Delayed onset muscle soreness (DOMS) occurs following intense workouts and can affect the entire body. Typically, DOMS pain begins a day or two following a bout of exercise, meaning that you will never feel this type of discomfort during or immediately following the workout itself - hence ‘delayed’.
In order to gain a better understanding of why DOMS occurs, whether you can prevent it and how you can effectively treat it, OriGym has put together this thorough guide where we will tackle the following topics to provide you with all the answers you need:
- What is DOMS?
- What Are The Symptoms of DOMS?
- What Causes DOMS?
- Who Typically Suffers from DOMS?
- How to Reduce DOMS?
- Ways to Prevent DOMS from Occurring
- Is DOMS The Sign of a Good Workout?
- Should I Workout With DOMS?
- When Should You Seek Medical Attention for DOMS?
But before we start, have you ever wanted to work in the fitness industry? OriGym’s award-winning personal training diploma will help you kick start your career, with the help of an incredible team who are on hand to guide you seven days a week.
Sound interesting? Be sure to download our FREE comprehensive prospectus today and explore everything we offer, and how it could be right for you.
Written by Professional S & C Coaches
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What is DOMS?
There is a fairly straightforward answer to the question ‘what is DOMS?’, and can be mostly understood from the name alone.
Delayed onset muscle soreness is a type of pain that is prompted by intense bouts of exercise that your body is not typically accustomed to performing.
It is worth noting that intense exercise will be subjective to each individual. If you’re someone who rarely or never exercises, then a singular HIIT session could offset DOMS. Whereas if you’re a regular gym-goer, DOMS may occur if you were to change your usual gym routine or significantly increase the intensity of your speed or weights, this could result in DOMS.
As stated within the introductory section of this article, DOMS pain typically occurs one-two days following a workout. However, this type of pain is only temporary and should not prohibit you from exercising for a prolonged period of time.
Nobody likes to be in pain, but try not to let DOMS deter you away from exercising.
In fact, if you’re experiencing delayed onset muscle soreness for the first time consider wearing it as a badge of recognition, as it actually means your fitness levels are improving (but more on that later).
Finally, in order to answer ‘what is DOMS?’, we must distinguish how DOMS pain differentiates from other nagging discomforts you may experience from exercising.
For example, acute muscle soreness (ACS) is the burning type of pain that affects the body immediately after exercising. This specific condition vastly differs from DOMS pain but is always mistaken for it.
As we will elaborate on within the next section, DOMS has a list of symptoms that makes it easily identifiable.
What are the Symptoms of DOMS?
Delayed onset muscle soreness symptoms are fairly easy to recognise, but in order to be accurately identified you need to have an understanding of the regular functioning of your own body. By noting any immediate differences within your body, you will be able to get an accurate DOMS diagnosis.
Typically, DOMS can be identified through the following symptoms, note you don’t need to suffer from all of these in order to have the condition:
#1 - Tender Muscles
DOMS pain is usually the symptom that is easiest to identify as it is both dull and deep, prompting your muscles to feel tender when moved excessively.
This kind of pain is commonly localised to the muscle group that you have been exercising with.
For example, DOMS in the arms may be caused by weightlifting, whereas DOMS in the legs could be caused by excessive running or lower body resistance training.
#2 - Reduced Range of Motion
Muscle DOMS not only cause pain throughout the body, but they also prohibit your range of motion. Instead of being able to move at your regular rate to your regular range, you will notice that your muscles have become stiff and uncomfortable and may encounter some restrictions.
#3 - Muscle Swelling
When suffering from DOMS, muscles may also become swollen and inflamed which can make even the simplest of movements, such as walking down the stairs, incredibly painful.
Much like with the tender muscles, you should notice swelling in areas in which your exercising routine has been primarily localised.
#4 - Short Term Fatigue and Loss of Strength
This symptom of delayed onset muscle soreness is every gym bunnies worst nightmare, as once this condition has developed you may notice an impact on your overall performance.
For example, the pain of DOMS has also been known to affect your overall strength levels, as your muscles won’t be able to sustain carrying as much weight as they usually would. Likewise, DOMS pain will also wear your body out, meaning that you’ll experience higher levels of fatigue at a much faster rate than you typically would.
When experiencing the painful symptoms related to DOMS or any of the other aforementioned symptoms, it’s important to stay as active as possible. Whilst this may cause further discomfort in the moment, movement and activity are actually an example of a DOMS remedy, due to the fact that it promotes blood flow to the injured areas.
What Causes DOMS?
In order to gain a further understanding and answer the question ‘what is DOMS?’, you must understand what factors can cause the condition to occur.
Within this section, OriGym will provide a detailed explanation into how and why DOMS muscle pain develops, whilst also debunking a common misconception of the condition surrounding this topic.
Firstly, the primary causing factor of DOMS is any form of high-intensity workouts, be it running, cycling, swimming etc.
High-intensity exercise causes microscopic tears to occur within muscle fibers. In order to respond to this damage, your body will increase the muscles' inflammation by triggering an influx of white blood cells that are arguably the biggest culprit in DOMS muscle pain.
Your white blood cells cause delayed onset muscle soreness as they can leave your muscles swollen at an unnatural size for up to 3 days. This explains why DOMS muscle pain can be at its worst several days after your initial workout, as this will be the point where the muscles are at their most swollen state.
Whilst any high-intensity workout has the capability to cause delayed onset muscle soreness, research has proven that eccentric exercises have been known to cause higher rates of the condition.
Eccentric exercises are performed at slow rates, they work to tense your muscles whilst also causing lengthening contractions. An example of an eccentric exercise that can cause DOMS is running downhill.
What specifically triggers muscle DOMS is the force of the eccentric contractions within the muscle. For example, running DOMS can occur when we run harder or faster than usual, whilst running downhill has also been known to trigger this pain.
Running DOMS can be particularly painful, as our leg muscles lengthen under the high impact, while simultaneously trying to contract or shorten. OriGym would strongly advise you to take it easy when running, this high-impact sport can be deceivingly lethal, so take care when engaging with it.
OriGym’s Level 2 Gym Fitness Instructor course provides further education on fitness-related topics such as DOMS. During this course, you will gain a better understanding of the principles of exercise and fitness, learning about how exercise routines can positively affect the human body and the damage they may be causing.
Can Lactic Acid Cause DOMS?
For years, articles and online journals have claimed that lactic acid was the leading cause of DOMS pain. However, this theory has been recently debunked and should not be taken into consideration when discussing the topic of delayed onset muscle soreness.
During intense bouts of exercise, your body taps into anaerobic metabolism for energy, using your body’s supply of glycogen without the need for oxygen. The process of burning glycogen is referred to as glycolysis, and lactic acid is a product of this process.
The theory that lactic acid contributed to DOMS pain originally stemmed from research conducted in 1922, which found frogs' legs stopped contracting after multiple forced simulations. From this, it was believed that glycolysis was the leading cause of oxygen debt within the body, which prompted the muscles to become tired, strained, and injured.
However, modern research has proven that delayed onset muscle soreness is multi-dimensional with multiple causing factors, none of which involve the production of lactic acid.
The theory that lactic acid build-up can cause muscle DOMS pain has been debunked several times since 1980, and therefore any source citing this theory should not be taken seriously.
Instead, lactic acid is now viewed as fuel for your muscles rather than a harmful product. In fact, the reason why so many athletes can exercise at higher rates of intensity is because their muscles are more equipped to absorb the lactic acid.
Who Typically Suffers from DOMS?
Let’s be honest, we all experience pain after a hard workout, but why is it that some suffer from muscle DOMS at a higher rate than others? This section will explain why certain populations are more likely to experience DOMS muscle pain than others.
Currently, there are two leading factors that influence who is more likely to suffer from DOMS pain, these are genetics and gender.
#1 - Genetics Influence on DOMS Pain
Genes can play a role in determining the intensity of the pain you feel post-exercise, with two types of genetics in particular known to have influence over DOMS pain. These genetics are ACTN3 (alpha-actinin-3) and MCLK (myosin light-chain kinase) both of which affect our body's pain receptors' response to delayed onset muscle soreness.
ACTN3 is linked to sports performance and plays an important role in muscle composition, higher rates of genes are likely to improve your performance levels in areas such as sprinting and heavy lifting. Whatsmore, this gene has also been implicated to help reduce pain throughout the body, caused by muscle overuse.
Those with XX chromosomes are more likely to be deficient in this gene, which in turn makes them more prone to muscle damage and soreness. Therefore, we can say that this gene plays an important role in the prevention of DOMS muscle pain, as without it you’re more likely to feel a higher intensity of pain.
However, the MLCK gene has been known to cause DOMS muscle pain, and negatively impact on a runners' performance.
When taking blood samples from professional marathon runners, the research found that those who trained intensively and participated in frequent marathons were more likely to have higher levels of MLCK. Therefore, if you frequently run at an intense rate, you will be more susceptible to DOMS muscle pain, than those who run as a mere hobby.
Unless you’re an athlete who is trained at a professional level, you probably won’t have access to blood tests, therefore, it can be somewhat difficult to determine whether or not it’s genes causing your DOMS pain.
#2 - Gender’s Influence Over DOMS Pain
Interestingly, delayed onset muscle soreness can also be influenced by gender and hormonal differences.
Some studies have hypothesised that women are less likely to suffer from muscle DOMS pain due to their levels of estrogen. In this particular study, the researchers found that women have lower levels of MLCK, a contributing factor of DOMS.
Therefore, if men have higher levels of MLCK within their bodies we can naturally argue that they are more likely to suffer from intense levels of muscle DOMS.
It was also found that elevated levels of estrogen due to birth control pills, also helped women combat the onset of DOMS muscle pain at a higher rate. On average, it is believed that men's DOMS recovery process begins after an average of 72 hours, whereas women’s begins at a much faster rate of 24 hours.
However, some still refute the idea that gender can influence the onset of muscle DOMS.
Instead, these individuals argue that men and women perceive pain differently, and therefore the way in which their bodies react to delayed onset muscle soreness will naturally differ.
At OriGym we would like to stress that the two aforementioned categories are all merely theories as to how muscle DOMS impacts different individuals to a greater extent. Naturally, there may be some overlap within these categories and some may suffer from intense bouts of DOMS for numerous reasons.
Everyone’s bodies are different, making it somewhat challenging to provide a generalisation of what groups are more likely to be affected by DOMS pain.
However, if you’re interested in studying anatomy and specifically how aspects of our biology can trigger different responses to exercise, then we’d recommend signing up for OriGym’s Level 3 Personal Trainer Course. Not only will you gain a better understanding of anatomy, but you’ll also learn how to adapt training to suit different individuals based on their specific needs.
How to Reduce DOMS
Now that you have a better understanding of what DOMS is and how it operates, we can now tackle the question ‘how to reduce DOMS’ by sharing a list of potential treatments.
Before we begin, please be aware that due to the uniqueness of our bodies there isn’t one method of treatment which is regarded as the best DOMS recovery method. Rather, you may respond better to one over the other, so be sure to try them all in order to see which one is more effective for you.
#1 - Massages
One of the most effective DOMS recovery treatments, which has been shown to be effective for up to 72 hours post-exercise, is by receiving a massage post-workout. Individuals who receive a message within this time frame are less likely to feel sore, compared to those who chose to go without.
Whilst receiving a professional massage following every workout isn’t really feasible, OriGym strongly recommends the process of self-massage which has been found to be an equally effective DOMS cure.
If you’re interested in this delayed onset muscle soreness treatment we’d recommend massaging some oil into the following body parts:
For an effective DOMS recovery process, knead, squeeze and gently shake your muscles, paying particular attention to muscles in which your workout was primarily performed.
If this delayed onset muscle soreness treatment particularly interests you, then we’d strongly recommend joining OriGym’s Level 3 Sports Massage Therapy course. On which you will be trained by industry experts, and will graduate as a fully qualified specialist in sports massage therapy.
#2 - Topical Analgesics
Topical analgesics are an example of a delayed onset muscle soreness treatment with medicinal properties. This method of care is significantly popular as it is not only easy to buy but also provides fast-acting effectiveness.
This particular DOMS recovery treatment has been known to be more effective with menthol and arnica-based analgesics. These types of products can be applied to injured areas of the body and will prompt cooling and warming sensations that will help distract your mind from the DOMS pain.
Note, this method of treatment is a short-term DOMS cure, if you find yourself suffering from consistent bouts of this condition, this may be the best course of treatment for you. Please, always be sure to use the products with care and follow any and all instructions given on the packaging.
#3 - Baths
Baths are a delayed onset muscle soreness Treatment that is adaptable to your preference, whether you prefer a hot bath or ice-cold baths, this is the therapy for you!
Having a cold bath for a total of 10-15 minutes has been found to act as a DOMS recovery method. Research supports this notion, by highlighting that fully submerging your body in 10–15°C water for this time period will have instant relieving effects.
For a more detailed analysis of the benefits of ice baths click here and read our article on the topic.
Similarly, hot baths also act as an instantaneous DOMS cure. However, if you’re looking to feel long-term effects OriGym advises to also use moist heat wraps following exercise too.
#4 - Anti-Inflammatory Foods
A poor diet can worsen inflammation throughout the body, with foods that are high in saturated fats and sugar being the worst culprits of this.
Alternatively, an anti-inflammatory diet focuses primarily on fresh fruits and vegetables, both of which are good sources of antioxidants, which combat the damaging effects of junk food.
When discussing the best way to get rid of DOMS many outlets often overlook anti-inflammatory foods. But in order to understand what good foods you should be eating, we felt it necessary to share the foods that you should avoid at all costs if you want to avoid DOMS.
The following foods can cause inflammation and DOMS pain:
- Chips and other fried foods
- Refined carbs such as white bread and pastries
- Fizzy drinks
- Red meat and processed meats
Now that you have an understanding of what foods to avoid, we can now discuss the foods which can act as a DOMS remedy:
- Olive oil
- Green leafy vegetables such as spinach, kale, and lettuce
- Nuts like almond and walnuts
- Fatty fish like salmon and mackerel
- Fruits such as strawberries, cherries, and oranges
This is arguably the best way to get rid of DOMS, as this change in diet benefits our body in multiple ways. Not only are you reducing the pain levels within your body, but you will also reduce the likelihood of developing chronic diseases.
Learning about food and nutrition can be incredibly beneficial, especially if you’re a personal trainer looking for a specialist area of expertise. At OriGym our Level 4 Advanced Sports Nutrition Course will equip you with knowledge surrounding food and diets needed to provide nutritional guidance to your clients.
As stated at the beginning of this section, when discussing delayed onset muscle soreness treatments there is no one size fits all, and treatments will differ in effectiveness from person to person.
Be sure to find a DOMS cure that works for you and your training method, adapting them as and when you see fit in order to ease your body’s pain.
If you’re enjoying this article on delayed onset muscle soreness we think you’d also like these other OriGym articles:
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Ways to Prevent DOMS from Occurring
Now that we have analysed delayed onset muscle soreness treatment methods, OriGym has put together some advice on how you can prevent DOMS from occurring in the first place.
Much like the DOMS cures and remedies listed in the previous section, we’d like to remind all readers that the effectiveness of these treatments will vary from person to person. We strongly advise all readers to try multiple prevention methods, before settling on one that works for them.
#1 - Stay Hydrated
Whether you’re suffering from DOMS in arms, legs or quads, often this muscle condition can be caused by a lack of electrolytes within the body. When exercising at a high intensity, your muscles are working harder and need more oxygen to sustain their regular function.
This oxygen will be carried around the body through your bloodstream which itself is made up of 82% water. Therefore, in order to prevent DOMS muscle pain from occurring, ensure that your blood can successfully carry this oxygen, be sure to aid the water in your body by staying as hydrated as possible.
A very simple way to stay hydrated is to bring a water bottle with you while training, OriGym recommends drinking after every completed set or alternatively for every five minutes of cardio. By replacing the fluid you lose throughout your workout you will successfully prevent delayed onset muscle soreness from occurring.
If you like the sound of this simple solution check out our article on the 15 best running water bottles for some product ideas.
If you’d like to try alternatives to water, we recommend coconut water or an electrolyte drink, both of which should be consumed immediately following your workout to keep hydration at bay. If you’re unfamiliar with such drinks do yourself a favour and read this OriGym article on the 17 best electrolyte drinks.
Whatsmore, in order to avoid DOMS muscle pain we’d strongly advise avoiding beverages that are high in sugar, salt and caffeine, all of which are known to increase the likelihood of dehydration.
The importance of hydration is stressed in our REP’s Hydration Training course, and if this is an area you’d like to learn more about then why not enroll today. This qualification covers topics such as the best sources of water, environmental factors to consider when planning routines for clients, the roles sports drinks can play in your diet and how to identify and combat dehydration.
#2 - Execute a Proper Warm-up and Cool Down
When looking to prevent DOMS in legs, arms or other areas in which exercise is typically localised, you should perform a good warm-up. Regardless of how eager you are to begin your workout, a 5-10 minute warm-up can make the difference between developing DOMS muscle pain or maintaining your regular muscle functionality.
Warming up helps to increase blood flow throughout your muscles, which will warm them up and reduce the risk of DOMS pain or other muscle soreness. We recommend conducting some light cardio before moving onto some stretches and then followed by easing into your workout session. If you’d like to learn more information relating to how stretches can benefit your body, why not check out our article dedicated to the 9 benefits of dynamic stretching.
However, cooling down following an intense workout session has also been known to reduce the likelihood of developing muscle DOMS. Mirror your warm-up routine and end your session with a light jog, this will help the body to cool down by reducing your heart rate and steadying your breathing.
Cooldown routines provide our bodies with increased blood flow that will help avoid soreness, whilst also providing the body with time to adjust its muscles to their regular length.
#3 - Get a Good Night's Sleep
It often comes as a surprise to many that sleep can be used as a powerful tool to prevent DOMS pain. Muscle-building chemicals are naturally produced during the deep stages of sleep, and it is recommended that adults should aim for an average of 7 hours of sleep in order for the body to recover from exercising.
If you struggle to reach a state of deep sleep, OriGym recommends practicing deep and slow breathing and turning off all electronics an hour before you go to bed. Alternatively, you can also take a relaxing bath prior to bed too, as this has also been known to encourage deep sleep.
Sleep is a regenerative process that allows your body to restore, rebuild and rejuvenate after a long strenuous day. Having a good night's sleep will not only help prevent DOMS pain, but will also help to improve your long-term muscle development.
#4 - Take it Slowly
Arguably the easiest way to prevent DOMS pain from developing is to take exercise as slowly as possible. We all like to challenge and push ourselves to reach new fitness goals, but by constantly conducting strenuous activities you will significantly increase the likelihood of developing delayed onset muscle soreness.
To prevent this from occurring, OriGym recommends setting SMART goals in order to reach your goals in a safe and efficient manner. As detailed in our article on SMART goals, by setting these types of aspirations you can achieve set targets without putting your muscles through too much strain.
SMART goals will also allow you to gradually build your stamina and strength levels, thus decreasing the likelihood of developing DOMS as you won’t have to strain yourself.
All of these prevention methods can effectively be incorporated into your everyday life, and will successfully protect you from the onset of DOMS muscle pain.
Much like the cures and remedies, we advise you to adapt your prevention methods to your personal exercise plan. No two human beings are the same, we can provide a generalised list of recommendations but you should always alter workouts and treatments to meet your personal needs.
Is DOMS the Sign of a Good Workout?
When working out with DOMS, many athletes and fitness professionals will state that it’s something to be proud of, and that said pain is the sign of a good workout, but just how true is this sentiment?
There are multiple ways to look at this statement, it's easy to argue that your body will naturally feel sore after you’ve pushed it to its limitations, and therefore DOMS pain is the sign of a successful workout.
On the other hand, your body will naturally become accustomed to exercise over time. In turn, pain such as muscle DOMS will decrease as your routine becomes less strenuous on the body.
Feeling less pain does not equate to an unsuccessful workout, it simply means your body has become accustomed to the rate at which you workout. If you want to experience DOMS pain you can always increase your intensity, however, pushing yourself to this point should never be viewed as a signifier of success.
Should I Workout With DOMS?
For those who have never experienced this condition before you may be questioning ‘should I workout with DOMS?’. This section of the article is dedicated to imparting advice on how you should be working out with DOMS in order to prevent the symptoms from worsening.
Working out with DOMS may sound like torture, but it can actually be really beneficial for the recovery process. Low-impact cardio sports, such as swimming in particular, have been known to gently ease the body back into exercise, providing a way that won’t cause you great pain.
Light stretching through practices, such as yoga and pilates, have also seen great results for easing DOMS muscle pain.
When discussing this topic we must divulge that you’re technically able to perform all workouts with DOMS. However, at OriGym we advise you to avoid placing too much strain on the sore body part and targeting the affected muscle groups, as this will only lead to further injuries.
Before even questioning ‘should I workout with DOMS?’, you should always be sure that it’s DOMS you’re suffering from and not another injury. Working out with DOMS may cause pain, but working out with an injury can cause significant damage to your body, so be aware of what's plaguing you before diving back into the gym.
DOMS muscle pain will feel dull and achy, whereas injuries will often prompt stabbing pains. Once this has been properly identified you can make a more informed decision regarding if you wish to workout with DOMS or not.
Deciding ‘should I workout with DOMS?’ isn't a choice that should be made lightly. We encourage all of our readers to take their bodies into account before chasing their fitness goals, go easy and never push yourself to a breaking point!
When Should You Seek Medical Attention for DOMS?
Regardless of whether you’re suffering from DOMS in quads, arms or legs, the pain may feel intense but it very rarely requires a visit to a hospital. However, it is recommended that you should seek out medical attention if DOMS muscle pain is prohibiting you from conducting your normal activities.
You should also seek medical help if:
- Your DOMS muscle pain lasts longer than 7 days
- Your urine is abnormally dark
- You have swelling in your arms and legs
Sharp pains, muscle spasms and numbness are notably different from DOMS pain. This is why it’s so important to know the difference between types of pain, if you’re suffering from any of the aforementioned feelings post-exercise please note they are not symptoms of DOMS, and may require immediate medical attention.
If you’re suffering from different types of pain we’d strongly advise checking out our article on how to prevent ACL injuries. This will provide insight on how you can identify and prevent a serious injury from occurring.
If you’re a personal trainer who is constantly bombarded with health-related questions from their clients, then we advise signing up for our Level 4 Personal Training Course. This degree will provide you with the specialist knowledge surrounding sports-related injuries and pain, ensuring that you’re more qualified to answer medical questions than before.
Are Over the Counter Tablets Effective in Treating DOMS?
Those who routinely suffer from DOMS in quads and other areas of localised exercise often turn to over-the-counter pain-relief tablets, however, this medication may be more counterproductive in this situation.
The way in which these types of tablets work is by blocking inflammation, however, in the process they may also block blood flow to damaged tissues and muscles. This is counterproductive to other DOMS cures, which typically treat the pain through increased blood flow.
Whatsmore, tablets such as ibuprofen don’t guarantee reduced inflammation or pain, in fact many professional runners have noted that the medication did nothing to relieve their soreness.
So, we can say that whilst they may offer short-term relief, the over-the-counter tablets won’t target the core issues of DOMS pain.
How Long Do DOMS Last?
Sadly, there is not a ‘one size fits all’ answer to ‘how do DOMS last?’, as this will vary from person to person, with some recovering quicker than others.
To give you a general idea, however, DOMs pain typically lasts between 3-5 days and usually begins a day following the workout. This is short-term muscle pain and, as stated within the section dedicated to medical attention, if you find yourself suffering for longer than 7 days, we’d recommend seeking further help.
Are There Any Other Exercises That Are More Likely to Cause DOMS?
As stated multiple times throughout this article, any type of exercise has the capability to cause DOMS muscle pain. However, stretching the body’s muscles whilst they’re simultaneously contracting is the biggest culprit for triggering the condition.
These types of exercises include:
- Chest Flyers
- Deep Squats
- Stiff-Legged Deadlifts
OriGym advises taking extra care when performing any of these exercises, in order to avoid the onset of DOMS pain throughout the body.
Written by Professional S & C Coaches
Download Your FREE 16 Week Home Strength Training Programme
Written by Professional S & C Coaches
Before You Go!
As our guide on Delayed Onset Muscles Soreness draws to a close, we hope that it has answered any unanswered questions that you may have had. Despite being a short-term medical condition this still requires the same level of attention as other exercise-related injuries.
OriGym would like to stress once again to be careful when pushing yourself with high-intensity exercise routines. Whilst it’s important to challenge yourself to advance your fitness levels, it should not come at the expense of your health, both short and long-term.
Before you go, have you ever wanted to work in the fitness industry? OriGym’s award-winning personal training diploma will help you kick start your career, with the help of an incredible team who are on hand to guide you seven days a week.
Sound interesting? Be sure to download our FREE comprehensive prospectus today and explore everything we offer, and how it could be right for you.
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- D G Allen et Al. (2008) Skeletal muscle fatigue: cellular mechanisms, National Library of Medicine
- Juan Del Coso. (2017) ACTN3 X-allele carriers had greater levels of muscle damage during a half-ironman. Springer
- P M Clarkson et Al. (2001) Are women less susceptible to exercise-induced muscle damage? National Library of Medicine.
- Aryane Flauzino Machado et Al. (2016) Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis. Sports Medicine NZ
- David C Nieman et Al. (2006) Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. National Library of Medicine