Can You Explain Delayed Onset of Muscle Soreness?


:dropcap_open:T:dropcap_close:he most common complaint of beginning any exercise program is the soreness or general stiffness the next day that may last one or several days. It may leave and then return when you feel that you have done very little to stress your muscles. This sign or symptom is commonly called Delayed Onset Muscle Soreness (DOMS). It should be anticipated that your patients will develop some degree of soreness when we introduce an exercise or rehabilitation program. The question is, when this happens and the patient looks to you for an answer as to why, can you answer the question? This can be especially difficult when the patient is an athlete that has been exercising for some time. Many patients may become frustrated as to why they are experiencing DOMS when they feel they are in good shape from a cardiovascular and flexibility standpoint.

This phenomena has been studied by many researchers since working out has become a popular thing to do. DOMS can affect anyone, from the elite athlete to the patient who is beginning a simple, supervised-rehabilitation program. It is easy to predict it in someone beginning a workout program or the patient that is coming off a layoff (whether it’s due to an injury or just simply taking some time off).

soremusclesThe primary cause is from overstressing a particular muscle group or joint. Your muscles and joints become accustomed to the repetitive movement patterns in which you place your neuro-musculoskeletal system. Does the term “muscle memory” ring a bell? When you do a new workout or activity that causes those muscles and joints to be used in a different pattern of movement, your muscle tissue must respond. We all have heard of the physical stress theory or the theory of adaptation and Wolf’s law. It is easy for our patients to understand why they have the soreness after bending over and picking up sticks from their yard after a wind storm if they normally do very little bending as part of their activities of daily living. Or if the patient typically has a sedimentary lifestyle and begins an exercise program, there is usually no questioning why he or she is sore. Keep in mind when you recommend an exercise program to patients that they may be hesitant on beginning it if they have experienced delayed onset muscles soreness before and remember it to be a painful experience.

The more difficult explanation comes when talking with the patient who exercises often and feels physically in good shape. Let’s use a runner for an example. Runners are creatures of habit; they generally run the same mileage and follow the same course. Many fall into this “location trap” because it is the only place where they can run without having to dodge cars and encounter unfriendly dogs. When we think about the biomechanics of running and walking, it is an A-P, P-A movement pattern. If they are running roads, the rule is to run facing oncoming traffic. This means that they will always run on a sloped plane, with the left being the low side, creating angulated stresses or repetitive stress through each and every step. Generally runners take 70-90 strides per minute. Each time the foot makes contact with the ground, we absorb anywhere from 4- 10 percent of our body weight through the kinetic chain affecting the neuro-musculoskeletal system. I love using the term when lecturing or explaining this principle that neurologically it is “from above down inside out”, but biomechanically it is “from the ground up.” It can best be described by the saying, “When the foot hits the ground, everything changes.”

Should we be concerned about delayed onset muscle soreness or DOMS? Look at it as an early warning signal. From a patient educational view, we ask patients questions geared toward identifying changes in their activities of daily living as the underlying cause. Typical questions include:

  • Did you change something in your workout?
  • Did you change the mileage you run, the surface you run on?
  • Have you added plyometric routines?

If the patient can tell us “yes” to the question, “Did you change something in your workout?”, then you can consider DOMS as a form of cross training, where the runner stressed the muscles or joints and the tissue responded like any normal healthy tissue would. 

If the runner answers “no”, then a more thorough consultation may be needed to help identify underlying causes. Other questions that you can ask include the following:

  • How old are your running shoes, and how many miles do you have on them?
  • Have your sleeping and dietary habits changed in the last 90 days?
  • Are you staying hydrated properly?
  • Does your gait pattern feel different?
  • When was the last time you changed your training program?

In addition to a good consultation, a new evaluation maybe in order to help identify postural changes and muscle imbalances. Focus on the hip extensor, adductor and rotator mechanisms. Another option is to perform a new digital foot scan to look for asymmetry between the arches of the foot. You could do a new gait analysis looking for asymmetry in a patient’s stride.

If your patient continues to develop episodes of delayed onset of muscle soreness, use this as a good precursor to re-evaluating your patient.


A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.

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