Muscle Tension & Soreness

Muscle Tension & Soreness

1. Definition and Overview

Muscle tension and soreness encompass a spectrum of related but mechanistically distinct phenomena affecting skeletal muscle. At one end of this spectrum is delayed onset muscle soreness (DOMS), a well-characterised, self-limiting condition arising from unaccustomed or high-intensity physical exertion. DOMS has a number of features that distinguish it from other forms of muscle pain. At the other end lies chronic or psychophysiological muscle tension, in which resting muscle tone is persistently elevated without a discrete exercise trigger. Both states engage overlapping biological systems but differ in their initiating causes, time courses, and tissue-level changes.

DOMS is a sensation of discomfort that occurs 1 to 2 days after exercise; the soreness has been reported to be most evident at the muscle–tendon junction initially, and then spreading throughout the muscle. Clinically, DOMS is characterised by localised muscle tenderness, stiffness, and pain, typically arising 24–72 hours following eccentric or high-intensity exercise. Cardinal signs and symptoms of DOMS are pain, decreased range of motion, decrease in muscle strength, and change in biochemical markers.

Muscle tension, in the broader sense, refers to a sustained or increased state of contractile or passive resistance within skeletal muscle fibres. The accompanying sensation of muscle stiffness is the result of a damage-related rise in passive tension within the muscle. In psychophysiological contexts, chronic pain may be associated with muscle tension, and muscle tension and stiffness may also contribute to pain in the shoulder, neck, upper back, hips, upper and lower legs, and feet.

2. Body Systems Involved

2.1 The Musculoskeletal System

The striated skeletal musculature accounts for 30 to 50% of the total body weight, depending on constitution, age, and gender. Skeletal muscle is the primary tissue affected in both DOMS and tension states. Frequently cited mechanisms of DOMS are "mechanical strain" and "metabolic overload" within the muscle structure; the inflammation associated with DOMS is caused by eccentric exercise-induced muscle damage. Coupled with the inflammatory process in laboratory tests is an elevation of damage and inflammation markers such as creatine kinase (CK), lactate dehydrogenase (LDH), interleukin-6 (IL-6), pentraxin-3 (PTX-3), and C-reactive protein (CRP).

2.2 The Nervous System

Muscle pain is produced by the activation of specific receptors called nociceptors, which consist of free nerve endings connected to the central nervous system by way of unmyelinated (group IV) or thinly myelinated (group III) fibres. They can be sensitised and activated by strong mechanical stimuli, such as trauma or mechanical overloading, as well as by endogenous inflammatory mediators including bradykinin, serotonin, and prostaglandin E2. Two activating chemical substances are particularly important for the generation of muscle pain: adenosine triphosphate (ATP) and protons (H⁺ ions); these chemical irritants activate nerve endings by binding to receptor molecules located in the membrane of the nerve ending.

In someone unaccustomed to eccentric exercise, localised areas of damage develop in muscle fibres; the present-day view is that the inflammatory response triggered by the damage leads to sensitisation of muscle nociceptors. It has led to the view that DOMS is a type of hyperalgesia and is distinct from other kinds of muscle pain such as myositis, where there is typically some chronic pain associated with tonic activity in nociceptors.

2.3 The Immune and Inflammatory System

It is possible that the inflammatory response may be responsible for initiating, amplifying, and/or resolving skeletal muscle injury; evidence from the literature includes the involvement of cytokines, complement, neutrophils, monocytes, and macrophages in the acute phase response. Within 12 hours of the initial damage, cellular infiltration of neutrophils is followed by monocytes, lymphocytes, granulocytes, and interleukins; further damage to cellular structures is caused by free radicals produced by infiltrated monocytes and calcium-stimulated proteases such as calpains.

Historically, DOMS was attributed to lactic acid accumulation; however, this theory has been refuted. Current evidence highlights microtrauma, inflammation, and nociceptor sensitisation as primary mechanisms. Current evidence supports a multifactorial pathophysiology involving myofibrillar microdamage, inflammatory cascades, and oxidative stress.

2.4 The Endocrine and Psychoneuroimmune Systems

Muscle tension of non-exercise origin involves the psychoneuroimmune axis. Research has revealed a positive medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Pain and poor sleep are common co-occurrences; short-term insufficient sleep has been associated with short-term manifestations of pain, stress, depression, and anxiety, while long-term sleep problems can result in inflammation, dyslipidaemia, and hypertension.

3. Contributing and Associated Factors

3.1 Type and Volume of Physical Activity

The muscle activity which causes the most soreness and injury to the muscle is eccentric activity. Eccentric contractions — in which a muscle is loaded while lengthening — generate disproportionately high mechanical forces per muscle fibre relative to concentric movements, making them the principal initiating factor in DOMS. Although the exact causal mechanism has not yet been precisely clarified, the mechanical load influence that exceeds the ultrastructural load capacity is assumed as the primary damaging mechanism, more so than the theory of metabolic stress. The term DOMS refers to a complex injury entity which is based on ultrastructural injury patterns; the injury is usually harmless and heals within a few days without sequelae, but at the time of manifestation there are sometimes considerable performance limitations and the risk of possible secondary injuries is increased.

3.2 Hydration Status

A dehydrated individual who performs eccentric exercise may exacerbate skeletal muscle damage, leading to structural, contractile, and enzymatic protein denaturation, in addition to the myofiber and connective damage resulting from the eccentric muscle tension. Osmotic shifts resulting from dehydration during exercise may therefore worsen DOMS outcomes, though well-powered studies on this specific interaction remain limited.

3.3 Psychological Stress and Mental Load

Psychological stress is an independent contributor to elevated muscle tension, particularly in the neck, shoulder, and lower back regions. High demands at work, minimal control of working conditions, little support from colleagues and superiors, and a seriously compromised employee sense of righteousness cause stress-related problems, resulting in poor health and reduced working capacity. Research has documented that mental stress causes muscle tension and is associated with musculoskeletal pain.

In clinical populations, tension-type headache is one of the most prevalent headache disorders worldwide; previous research suggests a potential link between myofascial factors such as trapezius muscle stiffness and headache severity. Increased trapezius muscle stiffness positively correlates with greater headache severity in tension-type headache patients.

3.4 Sleep Quality and Deprivation

DOMS mimics aspects of chronic pain, predominantly affecting peripheral pain mechanisms, while experimental sleep provocations have been shown to impact central pain mechanisms. In patients with chronic pain, poor quality of sleep is associated with increased pain intensity, spreading of pain, and pain-related disability. Sleep deprivation has also been associated with elevations of oxidative stress biomarkers and impaired muscle recovery.

3.5 Training Status and the Repeated-Bout Effect

Individuals unaccustomed to a particular movement pattern are substantially more susceptible to DOMS than trained individuals performing the same task. This is explained by the "repeated-bout effect," a well-established adaptation whereby a single bout of eccentric exercise confers relative protection against DOMS from subsequent similar bouts. Clinically, DOMS is a common but self-limiting condition that usually requires no treatment.

4. Nutrients, Herbs, and Natural Ingredients

4.1 Magnesium

Traditional Use

Magnesium has been used historically in hydrotherapy (Epsom salt baths, composed of magnesium sulphate) as a folk remedy for aching muscles and recovery from physical labour across European and North American traditions. Oral supplementation with magnesium-rich mineral waters was also a long-standing practice in European spa medicine.

Scientific Evidence

Magnesium is a micronutrient and an intracellular cation responsible for different biochemical reactions involved in energy production and storage, control of neuronal and vasomotor activity, cardiac excitability, and muscle contraction; magnesium deficiency may result in impaired physical performance; moreover, magnesium plays an important role in delayed onset muscle soreness after training.

A 2024 systematic review (PROSPERO-registered, CRD42024501822) identified four human intervention studies meeting eligibility criteria and found that magnesium supplementation reduced muscle soreness, improved performance, recovery, and induced a protective effect on muscle damage; to reach these positive effects, individuals engaged in intense exercise should have a magnesium requirement 10–20% higher than sedentary people, to be taken in capsules and 2 hours before training. However, the review was based on only four qualifying studies, which is a notable limitation. Clinical studies have shown that magnesium supplementation can improve muscle mass, respiratory muscle strength, and exercise recovery, and reduce muscle soreness and inflammation in athletes and patients with various conditions.

For muscle cramps specifically, a Cochrane-style systematic review found that there is moderate-quality evidence that magnesium supplementation does not offer a clinically important benefit over placebo in the prophylaxis of idiopathic cramps in older adults. For women suffering pregnancy-associated rest cramps the literature is conflicting and unclear; no RCTs evaluating magnesium for exercise-associated muscle cramps have been conducted.

Regarding pain mechanisms, magnesium plays an important role in the prevention of central sensitisation and in the attenuation of established pain hypersensitivity; its main mode of action appears to involve its voltage-gated antagonist action at NMDA receptors, and it has been investigated in various clinical conditions associated with acute or chronic pain. Numerous clinical studies have found that magnesium has beneficial effects in patients suffering from neuropathic pain, dysmenorrhea, tension headache, and acute migraine attack; these effects are considered to be due to blockage of the NMDA receptor, attenuation of central sensitisation, and muscle-relaxing effects. Evidence for magnesium specifically in exercise-induced DOMS in healthy active adults is of moderate quality and based on a small number of trials; optimal forms and dosing remain uncertain.

4.2 Tart Cherry (Prunus cerasus, Montmorency Cherry)

Traditional Use

Tart cherries have been consumed in European folk traditions for centuries as food and for their purported anti-inflammatory properties. Montmorency (sour) cherries were used as culinary medicine in Central European herbal traditions. Concentrated juice preparations for recovery purposes are a relatively modern development with origins in sports nutrition research from the early 2000s.

Scientific Evidence

Exercise-induced muscle damage is known to impair neuromuscular performance, provoke inflammation, and delay recovery; tart cherry juice, a polyphenol-rich nutritional product, has been proposed as a strategy to support recovery in athletes, however findings across studies remain inconsistent.

A 2026 systematic review and meta-analysis following PRISMA 2020 guidelines searched PubMed, ScienceDirect, Web of Science, and SPORTDiscus from inception to December 2025 and included 19 trials. Results revealed that tart cherry juice supplementation significantly improved maximal voluntary isometric contraction (MVC) recovery across all time points (post: ES = 0.63; 24 h: ES = 1.12; 48 h: ES = 1.29; 72 h: ES = 2.14; 96 h: ES = 4.82), with substantial heterogeneity (I² 69–93%). A separate 2025 systematic review and meta-analysis found that tart cherry juice supplementation significantly improved MVIC (weighted mean difference = 9.13%, 95% CI 6.42–11.84) and decreased IL-6 and IL-8 levels. Some clinical trials have shown a significant reducing effect of tart cherry juice supplementation on some markers of exercise-induced muscle damage, while others did not find any significant effect. Heterogeneity across studies is substantial, and most trials are conducted in trained athletes, limiting generalisability. Of the compounds reviewed in the broader literature, tart cherry and omega-3 fatty acids have the most compelling evidence for their use in the context of exercise-induced muscle damage and soreness.

4.3 Curcumin / Turmeric (Curcuma longa)

Traditional Use

Ginger rhizomes and related Zingiberaceae plants have been used in Asia for the treatment of asthma, diabetes, and pain, and have shown potent anti-inflammatory attributes. Turmeric (Curcuma longa) has an extensive history of use in Ayurvedic medicine in South Asia and in Traditional Chinese Medicine, where it has been employed for over 4,000 years for inflammatory and pain conditions, as a paste, decoction, or spice preparation. The rhizome is also central to the culinary traditions of India, Southeast Asia, and the Middle East.

Scientific Evidence

Curcumin is a polyphenol derived from the Curcuma longa L. (turmeric) plant and has gained attention through its perceived anti-inflammatory characteristics; the potential interaction with exercise-induced muscle damage and DOMS has led to investigation of curcumin as a post-exercise strategy that may have the potential to lessen acute reductions in functional strength following physical activity.

A 2022 systematic review and dose-response meta-analysis identified 10 eligible RCTs and reported that curcumin supplementation significantly reduced serum CK activity (WMD = −65.98 IU/L), muscle soreness (WMD = −0.56), and TNF-α concentration (WMD = −0.22 pg/ml); additionally, curcumin supplementation elicited significant improvements in maximal voluntary contraction and range of motion, although no significant changes in IL-6 and IL-8 levels were found. Curcumin supplementation may improve some aspects of DOMS, including muscle damage, muscle soreness, inflammation, muscle strength, and joint flexibility.

An earlier double-blind, randomised controlled crossover trial in 17 men found that at 24 and 48 hours post-exercise, curcumin caused moderate-to-large reductions in pain during single-leg squat (VAS scale −1.4 to −1.7), with an associated small increase in single-leg jump performance. Oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance; further study is required on mechanisms and translational effects on sport or vocational performance.

A 2025 randomised, double-blind, placebo-controlled crossover trial in 44 moderately active adults found that turmeric may alleviate exercise-induced muscle soreness and muscular function loss due to the strong anti-inflammatory and antioxidant activities of its active compounds, the curcuminoids. A key limitation across most curcumin trials is that standard curcumin has very low oral bioavailability, meaning that many positive results are observed specifically with enhanced or phospholipid-complex formulations. In human trials, curcumin supplementation — especially with bioavailability-enhanced preparations — consistently attenuated post-exercise increases in muscle-damage and inflammatory markers and improved recovery metrics. Overall, the evidence for curcumin in DOMS is promising but limited by small sample sizes, variability in formulations, and heterogeneous exercise protocols.

4.4 Omega-3 Polyunsaturated Fatty Acids (EPA and DHA)

Traditional Use

Diets rich in cold-water fatty fish have historically been associated with low rates of inflammatory disease in Arctic and coastal populations (e.g., Inuit, Japanese fishing communities). Fish liver oils were used in Northern European folk medicine for joint and muscle conditions from at least the 18th century. Cod liver oil was formalised as a nutritional supplement in 19th-century Europe.

Scientific Evidence

Omega-3 is a family of n-3 polyunsaturated fatty acids which have been used to treat a wide variety of chronic diseases, due mainly to their antioxidant and anti-inflammatory properties; omega-3 could serve as a post-exercise recovery agent and sports supplement that could improve performance by preserving and promoting skeletal muscle mass and strength. Omega-3 fats can be incorporated into cellular membranes, where they modulate inflammation, muscle protein synthesis, and immune function.

A systematic review and meta-analysis registered with PROSPERO (CRD42018085869) and performed according to PRISMA guidelines searched PubMed, EMBASE, CENTRAL, and ISI Web of Science to identify RCTs assessing n-3 PUFA on post-eccentric DOMS. Despite the fact that the majority of these studies are randomised controlled trials, their sample sizes are relatively small, which could not afford adequate statistical power. No conclusive evidence exists about the potential effects of omega-3 on post-exercise biomarkers and sports performance in physically healthy adults. Notwithstanding this, tart cherry and omega-3 fatty acids have the most compelling evidence among nutritional interventions for exercise-induced muscle damage and soreness. The International Olympic Committee consensus statement on dietary supplements has acknowledged omega-3 fatty acids among supplements that may be effective in improving training capacity, recovery, muscle soreness, and injury management. Evidence quality is rated low-to-moderate, with the main limitation being small, underpowered trials.

4.5 Ginger (Zingiber officinale)

Traditional Use

Ginger rhizomes (rich in gingerols, shogaols, paradols, and zingerone) have been used in Asia for the treatment of asthma, diabetes, and pain, and have shown potent anti-inflammatory attributes. Ginger has been used in Ayurvedic medicine, Traditional Chinese Medicine, and Unani medicine for musculoskeletal pain, digestive complaints, and rheumatic conditions for more than 2,000 years. It remains one of the most widely consumed spice-medicines in the world.

Scientific Evidence

Ginger and several of its constituents inhibit activity of COX-1 and COX-2, block leukotriene synthesis, and block the production of interleukins and tumour necrosis factor alpha in activated macrophages. Ginger has a pain-reducing effect and can modulate pain through various mechanisms: inhibition of prostaglandins via the COX and LOX pathways, antioxidant activity, inhibition of the transcription factor NF-κB, or acting as an agonist of vanilloid nociceptors.

A narrative review summarising ten years of RCTs found that the four eligible RCTs on DOMS suggested a reduction of inflammation after oral and topical ginger administration. A quasi-experimental study in 36 healthy female subjects using 2 g dried ginger extract found that 2 grams of ginger may have anti-inflammatory and analgesic effects on DOMS. However, a separate RCT using a higher dose found that 4 g of ginger supplementation may be used to accelerate recovery of muscle strength following intense exercise but does not influence indicators of muscle damage or DOMS. Results across human trials are therefore mixed, with small sample sizes, variable dosing, and heterogeneous preparations accounting for much of the discrepancy. Further information is required regarding the efficacy of ginger and several other promising supplements in the context of exercise-induced muscle damage.

4.6 Vitamin D

Traditional and Historical Context

The role of sunlight exposure in preventing rickets and muscle weakness has been recognised since the 17th century, and cod liver oil (rich in vitamin D) was used therapeutically in Northern European traditions for musculoskeletal conditions long before its active component was identified.

Scientific Evidence

Vitamin D is essential for the optimal health of the skeletal system and is also involved in muscle, immune, and inflammatory functions; some studies suggest that adequate levels of vitamin D support muscular function during exercise and accelerate recovery because they reduce specific pro-inflammatory cytokine levels, but those results have not always been observed.

A 2022 systematic review following PRISMA guidelines and including 11 eligible studies of moderate methodological quality concluded that vitamin D supplementation for periods of more than 1 week with a minimum dose of 2000 IU/day appears to be an efficacious strategy for attenuating muscle damage and inflammation after exercise. Evidence strength is rated moderate, and optimal supplementation protocols have not been definitively established. Trials are generally heterogeneous in design and populations studied.

4.7 Dietary Protein and Amino Acids

Scientific Evidence

Adequate dietary protein is required for the repair and synthesis of muscle tissue following damage. Exercise-induced muscle damage is caused by mechanical stress and subsequent inflammatory responses including reactive oxygen species and cytokine production; dietary supplements with anti-inflammatory and antioxidant properties have the potential to prevent and reduce muscle damage and symptoms characterised by loss of muscle strength and DOMS.

A 2023 systematic review and meta-analysis (29 studies; 40 trials in ≥1 meta-analyses) found that there were significant overall effects of protein for preserving isometric maximal voluntary contraction at 96 hours and for attenuating creatine kinase concentration at 48 and 72 hours; however, protein supplementation had no effect on muscle soreness compared to control; peri-exercise protein consumption could help maintain maximal strength and lower creatine kinase concentration following resistance exercise but not reduce muscle soreness, and conflicting data may be due to methodological divergencies between studies.

Curcumin, pomegranate, creatine monohydrate, β-hydroxy β-methylbutyrate (HMB), and branch chain amino acids (BCAAs) have a moderate level of evidence and may be worthy of consideration in the context of exercise-induced muscle damage, though evidence across these agents is preliminary and heterogeneous.

4.8 Creatine Monohydrate

Scientific Evidence

Creatine is an endogenous nitrogenous compound found in meat and fish. Its supplemental form has been one of the most extensively researched ergogenic nutritional aids. The International Olympic Committee consensus statement on dietary supplements includes creatine monohydrate among supplements that may be effective in improving training capacity, recovery, muscle soreness, and injury management. A 2021 systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, finding modest supportive evidence, though the evidence is graded as low to moderate and most trials are short-term and small in sample size.

4.9 Polyphenol-Rich Foods: Pomegranate and Beetroot

Scientific Evidence

Initial evidence suggests that the long-term consumption of antioxidant-rich foods such as tart cherry juice, pomegranate juice, beetroot juice, and watermelon juice may help to reduce symptoms of exercise-induced muscle damage and improve muscle function in a variety of populations. The mechanistic rationale involves inhibition of inflammation and mitigation of exercise-induced oxidative stress. Evidence for pomegranate and beetroot specifically is still emerging, with most studies small and preliminary.

4.10 Bromelain (Pineapple-Derived Protease)

Traditional Use

Pineapple (Ananas comosus) has been used in traditional Central and South American medicine as a topical anti-inflammatory remedy for wounds and trauma. Bromelain, a mixture of proteolytic enzymes derived from the stem and juice of pineapple, was isolated in the 20th century and has been used in European phytotherapy for post-surgical swelling and musculoskeletal inflammation.

Scientific Evidence

Further information is required regarding the potency of pineapple-derived proteases and several other promising supplements, including ginger, ginseng, curcumin, taurine, β-hydroxy-β-methylbutyrate, and caffeine in the context of exercise-induced muscle damage. Evidence for bromelain specifically in DOMS in humans is preliminary and based on small trials; it is listed as a "promising supplement" requiring further rigorous investigation.

5. Dietary and Lifestyle Factors

5.1 Overall Dietary Pattern and Antioxidant Intake

Dietary supplements with anti-inflammatory and antioxidant properties have the potential to prevent and reduce muscle damage and symptoms characterised by loss of muscle strength and DOMS. This principle extends to whole dietary patterns: diets rich in vegetables, fruits, whole grains, and oily fish provide a broad matrix of polyphenols, omega-3 fatty acids, vitamins C and E, and other antioxidants that cumulatively support the attenuation of exercise-induced oxidative stress. It has been suggested that both inflammatory responses and reactive oxygen species produced during and following exercise may be involved in DOMS; thus, nutrition-based interventions targeting post-exercise inflammation and/or oxidative stress responses have received much attention.

5.2 Hydration

Adequate fluid intake is essential for sustaining muscle function and moderating the severity of exercise-induced damage. A dehydrated individual who performs eccentric exercise may exacerbate skeletal muscle damage, leading to structural, contractile, and enzymatic protein denaturation, in addition to the myofiber and connective damage resulting from the eccentric muscle tension. Maintenance of euhydration before, during, and after exercise is therefore a foundational dietary consideration in the prevention of exacerbated muscle soreness.

5.3 Progressive Training and the Repeated-Bout Effect

From a lifestyle perspective, gradual, progressive increases in exercise load are the most evidence-supported strategy for minimising DOMS severity. Treatment considerations focus on the primary prevention of ultrastructural lesions during exercise, the treatment of the inflammatory response that leads to DOMS, and recovery strategies for manifest DOMS. Structuring training to avoid abrupt large increases in eccentric loading — particularly in populations returning after periods of inactivity — is strongly supported across the exercise science literature.

5.4 Sleep and Recovery

Short-term insufficient sleep has been associated with short-term manifestations of pain, stress, depression, and anxiety, while long-term sleep problems can result in inflammation, dyslipidaemia, and hypertension. Adequate sleep is therefore both directly relevant to pain perception and indirectly relevant through its effects on inflammatory tone. In patients with chronic pain, poor quality of sleep is associated with increased pain intensity, spreading of pain, and pain-related disability.

5.5 Psychological Stress Management

The relationship between occupational and psychological stress and musculoskeletal tension is well documented. When individuals must deal with stressful situations without real opportunities to influence them, it can lead to persistent stress and associated elevation of resting muscle tone and musculoskeletal pain. Approaches that reduce perceived psychological load — including exercise itself, mindfulness practices, and workplace ergonomic adjustments — have a plausible role in reducing stress-related muscle tension.

5.6 Physical Therapies Documented in the Literature

Many studies have evaluated various types of cold or heat therapy, compression, massage, physical therapy, and nutritional interventions for DOMS. Physical therapies including post-exercise massage, cryotherapy, low-level phototherapy, and vibration therapy, as well as pharmacologic NSAIDs, are among the predominant means employed to alleviate DOMS. These are documented in the scientific literature and are relevant to a holistic, natural-health approach to management.

5.7 Stretching

Both static stretching and ballistic stretching increase range of motion, most likely as a result of enhanced stretch tolerance rather than changes in muscle elasticity; four weeks of stretching may maintain range of motion and stretch tolerance in the days after eccentric exercise. However, stretching groups showed an increase in range of motion and stretch tolerance with no change in muscle stiffness, work absorption, or delayed onset muscle soreness in controlled laboratory settings, indicating that stretching's primary benefit is in flexibility and tolerance, not in directly reducing DOMS magnitude.

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