Not sure why you hurt? Could be delayed onset muscle soreness…

Have you ever had the experience where something suddenly starts hurting – your back, or ankle, or hand – and you would swear you have no idea why it’s hurting?

This is a very common scenario…

I’ve had patients come in saying they had been fine and then all of a sudden their back went out, or they started limping, or their wrist felt sore or they have a weird catch under their shoulder blade. When I ask what happened, the reply is usually “I have no idea!”

Very often, it’s a delayed effect called Delayed Onset Muscle Soreness (DOMS), though I like the more poetic term “muscle fever”.

This is a pain or soreness that you don’t feel immediately. It appears 24 to 48 to 72 hours after the activity that triggered it.

[Note: I am not talking about strains, sprains, and severe muscle issues like rhabdomyolysis where you also feel sick – these all require medical evaluation.]

Patient Scenario

Here’s a sample conversation with a patient who comes in on a Tuesday with a surprise new hamstring pain:

What triggered the pain? I have no idea!
What were your activities like yesterday (Monday)? Nothing, I just went to work like normal.
How about Sunday, what did you do that day? I mowed the grass but that was no different than usual.
What did you do Saturday? Ohhhh, I remember now – I was up and down a stepladder washing the windows.
Do you normally wash windows on Saturdays? Oh no, that’s once a year if I feel motivated.

I can’t say 100% for sure, but most likely this patient’s hamstring pain was brought on by washing the windows three days ago. It was an unusual activity for her, requiring muscle movements that are not part of her normal daily routine.

How do you know it’s Delayed Onset Muscle Soreness?

It’s often a surprise pain that you didn’t expect, having recently used muscles in a way that is not your norm.

It can feel differently for each person – soreness, tightness, stiffness, “locked up” feeling, catch-y, spasm-y. Many describe it more like a “muscle workout pain”, rather than a sharp, burning, or electric pain.

Why does Delayed Onset Muscle Soreness happen?

When we use a muscle, especially in a new or more intense way, little tiny micro-traumas happen to the muscle and it can get inflamed. It’s not a major injury that you feel right away. Instead it builds up slowly over time and peaks at the 24-48-72 hour window.

There are lots of articles online describing in great detail what actually happens to the muscle – you can search these easily if you want to learn more about it.

Common Trigger Activities

Sudden increase in exercise intensity, like starting a new-to-you bootcamp class.

“Weekend warrior” type activities, like a hilly hike or playing sports with the family.

Outdoor projects/indoor remodeling, like bending over planting a garden or painting your living room.

What should I do about Delayed Onset Muscle Soreness?

If it’s truly from DOMS and not a more serious injury, it should resolve on its own within a week.

If it’s hanging around longer than you want it to, schedule an acupuncture treatment.

Home remedies and common sense come in handy here.

Don’t repeat the activity until the muscle settles down.

Try topical creams (in the clinic I use Deep Blue Rub and Evil Bone Water – both are available at the front desk if you want to get one for home use).

Try an Epsom soak/bath.

Gentle massage or gentle foam rolling can also help.

These are just general ideas – stop if anything hurts more, don’t make it worse.

Can I prevent Delayed Onset Muscle Soreness?

Maybe not completely, but some tips will help…

Warm up: Even if you’re just going outside to weed a flowerbed, do a light warmup just like an exercise class. A few minutes of walking with some gentle dynamic stretches.

Take breaks: Watch how long you are in the same position without taking a break. Don’t push longer, thinking “just a little more, I’m almost done.”

Topicals: If you are prone to stiffness/soreness, apply a topical cream like Deep Blue BEFORE the activity, as well as after.

Hydrate: Dehydrated tissues are inflamed tissues and when you’re busy in an activity you might forget how long it’s been since you’ve had some water.

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