eMedicine Specialties > Physical Medicine and Rehabilitation > Muscle Pain Syndromes

Postexercise Muscle Soreness: Treatment & Medication

Author: Divakara Kedlaya, MBBS, Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine
Coauthor(s): Timothy Kuang, MD, Pain Management Fellow, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Jun 6, 2008

Treatment

Rehabilitation Program

Physical Therapy

Although it provides only temporary relief, exercise of the sore muscle probably is the best way to reduce DOMS. Muscular soreness diminishes acutely with exercise. With the cessation of exercise, however, the soreness returns, and this cycle continues until the muscle becomes conditioned sufficiently through training. Why exercise decreases DOMS is not clear, although several possibilities exist, including the following:

  • Breakup of adhesions from the injured, sore muscles takes place during exercise.
  • Increased blood flow or temperature in the muscle helps to decrease the accumulation of noxious waste products.
  • Endorphin release by neurons in the central nervous system increases during exercise.
  • Increased afferent input is noted from large, low-threshold sensory units in the muscles (muscle group-Ia, Ib, and II fibers [gate control theory]).
  • Subjects direct attention to the activity and away from the pain.
  • The training effect appears to be highly specific, not only for the particular muscles involved in the exercise, but also for the type of contractions performed. For example, Schwane and Armstrong found that in rats, the muscle damage that occurs during downhill running is prevented by downhill or level training but not by uphill training.2

Ice-water immersion and ice massage are frequently used, particularly among high-level athletes, to minimize the symptoms of DOMS. A randomized, controlled study by Sellwood and colleagues challenged the use of ice-water immersion  as a recovery strategy for athletes.12  In this investigation, ice-water immersion did not effectively minimize or prevent symptoms of muscle damage after eccentric exercise in young, relatively untrained individuals. Given that trained athletes are relatively well protected against DOMS, ice-water immersion is likely to offer them even less benefit for the minimal soreness they may experience after eccentric exercise.

Another study, by Isabell and coauthors, showed that the use of ice massage or ice massage with exercise did not significantly reduce the symptoms of DOMS.13

Medical Issues/Complications

No evidence supports the premise that DOMS is associated with long-term damage, reduced muscle function, or other complications.

Consultations

Consultation with the patient's athletic trainer and coach may be indicated.14,15

Other Treatment

  • A study by Barlas and colleagues indicated that acupuncture generally is not effective in the treatment of DOMS16 ; however, an unblinded study by Lin and Yang suggested that acupuncture is effective against DOMS.17
  • Mekjavic and co-investigators concluded that hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness.18
  • Zhang and colleagues noted that a double layer of Farabloc, an electromagnetic shield, wrapped around the thigh has been shown to reduce DOMS.19
  • In a study by Craig and coauthors, combined low-intensity laser therapy was not shown to be effective against DOMS.20 However, a study by Douris and colleagues that used 8 J/cm2 of phototherapy did show a beneficial effect.21
  • In one small (6 subjects in each group), randomized, double-blind, placebo-controlled study by Hasson and coauthors, individuals treated with pulsed ultrasonographic therapy (PUS) showed significantly reduced soreness.22 However, in a larger (12 patients in each group) randomized, double-blind, placebo-controlled study by Craig and co-investigators, no significant benefit from PUS was demonstrated.23 In a study by Ciccone and coauthors, there was some suggestion that ultrasonography may enhance DOMS and that phonophoresis with salicylate may have therapeutic benefits.24
  • Tourville and colleagues showed that sensory-level, high-volt, pulsed electrical current was not effective in reducing the measured variables associated with DOMS.25
  • Transcutaneous electrical nerve stimulation (TENS), in an uncontrolled study by Denegar and Perrin, showed some benefit in relieving the soreness associated with DOMS26 ; however, in a randomized, placebo-controlled study by Craig and colleagues, the use of TENS did not show any significant benefit.27
  • In a small study by Hasson and coauthors, dexamethasone iontophoresis immediately after exercise was shown to decrease muscle soreness perception in DOMS.28

Medication

In many controlled studies, general analgesics and nonsteroidal anti-inflammatory medications have not been consistently effective against postexercise muscle soreness.29

In a randomized, placebo-controlled study, Cannavino and colleagues showed that transdermal 10% ketoprofen cream was effective in alleviating self-reported DOMS in isolated quadriceps muscles of patients following repetitive muscle contraction, particularly after 48 hours.30 This relief was apparently secondary to the effects of the medication, because no other medications or pain relief measures were used in the study.

Oral ascorbic acid (vitamin C) and other antioxidants also have been investigated as possible medications for DOMS, with mixed results. A study by Connolly and coauthors suggested that a vitamin-C supplementation protocol of 1000 mg taken 3 times a day for 8 days is ineffective in protecting against selected markers for DOMS.31

The homeopathic medicine Arnica 30x was studied in a randomized, double-blind, placebo-controlled study and was found to be ineffective in treating DOMS.

Bajaj and colleagues showed that the prophylactic intake of tolperisone hydrochloride provides no relief of postexercise muscle soreness but that it does result in a reduction in isometric force.32

In a randomized, placebo-controlled study, Connolly and co-investigators showed that tart cherry juice can decrease some of the symptoms of exercise-induced muscle damage.33 Most notably, strength loss averaged over the 4 days after eccentric exercise was 22% with the placebo but only 4% with the cherry juice.

More on Postexercise Muscle Soreness

Overview: Postexercise Muscle Soreness
Differential Diagnoses & Workup: Postexercise Muscle Soreness
Treatment & Medication: Postexercise Muscle Soreness
Follow-up: Postexercise Muscle Soreness
References
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Further Reading

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Keywords

postexercise muscle soreness, delayed-onset muscle soreness, DOMS, post-exercise muscle soreness, muscle overuse, rhabdomyolysis, metabolic waste product accumulation, spastic contracture, myofibrillar alterations, cytoskeletal alterations

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Contributor Information and Disclosures

Author

Divakara Kedlaya, MBBS, Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine
Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy Kuang, MD, Pain Management Fellow, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Timothy Kuang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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