This article has Open Peer Review reports available.
Time course of muscle soreness following different types of exercise
© Vickers; licensee BioMed Central Ltd. 2001
Received: 28 August 2001
Accepted: 23 October 2001
Published: 23 October 2001
Post-exercise muscle soreness is a dull, aching sensation that follows unaccustomed muscular exertion. Primarily on the basis of previous laboratory-based research on eccentric exercise, soreness is usually said to follow an inverted U-shaped curve over time, peaking 24 – 48 hours after exercise. As such, it is often described as "delayed-onset" muscle soreness. In a study of long-distance runners, soreness seemed to peak immediately and then reduce gradually over time. The study is a secondary analysis of clinical trial data that aims to determine whether the time course of soreness following a natural exercise, long-distance running, is different from that following a laboratory-based exercise, bench-stepping.
This is a reanalysis of data from three previous clinical trials. The trials included 400 runners taking part in long-distance races and 82 untrained volunteers performing a bench-stepping test. Subjects completed a Likert scale of muscle soreness every morning and evening for the five days following their exercise.
Interaction between trial and time is highly significant, suggesting a different time course of soreness following running and bench-stepping. 45% of subjects in the bench-stepping trial experienced peak soreness at the third or fourth follow-up (approximately 36 – 48 hours after exercise) compared to only 14% of those in the running trial. The difference between groups is robust to multivariate analysis incorporating possible confounding variables.
Soreness in runners following long-distance running follows a different time course to that in untrained individuals undertaking bench-stepping. Research on exercise taking place in the laboratory context does not necessarily generalize to exercise undertaken by trained athletes when engaged in their chosen sport.
Post-exercise muscle soreness – a dull, aching sensation following unaccustomed muscular exertion – is usually said to follow an inverted U-shaped curve over time. Typical statements found in the literature are that soreness: "develops" 24 to 48 hours after exercise  ; "is usually perceived approximately 24 hours after the exercise bout [and] may linger for an additional 24 to 48 hours"  and "peaks 24–48 hours after exercise" .
The studies above involved exercise undertaken in a laboratory setting. With rare exceptions , post-exercise soreness has not been investigated in athletes undertaking their chosen sport. Whilst conducting data analysis on a study of long distance running, we noticed that soreness seemed to peak immediately and then reduce gradually over time (see figure 1). This was a similar time course to two previous studies in long-distance runners for which we had obtained original data [11, 12]. We therefore decided to examine the hypothesis that the time course of post-exercise soreness is different for long-distance running than for bench-stepping by examining data from three clinical trials we had completed. If the time course of soreness resulting from an "artificial" laboratory based exercise (bench-stepping) is different from that resulting from a sport (long-distance running) it is plausible that these two methods of soreness induction have different physiological consequences.
We compared data from a study in which soreness was induced by a bench-stepping regime with those from a trial in which soreness resulted from long-distance running. In the bench-stepping trial, healthy volunteers undertook a 10 minute period of bench-stepping while carrying a backpack containing sandbags equivalent to 10% of their body weight. This is a previously validated method of soreness induction . Only untrained individuals were eligible. Subjects were excluded if they regularly participated in vigorous exercise in the previous six months. "Vigorous exercise" was defined as playing a sport or undertaking an activity designed to increase physical fitness; "regular participation" was defined as undertaking the activity three or more times a week for more than three consecutive weeks and for more than 15 minutes at a time. We included data from 82 subjects in two trials in which the eligibility criteria and method of soreness induction were identical . The running trial studied 400 runners expecting soreness after a long-distance run . Subjects took part in a number of different runs. Mean race length was 21.4 miles SD (7.79). The shortest race was just under 2 miles (one subject) and the longest 50 miles (one subject) but 95% of the races were between 6.2 and 26.2 miles. Approximately two-thirds of participants ran races of marathon length. The trials were approved by the joint University College London / University College London Hospital committees on the ethics of human research and written informed consent was received from participants.
In both the bench-stepping and running trials, differences in muscle soreness between treatment groups were small and did not reach statistical significance. It therefore seemed appropriate to analyze the data from each trial as a whole, ignoring treatment assignment.
The ages and total 5 day soreness scores for the two trials were compared using the Wilcoxon ranksum test. The male : female ratio of the two trials were compared using χ2.
To test the hypothesis that the time course of post-exercise soreness was different between trials, we examined three different analysis models. The purpose of doing so was to determine whether the results depended on the particular model used. In the first model, a subject was classed as experiencing delayed soreness ("DS1") if the soreness score at the third or fourth follow-up time (approximately 36 and 48 hours post-exercise) was higher than the soreness score at both the first and second follow-ups. In an alternative model, a subject was classed as experiencing "DS2" if they met any of the criteria of the first model or soreness at the second follow-up was higher than at the first follow-up. χ2 was used for differences between groups. An ANOVA was also conducted with time, trial and interaction between time and trial as co-variates. Analysis was conducted using the statistical software package STATA 6 (Stata Corporation, College Station, Texas 77840 USA). p < 0.05 was considered to be statistically significant.
Comparison of age, soreness and male : female ratio
(inter quartile range)
(inter quartile range)
n = 82
n = 400
27 (22 – 33)
42.5 (34 – 49)
p = 0.0001
Male : Female
294 : 106
χ2 = 24 p<< 0.0001
Total 5 day soreness
p = 0.02
Frequency of delayed soreness (defined in two different ways, see text) following each trial
67 / 82 (82%)
Exploratory analyses were undertaken to see whether other differences between the two trials could have been responsible for the different time course of post-exercise soreness in each. First, a sub-group analysis including runners only in races of the same length, marathon distance, continued to find differences between running and bench-stepping (χ2 = 71 p << 0.0001 for DS2). Results would be unaffected even if the sample was restricted to runners in a single race, the London marathon. Age, sex, total soreness and trial were entered into a logistic regression with DS2 as the dependent variable. Backwards stepwise regression was used where a p value of 0.05 was the criterion for keeping a variable in the model. The final model included only age and trial. The coefficient for age was small and did not substantially affect the relation between trial and DS2, which remained significant (p << 0.0001).
The time course of soreness experienced by participants in the bench-stepping trials is typical of that described in the literature. Subjects in the running trial, however, generally recorded peak soreness at the first follow-up, rather than experiencing delayed soreness. The difference in time course of soreness between the two conditions was highly statistically significant and robust to exploratory analyses of the possible effect of confounding variables.
The two trials differed in intensity, duration and nature of the exercise and the training status of the subjects. It is not possible to state definitively which of these factors or combination thereof led to the different time course of muscle soreness. However, training status seems unlikely: the inverted U time course of "delayed" muscle soreness has been reported in trained as well as untrained subjects undertaking exercises such as bench-stepping. In perhaps the only direct comparison of soreness in trained and untrained subjects , the time course for subjective soreness was remarkably similar in each group, though trained subjects experienced a smaller rise in markers of muscle damage.
It seems more likely that the type of exercise – intensity, duration or type of contraction – influences time course. Most researchers have started from the observation that soreness is most severe after eccentric contractions  and have designed regimes which involve short, intense, exhaustive, eccentric exercise, typically of a single muscle group. A typical example would be Rodenburg et al. [6, 7] who designed a complex apparatus involving a pulley system in which subjects slowly lowered a weight by elbow extension. So that subjects did not undertake exercise other than this single eccentric contraction, the weights were lifted back into place by a team of student volunteers (Rodenburg, personal communication). Long-distance running, like most forms of sporting activity, differs from the exercises used in this and other post-exercise soreness studies because it involves a large number of different muscle groups, each of which is subject to a variety of different forms of contraction. It seems plausible that short, intense, exhaustive, eccentric exercise produces physiological changes in muscle that are distinct from exercise involving mixed types of contraction taking place with less intensity over a greater period of time.
One note of caution is that the comparison between the bench-stepping and running trials was not randomized. It may be worth replicating this study as a parallel trial with randomized assignment to different forms of soreness induction. That said, there is a persuasive consistency in the results from different studies. In all three trials of long-distance running, mean soreness was highest at the first follow-up. In all of the numerous laboratory-based studies, soreness showed an inverted U-shaped curve over time.
The results of this study suggest that research in the laboratory setting does not necessarily generalize to areas in which trained athletes engage in their chosen sport. Whether there are characteristics of exercise other than the time course of post-exercise soreness that are different in laboratory and natural sports settings is for other researchers to determine. Further research might also examine the time course of objective correlates of muscle soreness, such as performance decrement, following different forms of exercise.
- Byrnes WC, Clarkson PM: Delayed onset muscle soreness and training. Clinics in Sports Medicine. 1986, 5: 605-614.PubMedGoogle Scholar
- Hasson S, Mundorf R, Barnes W, Williams J, Fujii M: Effect of pulsed ultrasound versus placebo on muscle soreness perception and muscular performance. Scandinavian Journal of Rehabilitation Medicine. 1990, 22: 199-205.PubMedGoogle Scholar
- Donnelly AE, McCormick K, Maughan RJ, Whiting PH, Clarkson PM: Effects of a non-steroidal anti-inflammatory drug on delayed onset muscle soreness and indices of damage. British Journal of Sports Medicine. 1988, 22: 35-38.View ArticlePubMedPubMed CentralGoogle Scholar
- High DM, Howley ET, Franks BD: The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. Research Quarterly for Exercise & Sport. 1989, 60: 357-361.View ArticleGoogle Scholar
- Byrnes WC, Clarkson PM, White JS, Hsieh SS, Frykman PN, Maughan RJ: Delayed onset muscle soreness following repeated bouts of downhill running. Journal of Applied Physiology. 1985, 59: 710-715.PubMedGoogle Scholar
- Rodenburg JB, Bär PR, de Boer RW: Relations between muscle soreness and biochemical and functional outcomes of eccentric exercise. Journal of Applied Physiology. 1993, 74: 2976-2983.PubMedGoogle Scholar
- Rodenburg JB, Steenbeek D, Schiereck P, Bar PR: Warm-up, stretching and massage diminish harmful effects of eccentric exercise. International Journal of Sports Medicine. 1994, 15: 414-419.View ArticlePubMedGoogle Scholar
- Clarkson PM, Tremblay I: Exercise-induced muscle damage, repair and adaptation in humans. Journal of Applied Physiology. 1988, 65: 1-6.PubMedGoogle Scholar
- Vickers AJ, Fisher P, Smith C, Wyllie SE, Lewith GT: Homoeopathy for delayed-onset muscle soreness: a randomised, double-blind, placebo-controlled trial. British Journal of Sports Medicine. 1997, 31: 304-307.View ArticlePubMedPubMed CentralGoogle Scholar
- Vincent HK, Vincent KR: The effect of training status on the serum creatine kinase response, soreness and muscle function following resistance exercise. Int J Sports Med. 1997, 18: 431-437.View ArticlePubMedGoogle Scholar
- Tveiten D, Bruset S, Borchgrevnink CF, Løhne K: Effect of Arnica D 30 after hard physical exercise – A double blind randomized control study. Tidsskrift for Den Norske Laegeforening. 1991, 11: 3630-3631.Google Scholar
- Tveiten D, Bruset S, Borchgrevnink CF, Norseth J: Effects of the homeopathic remedy Arnica D 30 on marathon runners: a randomized, double-blind study during the 1995 Oslo Marathon. Complementary Therapies in Medicine. 1998, 6: 71-74.View ArticleGoogle Scholar
- Vickers AJ, Fisher P, Smith C, Wyllie SE, Rees R: Homoeopathic Arnica 30x is ineffective for muscle soreness after long-distance running: a randomised, double-blind, placebo-controlled trial. Clinical Journal of Pain. 1998, 14: 227-231. 10.1097/00002508-199809000-00009.View ArticlePubMedGoogle Scholar
- Newham DJ, McPhail G, Mills Kr, Edward RH: Ultrastructural changes after concentric and eccentric contractions of human muscle. Journal of Neurological Science. 1983, 61: 109-122. 10.1016/0022-510X(83)90058-8.View ArticleGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/2/5/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.