When we use the term DOMS or Delayed Onset Muscle Soreness, we are referring to the post workout pain that tends to peak around the 24 to 48 hour mark.  We want to discuss the potential treatment for DOMS and recommendations for the prevention of this pain.  After reading a great, lengthy article on this subject by Paul Ingraham (painscience.com) , I will summarize some his points. 

How delayed is this muscle pain?  The muscle soreness can come on almost immediately post exercise, but tends to start the next day, particularly after sleep, when our bodies have taken a rest.  Some have reported the pain starting on the second day post exercise.  Most of us have experienced DOMS likely several times in our life and can attest to feeling the most amount of pain two days after a workout.  

The severity of DOMS can be dependent on several factors.  In most cases, when we start a new exercise regime, the first few workouts have the worst DOMS.  The repeated bout effect (RBE) is responsible for reducing the frequency of DOMS.  In other words, the more times we complete the same workout, the muscles get used to the motions and DOMS may completely go away for that particular set of worked muscles.  Obviously, as we introduce new muscle groups to workouts, more soreness may be triggered.  The type of muscle contraction can also have an effect on whether DOMS occurs.  Eccentric contractions, muscle contractions in the lengthened position, tend to bring on more DOMS than concentric contractions, muscle contractions that occur when we shorten a muscle.  An example of an eccentric contraction would be a wall squat. 
Here, you are eccentrically contracting your quadriceps muscle in its lengthened position.  So you should keep in mind that if you tend to do workouts with eccentric contractions, you may have a bit more soreness.  

The exact cause of DOMS is not known.  There are several research theories as to what and why this is happening, but again they are theories.  As muscles complete mechanical work, one of the more popular theories is that there is some kind of mechanical or metobolic stress that occurs.  The chemicals, proteins or molecules have not been identified but Pollak et al have suggested a longer lasting effect of the chemicals involved in  "the burn" of intense exercise are the culprits- specifically the protons, lactate and ATP
 all working synergistically and only all three together.  In their research, there was no change when the individual metabolites were used.  

There are several other theories as to what is structurally and chemically happening to cause DOMS.  The research in this area all have issues or have come to inconclusive results.  Some of these theories include:

·         A mild form of Rhabdomyolysis, which is a very dangerous medical emergency that results in kidney damage, and often follows very extreme workout regimes. (Yu et al 2004, Malm et al 2004)

·         Exercise causes a release of several chemicals as a result of the metabolic stress that comes along with some muscle activation resulting in DOMS

·         The pain associated with DOMS comes from inflammation of muscle tissue, (Semark et al 1999 and Mizumara, Taguchi 2016 vs Dehyle et al 2015)

·         Muscle activation during exercise causes the release of neurotrophic factors that aid in the support, growth and regeneration of nervous tissue as muscles grow in size

Treatment of DOMS

Surprisingly to me, there is no supportive research for the following commonly suggested treatments: ultrasound, ice, TENS, Epsom salts, light warm up, stretching, glutamine or arginine supplements, compression stockings, drinking extra water, or drinking cherry juice.  There are some slightly positive findings for the following treatments; however, keep in mind, the research for these treatment sources is minimal. 
Vitamin D- deficiency in Vit D has shown to produce a stronger DOMS that may last longer.  This is not a direct relationship, but is indirectly linked.  Often, Vit D has been recommended to help suppress pain in general.    
Massage - There is some research identifying massage therapy as beneficial for relieving DOMS; however, there is also lots of contradictory research that suggests massage therapy can actually cause DOMS.  Still more needs to be done in this area for good valid research with larger sample sizes.  
Curcumin- Curcumin, which is the active ingredient in Tumeric caused moderate to large pain reductions in men with very sore leg muscles.  There were also improvements in strength.  Nicol et al, 2015 produced some very promising results, and probably the best treatment option for DOMS, though the sample size was small and needs to be replicated.    
Vibration therapy - little research has been done here, but what has been done shows that vibration reduces muscle soreness and IL6, stimulating lymphocyte and neutrophil activity aiding in muscle inflammation.  
Fish oils - Improved range of motion and strength were found in this study, but there were no effects on pain.  Sample size here was also small.  
Heat - there have been a couple studies here.  One study looked at the use of a hot tub to reduce the effect of DOMS.  The results showed that the heat takes the edge off, but not a miracle cure.  The studies done with heat have had small sample sizes.  They just need to be repeated on a larger scale.  
Treatment for insomnia - Kundermann et al, 2004, sleep deprivation causes hyperalgesic changes.  As sleep is improved, reports of pain go down.  
NSAIDS or COX-2 inhibitors - use of Ibuprofen has shown to diminish the effects of pain from DOMS and does not help the diminished muscle function.  

In conclusion, there is not one single proven treatment for DOMS as the physiological processes of DOMS is still poorly understood.  There appears to be some promising treatments, all of which need further research to support their validity;, however, some of them may be able to supply you with some needed relief in the meantime.