Sore days after a workout? It could be DOMS

Overworked muscles may breakdown or swell.

A little muscle soreness following a new exercise routine can sometimes feel satisfying. However, aches and pains that aren’t treated properly or outright ignored can actually lead to a very serious issue.

Delayed onset muscle soreness (DOMS) is the clinical name given to the aches and pains someone experiences after a workout. It’s a common problem associated with eccentric exercise, a workout that strains a muscle by lengthening or placing force upon it. DOMS occurs about 24-48 hours after the physical activity and can last up to three to five days.

“The reason for delayed onset muscle soreness has been a topic of debate for quite some time,” said Scott Albright, MD, a sports medicine physician with Premier Orthopedics. “We used to think it had to do with lactic acid buildup, but now we believe it involves changes at the cellular level where the muscle experiences micro tears. The soreness is a sign that the body is attempting to heal those tears.”

DOMS can occur anytime a person engages in physical activity, particularly when it involves an exercise or routine that is new. The best way to treat the condition is to back off the activity for a couple of days and to treat the symptoms by icing the area and taking anti-inflammatory medication such as ibuprofen.

Dr. Albright said a person can return to exercise, but if the affected area is still sore they should consider changing their routine to work new muscles. For instance, concentrate exercise on the upper body if the soreness is in your legs. Failure to give your muscles a break can lead to more serious problems. One of these is called rhabdomyolysis, a condition where the muscle breaks down to a point where a portion of it is excreted through the kidneys.

“Unfortunately, it’s a rather common condition,” Dr. Albright said. “I will probably see a couple of cases a year, especially from football players who are doing two-a-days, when they are doing a lot of strenuous and repetitive activities. The muscles just continuously break down until they swell. In some cases, that swelling can lead to compartment syndrome, where the muscles swell so much that there is no place for them to go.”

Rhabdomyolysis often requires hospitalization, and compartment syndrome may require surgery to help relieve the pressure caused by the swollen muscle. In very serious cases, a person may experience kidney failure.

“These situations can happen at any age, but we most often see it in teenagers who don’t want to let their coaches down,” he said. “It is usually at the beginning of a sport season during conditioning time, and they push themselves past the point that their bodies can handle.”

Dr. Albright recommends that a person keep the following in mind when evaluating their muscle soreness:

Listen to your body: The pressure can come from all different places. Perhaps you're excited to stick to a personal workout routine or may not want to let down your teammates. Regardless, what matters most is what your body is telling you through pain.

Look for the signs: There are classic signs your body exhibits to tell you something's wrong. Look for muscle swelling that is disproportionate, urine that turns normal yellow to dark brown, and pain that isn't relieved through the use of anti-inflammatories. Seek professional help right away if you see any of these symptoms.

Don't hide information: Don't keep symptoms to yourself. Parents should check in with their teenagers during strenuous sports training sessions. Tell your health care providers or athletic trainers about symptoms earlier rather than later.

For more information on delayed onset muscle soreness or to find a Premier Physician Network physician near you, visit

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