If you’ve ever felt sore muscles after trying a new sport, returned to activity after a long absence or advanced your physio exercises (way to go by the way!), it is very likely that you have experienced some level of Delayed Onset Muscle Soreness. We often refer to this as DOMS. 

It is common for patients to have concern about the level of pain they get from exercise, whether that’s because their muscles have reconditioned or they are increasing intensity or volume. While there is always an argument to use pain as a reliable guide, pulling up sore can also be a great sign your body is adapting and improving its capacity for more work. 

What your pain is trying to tell you isn’t always clear cut. How can you tell the difference between post-session soreness and suspecting an injury? At what point do you consider a visit to the physio? And how much pain is good pain?

First off, what is DOMS?

How long does DOMS last?

It is normal for muscle soreness to occur after a workout that was challenging or new to the body. DOMS is thought to be temporary muscle damage in the form of micro tearing and inflammation which can start within 2 hours of the activity, usually peaking within 48 hours or even lasting up to a week. Some people call this ‘second day soreness’. It’s this muscle damage that sends the signal to your body to repair and build back the muscle fibres stronger than before. In small and consistent doses, this is the principle of progressive overload. 

Progressive overload involves continually increasing the demands on the musculoskeletal system to continually make gains in muscle size, strength, and endurance. Simply put, in order to get stronger, you must continually stimulate your muscles to work harder than they normally do. 

How to tell an injury and DOMS apart

1. Innocent muscle soreness will feel achy, stiff or tight. An injury will usually cause sharp pain. 

Soreness from exercise is a tender, tired or even burning feeling, often in a wide muscle group that worked really hard, rather than one specific spot as you would usually find with an injury. For example, your calf and quadricep muscle groups might feel tight and achy in general after running a stair session, usually an indicator of DOMS. In contrast, an injury might limit normal functions like walking, sitting or picking objects up because the pain is too deep, sharp or severe. Swelling is also a reason to suspect an injury might have occurred. 

2. The pain has not eased after a few days

Every case of DOMS is different and can depend on a number of factors like your physical fitness, type of session, hydration levels and amount of sleep. Generally you can expect your DOMS soreness to peak around 24 to 48 hours post-activity, usually subsiding after 3 days. If the pain doesn’t ease after 3 days, or becomes worse, it may be a sign that an injury could be at play. Furthermore, general soreness may mask an underlying injury so if you start to workout again and the pain immediately returns, a true injury may be apparent. 

3. It doesn’t feel like muscle 

Experiencing tenderness or swelling in a bone or joint area isn’t usually associated with DOMS. If this is the type of pain you’re experiencing post session, or is pain that is getting worse across multiple sessions, then this could be a sign that you have sustained an injury, which is worth getting checked out by a physio. 

How to prevent DOMS 

In some cases, DOMS is a necessary evil to get back into your sport or exercise, or to work through those physio exercises. Keep remembering that this is your body’s way of adapting! 

To prevent DOMS, make sure you’ve done a global warm up to get your heart rate ready to exercise that is followed by some more specific moves to prime those muscle groups that will do the bulk of the work. An active warm down of stretching and mobility is also a wise way to recover immediately and get ahead of the DOMS curve and reduce it. Make sure you stay on top of your hydration by replacing lost fluids, and eat a protein and carbohydrate source after intense exercise (for example, a ham and cheese sandwich or a banana and protein shake)

Monitoring how much you increase your load and intensity is the best way to reduce DOMS. Making small and incremental increases (progressive overload) is also the best way to stay uninjured. 

How to get rid of DOMS

Get rid of DOMS by flushing it out through a balance of rest and active recovery. The soreness can often subside if you can warm up that muscle group with another workout. Make sure to respect the fact your body is in repair mode, so ensure that the following workout is gentle, focused on recovery and pain guided. Give your body the best chance to heal with lots of sleep, some foam rolling and even some active stretches. 

What to do if you think you have an injury

If you think you might be hurt, schedule a visit with your Melbourne CBD Physiotherapy and Sports Medicine to rule out any potential injury or offer you a fast diagnosis. 

It’s our job as physiotherapists to help you understand your body better. If you have any concern about the level of pain you feel from sport or your physio exercises, we will always encourage you to chat with us about strategies to mitigate your risk and make the most out of your activity. 

Try to remember what you were doing when you the pain came on, any specific moments in time or positions you were in that brought it on. Try to also describe what the pain feels like as this will ultimately help your physio determine what’s going on. 

An injury doesn’t mean you have to stop exercising all-together. In fact, it’s our goal to find ways for you to still get your fix! Your physio will also help you refine your understanding of progressive overload to help minimise the effect of DOMS or the risk of injury might have in the future.