Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. However, an integration of two or more theories is likely to explain muscle soreness. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. The intensity and duration of exercise are also important factors in DOMS onset. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. Symptoms can range from muscle tenderness to severe debilitating pain. Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete.
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