Coping with Delayed Onset Muscle Soreness (DOMS)

Interviewer:            Welcome to the Clinician’s Corner from Natural Horizons Wellness Center.  A weekly podcast focused on integrative medicine, healing, nutrition and exercise.  I’m your host, Jacque **** and I’m here to help you learn ways to improve your life as we explore treatments and therapies that will lead to a healthier you.  Our guest today is Dr. Vishal Verma; he’s a doctor of Chiropractic.  We are going to talk today about the effects of Delayed Onset Muscle Soreness or what we more commonly refer to as DOMS.  Welcome Dr. Verma. 


Dr. Verma:            Thank you for having me. 


Interviewer:            When it comes to DOMS, I think it’s helpful if we have a good kind of a definition of what DOMS is. 


Dr. Verma:            Well, I mean, normally when my patients come in, what I see out of DOMS is going to be obviously based on injury too, but for the average person and for the, you know, elite athlete and novice athlete, DOMS are Delayed Onset Muscle Soreness is going to be a tenderness and/or a muscle soreness basically post exercise and it’s caused by usually the breakdown of muscle tissue as the person is exercising and it takes about 24 to 48 hours to sort of set in.  But the best definition is the soreness that you feel after an exercise is done.


Interviewer:            And is that just on the first time you do exercise or is it something that kind of carries on?


Dr. Verma:            No, typically you will see the person have it… the first time you’ll definitely feel it, if you haven’t done an exercise in a while, most of my clients will describe it as, yeah I definitely was sore after I did an exercise.  But it can also happen to a conditioned athlete as they try to increase their intensity or their… they increase their resistance or if they come back to the exercise or activity again after a long layoff.  Any change at all in their activity level we’ll say, you know, like you said, resistance, frequency, intensity, anything like that will probably give then a little more DOMS. 


Interviewer:            So now your client has DOMS.  There’s a risk involved. 


Dr. Verma:            Yeah, with the Delayed Muscle Soreness, one of the things to remember is, the initial effect is soreness.  What I think a lot of people fail to recognize is, with that soreness comes the potential for injury to occur if that muscle that is sore or and/or broken down is pushed in a strenuous way before it fully recovers. 


Interviewer:            Well, you also have a range of motion issue there too because they’re changing the range of motion because of the point of tenderness.  And so that change in range of motion can cause some damage to the connective tissue. 


Dr. Verma:            Right.  And that’s when you get into ligament damage, you get into tendonness[ph] damage and that’s when you see a lot of people with chronic injuries and they just battle through it and battle through it thinking they’ll be okay and that leads to subsequent greater injury. 


Interviewer:            so you’ve got this inflammation, then you’ve got the tearing and then it never really ever heals.  The person who has DOMS and this is their first time exercising, they need to stop exercising at that point and take a break, let themselves heal because they are at real risk for connective tissue injury. 


Dr. Verma:            Right. 


Interviewer:            If it’s not as severe and it’s their first time exercising, is it safe to continue exercising? 


Dr. Verma:            I would say it’s safe to continue exercising taking the usual post-48 hours off of exercise and then coming back to the muscle.  And it’s actually shown in research that the best treatment for DOMS is to actually move the muscle and to actually get back to moving without, of course, putting it through the same resistance and motions that you did before, but 48 hours post-DOMS, you can probably get back into the exercise and not injure yourself. 


Interviewer:            So there’s a difference between tenderness and debilitating pain. 


Dr. Verma:            Right. Right. 


Interviewer:            And what we want is, just for the sake of our conversation, let’s just assume that they have not gotten to the point of being debilitating.  They can still function.  You know, I was doing some research and I know that you were looking at some of the research to try to figure out, you know, what’s effective in the treatment.  And we’re going to get to that in just a second, but first I want to talk about, we need some definitions here.  So let’s talk about definitions of exercise.  We have cardiovascular exercise and then you’ve also got resistance exercises, different timing, and intensity levels, those kinds of things. 


                        All right, let’s talk about the actual tenderness because I think it’s important that people are able to distinguish between muscle soreness and connective tissue soreness, how do you tell? 


Dr. Verma:            Well, I think with Connective Tissue Disorder, which is a lot of what I deal with, you’re going to get a lot… you’re going to get a different type of pain, it’s going to be a deep searing pain and obviously it’s going to affect our function of the muscle because the connective tissue normally is going to consist of ligaments and tendons and fascia and things like that that are the deeper level.  These should not come into play as much as when you’re exercising and especially when it comes into DOMS, the DOMS actually affects the muscle itself.  So you’re actually getting muscle fiber breakdown, fiber tissue breakdown.  And when that muscle breaks down, it’s going to cause an inflammatory reaction of the muscle which is then going to lead to lactic acid in the area, which is then going to lead to inflammation to the area in general and that’s when you’re going to get the actual muscle soreness.  But it’s not a connective tissue disorder.  It’s good to remember that. 


Interviewer:            Yeah, and the important thing there is for the lay person, okay, I feel an injury.  I feel some pain in my arm.  Let’s say they were doing some bicep curls, they’ve gone a little crazy and they want to work on their biceps.  They’re doing the curls and next day, they’re feeling some pain.  All right, how do you know if it’s muscle or connective tissue that you’re feeling? 


Dr. Verma:            Normally, assuming that this person is going have… if they’ve done a bicep curl, if it hurts right in the center of the bicep muscle, it’s probably going to be muscle soreness. 


Interviewer:            There’s your indicator. 


Dr. Verma:            Right.  For connective, at the joint end where it connects and where it ends. 


Interviewer:            right.  So that’s what I’m trying to get at is where, you know, if you feel tenderness in the joint, it’s probably connective tissue, ligament, cartilage, fascia, whatever, at the joint you’re going to feel it.   At the joint, you’re gonna feel it.  If it’s in the muscle body itself, to even touching it with you finger, if you poke it with your finger it’s gonna hurt, right?  That’s the indicator.  Now certainly if you had like tendonitis, you know, in your elbow, that’s inflammation of the connective tissue, that’s where that’s gonna be.  And it’s as you move the joint through its range of motion, you’re gonna fell it in the joint.  So it’s… this is another thing that we need to make sure that we’re distinguishing for the lay person to understand the difference between the two because the treatment for Delayed Onset Muscle Soreness is not going to be effective in anyway with connective tissue. 


                        As we… as you and I have kind of gone through research here to try to figure out what works and what doesn’t, let me just run through the various things that I’ve heard over the years and maybe you can throw some in as well:  Aspirin, Ibuprofen, those kinds of things.  Either topically or ingesting it in pill form.  Massage, you have hydrotherapy in a tub or a whirlpool.  You’ve got acupuncture, Shiatsu, different types of massage. 


Dr. Verma:            Clinically you can get into ultra-sound, you know, deep infrared heating and of course, electric stimulation of the muscle, which is normally for pain and things like that, but those are some of the things clinically you can get into.  Maybe even lasers. 


Interviewer:            Lasers?  Yeah.  Water… I’ve heard people attempting protein intake, high amounts of water, for flushing purposes. 


Dr. Verma:            High amounts of water, sure.  Antioxidants.  A lot of ingestion of antioxidants, supplements.  You said protein, but you know, more multi-vitamins and certain companies that claim that their vitamins and their minerals can help delay or reduce the amount of DOMS that you have. 


Interviewer:            So, herbal…


Dr. Verma:            Herbal remedies…


Interviewer:            Over-the-counter medications, branch amino acids supplementation, things like that, okay.  So we’ve got a pretty broad range there.  Let’s talk about what works and what doesn’t.  Does any of it work? 


Dr. Verma:            Well, here’s the thing.  According to people and the placebo effect, I’m sure it does.  But in reality, the research shows that most of the remedies that are out there are not going to have a significant reduction in the amount of soreness you’re going to feel.  It mask or take care of some of the symptoms that you are feeling from the soreness itself, but it’s not going to really reduce the amount of soreness that you’re going to have over time. 


Interviewer:            Do we even know what causes it? 


Dr. Verma:            That’s a bigger question.  I think there’s so many theories out there on what causes from the, as I mentioned earlier, from the lactic acid production to the just muscle fiber breakdown, none of us really know what causes it.  So trying to find a cure for something that we don’t know what causes it is a little bit difficult. 


Interviewer:            You know, I was trying to figure out why, you know, why is it that we don’t know what causes it? Well, pain is a perception.  The intensity of pain is perceived.  We cannot do something and eliminate any of the other things that that are interacting, lactic acid, you know, depletion of branch amino acids, muscle tearing, inflammation.  You can’t exercise a muscle and eliminate four of those things and just keep one.  Doing muscle biopsies where you’re taking tissue out.  All you can look at is what’s going on in the muscle chemically at that particular moment, but that’s not going to give you an idea of what the perceived pain is caused by.  So it’s very difficult to… if not impossible to figure that out with the technology we have today.  Lactic acid, muscle spasms, connective tissue damage, muscle damage, inflammation, enzyme efflux, different theories like that.  And I can remember we, you know, it’s lactic acid… five years later it’s not lactic acid, it’s something else and we’re back and forth and back and forth. 


                        But the truth is, we just don’t know.  We don’t have any clinical proof of anything.  So let’s talk about some strategies on what you can do to kind of reduce the impact of Delayed Onset Muscle soreness because with DOMS, you’re gonna get it no matter what.  I mean, it’s just gonna happen.  It’s just how severe, again, we don’t want it to be debilitating.  So let’s talk about some strategies since obviously, post-exercise, there are some strategies we can employ to reduce the effects of it. I think we’ve found that to be true in some of the research.  But let’s talk first about how we kind of reduced the impact because it’s gonna happen. 


                        What I try to get people to do when I’m giving them an exercise routine to follow is, I will tell them, look, what I want you to do for the first two weeks, even though it sounds kind of stupid.  I want you to just do cardiovascular exercise, some cardio work and I want you to do it from 10 to 15 minutes and we’ll progressively move up by five minutes blocks of so each time and only do that three times a week for two weeks.  That incremental progression in their exercise will help them reduce the impact of DOMS as they begin resistance training.  I don’t let them do resistance training first.  And they kind of… they don’t like it and sometimes they’ll cheat and they’ll do the resistance exercises anyway and then they report back to me that they’re really sore.  And it’s like; well that’s why I didn’t want you to do it.  So that’s the method use when I’m trying to get people to, when they’re introduced to fitness. 


                        What are some of the things that you recommend? 


Dr. Verma:            I agree with the way that you just talked about training is that the  number one thing you see, even clinically is you know, not matter what treatment we start, we start light progressions and we work up to more active tense training..  That’s just the way it always has been, but you know, the whole thing is, you can’t run a marathon on the first day.  You have to start slowly and work your way up. 


Interviewer:            You can’t? 


Dr. Verma:            No.  And if you try, you’ll have DOMS like you wouldn’t believe.


Interviewer:            That would be the debilitating effects of DOMS. 


Dr. Verma:            One of the methods that has been shown in the research to help with DOMS is tender point acupuncture, which is applying acupuncture needles to the area that is actually sore into the muscle belly of, let’s say, the bicep or hamstring or whatever muscle is sore.  It has been shown to alleviate the pain associated with DOMS.  Another one is, massage, which seems to temporarily help with some of that.  Some of the muscle soreness itself. Possibly just because I think the muscle tends to relax for a little bit and tends to get contracted afterwards, but at least it helps with temporary alleviation of the pain. 


Interviewer:            But that also works in conjunction or along the same lines as movement.  Right? 


Dr. Verma:            Right. And that’s another great one.  I think the best method has been found to be movement, post exercise and post soreness is to just get out there and get moving again because when you move, you’re moving around, you’re actually helping the blood flow along, you’re actually helping the… if it is a lactic acid production, you’re helping move the waste product out of the muscle tissue which will help you heal faster.  So you’re actually reducing the time too. 


Interviewer:            And that’s, that’s one of the things that the research also kind of showed was that it was the increase of blood flow that seemed to have the effect.  So movement does that and it’s the old thing where , you know, if you feel bad, get up and walk around and you’re fine, as soon as you sit down for 20 minutes it’s right back there. 


Dr. Verma:            Absolutely.  And I think that plays right along with this other piece of research that showed something called cardio acceleration before a resistance exercise, which will help you reduce the amount of soreness you have.  Cardio acceleration is defined as getting your heart rate up to about 63% along with the research shows of your heart rate.  And this says that by professing the muscle with blood, you’re actually increasing the likelihood of the muscle to heal and decreasing the chance of the soreness by actually getting the blood into the muscle earlier. 


Interviewer:            So what you’re saying is, they’re going to get on a bike and they’re gonna petal, petal, petal until they get their heart rate up to about 63% of its maximum rate using the Karvonen Method of calculating like you do any cardio work.  And at that 63%, a soon as it gets to 63%, they hop off the bike or whatever they’re on, do their set of resistance exercises and then you know, a slight rest because when you’re doing resistance exercises, you want at least a minute and a half between sets. 


Dr. Verma:            Sure. 


Interviewer:            So you’re gonna get back on the bike and you’re gonna, you know, maybe slowly petal and then get it up to 63% of your maximum heart rate, hop off and go at it again. 


Dr. Verma:            That seems like a time-consuming type of thing, but…


Interviewer:            It would take a long time…


Dr. Verma:            it would take a long time to exercise; however, I think the whole, the thing to take home with that is, obviously getting blood profusion and again, going back to the movement we talked about, getting your blood to flow, getting the blood to your muscle tissue I think is the number one way of helping with DOMS.  Of course, time is the most efficient way as to allow the muscle to heal, but in doing so, in giving it time, why not have a little bit of movement, which will help you recover a little faster. 


Interviewer:            And remember, DOMS really is the effect that is felt after a change in your workout.  So what I took away from the research that said do it with the 63% increase in heart rate is, yeah.  You just turned a 45-minute workout into a three-hour workout by doing that; however, I’m going to extrapolate from that that if you did it that one time you changed your workout and you then began your workout without that interval of cardio work before each set, you perhaps would feel the DOMS because you’ve gone through that barrier of having done the work before that.  So, you know, I think creativity is one thing.  Basically you’re gonna affect… you’re going to felt he effects of DOMS, no matter what, it’s gonna happen.  You can’t prevent it anytime you change.  And the research that I saw was that it didn’t matter if you were a trained athlete, an elite athlete, or a beginner with no experience with fitness activities at all, you’re still gonna feel DOMS if you change and/or begin an exercise routine.  The elite athlete felt DOMS as much as the non-athlete, if they change their routine. 


                        Once it does happen, there are some ways to effect a change, does not get rid of it.  I think the highest change that we saw using a Borg Scale of Perceived Pain was like a, what 30 percent, 40 percent was I think the most reduction of…


Dr. Verma:            ****. 


Interviewer:            And 40 percent of a perceived pain, if it’s not debilitating, still, you’re still gonna feel it.  So you’re talking about 60 percent pain perception. 


Dr Verma:            Yeah.  An impaired function of the muscle because you’re not going to be able to use that at the same level, so you’re going to… you’re definitely going to feel the affects of DOMS and again, I guess the real issue is, can you do anything to alleviate some of the symptoms?  Well, we mentioned some, but at the same time, again, I think the key element here is time.  It’s just allowing the healing process to occur.  It sounds like a clinical answer, but it’s been the answer for the longest time. 


Interviewer:            And it still is. 


Dr. Verma:            and it still is. 


Interviewer:            So, the other thing that we want to make sure we’re cautioning people about is, if you are feeling the effects of DOMS and its debilitating, you need to stop and heal completely from a DOMS really before you begin exercising again because you’re risking injury at the connective tissue point. 


Dr. Verma:            Absolutely. 


Interviewer:            Thank you Dr. Verma for stopping by today. 


Dr. Verma:            Thank you for having me. 


Interviewer:            And that’s it for this edition of Clinician’s Corner, a regular podcast brought to you by the Natural Horizons Wellness Centers located in Fairfax, Virginia.  We can be also found on the web at  If you have any questions for our clinicians about hour health issues, you can contact us through the website.  And we look forward to you joining us once again for another edition of the Clinician’s Corner. 

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