Sore muscles after a workout (DOMS): why it happens and what helps

What DOMS is

A dull, tender ache in the muscles you worked. It starts 12 to 24 hours after exercise you're not used to, is worst 1 to 3 days later and is gone within about a week. New exercises, more volume and lowering movements cause the most.

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It fades with repetition

After one session your muscles are protected for weeks to months, which is called the repeated bout effect. In a trial, even a very light session 2 days beforehand cut the peak soreness from a hard session by about a third to a half.

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Soreness isn't progress

Soreness tracks muscle damage poorly, and people who built up gradually without getting sore gained just as much muscle and strength.

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What helps, a little

Massage, compression clothing, cold water and foam rolling ease soreness modestly, and gentle movement eases it while you move. Stretching doesn't help. The trials are small, and expectation may explain part of the effect.

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Training while sore

Usually fine: training sore muscles didn't make the damage worse in trials. If soreness limits how you move, go lighter or train something else.

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When it isn't DOMS

Severe muscle pain or weakness that is out of proportion to the workout, or red, brown or cola-coloured pee, needs urgent medical help. Sudden sharp pain during exercise is more likely an injury, such as a strain.

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How long it lasts

DOMS is a dull, aching pain, usually felt when you press, contract or stretch the muscle. It typically starts 12 to 24 hours after unaccustomed exercise, peaks between 24 and 72 hours, and disappears within 5 to 7 days.

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What brings it onStrong evidence

Exercise you're not used to, especially lowering (eccentric) movements: the way down in a squat, lunge or curl, downhill running, Nordic curls and landings. Higher intensity, more repetitions and working at long muscle lengths cause more. It's most common at the start of a season, after a break and with new activities.

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Where the pain comes fromMixed evidence

Nobody is sure. In animal studies, substances that sensitise nerve endings produced the tenderness, sometimes without visible muscle damage. One theory places the pain in the fascia, the connective tissue around the muscle. What is clear is that it isn't lactic acid: a panel of 20 researchers states that lactate is not related to DOMS.

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Soreness isn't the same as damageEmerging evidence

In 110 men, 12, 24 or 60 hard lowering reps for the arm muscles caused similar soreness, even though the bigger sessions caused clearly more damage on other measures.

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What it does to your trainingEmerging evidence

While you're sore, your range of movement, shock absorption and peak force can drop for a few days. Moving gently eases the pain, but only while you're doing it.

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Who gets it worst

People new to an exercise, or coming back after a break or an injury. Trained people get less from the same session but aren't immune after a new exercise or a big jump in volume. Arm muscles are often hit harder than leg muscles, and the hamstrings harder than the quads. Our menstrual cycle guide covers soreness across the cycle.

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Age doesn't make it worseEmerging evidence

Across 36 studies, older adults showed no more muscle damage after exercise than younger adults, and they reported less soreness.

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The repeated bout effectStrong evidence

One bout of lowering exercise protects the same muscles from damage in later bouts, through changes in the nerves, the muscle's mechanics and its connective tissue. The protection can start within a day. For the arm muscles it lasted at least 6 months and was gone by 9 to 12 months.

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A light first session protects youEmerging evidence

In 24 untrained men, a very light session of 50 lowering reps at 10% of their maximum, 2 days before a hard session, cut peak soreness by 36 to 54% across nine muscle groups, and strength came back faster.

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You can grow without getting soreEmerging evidence

In a trial, people who built up over 3 weeks avoided signs of muscle damage, yet gained as much muscle, and as much strength (25% against 26%), as people who started with a damaging session. In 10 men, the early rise in muscle building went on repair and didn't predict growth; from about week 3, once the damage had settled, it did.

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MassageEmerging evidence

Across 99 studies, massage had the largest effect on soreness of any recovery method, and two other reviews (11 and 10 trials) agreed it eases DOMS. The trials were small and couldn't be blinded, and the reviews disagreed on whether massage helps strength afterwards: the largest, of 29 studies, found no effect on strength, sprinting, jumping or endurance.

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Foam rollingEmerging evidence

Rolling after exercise reduced perceived soreness a little, by about 6%, and 7 of 8 studies found a short-term reduction. About 90 seconds per muscle looked like the minimum useful dose: for example 2 rounds of 45 seconds, at a pressure you can breathe through.

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Compression clothingEmerging evidence

Compression garments worn after muscle-damaging exercise moderately reduced soreness across 12 studies.

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Cold waterEmerging evidence

A Cochrane review of 17 small, low-quality trials (366 people) found cold water immersion reduced soreness for up to 4 days compared with resting. An umbrella review suggested 10 to 15 minutes at 10 to 15°C (or 5 to 10°C) works best, though the certainty of that evidence is low.

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But regular ice baths can blunt your gainsEmerging evidence

Used after every strength session, cold water reduced muscle growth across 8 studies, and in a 12-week trial of 21 men it blunted gains in strength and muscle. Save it for when you need to perform again soon.

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Gentle movementMixed evidence

Light activity eased soreness for a short time in pooled studies, but most cool-down studies found no real effect. Our editorial starting point: 10 to 20 minutes of walking or easy cycling at a pace you can chat at, if it helps you feel better.

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What doesn't help: stretchingStrong evidence

Across 12 studies, stretching before or after exercise reduced soreness by about 1 point or less on a 100-point scale. Gentle stretching is fine if it feels good, but it won't speed things up. Electrical stimulation didn't help either.

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How much is expectation?Emerging evidence

In 16 trials of elite endurance athletes, no recovery method beat simple rest, and a sham bath at a neutral temperature did as well as the real methods. These trials can't be blinded, so believing in a method may explain part of its effect.

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PainkillersEmerging evidence

Ordinary soreness doesn't need painkillers (our view). In a trial of 31 young adults, a high daily dose of ibuprofen (1,200 mg) for 8 weeks halved the muscle growth from training compared with a low daily dose of aspirin, so don't take anti-inflammatories routinely to train. For a sprain or strain, the NHS suggests paracetamol to ease pain and ibuprofen gel to bring down swelling.

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Usually, yesEmerging evidence

In small trials of the arm muscles, repeating hard lowering exercise 2 and 4 days after a damaging session, or on 6 days in a row, didn't make the damage worse or slow recovery.

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Expect to be a little weakerEmerging evidence

Range, shock absorption and peak force can be down while you're sore. One review suggests reducing intensity and duration for 1 to 2 days after a very sore-making session, or training the less sore areas. Another advises against high-intensity and explosive efforts until the muscle has recovered, because the changes in how it works may make strains more likely.

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A simple rule

Our editorial rule, built on the trials and reviews above:

• Mild to moderate soreness that eases as you warm up: train as planned.
• Heavy soreness that limits your range or form: train other muscles, do a lighter version (fewer sets, lighter weights, a smaller range) or easy cardio, and leave sprints, jumps and maximal lifts until it eases.
• Sharp, one-sided or joint pain, or pain that gets worse during a set: that isn't DOMS. Use the move's easier option, and see a clinician if it persists.

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Build up over 1 to 2 weeksEmerging evidence

Introduce new exercises, lowering work or a new sport over 1 to 2 weeks rather than all at once. In a trial, a 3-week ramp-up avoided muscle damage without costing any gains.

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Make the first session lightEmerging evidence

A light first session protects you for the next one. Our plans do this: in the first two weeks, you stop each set with 3 or 4 reps to spare.

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Go easy on lowering-heavy moves

Nordic curls, Copenhagen planks, walking lunges and downhill running are built on lowering under load, so start with a few reps and build up.

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After a long break, restart lighterEmerging evidence

The protection fades over months: for the arm muscles it was gone 9 to 12 months after the first session. After a break of more than a few weeks, our suggestion is to restart with lighter weights and fewer sets.

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Get urgent medical help

After hard or unfamiliar exercise, these are not ordinary soreness. They can be signs of rhabdomyolysis, a breakdown of muscle that NHS clinical guidance describes as potentially life-threatening; its main danger is damage to the kidneys. Get urgent medical help if you have:

• Muscle cramps, severe pain or weakness, worse than you'd expect from the workout.
• Feeling so weak or tired that you can't finish a workout or everyday tasks you could do before.
• Red or brown pee, or dark pee that looks like tea or cola.
• A high temperature as well as the muscle pain.
• Peeing a lot less than usual, feeling very thirsty, being sick, or feeling confused or sleepy.

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Why it happens, and when

NHS clinical guidance links it to exercise that is unaccustomed (too much, too fast, too hard or too soon) or done when fasting, dehydrated or ill. Symptoms may not start until hours or days after the exercise, so don't ignore them. If you take a statin such as atorvastatin, the NHS says to call 111 if you think you might be having serious side effects, which include muscle cramps, severe pain and weakness.

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Call 999 or go to A&E

• Sudden, severe pain in any part of your body.
• Pain and swelling in one leg (a possible blood clot) with shortness of breath or chest pain.
• An injury where you heard a crack, the area has changed shape or points at an odd angle, it is numb or tingling, or the skin looks blue or grey or feels cold.
• Chest pain that feels tight or spreads to your arms, neck or jaw, or someone has passed out and is not responding normally.

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Get urgent advice

• Throbbing pain in one calf or thigh, with swelling and red, blue or darkened skin around it (a possible blood clot): the NHS says to ask for an urgent GP appointment or contact NHS 111. Don't roll it.
• An injury that is very painful or getting worse, has a lot of swelling or bruising, or that you can't put weight on: the NHS says to get help from NHS 111, or you could go to an urgent treatment centre.

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See a GP or physiotherapist

• Pain, numbness or swelling that keeps coming on when you exercise.
• A sprain or strain that is getting worse, or not feeling better after treating it yourself.
• Soreness that isn't better after a week, keeps coming back after normal sessions, or is in one spot (our suggestion).

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Soreness or injury?

Normal DOMS is a dull, even ache in the muscles you worked, usually on both sides, that starts the next day and fades within a week. A strain usually starts suddenly during exercise, with sharp pain in one spot, and may bring swelling, bruising or trouble putting weight on it. Our guides to hamstring strains and calf pain cover the common ones.

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"No pain, no gain: soreness means it worked"Emerging evidence

Soreness tracks muscle damage poorly, and people who built up gradually without soreness gained as much muscle and strength (25% against 26%). An expert panel notes that regular sessions shouldn't commonly leave you sore.

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"DOMS is lactic acid"Emerging evidence

DOMS peaks 1 to 3 days after exercise, and an expert panel states that lactate is not related to DOMS. Cool-downs clear lactate from the blood faster, yet they mostly don't reduce soreness.

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"Stretch it out"Strong evidence

Stretching reduced soreness by about 1 point or less on a 100-point scale: not a meaningful effect.

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"If you're not sore, you're not making progress"Emerging evidence

Soreness fades because your muscles adapt to the exercise, not because the training stopped working. Judge progress by the weights and reps you lift.

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"Never train a sore muscle"Emerging evidence

Training sore muscles didn't worsen damage in trials. Go lighter or train other muscles if soreness limits your form.

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"Ice baths after every session help you grow"Emerging evidence

They ease soreness, but used after every strength session they blunt muscle and strength gains.

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