Have you ever worked out, felt great but been hit with incredible soreness a couple days later? You’ve experienced DOMS: delayed onset muscle soreness. It’s a phenomenon many athletes, fitness enthusiasts and those just beginning to work out will face.

Delayed onset muscle soreness simply refers to the normal muscle discomfort that develops 24-48 hours after vigorous physical activities to which your body is not accustomed. DOMS typically peaks approximately one to three days after exercising and then begins to lessen gradually.

Exercise causes micro-tears in the muscle fibers being exercised. Such tears can be more common when a muscle has not been challenged in a while. The micro-damage from the strenuous activity causes stimulation of pain receptors within the muscle tissue, resulting in DOMS.

Research suggests there are some types of exercises that are more likely to result in DOMS:

• New activities or exercise programs which have not previously engaged dormant muscle groups
• Eccentric exercises that include, but are not limited to, exercises such as squats, push-ups and pull-ups
• High-intensity exercises that include, but are not limited to, exercises such as burpees, mountain-climbers and jumping jacks

Although there is variability in the sensation, DOMS is a good reminder for your body. Stronger pain intensity can tell your body to tone down the power and rest before returning to similar activity.

If the soreness is mild, you can continue to run with DOMS. Though it may seem counterintuitive, moving and continuing exercise can help lessen the pain and ease the stiffness. I recommend recovery runs of mild to moderate intensity and avoid sprints and high-intensity interval training (HIIT) while recovering from DOMS. 

You should rest in the case of severe pain and stick with lower impact activities such as cycling, swimming or walking instead of running during a DOMS recovery period.

Read: How to Treat an Achilles Tendon Tear

DOMS is treated by what we physicians call a “tincture of time.” One must allow the body to heal itself and recover over time. It is recommended you do gentle exercises and activities to ease symptoms and avoid high-intensity movements or strenuous lifting. Though controversial, some studies support massages or foam-rolling within days of intense exercising to lessen soreness associated with DOMS. Topical analgesics may also help ease symptoms. These medication types include NSAID ointments applied to the skin or natural anti-inflammatory creams such as arnica.

Elite athletes often use cold baths—commonly referred to as cryotherapy—immediately after intense games, practices or training sessions to stave off DOMS development. However, there is no definitive proof to support whether cryotherapy truly helps accomplish this goal.

You can prevent severe DOMS by gradually increasing the intensity of whatever exercise you’re engaging in over time, instead of quick, sudden or intense changes in your activity.

It is crucial to distinguish between pain from an orthopedic or musculoskeletal injury and DOMS. The easiest way to do this is to consider the development of pain. Was it sharp and acute after a specific movement? If the answer is yes, this might signal an injury rather than DOMS, which features a soreness delay.

If there was a delay in your pain or discomfort, is pain severity improving over time? With DOMS, the pain will gradually lessen within a few days. However, with an orthopedic injury, the associated pain can often increase or remain the same over time, rather than abating. Knowing how to tell the difference is essential. Pay close attention to your body and be sure to alert your healthcare provider about any pain that hasn’t resolved or is worsening over time.

Take time to consult your physician about your workout regimen and how to prepare for the inevitable muscle soreness that will follow. Once you have a game plan in place, you can tackle your goals…one step at a time.