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Sportverletz Sportschaden. 2018 Dec;32(4):243-250. doi: 10.1055/a-0753-1884. Epub 2018 Dec 11.

Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics.

Author information

Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
Muscle Research Center Erlangen, Interdisciplinary Center for Muscle Research, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
High Performance Sports Commission, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS).
Department of Movement and Training Science, University of Wuppertal, Germany.
Department of Orthopedic, Trauma and Hand Surgery, Klinikum Osnabrück, Germany.
Department of Orthopedic and Trauma Surgery, Sportsorthopedics and Sportsmedicine, Klinikum Bamberg, Germany.
Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany.
Department of Radiology, University Hospital Erlangen, Germany.


in English, German

Delayed-onset muscle soreness (DOMS) is a type of ultrastructural muscle injury. The manifestation of DOMS is caused by eccentric or unfamiliar forms of exercise. Clinical signs include reduced force capacities, increased painful restriction of movement, stiffness, swelling, and dysfunction of adjacent joints. Although DOMS is considered a mild type of injury, it is one of the most common reasons for compromised sportive performance. In the past few decades, many hypotheses have been developed to explain the aetiology of DOMS. Although the exact pathophysiological pathway remains unknown, the primary mechanism is currently considered to be the ultrastructural damage of muscle cells due to unfamiliar sporting activities or eccentric exercise, which leads to further protein degradation, apoptosis and local inflammatory response. The development of clinical symptoms is typically delayed (peak soreness at 48 - 72 h post-exercise) as a result of complex sequences of local and systemic physiological responses. The following narrative review was conducted to present an overview of the current findings regarding the damaging mechanisms as well as the pathophysiology of DOMS and its diagnostic evaluation.


Conflict of interest statement

The authors declare that they have no conflict of interest.

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