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Thursday, July 10, 2025

Dirt Un­der the Nails

Why we get sore after exercise

by

20131220

Right now, I have DOMS. It's not one of those strange dis­eases that seem to pop up so reg­u­lar­ly these days. It's ac­tu­al­ly de­layed on­set mus­cle sore­ness (DOMS) from my work­out yes­ter­day. I have it from head to toe, and in all the mus­cles that should be sore from train­ing the hu­man body's fun­da­men­tal move­ment pat­terns as ag­gres­sive­ly as I did yes­ter­day.

I have my train­er to thank for that suc­cess­ful work­out. I deem it suc­cess­ful part­ly be­cause I have DOMS. While some per­sons may think I am quite crack­ers to rev­el in the painful tor­ment of DOMS, I see it dif­fer­ent­ly. It has been sug­gest­ed that DOMS may be used as a gen­er­al (al­though vague) mea­sure of the ef­fec­tive­ness of work­outs, and there is some re­search to jus­ti­fy its use in such a case. How­ev­er, it must be used with cau­tion.

The cur­rent the­o­ry is that DOMS is ac­tu­al­ly a re­sult of mus­cle dam­age from a dif­fi­cult or un­fa­mil­iar ex­er­cise. The ex­act mech­a­nisms of how DOMS oc­curs re­main un­clear, but it seems to be the prod­uct of in­flam­ma­tion that oc­curs as a re­sult of the mus­cle dam­age. A teacher once de­scribed it to me in these very sim­ple terms which I still use with my pa­tients to­day: When one does an ex­er­cise with in­creased weight, or an un­fa­mil­iar move­ment, the body is not ac­cus­tomed to that stress and one's mus­cles ac­tu­al­ly de­vel­op mi­cro­scop­ic tears in re­sponse to the stress. When those mus­cles heal, they adapt to the stress and that is how we get stronger.

The pain is a con­se­quence of the mus­cle dam­age and re­sult­ing in­flam­ma­tion. That is why we are ten­der when our mus­cles are touched or squeezed.

As a gen­er­al rule, DOMS usu­al­ly ap­pears around 5-8 hours af­ter the nov­el stress to the body, and peaks 48 hours af­ter ex­er­cise. How­ev­er, this is vari­able and the in­ten­si­ty of the DOMS can de­pend on the in­di­vid­ual, the dif­fi­cul­ty of the work­out, the lev­el of fit­ness of the in­di­vid­ual and one's ge­net­ics.

De­spite some the­o­ret­i­cal jus­ti­fi­ca­tion for its use, coach­es, train­ers and ath­letes need to be care­ful when us­ing DOMS to gauge the suc­cess of their work­outs for a num­ber of rea­sons. First­ly, there is no di­rect ev­i­dence link­ing DOMS to in­creas­es in mus­cle size and strength. There are just the­o­ries and they are not con­clu­sive.

In ad­di­tion, se­vere DOMS, which may in­di­cate sig­nif­i­cant ex­er­cise in­duced mus­cle dam­age (EIMD), can re­duce the per­son's abil­i­ty to gen­er­ate force by 50%. This means that the mus­cle's ca­pac­i­ty for ex­e­cut­ing a task is re­duced. Quite frankly, when I have DOMS (al­though it is rarely se­vere), all I want to do it to lie in bed. My abil­i­ty to be phys­i­cal­ly ac­tive is di­min­ished, as my body screams for re­cov­ery time.

In fact, se­vere DOMS can de­crease an ath­lete's mo­ti­va­tion to train. This can al­so re­duce ad­her­ence to ex­er­cise in those who do not en­joy the ac­tiv­i­ty, but are do­ing it for health-re­lat­ed rea­sons. Train­ers and coach­es need to mod­i­fy work­outs and al­low for enough rest to ac­com­mo­date for DOMS, oth­er­wise they risk in­jury and non-com­pli­ance. Work­outs that may pro­duce se­vere DOMS should be avoid­ed be­fore com­pe­ti­tion. Stud­ies have shown that in se­vere cas­es of EIMD re­gen­er­a­tion of mus­cle can take 3 or more weeks. An ex­pert in the strength and con­di­tion­ing field has stat­ed, "high lev­els of sore­ness last­ing for days should be re­gard­ed as detri­men­tal to the ath­lete be­cause it is an in­di­ca­tor that the body has ex­ceed­ed its ca­pac­i­ty to heal ef­fi­cient­ly." Quite frankly, se­vere DOMS should be avoid­ed in gen­er­al be­cause it im­pedes progress.

So giv­en that DOMS is a vague in­di­ca­tor of EIMD, and that EIMD fa­cil­i­tates in­creas­es in strength through adap­tive re­spons­es of the mus­cle, there is some jus­ti­fi­ca­tion that DOMS may be used as a gross in­di­ca­tor of the ef­fec­tive­ness of a work­out, if strength is the main goal. How­ev­er, this must be done with great cau­tion, giv­en that there is a lot of the­o­ry and lit­tle hard ev­i­dence link­ing the two. There is al­so a lot of vari­abil­i­ty in each in­di­vid­ual's re­sponse to ex­er­cise as many may ex­pe­ri­ence con­sis­tent sore­ness, while for oth­ers it is a rare oc­cur­rence. Cau­tion must al­so be used, as ex­ces­sive DOMS is detri­men­tal to per­for­mance and to the in­di­vid­ual's health, so coach­es and train­ers must pre­scribe ex­er­cise of the ap­pro­pri­ate in­ten­si­ty, giv­en the per­son's abil­i­ties.

As a re­sult, DOMS should not be used as a de­fin­i­tive mea­sure of re­sults, giv­en its in­her­ent lim­its in as­sess­ing work­out qual­i­ty. Rather, it should be a sim­ple tool to be used in con­junc­tion with the sci­en­tif­ic ex­per­tise and ex­pe­ri­ence of the ex­er­cise pro­fes­sion­al.

Car­la Rauseo, DPT, C.S.C.S. is a doc­tor of phys­i­cal ther­a­py and cer­ti­fied strength and con­di­tion­ing spe­cial­ist at To­tal Re­ha­bil­i­ta­tion Cen­tre Lim­it­ed in San Juan.

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