Exercise can cause muscle pain for a number of reasons. Usually the pain is experienced during the exercise and recovers rapidly afterwards. There is one type of muscle pain that has a very different and characteristic time course. In this situation the exercise itself, and the immediate post-exercise period are painfree. The pain is not felt for about eight hours and is maximal 1 or 2 days later. Delayed onset muscle pain occurs after unaccustomed, high force contractions and is particularly associated with eccentric contractions. The concensus of opinion is that the pain is caused by some form of damage, but the mechanism for the pain is not known. This review summarises the literature on the consequences of eccentric contractions and relates them to delayed onset muscle pain. There is clear evidence of damage to the muscle fibres themselves, their membranes and, at a later stage, mononuclear cell infiltration, but all these have very different time courses and none are the same as the pain. Intramuscular pressures are raised in some, but not all, painful compartments and even when raised follow a different time course to the pain. Anti-inflammatory agents do not affect the pain, but due to the incomplete understanding of the action of these drugs, the role of inflammation in delayed onset muscle pain is uncertain. Despite the considerable evidence of damage after eccentric contractions, the cause of delayed onset muscle pain is still unknown.