS, blood tests often show raised muscle enzymes such as creatine kinase and lactate dehydrogenase, which are consistent with temporary muscle fibre disruption. Swelling, altered muscle firing patterns and pain combine to reduce strength, control and range of movement for a short period.

DOMS Symptoms

Typical features of this type of post-exercise muscle soreness are similar to early signs seen in common muscle injuries:

• Dull, aching pain in the affected muscles
• Onset 12–24 hours after new or strenuous exercise, peaking at 24–72 hours
• Muscle stiffness, tightness and tenderness on touch
• Increased pain during passive stretching of the sore muscle
• Temporary loss of strength and reduced joint range of motion
• Occasional mild swelling in the involved muscle groups

Many people notice that the first few steps or movements feel the worst, then symptoms ease once they “warm up”. However, tasks such as walking downstairs can be difficult if your quadriceps are affected.

How Is DOMS Diagnosed?

DOMS is a clinical diagnosis. Your physiotherapist will talk through your recent training loads, examine the sore areas and test muscle strength and control. The pattern of delayed onset pain, localised muscle tenderness and reduced strength is usually clear.

Your physiotherapist will also exclude more serious injuries such as significant muscle tears, strains or ruptures. If symptoms suggest a larger injury, the assessment may follow similar steps to those used for common muscle injuries or possible stress fractures. Imaging such as ultrasound or MRI is not usually required for DOMS itself, but may help if a larger muscle injury is suspected.

DOMS Treatment

Most cases of this post-exercise muscle soreness respond well to simple measures and time, similar to other conditions described in our common physiotherapy treatment techniques guide. Helpful options include:

• Active rest: Keep moving with gentle, low-impact activity such as easy walking or light cycling rather than complete rest.
• Cold or heat therapy: Ice packs can help early soreness. Later, heat packs may ease muscle tightness, particularly around the back and hips.
• Pain relief: Short-term use of simple pain relief or NSAIDs may help. Long-term or heavy use of anti-inflammatory medication is not recommended without medical advice.
• Gentle massage and compression garments: Light massage and compression can reduce the intensity and duration of DOMS. Avoid deep tissue massage in the first 24 hours.
• Gentle stretching: Short, comfortable stretches can ease stiffness, but avoid forcing long, painful stretches early on.
• Low-load exercise: Easy cycling or water-based exercise may temporarily ease DOMS-related pain and stiffness.

You should avoid aggressive exercise while DOMS is at its peak. During this period your muscles have reduced capacity to absorb shock, coordinate movement and generate force, which may increase your risk of a true muscle strain.

Can You Exercise With DOMS?

Light exercise is usually safe if your symptoms are mild and improving. Many people cross-train with lower impact activities, using ideas from our sports injury and exercise advice, until the soreness has settled. Scale back the intensity, reduce eccentric loading and avoid repeating the same heavy session until the soreness has settled. If the pain is sharp, worsening or affecting your joints, stop and seek professional advice.

How Can You Prevent DOMS?

You can minimise this kind of post-exercise muscle soreness by following these tips:

• Increase training loads gradually rather than in big jumps.
• As a guide, avoid increasing your sets, reps, distance or weights by more than 10% per week.
• Introduce eccentric exercises slowly, especially downhill running, plyometrics and strength work that emphasises the lowering phase.
• Include a proper cool down with light movement after games, classes or heavy sessions.
• Long-distance runners should include regular eccentric quadriceps and calf training in their program.
• Plan rest and recovery days into your weekly schedule to allow tissues to adapt, which also helps reduce the risk of overuse injuries.

DOMS Prognosis

The good news is that most cases of this post-exercise muscle soreness settle on their own and leave no lasting damage. Many people feel noticeably better within one to three days.

You should see a physiotherapist if:

• Pain is severe, sharp or not improving after 48–72 hours.
• Pain started suddenly during exercise rather than the next day.
• The soreness centres around your joints rather than the muscle belly.
• There is significant swelling, bruising or loss of function.

What to Do Next

If you are unsure whether your pain is simple delayed onset muscle soreness (DOMS) or a more serious muscle or joint injury, a physiotherapist can help you make that call. Our sports physiotherapy team can review your training loads, assess muscle and tendon function and design a safe return-to-exercise plan. If you are recovering from overuse issues, you may also find our information on overuse injuries helpful.

Delayed Onset Muscle Soreness FAQs

How long does DOMS last?

Delayed onset muscle soreness (DOMS) usually begins 12–24 hours after unfamiliar or intense exercise, peaks at 24–72 hours and then steadily settles. Most people feel close to normal again within three to five days.

Is DOMS a good sign?

Mild DOMS can indicate that your muscles have been challenged and are adapting. However, severe soreness that affects walking, work or sleep is not essential for progress and may signal that you increased your training load too quickly.

Can I train again if I still have DOMS?

Light training is usually safe if your soreness is mild and improving. Avoid repeating the same heavy or eccentric session until the pain has eased, and reduce your load if symptoms flare during or after exercise.

What helps DOMS recover faster?

Gentle movement, light stretching, massage, adequate hydration, sleep and good nutrition all support recovery. Avoid overloading sore muscles with heavy strength or high-impact sessions while symptoms are at their peak.

When should I see a physiotherapist for muscle soreness?

Seek assessment if your pain is sharp, starts during exercise, involves swelling or bruising, affects your joints, or does not improve within a few days. These features are less typical of DOMS and may indicate a muscle tear or other injury.

Related Articles

1. Common Muscle Injuries – A Physiotherapist’s Guide
2. Common Physiotherapy Treatment Techniques
3. Sports Physiotherapy
4. Sports Injury Management
5. Overuse Injuries
6. Stress Fractures
7. Achilles Tendinopathy
8. Tendinopathy – Tendon Pain Conditions
9. Remedial Massage in Brisbane
10. Further Reading: DOMS – Research Overview (NCBI)

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