DOMS and Cold Therapy

2432540948_f156f15638_shoothead_runningDOMS and Cold Therapy

Learn how ice reduces pain associated with Delayed Onset Muscle Soreness.

Kathy Weber, M.D., M.S.
Director of Primary Care Sports Medicine
Rush University Medical Center, Chicago, IL


  • DOMS is a result of microscopic tears in the muscle fibers caused by a new or increased training level.
  • The amount of muscle micro-trauma and resulting soreness depends on the intensity, duration, and type of exercise done.
  • Performing an adequate warm up to increase core body and local temperature helps decrease the risk of developing muscle soreness.
  • Ice can also reduce the pain associated with the micro-trauma of regular exercise and DOMS.
  • Increase exercise intensity and duration slowly and consistently over weeks to allow adapation by the muscle and decrease the risk of DOMS.


There are two types of muscle soreness associated with exercise: acute soreness and delayed onset muscle soreness. Acute soreness occurs during or immediately after exercise while delayed muscle soreness occurs 24 to 72 hours after exercise is completed. Acute soreness usually results from muscle fatigue secondary to a build up of normal by-products produced during exercise. Typically the muscle soreness resolves within a few minutes of rest and exercise can be resumed without residual effects (1).


(DOMS) is a well known phenomenon that occurs 24 to 72 hours after exercise and generally resolves in 5 – 7 days after the soreness onset (2).  DOMS typically causes muscle stiffness, swelling, strength loss and pain  (3,4). Although lactic acid build-up was once thought to be the cause of muscle soreness, it is now well known that lactic acid is removed rapidly after exercise. Typically blood and muscle lactate levels return to normal with 30 – 60 minutes after exercise has ended and it is unlikely that the muscle pain is caused by DOMS.

The more recent theory is that DOMS is a result of microscopic tears in the muscle fibers caused by new or increased training levels especially seen in eccentric-type training. In addition to the microscopic tearing, swelling in the area increases pressure in the region, resulting in greater muscle pain and stiffness (1).  Research conducted by Yu suggests that DOMS is not the result of pain from damaged muscle cells, but rather from the muscles’ response to training resulting in the development of a new sarcomere. Yu proposes that this process results in cell swelling, causing pressure on the surrounding nerves and vessels and resulting in the delayed pain associated with the exercise bout (5).

Both proposed theories suggest that the micro-trauma or cell swelling, results in significant pain. Although the precise cause is still unknown, DOMS is thought to be a normal response to unusual levels of exertion. The amount of muscle microtrauma and resulting soreness depends on the intensity, duration, and type on exercise done. Activity that involves eccentric contractions, such as downhill running or weight training emphasizing eccentric-type strengthening (muscle contracts while it is lengthening), results in the more severe DOMS  (2,6,7). This type of training has been shown to result in more muscle cell injury than is seen with concentric contractions (muscle shortens against the load) (7).


While muscle soreness is common, there are ways to try to prevent its occurrence. Performing an adequate warm up to increase core body and local muscle temperature will prepare the body for the exercise bout.
Activities that include cardiovascular and specific muscle activities such as walking/jogging, cycling, lunging, performing squats, and stretching help prepare the body for the exercise. It is important to increase exercise intensity and duration slowly and consistently over the course of weeks.

This slow progression allows the muscles to adapt to the training and decreases the risk of DOMS
and musculoskeletal injury. Eccentric type exercises, such as plyometrics, running downhill, and weight lifting should be added slowly since these types of exercise increase the risk of DOMS. Even regular exercisers should be aware that any unaccustomed exercise can cause DOMS. It is important to avoid sudden significant changes in the exercise routine.

Ice, although predominantly used in injury management, in theory can also reduce the pain associated with the micro-trauma of regular exercise and DOMS. Although limited research has been done, the therapeutic effects of cold therapy may help reduce the inflammation and pain that is associated with DOMS. A paper by Johnston recommends that at the completion of exercise, cryotherapy be applied to reduce micro-trauma and the associated pain (8).


  • Ross M. Delayed-onset muscle soreness. The Physician and Sportsmedicine. 1999;27.(1)
  • Clarkson PM, Hubal MJ. Exercise-induced muscle damage in humans. Am J Phys Med Rehabil. 2002 Nov;81(11):S52-S69.
  • Connolly DA, Sayers SP, McHugh MP, Treatment and prevention of delayed onset muscle soreness. Journal of Strength & Conditioning Research. 2003;17(1):197-208.
  • Szymanski D. Recommendations for the avoidance of delayed-onset muscle soreness. Strength and Conditioning Journal. 2003;23(4):7-13.
  • Yu JG, Carlsson L, Thornell LE. Evidence for myofibril remodeling as opposed to myofibril damage in human muscles with DOMS: an ultrastructural and immunoelectron microscopic study. Histochemistry & Cell Biology. 2004;121(3),219-227.
  • Clarkson PM, Newham DJ. Associations between muscle soreness, damage, and fatigue. Adv Exp Med Biol.1995;384:457-469.
  • Newham DJ, Mills KR, Quigley BM, Edwards RH. Pain and fatigue after concentric and eccentric muscle contractions. Clin Sci. 1983;64(1):55-62.
  • Johnson B. Injury Rehabilitation and the Role of Cryotherapy. Synergy.2004

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