DOMS (Delayed Onset Muscle Soreness)

Other

Overview

DOMS is a transient muscle pain syndrome occurring 24–72 hours after unaccustomed or eccentric exercise. It is self-limiting and resolves within 5–7 days without intervention.

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Medically Managed — Refer Early

This condition is primarily medically managed. Osteopathic care may play a supportive role — refer early if suspected.

Typical Presentation

Site

Localised to exercised muscle groups; commonly quadriceps, hamstrings, biceps, pectorals

Quality

Deep aching, stiffness, tenderness to palpation and movement

Intensity

Mild to moderate; peaks at 48–72 hours post-exercise

Aggravating

Active contraction, stretching, or palpation of affected muscle

Relieving

Rest, light movement, heat, time

Associated

Temporary strength reduction, reduced ROM, mild swelling

⚠ Red Flags

  • •Dark or cola-coloured urine following intense exercise suggesting rhabdomyolysis — urgent medical referral
  • •Severe weakness disproportionate to exercise load
  • •Symptoms persisting beyond 10–14 days without resolution

⚡ Yellow Flags

  • •Excessive exercise as compensatory behaviour suggesting disordered relationship with exercise or eating
  • •Avoidance of all physical activity due to fear of recurrence

Referral Criteria

  • •Emergency referral if rhabdomyolysis suspected (dark urine, severe pain, weakness)
  • •GP referral if symptoms persist beyond 2 weeks without improvement