As I sit down to write this, I can feel the tension and pain in my thighs. Every step up to my room initiates an unanswered cry for help from my quads. I am experiencing DOMS or delayed onset muscle soreness. My quads are screaming at me because I did an intense Crossfit workout at Crossfit Low Oxygen involving 60 air squats, 50 cals on the bike, 60 air squats, and then finishing with 60 weighted step ups with 35 lb dumbbells. Then I worked half the day in the clinic and finished my legs off by going skiing in the afternoon. The skiing 13k feet at the end of the day wasn’t exactly planned but it was one of the first good snow days of the season so I went out anyways. 

While skiing I was definitely beginning to feel the toll that my activity for the day was taking on my legs. My turns were pretty sluggish and by last chair I was pretty wiped out. I knew what was coming down the line. However, trading in the discomfort of DOMS for one of the first decent days of snow for the season is something I, and many of the other masochistically active residents of Summit County will gladly do. 

Delayed onset muscle soreness is a common side effect of activity, and especially overactivity or doing a bit more of something than we are used to. My workout above is a classic example of performing a lot of an activity that I have not really been preparing for. For instance, I have been a climber for about 7 years now, and as a result of training I will rarely experience soreness in my forearms. Recently I have begun doing Crossfit workouts and skiing. Because of how Crossfit workouts are designed, with higher rep schemes and continually variable workouts, soreness is a natural resultant product (but does not lead to higher injury rates, to read why click HERE ). Skiing is another new activity for me, growing up in Texas doesn’t really yield many opportunities for snow sports. So as a result I experience DOMS fairly frequently. 

In spite of how frequently DOMS occurs in athletes, it has been difficult for researchers to really nail down the specific cause of DOMS. Earlier theorists believe that it was due to the release and manufacture of lactate and lactic acid during exercise that led to DOMS. However this is not the case because lactate is actually an energy substrate for muscles when the demand for oxygen is higher than can be supplied through aerobic respiration. *Side note: lactate should not be confused with lactose, a sugar molecule found in dairy products. We in the exercise physiology field then pivoted to the Hydrogen Ion theory. We assumed that the hydrogen ions (H+) generated during anaerobic energy creation (the process used to create lactate) acidify the tissues, leading to a chemically induced pain response in the tissues. However this singular physiological event is not enough to explain the accompanying cascade of physiological responses necessary for DOMS to occur. Many other physiological byproducts have been implicated in causing DOMS including, but not limited to; Bradykinin (a peptide that alters vascular permeability) Nerve Growth Factor, creatine kinase (a marker of muscle damage), free radical production (not the political kind, but the unstable atoms created as a byproduct of metabolic processes kind, H+ ions are an example), as well as various other inflammatory markers (Murase et al. 2010), (Lee et al. 2002), (Close et al. 2005).  

Putting the hardcore physiological mechanistic viewpoint aside, we know that DOMS is most prevalent after exercise that we are unnacustome to, and also eccentric exercise (exercises in which we lengthen muscles while they are contracted). So what do we do about it? Over the years there have been many promoted or suggested treatments and therapies for decreasing DOMS, here is a list of interventions that have been shown to help: 

Physical interventions: 

Massage:

This treatment works by increasing blood flow to the tissues in order to enhance the drainage of all of the proposed aftereffects of exercise that lead to DOMS. Massage also may assist in decreasing mechanical sensitivity simply due to the analgesic (pain decreasing) effects of human touch (Geri et al. 2019; Bishop et al. )

Normatec recovery: 

Normatec devices use graded pneumatic compression to facilitate drainage of the metabolic byproducts from activity. It works in a similar manner to massage in terms of clearing out the byproducts of exercise, without the human touch aspect. I have personally benefited from using our offices set of Normatec boots in order to help me recover and stave off DOMS. They have also been shown to be more effective than compression garments in increasing blood flow and oxidative markers of stress. (Kephart et al. 2015; Martin et al. 2017; Kevin Stetter 2013)

Want to learn more about Normatec? Check out our page devoted to the topic by clicking HERE

Nutrition Interventions: 

The main aspect we should focus on with our nutrition should be intaking adequate amounts of macronutrients from whole food sources as often as possible. All of the booster shots and IV drips in the world won’t be very effective if you are not intaking the proper nutrients to recover, or they are coming from sources such as refined sugars or flours which may further promote an inflammatory response in the body. Once we are sure that we are intaking the adequate amounts of nutrients, we can supplement with the following:

Tart Cherry juice: 

Intake of tart cherry juice in the days leading up to strenuous activity such as a marathon, ski trip, or other athletic endeavor increases the amount of antioxidants circulating in the body. The increase in antioxidants leads to an increased ability for the body to buffer the inflammatory cascade response to bouts of exercise. Tart cherry juice has been shown to decrease not only DOMS, but also help maintain more strength and mitigate strength loss due to fatigue. (Kuehl et al. 2010; Connolly et al. 2006; Howatson et al. 2010). Important to note here that tart cherry juice was consumed consistently in the days leading up to the athletic event. Drinking tart cherry juice after exercise when you are sore will not be as effective in decreasing DOMS. 

Omega 3 fatty acids: 

EPA and DHA are fatty acids that are found in fish and fish oil supplements. They both have a role in regulating the inflammatory response in our bodies. It is important to recognize that intake of Omega 3’s need to be done on a consistent basis and will likely have negligible effects when taken acutely after DOMS have already started (Kim and Lee 2014).

Caffeine: 

One of the most widely utilized drugs in the world, caffeine has long been known to increase exercise performance, while also lowering levels of perceived exertion. The effects of caffeine both in increasing wakefulness and decreasing DOMS are mechanistically linked to its effect in blocking adenosine receptors in the nervous system. Caffeine molecules are shaped very similarly to adenosine molecules, which leads to the blockage of adenosine. This is theorised to decrease central nervous system responses to both fatigue and pain that is induced by exercise (Kim and Lee 2014; Hurley et al. 2013). As far as sources of caffeine go, I prefer well sourced and locally roasted coffee; like what is produced at Mountain Dweller coffee shop in Frisco Colorado (@mountaindwellercoffee on instagram) . In addition to caffeine, black coffee also contains a host of other beneficial vitamins such as B6, and antioxidants. 

CONCLUSION:

There are many other proposed methods for decreasing DOMS which I could easily elaborate on. However,  as write this on my Sunday I look outside to a bluebird day with fresh, powdery snow on the ground. I have spent probably a combined 2 hours in the office Normatec boots since Friday, and I can almost feel the fatigue blocking effects of my morning coffee in my quads. So, I am going skiing. 

Cheers, 

Dr. Nic