Delayed onset muscle soreness (DOMS): treatment and prevention tips

You know that stiff, achy feeling you get the day after a tough workout or strenuous activity like hiking or moving furniture? That’s called delayed onset muscle soreness, or DOMS. While it can feel uncomfortable, or sometimes borderline painful, it’s often not as bad as it seems. 

“DOMS is a normal, healthy response from your body,” says Kim Anderson, PT, DPT, a physical therapist at Hinge Health. It’s part of the body’s recovery process and typically fades away on its own within a few days. But there are ways to ease DOMS and speed up your recovery.

“Ironically, the best way to manage DOMS is exercise,” Dr. Anderson says. Taking some rest is fine, but engaging in gentle movement and stretches can help reduce muscle tightness and discomfort.

Learn more about DOMS, including expert tips from Hinge Health physical therapists on how to prevent and treat it effectively.

What is delayed onset muscle soreness (DOMS)?

Delayed onset muscle soreness (DOMS) is muscle discomfort or stiffness usually starts about 12 hours after your workout or bout of physical activity, peaks around 48 hours post-activity, and then decreases each day. 

Think of your muscles as a road. When heavy traffic creates small cracks, road crews don’t just patch them up — they rebuild them with stronger materials so the road can handle even more weight next time. 

Your muscles work the same way. Exercise causes tiny microtears in your muscles, but your body repairs them to be even stronger, which prepares you for more challenges. “DOMS makes your muscles stronger and more resilient,” Dr. Anderson says.

What causes muscle soreness (DOMS)?

These are the most common contributors of DOMS:

• Overdoing it. “Doing more exercise or activity than your body is ready for can make you more prone to DOMS,” says Dr. Anderson. Your body is capable of doing challenging things, such as lifting heavy weights, running long distances, and spending hours working in the garden. Pacing yourself and slowly building up your activity level can help your muscles adapt and prevent you from overdoing it.

• New activities. Picking up a new sport like pickleball or a new hobby like painting can lead to soreness if your body isn’t used to performing those movements. Any time you physically challenge your body, especially after periods of inactivity, you’re more likely to experience DOMS. 

• High-intensity exercise. Engaging in high-intensity workouts such as lifting heavy weights, sprinting, or jumping can create more microtears in muscles, leading to soreness. While these exercises often bring quicker results, it’s important to mix them with gentler activities to prevent overexercising and too much soreness.

• Eccentric movements. This movement emphasizes the lengthening phase of exercises, such as lowering your arm when doing a bicep curl, Dr. Anderson says. This movement places tension on your muscles, making them stronger. This type of movement can lead to muscle soreness because it places extra demands on the muscle fibers. Other eccentric movements include running downhill, slowly lowering into a squat, or lowering a weight very slowly.

Symptoms of DOMS

Muscle soreness is the main symptom of DOMS. Others can include: 

• Stiffness 

• Tenderness

• Reduced range of motion

• Pain when using the affected muscles

• An achy, tired feeling

• Swelling

How movement eases DOMS

Movement is medicine. It’s the key to keeping muscles and other tissues flexible and mobile, so that they don’t become stiff or tight and cause discomfort. Doing yoga, tai chi, a low-intensity elliptical workout, or swimming laps at an easy to moderate pace are all examples of active recovery, or exercises you can do to help heal your muscles. These movements, and many others, help deliver nutrients to muscles that are actively repairing, which can reduce muscle soreness more quickly.

All of these gentle movements can help loosen stiffness and ease tension from DOMS. Consider doing these movements alongside low-intensity activity, like swimming or cycling, until your muscle soreness subsides.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How to manage DOMS

Muscle soreness typically goes away with certain strategies after a few days. These include:

• Try physical therapy and targeted exercises. Targeted exercises and stretches can alleviate muscle soreness. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. “A PT can also guide you on how to gradually start an exercise routine and progress safely without overdoing it,” Dr. Anderson says. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Perform gentle movements. “Even if it feels challenging or uncomfortable, keep moving your body,” says Dr. Anderson. “Many people think resting is best when you have DOMS, but it can actually lead to more stiffness and soreness.” Activities like stretching, doing yoga, or going on a leisurely bike ride or short walk can all boost blood flow and warm your muscles. These movements reduce stiffness and support healing.

• Get a massage. Massage can help ease muscle tension and soreness while boosting circulation and promoting healing. According to a review, a post-exercise sports massage can relieve DOMS symptoms and improve your comfort. You don't need a professional massage to find relief. You can do a self-massage or use tools like a ball or a massage gun.

• Foam roller. Using a foam roller is another tool for self-massage. Rolling and pausing on tight spots can ease tension and increase muscle flexibility. Research has shown that foam rolling is an effective way to reduce DOMS symptoms.  

• Apply heat or ice. An ice pack, ice massage, or ice bath can reduce inflammation and numb pain, says Dr. Anderson. Heat warms muscles, increasing blood flow to stiff muscles. Both heat and ice therapy have been shown to reduce soreness after intense exercise, according to research. Some people find relief by alternating heat and ice. Choose the one that works best for you.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for severe DOMS. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Complementary treatments. Talk to your provider if you’re interested in trying alternative ways of managing DOMS, such as massage, acupuncture, or chiropractic care.

How to prevent DOMS

Use these strategies to challenge your body while minimizing post-workout discomfort.

• Start slow, progress gradually. "Soreness is normal when starting a new workout routine," says Dr. Anderson. Even seasoned gym-goers can feel sore if they push beyond their usual limits or try different types of movement. Begin with shorter sessions or lighter weights to prevent excessive soreness, Dr. Anderson says. For example, try gardening or jogging for 10 to 20 minutes. You can gradually increase your workout duration, resistance, and intensity.

• Do a warm-up. Before you start a workout, recreational activity, or chores, try to warm up for five to 10 minutes. Doing dynamic stretches prepares your body for physical activity. Research suggests it can reduce DOMS.

• Space out intense workouts. Schedule high-intensity exercise every other day (or every two days) to give your body time to recover and reduce soreness between workouts. On the days in between, choose lower-intensity and lower-impact activities, such as cycling, swimming, walking, or doing a workout on the elliptical. 

• Stay hydrated. Your muscles are mostly water, so drinking plenty of it daily can support muscle function and recovery. More specifically, staying hydrated helps transport nutrients to muscles, remove waste products, and keep muscles flexible.

• Eat nutritious foods. A diet rich in fruits, vegetables, lean protein, and healthy fats supports recovery and an active lifestyle. Protein is essential for muscle repair, so after a tough workout, try to prioritize that by enjoying a protein shake, Greek yogurt, or grilled chicken. 

• Slip into compression garments. Research suggests wearing compression tights after a strenuous lower-body workout can reduce post-workout muscle soreness before it starts. 

PT tip: Slow down, but stay consistent 

“Consistency over intensity is key when starting any new exercise routine or activity,” says Dr. Anderson. Severe soreness can discourage you from continuing, so aim for lower-intensity exercises. Focus on building a consistent exercise routine first, and then gradually increase the intensity to avoid major soreness or discomfort, Dr. Anderson says.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Davis, H. L., Alabed, S., & Chico, T. J. A. (2020). Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine, 6(1), e000614. doi: 10.1136/bmjsem-2019-000614

2. Pearcey, G. E. P., Bradbury-Squires, D. J., Kawamoto, J.-E., Drinkwater, E. J., Behm, D. G., & Button, D. C. (2015). Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. Journal of Athletic Training, 50(1), 5–13. doi: 10.4085/1062-6050-50.1.01

3. Olsen, O., Sjøhaug, M., Van Beekvelt, M., & Mork, P. J. (2012). The Effect of Warm-Up and Cool-Down Exercise on Delayed Onset Muscle Soreness in the Quadriceps Muscle: a Randomized Controlled Trial. Journal of Human Kinetics, 35(1), 59–68. doi: 10.2478/v10078-012-0079-4

4. Wang, Y., Li, S., Zhang, Y., Chen, Y., Yan, F., Han, L., & Ma, Y. (2021). Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Physical Therapy in Sport, 48(1), 177–187. doi: 10.1016/j.ptsp.2021.01.004 

5. O’Riordan, S. F., Bishop, D. J., Halson, S. L., & Broatch, J. R. (2022). Compression-induced improvements in post-exercise recovery are associated with enhanced blood flow, and are not due to the placebo effect. Scientific Reports, 12(1). doi: 10.1038/s41598-022-21029-2