Muscle Soreness (DOMS): who to see and what helps

Muscle Soreness (DOMS) · Kitchener, Waterloo & Cambridge

Delayed onset muscle soreness, or DOMS, is the ache and stiffness that builds a day or two after exercise your muscles were not used to. It goes away by itself and rarely lasts more than five days. Of the recovery methods that have been tested, massage has shown the largest effect on soreness, in trials that were small and of low quality. Muscle pain that is more severe than you would expect, being too weak or tired to finish a workout you could manage before, or dark urine is different: call 911 or go to an emergency department. For help with ordinary soreness, start with a Registered Massage Therapist.

What DOMS is

DOMS is muscle pain that follows intense exercise. Researchers describe it as temporary muscle damage. The exact mechanism remains unclear; the leading theory is mechanical damage to muscle fibres during the exercise, followed by inflammation.

What causes it

Working muscles harder than they are used to. Exhaustive or unaccustomed exercise does it, most of all exercise built on eccentric contractions, where a muscle is working while it lengthens. Starting a new sport or workout is the classic set-up. Here that might be the first week back at the gym in January, or the first heavy snowfall of the winter and a long driveway to clear.

Symptoms

• Soreness in the exact muscles you worked, not all over
• No pain during the exercise itself: it builds over several hours and usually starts within the first day, sometimes not for two or three
• A peak between 24 and 72 hours after the exercise
• Muscles that are tender to touch and stiff, with less range of movement
• Sore muscles that feel weaker than usual, and are sometimes a little swollen

Soreness, a strain or a knot?

Timing separates them. DOMS is not felt while you exercise and fades within days. Pain that is sharp and constant, or soreness that lasts a week or more, may be an injury such as a muscle strain: see Muscle Strains & Bruises. For a tender knot in a muscle, see Myofascial Pain Syndrome & Muscle Knots.

When muscle soreness is an emergency

Rarely, hard exercise damages muscle badly enough that its contents spill into the blood. This is rhabdomyolysis, and it is a medical emergency that can damage the kidneys. A second emergency, acute compartment syndrome, is a rise in pressure inside a muscle that restricts its blood flow. Call 911 or go to an emergency department right away, and do not drive yourself, if after exercise you have any of these:

• muscle cramps, aches or pains that are more severe than you would expect
• dark urine, the colour of tea or cola, or blood in your urine
• feeling weak or tired to the point that you cannot finish a workout you could manage before
• severe swelling around a muscle
• sudden, severe pain in a muscle: it may be worse when the muscle is stretched and may come with swelling, tightness, numbness, weakness, pins and needles or difficulty moving the area, but the pain alone is reason enough to go
• nausea and vomiting, a fever or a racing heart along with sore muscles

Stop the activity and drink more liquids, preferably water, while you get to care, without letting either delay you: that is the advice of the U.S. Centers for Disease Control and Prevention for anyone with signs of rhabdomyolysis.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

The signs of rhabdomyolysis may not begin until hours or days after the exercise, and dehydration and heat cramps can cause the same symptoms. Repeated blood tests are the only accurate way to tell, so this cannot be judged at home or at an appointment with us. Treated right away, most people make a full recovery. The risk is highest when someone abruptly and greatly increases their activity; hot or humid weather and dehydration add to it.

If soreness lasts more than a week, feels sharp and constant, or does not improve with rest, have it checked by a physician, a nurse practitioner or a physiotherapist. See a physician or nurse practitioner if you keep getting pain, numbness, swelling or difficulty moving a part of your body when you exercise, even if it goes away when you rest. They can help find out whether the cause is chronic compartment syndrome, the form that comes on gradually, or another condition.

What the evidence says about treating DOMS

• It clears up without treatment. Everything below is about being more comfortable while it does.
• Massage: the largest effect, on weak trials. A 2017 meta-analysis of 11 trials (504 participants) found that massage after strenuous exercise reduced soreness at 24, 48 and 72 hours, most at 48 hours. Its authors rated the quality of every trial as low, and in none could participants be blinded to whether they had a massage.
• How massage compares. A 2018 review of 99 studies of recovery techniques found that massage seems to be the most effective for soreness and perceived fatigue, with an effect still measurable 96 hours after exercise. It could not rule out a placebo effect. A 2020 review of sports massage put the improvement in soreness at 13% across 10 studies (311 participants), and noted that a single outlying study drove that figure.
• Compression, cold water and active recovery: smaller effects. In the 2018 review, compression garments, active recovery, cold-water immersion at 15°C or below, contrast baths and cryotherapy each reduced soreness by less than massage did. Warm-water immersion and electrical stimulation made no significant difference.
• Stretching does not prevent it. A Cochrane review of 12 studies concluded that stretching before exercise, after it, or both does not produce clinically important reductions in soreness: about one point or less on a 100-point scale a day later.
• Acupuncture: conflicting. A 2020 review found five trials (182 participants). Three favoured acupuncture over no treatment and two found no significant difference; the authors call the evidence “conflicting to limited”.

How each CARESPACE service treats muscle soreness

Massage Therapy

A Registered Massage Therapist can massage the muscles you worked. The trials mostly used Western massage strokes for six to 30 minutes after hard exercise, and found the benefit greatest about two days later. That makes massage a reasonable choice after an event or a punishing session, with the reminder that the soreness would also have gone without it.

See our massage therapy team →

Physiotherapy

Soreness that does not behave like DOMS may be an injury. If soreness lasts more than a week, feels sharp and constant, or does not improve with rest, have it checked by a physician, a nurse practitioner or a physiotherapist. Pain that came on during the exercise itself is not DOMS either. A physiotherapist can test the muscle for a strain and start treating it at the first visit.

See our physiotherapy team →

Kinesiology

The standard advice for preventing soreness is not to rush into new workouts and to avoid sudden, large increases in a fitness program. If you are sore after most sessions, a kinesiologist can set that progression: how much to add each week, and how to bring in new exercises gradually.

See our kinesiology team →

Other services people ask about

Acupuncture: the one review we read calls the evidence conflicting to limited, so it has no section here.

Where most people start

Most people with DOMS need no appointment. If you want help with it, start with a Registered Massage Therapist. If soreness lasts more than a week, feels sharp and constant, or does not improve with rest, have it checked by a physician, a nurse practitioner or a physiotherapist. If any emergency sign fits, call 911 or go to an emergency department.

How your team works together

This is mostly a one-service problem. Massage therapy covers the soreness itself; a kinesiologist comes in only when the training plan is what keeps causing it, and a physiotherapist when it may be an injury.

Browse by service: registered massage therapists, physiotherapists and kinesiologists.

What to expect at your first visit

1. What you did. You may be asked about the session or event, when the soreness began and what training is coming up.
2. Which muscles. Where it is tender, and how freely the area moves.
3. A plan to leave with: which muscles to treat, and how to time massage around your training.

What you can do at home

• Rest the sore muscles from intense exercise; everyday movement is fine, and gentle movement can help loosen them.
• Use heat for stiffness or cold for pain.
• Try a foam roller on the sore muscles.
• Drink enough fluids.
• Ask a pharmacist about over-the-counter pain relief.

To make the next bout milder: build new workouts up gradually, warm up with a few minutes of light cardio, and cool down instead of stopping abruptly. In the heat, give yourself time to acclimatize, stay hydrated, and do not train hard when you are sick.

How long DOMS lasts

It starts within one to three days of the exercise, peaks between 24 and 72 hours, and rarely lasts more than five days. Soreness that goes on for a week or more is a reason to have the muscle checked. It can return whenever you ask your muscles for something they are not used to.

Muscle soreness treatment in Kitchener, Waterloo and Cambridge

Kitchener. Massage Therapy in Kitchener, Physiotherapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Massage Therapy in Waterloo, Physiotherapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Locations: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Should I work out when I’m sore?

Everyday movement is fine, and moving the sore muscles can help loosen them. Try to avoid intense exercise with those muscles while they are sore.

Does stretching prevent sore muscles?

No. A Cochrane review found that stretching before or after exercise makes little or no difference to soreness. Its largest study, of about 2,300 people, found a reduction of about four points on a 100-point scale over a week, which the reviewers call very small.

Ice bath or hot bath?

Cold water, at 15°C or below, had a measurable effect on soreness in the trials, smaller than that of massage; warm water did not. Heat can still ease stiffness.

How do I know it is DOMS and not rhabdomyolysis?

You cannot be certain at home, because only blood tests can tell. Treat pain that is more severe than you would expect, being too weak or tired to do what you normally can, and dark urine as an emergency.

Where can I get help with muscle soreness in Cambridge?

Book Physiotherapy in Cambridge, or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Guo J, Li L, Gong Y, et al. Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 2017.
• Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology, 2018.
• Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine, 2020.
• Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews, 2022, Issue 4 (an update of a 2007 review; its searches ran to 2010).
• Ko GWY, Clarkson C. The effectiveness of acupuncture for pain reduction in delayed-onset muscle soreness: a systematic review. Acupuncture in Medicine, 2020 (abstract).
• Cleveland Clinic. Delayed Onset Muscle Soreness (DOMS). Reviewed December 2025.
• National Defence, Government of Canada. Ask the Expert: Exertional Rhabdomyolysis: what’s that? The Maple Leaf, June 2024.
• HealthLink BC. Rhabdomyolysis. Current as of March 2023.
• U.S. Centers for Disease Control and Prevention (NIOSH). Rhabdomyolysis: signs and symptoms and about rhabdomyolysis. Published May 2024; the signs and symptoms page was updated in October 2026.
• NHS. Compartment syndrome. Reviewed September 2026.

Related conditions

Sports Injuries & Return to Sport

Hamstring Strain & Tendinopathy

Calf Strain

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