Does massage get rid of DOMS?

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Jul 26

What is DOMS?

DOMS is an acronym for Delayed Onset Muscle Soreness which is a common cause of exercise induced muscle soreness that can occur following a strenuous or unaccustomed form of activity. It typically leads to muscle pain and stiffness that affects the soft tissues, and occurs after exercise has been completed. Typically maximal levels of DOMS occurs after 2 to 3 days and may last up to 7-10 days.

DOMS is one of the symptoms of exercise-induced muscle damage but it DOES NOT necessarily indicate that muscle damage is there. Additionally, the level of DOMS does not reflect the extent of muscle damage, and how long it takes to recovery is also NOT an indicator of muscle damage. In this respect, the goal of exercise or training should not be to trigger a DOMS effect but rather to progressively load muscles within tolerable limits.

While all sorts of exercises can lead to DOMS, it is most typical for it to occur after eccentric contraction. Eccentric contractions occur during the negative phase or downward phase of a movement. This occurs in activities like downhill running, ballistic stretching, plyometrics, and other shock absorbing based activities.

DOMS can occur in both the athletic and nonathletic populations, regardless of skill level or strength levels. As long as the individual is exposed to unaccustomed or unfamiliar exercises, DOMS may occur 24-72 hours post-exercise. In all populations, DOMS can also lead to decreased muscle force production, reduced range of motion, increased discomfort, and may increase the risk of injury.

Why does DOMS occur?

DOMS has many different proposed mechanisms that trigger the associated pain and stiffness. Some theories believe that it occurs due to:

Micro-lesions in muscle fibers
Inflammation
Metabolite accumulation within the skeletal muscle
Connective tissue microtrauma (fascia)
Algogenic nociceptor stimulation

Although it was originally believed that DOMS originates in the muscle itself, it is not becoming apparent that DOMS can originate in the muscle associated connective tissue instead.

Lactic acid and DOMS

One of the primary theories for the occurrence of DOMS is the accumulation of lactic acid or lactate. Lactate is produced during glycolytic metabolism which occurs as a result of physical activity. With a build up of lactate, a noxious stimulus is created which activates the pain-sensitive free nerve endings of type III and type IV afferents. These free nerve endings are found within small blood vessels of muscles.

It should be noted that this old theory has been rejected as the cause of DOMS. This is because the timeline of when lactate concentrations peak do not correlate with the peak level of DOMS discomfort. Typically lactate levels return to baseline after physical activity has ended, whereas DOMS peaks 2-3 days after physical activity has ended.

Another reason why the lactic acid theory is rejected is due to the fact that lactate production is higher in concentric contractions and lower in eccentric contractions. Additionally, it is widely accepted that DOMS is highest with eccentric contractions. Thus the observation of when lactate peaks and when DOMS peaks do not correlate at all.

Muscle damage and DOMS

As previously mentioned, exercise induced muscular damage can lead to DOMS, but having DOMS is not always an indicator of muscular damage. Although microtrauma of muscular tissue can produce pain by the activation of mechanosensitive type III afferents, this would only explain why pain sensation is felt during exercise and not DOMS. These receptors also require a high activation threshold which is not typically reached with normal contractions.

Other studies also show that although DOMS can be induced through eccentric exercises, this was not correlated with the presence of plasma creatine kinase, which is a biomarker of muscular damage.

Inflammation and DOMS

The inflammation theory of DOMS is one of the few theories that can help to explain the delayed and sustained pain experienced following exercise. Inflammation-associated intramuscular swelling can cause activation of type III afferents through increased pressure of these mechanosensitive receptors. Observations of peak swelling does correlated with DOMS peak leading to support of this theory.

Inflammation can also increase pain sensitivity through inflammatory chemicals released during the recovery process. Inflammatory cells are though to enter the damaged tissue, releasing pain inducing chemicals.

It is also believed that this theory is linked with the muscular damage theory in that muscular damage can lead to increased inflammation.

Why do eccentric contractions lead to more DOMS?

Eccentric contractions lead to higher mechanical stress to soft tissue leading to overload of the sarcomeres within muscles. This can lead to micro-ruptures located near or in the Z-disk of the muscle fiber. To understand this further we need to first understand a little more about muscle fibers.

Muscles are generally categorized into slow-twitch type I fibers, or fast-twist type II fibers. Type II fibers are high force, high power, high speed muscles with limited endurance and type I fibers are high endurance, slow contraction, and high fatigue resistance muscles. Type II fibers have weaker Z-disks and less compliant titin filaments, which can lead to greater mechanical stress during eccentric contractions. They also have less sarcomere-stabilizing protein nebulin.

The high loading nature of eccentric contractions will cause your type II muscle fibers to be recruited over your type I fibers, however due to their weaker structure and decreased stabilization capabilities compared to their type I counterparts, these fibers can become overloaded leading to muscular damage.

Can DOMS increase my risk of injury?

As previously mentioned, DOMS can lead to a reduce range of motion which may lead to inefficient shock absorption due to inefficient biomechanics during physical activity. These altered positions can lead to increase strain to soft tissues that are unaccustomed to these new positions.

Decreased force production in muscles associated with DOMS may also increase recruitment of compensational muscles. Due to the increase in workload for unaccustomed muscles, excessive strain may be experienced in these muscles.

How do you get rid of DOMS?

Fascia oriented treatment methods and techniques can help to prevent or treat DOMS. Examples of this include:

Foam rolling
Collagen supplementation
Percussive massage or vibration therapy
Massage therapy

Vibration therapy and DOMS

Vibration therapy or percussive massage uses a mechanical oscillatory motion to provide muscular tissues a vibrational stimulus. Vibration therapy has been shown to improve range of motion, increased blood flow, and muscular strength through its effect on proprioception.

Percussive massage can help to decrease DOMS through the stimulation of large diameter fibres while suppressing the transmission of pain in small diameter fibres. Small studies have also shown that it helps with the reduction of DOMS and recovery of ROM after strenuous eccentric exercise.

Vibration therapy may also decrease the effect of DOMS by increasing proprioceptive awareness to supportive muscles for better load management. In this regard, it is theorized to have an indirect effect on reducing DOMS by decreasing eccentric loads experienced in any single muscle (by spreading the forces through supportive muscles).

It should be noted that studies investigating vibration therapy on DOMS are small and research should be considered to be in the preliminary stages. Further research will be required to verify it’s positive effect.

Massage therapy and DOMS

One systematic review and meta-analysis found that massage therapy is not only effective for alleviating DOMS but also improving muscle performance in the short term. Techniques such as Swedish massage, effleurage massage, self massage (foam rolling), and vibration were shown to be effective at reducing DOMS symptoms. There are three main proposed mechanism on how massage positively impacts DOMS:

Modulation of activity of the parasympathetic nervous system
Increase in blood and lymphatic flow to clear biochemical markers of muscle damage
Psychophysiological response in reducing pain

Massage has also shown to be a reduce of serum CK level which is used as a biomarker of inflammation and skeletal muscle damage. These findings suggest that massage therapy can decrease DOMS through its effect on the inflammation theory and muscle damage theory of DOMS (details on these theories are mentioned above). It is theorized that the clearance of serum CK levels from the circulatory system is how massage promotes muscle recovery and performance.

It should be noted that the studies included in this systematic review are considered to be of low quality. Further research is required to verify it’s positive effect on DOMS

Who can treat my DOMS

Any healthcare practitioner that utilizes massage therapy as part of their treatment can be seen for the treatment of DOMS. Clinicians including trained physiotherapists, chiropractors or sports massage therapists can provide massage therapy or vibration therapy. In addition, they can teach you how to self massage using a foam roller or massage ball for the self management of DOMS symptoms. To visit a qualified massage therapist in Markham, visit our clinic in Markham by checking in with us using the button below:

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Written by:

Dr. David Song, Chiropractor, Acupuncture Provider, Rehab Coach

References

Wilke J, Behringer M. Is "Delayed Onset Muscle Soreness" a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort. Int J Mol Sci. 2021 Aug 31;22(17):9482. doi: 10.3390/ijms22179482. PMID: 34502387; PMCID: PMC8431437.
Veqar Z, Imtiyaz S. Vibration Therapy in Management of Delayed Onset Muscle Soreness (DOMS). J Clin Diagn Res. 2014 Jun;8(6):LE01-4. doi: 10.7860/JCDR/2014/7323.4434. Epub 2014 Jun 20. PMID: 25121012; PMCID: PMC4127040.
Zainuddin Z, Newton M, Sacco P, Nosaka K. Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train. 2005 Jul-Sep;40(3):174-80. PMID: 16284637; PMCID: PMC1250256.
Guo J, Li L, Gong Y, Zhu R, Xu J, Zou J, Chen X. Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Front Physiol. 2017 Sep 27;8:747. doi: 10.3389/fphys.2017.00747. PMID: 29021762; PMCID: PMC5623674.