What Causes Muscle Pain After Exercise?

What Causes Muscle Pain After Exercise?

Have you ever wondered why your body hurts not the day after training, but 2 days later? Here’s what causes muscle pain after training.

What is DOMS?

DOMS is something we’ve all suffered at some point in our lives, either because we’ve just started training again, or because we’re been pushing ourselves.

Heard of it?

Doms means (Delayed-Onset Muscle Soreness).

It is characterised by the late onset of:

  • Fatigue.
  • Reduced range of joint motion.
  • Muscle stiffness.
  • Swelling.
  • Loss of the ability to generate strength.
  • Decreased proprioceptive function.

(Clarkson, Nosaka and Braun, 1992).

Who can suffer from it?


Currently, the most prominent theory explains DOMS as micronerve damage that occurs due to multiple compressions at the level of the neuromuscular spindle, leading to structural alterations in the axons (the end part of the nerves).

Musculoskeletal tissue

Figure I. Ultra-structural graphical representation of the musculoskeletal tissue and its nerve innervation in the neuromuscular spindle. The image shows the evolution of the etiology of muscle damage induced by physical exercise (Sonkodi et al., 2020).

This leads to subsequent inflammation of the musculoskeletal tissue, the result of muscle damage, which produces an activation of the immune system that sensitises the area.

Anyone can suffer from DOMS if they voluntarily exceed their capacity to produce strength.

That’s why DOMS normally appear when returning to training (or significantly changing your training programme), where the exposure to the stimulus is new and our tissue isn’t adapted.

Athlete with DOMS

Figure II. Athlete experiencing DOMS.

IS DOMS as the same as normal aches and pains?


“Aches” are another name for DOMS.

They’re called aches because of the subjective sensation of transient, intermittent throbbing pain that a person with DOMS experiences when demanding strength from the affected tissue (such as when walking when our legs are aching).

How to relieve muscle pain (DOMS) after exercise

Let’s start by explaining that the smartest thing to do is to avoid significant DOMS so as not to have to reduce your training load in the following sessions.

Why do I say this?

Because currently NO therapy has been shown to be truly effective for the significant reduction of DOMS when it appears. The most effective treatment is physical exercise, although pain reduction is temporary.

We don’t yet know of any recommended physical exercise programmes for the reduction of DOMS, it’s only been hypothesised that the positive effects are mediated by the release of endorphins and other neutrotransmitters inhibiting pain signalling.

And increased vascular flow by irrigation of the affected tissue that promotes the clearance of waste substances.

Hence, the recommendation is to maintain a high rate of low-intensity, moderate-duration physical activity.

What methods work to combat DOMS?

There is a lot of variability in the studies, and no clear conclusions are reached, but by way of simplification, in the following table you can see the effectiveness of the different, most widespread methods for the treatment of DOMS.

Active recoveryYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes check
MassageYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes checkYes check
CompressionYes check
Cold immersionYes checkYes check
Temperature contrastYes checkYes check
CryotherapyYes check
ElectrostimulationYes check

Figure III. Effectiveness of DOMS mitigation therapies in terms of post-training timing (Adapted from Dupuy et al., 2018).

Treatments for muscle pain

There are some pharmacological treatments and dietary supplements commonly used for the treatment of DOMS symptoms, such as:

  • NSAIDS: Like ibuprofen or naproxen, although they’re not recommended if you’re looking to improve your physical condition through this.
  • Opioids: These aren’t recommended due to the risk of overdose, life-threatening ventilatory depression and addiction.

And among the dietary supplements, the standouts are those that work with these mechanisms:

  • Reduction of muscle damage.
  • Reduction of fatigue and pain.
  • Reduction of inflammation.
  • Improved muscle function.

Gonzalo Argo made a good graphical summary of a great review by Harty et al. (2019) that’s open-access and which you can find in the bibliographic references section:

Is DOMS a good sign in training?


For many years it was thought (hypothesised) that aches and pains were a good thing, because for many years muscle damage has been proposed as a key factor in muscle mass gain:

“No pain no gain”

Now we know that this isn’t the case.

Damas (2017) published a review on the role of muscle damage on protein synthesis and the fate of this increase in MPS:

Evolution of protein synthesis in relation to muscle damage

Figure V. Evolution of myofibrillar protein synthesis and its orientation in relation to muscle damage according to the weeks of training. (Damas et al., 2017).

The conclusion was that although protein synthesis increases significantly with muscle damage, it was intended for repair and did not create “new tissue”.

When the body adapted to training, muscle damage was reduced, DOMS too, and hypertrophy increased significantly, as although there was less MPS, it was used to create new contractile tissue.

Can DOMS be prevented?


It can be prevented by handling the training load.

Our body is able to exert a certain degree of voluntary effort (depending on your level of training, body composition, strength, etc.).

If we don’t exceed this capacity, we can combat DOMS effectively and therefore perform better in subsequent sessions, and our potential for physical improvement will be greater than if we developed DOMS.

How do you know your ability level?

You need thorough monitoring of previous training sessions.

It’s best to start with a training load (volume and intensity) that we know we can tolerate well, that won’t develop significant muscle soreness, and won’t limit our physical capacity in future training sessions.

When should you seek medical help?

One of the risks of intense physical exercise, which produces DOMS, is the development of Rhabdomyolysis.

This is characterised as the structural disruption of muscle cells that “die” and release intracellular components into the vascular bed.

After an extremely intense physical exercise session, if you experience:

  • Severe muscle pain.
  • Fatigue.
  • Dark urine.
You should go immediately to the emergency department of the nearest hospital, as you run the risk of extensive necrosis and potentially lethal acute kidney failure.

Other classic but more non-specific symptoms are:

  • Headaches.
  • Slow mental speed.
  • Thirst.
  • Muscle cramps.
  • Diarrhoea.
  • Nausea and vomiting.

Bibliographic references

  1. Cheung, K., Hume, P. A., & Maxwell, L. (2003). Delayed onset muscle soreness: Treatment strategies and performance factors. Sports Medicine, 33(2), 145–164.
  2. Damas, F., Libardi, C. A., & Ugrinowitsch, C. (2018). The development of skeletal muscle hypertrophy through resistance training: the role of muscle damage and muscle protein synthesis. European Journal of Applied Physiology, 118(3), 485–500.
  3. Dupuy, O., Douzi, W., Theurot, D., Bosquet, L., & Dugué, B. (2018). An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, Soreness, fatigue, and inflammation: A systematic review with meta-analysis. Frontiers in Physiology, 9(APR), 403.
  4. FarragBahbah. (2017). Rhabdomyolysis .-dr.-osama-2017 [Diapositivas].
  5. Harty, P. S., Cottet, M. L., Malloy, J. K., & Kerksick, C. M. (2019). Nutritional and Supplementation Strategies to Prevent and Attenuate Exercise-Induced Muscle Damage: a Brief Review. Sports Medicine – Open, 5(1), 1.
  6. Hohenauer, E., Taeymans, J., Baeyens, J. P., Clarys, P., & Clijsen, R. (2015). The effect of post-exercise cryotherapy on recovery characteristics: A systematic review and meta-analysis. PLoS ONE, 10(9), e0139028.
  7. Sonkodi, B., Berkes, I., & Koltai, E. (2020). Have we looked in the wrong direction for more than 100 years? Delayed onset muscle soreness is, in fact, neural microdamage rather than muscle damage. Antioxidants, 9(3).
  8. Visconti, L., Forni, C., Coser, R., Trucco, M., Magnano, E., & Capra, G. (2020). Comparison of the effectiveness of manual massage, long-wave diathermy, and sham long-wave diathermy for the management of delayed-onset muscle soreness: a randomized controlled trial. Archives of Physiotherapy, 10(1), 1.

Related Entries

  • What causes Rhabdomyolysis? We tell you here
  • If you want to know how to regulate your training, check out this link.
  • Why should you not take anti-inflammatories after training? Find the answer inthis post.
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About Javier Colomer
Javier Colomer
"Knowledge Makes Stronger", Javier Colomer's motto, sets out his clearest statement of intentions expressing his knowledge and fitness experience.
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