DOMS: Prevention And Treatment.

Delayed Onset Muscle Soreness (DOMS) is a serious and painful condition that affects every athlete. Learn more about DOMS, how it might effect you, etc. Get the details below.

Delayed Onset Muscle Soreness (DOMS) is a serious and painful condition that affects every athlete. Some athletes get DOMS only occasionally, while other athletes suffer from it on a continual and chronic basis.

DOMS prevention is one of the most important considerations for an athlete because DOMS dramatically affects every aspect of training, including working intensity, muscle strength, muscle gain, training effect, body composition, hormone levels, anabolism, catabolism and exercise recovery.

In this article, I will discuss briefly:

  • What is DOMS
  • How you get DOMS
  • Why DOMS is an equal opportunity condition
  • How to prevent and treat DOMS

What Is Doms

Delayed Onset Muscle Soreness (DOMS) is a debilitating and painful condition. It is often confused with regular muscle soreness, but regular muscle soreness and DOMS differ fundamentally.

DOMS differs from regular muscle soreness in severity, duration of soreness and in causal factors. Whereas normal muscle soreness results immediately following exercise and usually lasts for less than two days, DOMS onset occurs several days following an exercise session. And, regular muscle soreness and DOMS are caused by different variables.

Muscle Soreness
Regular Muscle Soreness Results Immediately Following Exercise.

How You Get Doms

It used to be thought that delayed onset muscle soreness was caused by the build-up of lactic acid in muscle tissue. However, new research has disproved this hypothesis, and it is now clear that whereas regular muscle soreness is predominantly due to microtrauma structural damage to muscle fibers, DOMS is primarily caused by the bodies inflammatory response to exercise1 and several other variables.

Today, scientists know that DOMS is influenced by:

  • Athletic conditioning, age, and the skeletal muscular system
  • Structural damage to muscle tissue and tendons
  • The inflammatory response system

Athletic Conditioning, Age, & The Skeletal Muscular System

Your athletic conditioning, age and the condition of your skeletal muscular system all contribute to DOMS onset. Your degree of athletic conditioning - i.e. how adapted is your body to training - will determine, in part, the inflammatory response to exercise.

Young athletes are susceptible to DOMS because their conditioning is not yet fully developed to handle heavy and intense workouts, and older athletes are susceptible to DOMS because of their age, shifting hormonal status and decreased recovery responses.

Structural Damage

Structural damage to muscle tissue and tendons contributes to DOMS onset, but only because of the inflammatory response to muscular damage, as outlined above.

Inflammatory Response System

The inflammatory response system that activates following resistance training stimulus triggers the activation of pro-inflammatory cytokinases and PGE2 - prostaglandin E2. The activation of this pro-inflammatory response system and PGE2 draws water to the damaged body part, leading to edema, and increased pain sensitivity to exercise.

DOMS: Equal Opportunity Condition

It doesn't matter if you're young or old, conditioned or unconditioned, male or female: DOMS doesn't discriminate and you're equally likely to get DOMS.

While younger and less conditioned athletes are all likely to experience DOMS at some point in the beginning phases of their bodybuilding careers, older and more experienced athletes are equally likely to experience DOMS, despite their muscular maturity and excellent conditioning.

In the case of the young athlete, DOMS sets in because they lack muscular conditioning and because the pro-inflammatory response system that's triggered by exercise is over-active and not adjusted to their training volume.

By contrast, advanced athletes are likely to experience DOMS, not because they lack muscular conditioning, but because their enzyme levels and their inflammatory response systems are slower and less efficient due to age. In both cases, both young and old athletes lack the anti-inflammatory enzymes needed to stifle prolonged inflammation and DOMS onset.

DOMS: Prevention & Treatment: Enzyme Science

It used to be thought that speeding recovery and preventing DOMS was as simple as increasing protein, fats and carbohydrates intake. Now, however, its clear that while repairing structural damage to skeletal muscles by nutritional means is relatively simple, controlling or reducing the inflammatory response to exercise and preventing or reducing the painful symptoms that come with DOMS is more complicated.

Until recently, the only anti-DOMS recourse for athletes has been to use non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. Unfortunately these over-the-counter pain killers stunt muscle growth2 and can damage the liver.

Using enzymes to combat DOMS is well established. A study by Innerfield in 1957 examined the anti-inflammatory effects of protease enzyme therapy and showed that protease enzyme supplementation may have anti-inflammatory effects.3 Unfortunately, absorption issues and the destruction of enzymes in the gut have severely limited the effectiveness of traditional anti-DOMS enzyme therapy.

Typically, the absorption rate of orally ingested enzymes is low - with protease enzymes absorption rates ranging between 40% for bromelain and greater for mixed protease products4, and a rate of about 5% absorption for orally ingested sitosterols.5

To solve these absorption difficulties, scientists added the ingredient piperine to enzyme mixtures. They found that piperine - an ingredient extracted from pepper - increased enzyme absorption by up to 60%!6,7

Protease Enzymes

Protease enzymes are essential because they play an especially important role in the exercise induced muscular inflammation process that causes DOMS.

Protease enzymes include trypsin, bromelain, chymotrypsin and papain, and they help cleanse your blood of excess proteins, prevent invading organisms from attacking your immune system, and they're scientifically proven to inhibit the pro-inflammatory response that leads to DOMS.8,9,10

In addition, protease enzymes inhibit the action of PGE211,12,13 and stimulate anti-inflammatory agents8,14 - leading to less muscle pain from exercise, faster recovery, and a decreased chance of DOMS onset.


Sitosterols are plant sterols15 and they're especially good at combating DOMS because they can increase T-Cell and CD4 activity, while simultaneously decreasing levels of IL-6 (interleukin 6) - an inflammatory chemical that increases in response to exercise.16

Sitosterols also reduce cortisol levels and improve cortisol to DHEA ratios17 and have indirect muscle-building effects.

Why Regular Digestive EnzymesDon't Work

Regular digestive enzymes are great for food digestion and nutrient absorption, but they can't control the exercise induced inflammatory response or combat DOMS. Only a special, scientifically proven formulation of protease/proteolytic enzymes along with sitosterols can exert the systemic effects needed to effectively combat DOMS.

During the course of my research I came across a product that specifically uses clinically proven anti-inflammatory, anti-DOMS enzymes15 and the research shows that these enzymes can reduce post-workout muscle inflammation by up to 63%.4

By addressing the underlying enzyme-based inflammatory process that causes DOMS, you'll lessen the effects of DOMS or prevent its onset altogether.

Scientific References

  1. Nosaka K, Newton M, Sacco P. Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage. Scand J Med Sci Sports. 2002 Dec;12(6):337-46.
  2. T. A. Trappe, F. White, C. P. Lambert, D. Cesar, M. Hellerstein, and W. J. Evans. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 282: E551-E556, 2002.
  3. Innerfield I. The anti-inflammatory effect of parenterally administered proteases. Ann N Y Acad Sci. 1957 Aug 30;68(1):167-76; discussion 176-7.
  4. Miller et. Al. The effects of protease supplementation on skeletal muscle function and D.O.M.S. following downhill running. Journal of Sports Sciences 22, 365-372;2004.
  5. Kelly GS. Sports nutrition: A review of selected nutritional supplements for bodybuilders and strength athletes. Alt Med Rev 1997;2:184-201.
  6. Atal CK, Zutshi U, Rao PG. Scientific evidence on the role of Ayurvedic herbals on bioavailability of drugs. J Ethnopharmacol. 1981 Sep;4(2):229-32.
  7. Velpandian T, Jasuja R, Bhardwaj RK, Jaiswal J, Gupta SK. Piperine in food: interference in the pharmacokinetics of phenytoin. Eur J Drug Metab Pharmacokinet. 2001 Oct-Dec;26(4):241-7.
  8. Woolf RM, Snow JW, Walker JH, Broadbent T. Resolution of an artificially induced hematoma and the influence of a proteolytic enzyme. Journal of Trauma 1965; 5: 491-493.
  9. Vellini M, Desideri D, Milanese A, et al Possible involvement of eicosanoids in the pharmacological action of bromelain Drug Research 1986; 36: 110-112.
  10. Taussig SJ, Batkin S Bromelain, the enzyme complex of pineapple and its clinical application Journal of Ethnopharmacology 1988; 22: 191-203.
  11. Donaho C, Rylander C Proteolytic enzymes in athletic injuries: a double blind study of a new anti-inflammatory agent Delaware Medical Journal 1962; 34: 168-170.
  12. Cirelli MG Clinical experience with bromelains in proteolytic enzyme therapy of inflammation and edema Medical Times 1964; 92(9): 919-922.
  13. Deitrick RE Oral proteolytic enzymes in the treatment of athletic injuries: a double-blind study Pennsylvania Medical Journal 1965; 68: 35-37.
  14. Remuzzi G, Misiani R, Marchesi D, Livio M, Mecca G, de Gaetano G, Donati MB. Haemolytic-uraemic syndrome: deficiency of plasma factor(s) regulating prostacyclin activity? Lancet. 1978 Oct 21;2(8095):871-2.
  15. Taussig SJ The mechanism of the physiological action of bromelain Medical Hypotheses 1980; 6: 99-104
  16. Keller C, Steensberg A, Hansen AK, Fischer CP, Plomgaard P, Pedersen BK. Effect of exercise, training, and glycogen availability on IL-6 receptor expression in human skeletal muscle. J Appl Physiol. 2005 Dec;99(6):2075-9. Epub 2005 Aug 11.
  17. Bouic PJD, Clark A, Lamprecht J, et al. The effects of b-sitosterol (BSS) and b-sitosterol glycoside (BSSG) mixture on selected immune parameters of marathon runners: inhibition of post marathon immune suppression and inflammation. Int J Sports Med 1999;(In Press)