Torres et al. (2012) published a systematic review of various interventions and modalities used to decrease delayed onset of muscle soreness (DOMS). Most DOMS occurs during the eccentric portion of the lift; lengthening under load appears to cause sufficient microtrauma to the muscle as to cause significant pain after the workout. Concentric work seems to have minimal DOMS associated with it.

Anyone who has trained with moderate-high intensity load knows that within 1-3 weeks, one’s muscle quickly adapt to a load and the soreness associated with that type of work quickly dissipates by 20-80% (studies report varying results). Most people who continue to exercise report minor muscle sorenss post-training but rarely feel that degree of soreness again once physiological adaptation has occurred. Nonetheless, each time eccentric loading is introduced into a workout regime, DOMS rears its head and many athletes wake up the next day feeling quite sore and spend some time moving like arthritic riddled geriatrics.

Torres and his team included English and Portuguese studies published in the last few decades. They cut them down to include only the randomized control studies performed on adults (18-60 years old).

10 studies examined cryotherapy, 9 examined massage therapy, 9 investigated stretching, and 7 looked at low-intensity exercise as methods of recovery. These are all common interventions used to reduce DOMS. Of all these interventions and all the different (non-standardized) protocols used on these exercise populations, the ONLY intervention which demonstrated any effect was massage. Massage immediately, or shortly after a workout, decreased muscle soreness by 1.87% and decreased swelling by 0.33cm 24hr after exercise.

That has got to be the least effective recovery modality I have ever heard of and yet it proved to be the only one stronger than placebo.

This raises the question as to how useful intervention strategies are in reducing DOMS. Anecdotally, we hear of coaches, sports therapists and physios recommending ice baths, stretching and low-intensity exercise (at 30-50% of max) despite the fact they seem to be ineffective. The problem is that DOMS sets in at sub-cellular level and involves a complex imbalance in muscle biochemistry. One aspect of this disruption to homeostasis is an abundance of calcium protease Calpain that eats away at the muscle cytoskeleton, permitting extracellular fluid to enter into the fibre and fattening it up nicely. This leakage of fluid into the muscle reduced its’ ROM and takes 48-72 hours to reverse. Superficial treatments such as stretching or massage do not adequately address the intracellular processes that have occurred under DOMS, and as a result seem pointless from a physiological perspective.

So what should one do for recovery? The best preventative strategy to prevent DOMS is to stay physically prepared to compete all year round, and prevent detraining at all costs. Two to three weeks is enough time off for detraining to occur and to lose physiological adaptations. Staying fit coupled with good sleep (7-8 hours, or 5-6 * 90min sleep cycles), good nutrition and foam rolling muscles should be the basic routine of any serious athlete.

We’re not closing the door on ice baths or ice massage but keep in mind that based on RCT evidence at this time, it is not better than a placebo. As such, unless the athlete truly finds it (or another modality) highly useful, relying on it should be reconsidered and massage, sleep and nutrition investigated.

Good luck in training and recovery.