by Elizabeth Kwon, SPT

The triathlon race is unique in that it combines running, swimming, and cycling requiring high amounts of endurance and strength. As the sport grows in popularity and relevance, studies have continued to ask how do best improve the performance of these athletes. Past studies have shown that exercise-induced muscle damage, which contributes to muscle soreness, is a key component in the performance of and level of muscle fatigue present in triathletes. Thus, the authors aimed to describe what is currently best-known regarding recovery from muscle soreness.

What is ‘muscle soreness’?

Delayed onset muscle soreness (DOMS), also known as exercise-induced muscle damage (EIMD), occurs when muscle fibers are overloaded during a workout thus resulting in damage to the muscle. This requires the muscle fibers to be restructured in order to be stronger, and it typically results in the feeling of soreness, stiffness, mild swelling, and less ability to generate maximum force beginning 6-12 hours after exercise that resolves within 2-3 days. Additionally, metabolic exhaustion, caused by electrolyte imbalances, dehydration, inflammation, and/or nutrition, can contribute to the severity of DOMS.

Treatments for DOMS:

Various treatments attempt to enhance recovery via several different methods including: preventing the breakdown of muscle fibers during exercise (prevent DOMS), decreasing inflammation, and/or improving recovery from DOMS.

  • Sleep
    • Increased quantity and quality of sleep is associated with better performance and less risk of injury
    • Long-term rest is more effective than short-term rest; it is better to get a good night’s sleep rather than taking power naps!
  • Compression Therapy
    • Post exercise compression therapy may speed up recovery from DOMS, particularly improvements in muscle stiffness
    • Compression therapy during exercise (intermittent) can neither be recommended or discouraged at this time; however, if an athlete feels it is beneficial to them, then it may have a positive impact.
  • Cold water immersion therapy (CWI)
    • CWI is able to enhance regeneration of the muscle fibers and is effective in reducing DOMS, especially up to 96 hours post exercise
    • It is recommended to use a water temp of 11-15 deg C for 11-15 min
  • Heat therapy
    • Evidence for heat therapy has mixed results so that heat can neither be recommended or discouraged. Post-exercise heat therapy may have a positive effect on regaining range of motion and improving muscle contraction and mass; however, heat pre-exercise may inhibit improvements in muscle mass.
    • Cold therapy is preferred for acute injuries and with inflammation, but for non-inflammatory conditions, heat can improve tissue healing.
  • Active regeneration
    • Low intensity training of 15 min of pedaling is recommended for after eccentric or high-intensity training for its potential short-term alleviation of DOMS pain, but there is limited evidence on its effectiveness
    • Stretching may be ineffective for reducing DOMS; however, there is limited data to form a conclusive decision
    • Foam rolling is effective in reducing pain with DOMS and may or may not be effective in improving performance with DOMS
  • Nutrition
    • Protein supplementation post-exercise is recommended to increase muscle regeneration
    • Branched-chain amino acids (BCAAs) are effective in improving immune response, stimulating muscle recovery, and decreasing some symptoms of DOMS.
      • A 2-3g leucine/isoleucine to 1 g valine amino acids is suggestive of best recovery
      • For masters athletes (> 40 yrs), high daily BCAAs supplementation of >200 mg/kg per day for at least 10 days may be most effective for better recovery
    • Omega 3-fatty acids can significantly reduce DOMS due to their anti-inflammatory effect and ability to reduce oxidative stress
      • It is recommended to take 1.8-3 g of omega 3-fatty acids after exercise

Overall, evidence is mixed on the efficacy of many of the treatments for DOMS and recovery can vary for each athlete depending on the individual’s body and type of sport. At Physical Therapy First, your physical therapist develops an individualized exercise plan for you that may result in DOMS and they can discuss with you the various methods for reducing post exercise muscle soreness. Talk to your physical therapist about if you are experiencing DOMS, what it means, and how you can reduce its effects; however, understand that DOMS is a normal and temporary condition that demonstrates that the muscles are getting stronger.


Hotfiel T, Mayer I, Huettel M, Hoppe MW, Engelhardt M, Lutter C, Pottgen K, Heiss R, Kastner T, Grim C. Accelerating recovery from exercise-induced muscle injuries in triathletes: considerations for Olympic distance races. Sports. 2019; 7 (143): 1-17.