What Research Shows To Best Reduce Post-Exercise Muscle Pain

​Rollers and compression garments are low on the list

Photo by Victoire Joncheray on Unsplash

We've all experienced it - that pain that starts to swell from within about 12 hours after a tough, or unusual, exercise session. From there, it can get worse, making it painful to walk up steps after about 2 days. There's good news and bad news. The good news is that it will disappear. The bad news? There's little that can we can do to make it disappear a lot faster.

We'll take a look at the best four things that scientists regard as proven to reduce the pain. It's a short list (based on recent research).

We don’t know what causes DOMS

This soreness is known as Delayed Onset Muscle Soreness (DOMS). The precise underlying causes of DOMS remain unknown (2019). We know that is exercise-induced muscle damage caused by intense and exhausting exercise and/or unfamiliar sporting activity.

For example, elite triathletes suffer from DOMS, especially when meets are stacked, but in the main DOMS results from the running leg, not swimming or cycling. 

In a triathlon, running is the last event and the athletes' central neuromuscular system is exhausted. It is thought that the nerves within the muscles become less effective in activating the muscle fibre, resulting in stress damage and DOMS.

Beyond best guesses - which treatments work?

Perhaps it is because the underlying causes are still unclear that there are so many suggested "cures". Without knowing the root cause of DOMS it is not possible to design a definitive treatment.

For example, typical treatments include: 

• A cold bath
• Topical analgesics like Icy Hot or Voltaren  
• Foam rolling or percussive therapy
• Compression therapy
• A warm bath or heat wrap 
• A massage.

Without knowing the exact cause, the best we can do at present is to conduct well-designed experiments to determine any of those suggested treatments work. Here is what the latest research found worked (and popular "solutions" that don't work).

Sleep

Firstly, something rarely mentioned in a DOMS treatment checklist is sleep. Sleep deprivation is associated with lower physical and mental performance whilst optimal levels of sleep (in both quantity and quality) have been linked to increased performance and reduced risk of injury, including DOMS.

So a good sleep regime may be preventative of DOMS. Conversely, if you have slept poorly - particularly chronic poor sleep - then take that into account before pushing yourself too hard.

An option in the case of an insufficient night's sleep could be a power nap before exercising. Research shows that 30-min maximum works best for recovery.

Compression therapy

Various forms of compression therapy are widely recommended to prevent, or minimise, or help recover from DOMS.

Existing systematic reviews have concluded that compression garments post-exercise are effective in enhancing recovery from exercise-induced muscle damage.

Wearing compression garments during exercise is also heavily promoted for performance, and for reducing the causes of DOMS. However, the majority of studies [up to July 2019] "failed to support a performance-enhancing effect of wearing compression garments during exercise".

A systematic review by Beliard et al. reported that nine from ten studies did not show any performance-enhancing effects, nor significant changes in objective physiological variables, e.g. increased oxygen uptake.

In summary of the research, there is evidential support for the role for compression garments post-exercise for use in terms of DOMS recovery.

Thermal therapy

Cold-water therapy is reported to be superior in comparison to passive recovery strategies - the former achieving the best results in reducing the symptoms of DOMS. Cold-water treatment retains this superiority up to 96 hrs post exercise.

The best relief results from a water temperature between 11 and 15 °C for 11–15 min. Cold water treatment is thought to be most effective in treating DOMS induced by whole-body prolonged endurance-based exercise, rather than strength training.

Heat treatment for DOMS is more controversial - "Unfortunately, there are no available studies with an endurance-based protocol, specifically relating to long-term muscle load such as the duration of a triathlon event." [Accelerating Recovery from Exercise-Induced Muscle Injuries in Triathletes - July, 2019]

Cooling remains the preferred strategy, especially for acute injuries in the first inflammation phase. After the inflammatory response or recovery without muscle injury, heat therapy can help regeneration and improved tissue healing. 

From research, no general recommendation has emerged regarding the use of heat treatment for DOMS resulting from elite endurance exercise.

Active recovery

"Doing the same thing lighter" is my go-to suggestion for muscular recovery and for DOMS relief. It turns out that there is little evidence to support this.

Research shows that although it is metabolically helpful to keep the blood flowing to exercised muscles and tissues, that DOMS isn't responsive.

There is also insufficient data to support stretching as a strategy to enhance recovery, nor for foam rolling. Despite the ubiquitous use of foam rolling, there are no conclusive research benefits aside from pain reduction. The underlying physiological principles and potential risks also remain unclear.

As an active recovery strategy, low-intensity training such as 15 min of walking or pedalling directly after exercise might have a recovery enhancing effect. However, there is little evidence of performance enhancement or objective support for muscle healing.

Food

Two nutritional solutions are effective in reducing DOMS pain, and potentially speeding muscular repair.

A review analysing the effects of branched-chain amino acids (BCAAs) in endurance sports concluded that supplementation with BCAAs lowers the degree of pain and muscle damage, perceived exertion and mental fatigue. Simultaneously BCAA stimulates the anabolic response in recovery and improves the immune response.

There was no consensus about the dose and timing, but "it seems to be most effective if there is 2–3/1/1g relationship between leucine/ isoleucine and valine amino acids".

Research suggests that masters athletes may have slower recovery rates due to "impaired muscle remodeling" mechanisms compared to younger, equally trained athletes, after muscle-damaging endurance exercise. 

In light of this finding, masters athletes could benefit from higher doses of post-exercise dietary protein intake, especially with leucine.

Another important nutritional component found to help a fast and ideal recovery are the omega-3-fatty acids. By limitation of anti-inflammatory responses and oxidative stress, omega-3-fatty acids significantly reduce the DOMS sensations. The effective dose is 1.8–3 g of omega-3-fatty acids after exercise.

Four top treatments

Based on the evidence, here are the most effective things to do when suffering from DOMS to alleviate the pain effectively, and to assist muscle recovery:

1. Take cold baths - water temperature between 11 and 15C for 10 to 15 minutes for up to 96 hours post-exercise.
2. Apply post-exercise compression garments, if possible.
3. Supplement with BCAA in the ratio 2–3/1/1g relationship between leucine/ isoleucine and valine amino acids, following dose recommendations of the supplier.
4. Eat foods rich in Omega-3 e.g. cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines - and nuts and seeds such as flaxseed, chia seeds, and walnuts.

Low-intensity activity will assist further metabolic recovery, and adequate sleep is protective.

May your DOMS recover more quickly.

Good luck.

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