Why do my legs hurt most after a new or downhill session?
Unaccustomed, mostly eccentric work brings delayed soreness; this 2003 review lists six proposed causes, expects several together and advises 1-2 easier days (C+, abstract).
Cheung, Hume and Maxwell reviewed what was known by 2003 about delayed-onset muscle soreness: why it happens, how it affects performance and what treats it.
In their account DOMS ranges from tenderness to severe pain, is most frequent when athletes return to training after a lay-off at the start of a season or meet a new kind of activity at any time of year, and follows eccentric work more often and more severely than other muscle actions, with intensity and duration also mattering.
They list up to six proposed explanations — lactic acid, muscle spasm, connective-tissue damage, muscle damage, inflammation and enzyme efflux — and judge that a combination of two or more is the likely answer.
DOMS, they write, reduces joint range of motion, shock attenuation and peak torque, and may change muscle sequencing and recruitment so that ligaments and tendons take unaccustomed stress, raising injury risk if an athlete returns too early.
On treatment: anti-inflammatory drugs showed dose-dependent effects that may depend on timing; massage gave mixed results depending on timing and technique; cryotherapy, stretching, homeopathy, ultrasound and electrical current showed no effect on soreness; exercise relieved the pain best, but only temporarily.
Their advice: after intense DOMS-inducing exercise, cut intensity and duration for one to two days or train less affected body parts, and introduce eccentric or novel exercise progressively over one or two weeks.
Our reading: a sound general picture of when DOMS appears and why its cause is unsettled, but the treatment verdicts are dated — later meta-analyses in the base found cold-water immersion, cryotherapy and above all massage reduced DOMS (REF-385, A; REF-250, A), while stretching did not (REF-385) — and the abstract gives no time course in hours or days; that comes from REF-1347.
Protocol
Key Results
The authors' conclusions by topic (abstract; no numbers are given), with how the base stands on each today:
| Topic | What the abstract says (the authors' synthesis) | Where the base stands now |
|---|---|---|
| When DOMS appears | most common at the start of a season after reduced activity, and on first exposure to certain activities at any time of year | consistent with REF-660 (least accustomed suffer most) and REF-1347 |
| Type of work | eccentric actions cause micro-injury more often and more severely than other actions; intensity and duration also matter | consistent with REF-704, REF-1347 |
| Cause | up to six proposed theories — lactic acid, muscle spasm, connective-tissue damage, muscle damage, inflammation, enzyme efflux; probably two or more combined | still debated; REF-1347 (2019) favours inflammatory sensitisation of nerve endings (nerve growth factor, GDNF) and also lists lactic acid only as a proposed hypothesis |
| Performance | lower joint range of motion, shock attenuation and peak torque; altered muscle sequencing and recruitment may stress ligaments and tendons; injury risk on a premature return | strength loss confirmed as the best indirect marker (REF-1351, REF-1347); in cycling, damage lowered sprint and peak power but not time trials (REF-701) |
| Anti-inflammatory drugs | dose-dependent effects, possibly depending on when they are taken | REF-1347 advises against them in healthy people; kidney and gut risks in REF-892, REF-983 |
| Massage | varying results, attributed to timing and technique | overtaken: most effective technique for DOMS in a meta-analysis of 99 studies (REF-385, A) |
| Cryotherapy | no effect on soreness or other DOMS symptoms | overtaken: cryotherapy and immersion reduced DOMS (REF-385, A); one cold-water immersion lowered soreness at 24 h, not strength recovery (REF-250, A) |
| Stretching, homeopathy, ultrasound, electrical current | no effect | stretching and electrostimulation: no change in REF-385 (agrees) |
| Exercise | the most effective means of relieving DOMS pain; the effect is temporary | no newer entry tests this |
| Advice | 1-2 days of reduced intensity and duration after intense DOMS-inducing exercise, or work on less affected body parts; introduce eccentric or novel exercise over 1-2 weeks | recommendations, not tested here; consistent with the repeated-bout effect (REF-549, REF-1297) |
Mechanisms
Practical Application
Limitations
How this entry was checked and changed
a narrative review without a stated systematic method, from a sports-science school (Auckland University of Technology) that is not one of the field's leading muscle-damage laboratories; it is widely cited, which the rubric does not count. Read from the abstract only: there is no Europe PMC copy and OpenAlex lists no repository copy. Two of its treatment verdicts (cold, massage) are contradicted by later meta-analyses in the base (REF-385, REF-250)