Delayed Onset Muscle Soreness (DOMS)

Activity-induced muscular pain syndrome

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Definition

DOMS refers to the sensation of pain and stiffness in muscles occurring 1-5 days after relative abnormally intensive bout of exercise¹. This process can result in decreased muscular performance due to voluntary reduction of effort and/or decreased muscular capacity¹.

Note

Whether an unconscious neuromuscular decrease in recruitment in the muscle should be considered as well.

Prognosis

• DOMS symptoms will peak at 24-72hrs and then subside by 5-7 days¹.

DDX

DOMS is a completely different syndrome from other exercise induced muscular discomfort such as:

• “Charlie horse”¹
• Muscle strain¹
• Muscle tear¹
• Chronic leg pain¹
• Exercise Muscle soreness due to nutritional deficiencies
  • phosphorylase¹
  • Phosphofructokinase¹
  • Carnitine palmityl transferase¹.

Pathophysiology

There is limited information on that true pathophysiology of DOMS. It is probable that the cellular mechanisms and neural pathways of DOMS are similar to other activity-induced muscular pain syndromes¹.

Note

Armstrong¹ postulates that exertional rhabdomyolysis is a severe form of DOMS¹.

Location

The location of DOMS is not specific since any skeletal muscle that is over-exerted can experience DOMS¹. The tenderness symptoms are usually felt distally at the muscle-tendon junction¹. The causes of this localization of symptoms were theorized by Newham¹:

1. Muscle pain receptors are most concentrated in the tendon and connective tissue of this complex¹.
2. Localization of damage to the distal aspect of the muscle¹.

Clinical Correlates

1. Plasma intramuscular enzymes are considered indicators of muscle damage, particularly sarcolemma damage¹.
2. Plasma myoglobin¹.
3. Plasma hydroxyproline as an indicator of connective tissue damage¹.
4. Plasma creatinine
5. Hyperkalemia

References

1.

Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: A brief review. Medicine and Science in Sports and Exercise. 1984;16(6):529-538.