Exercising with muscle soreness after 48 hours: why the second day hurts more, what light movement does and when to see your GP

In this article you will read why muscle soreness often feels worse on the second day than on the first, and whether you can exercise with muscle soreness after 48 hours. You will also read what light movement does and doesn’t do, and which signs are a reason to call your GP. That matters, because many people stop moving for days or push on with a hard workout, and the studies below point to a calmer middle way. The BioProfile recovery scan gives you an indication of where you stand on recovery today. The scan is not a diagnosis. It is insight into where you stand today, and it can help you make better choices in your training and lifestyle. The scan does not look for the cause of your muscle soreness. Only a doctor can assess that.

Why the second day often hurts more

Muscle soreness that only comes on a day or more after training has a name in research: delayed onset muscle soreness, or DOMS. One review describes DOMS as very small damage in muscle cells. That damage follows exercise you are not used to, or eccentric exercise, where the muscle works while it lengthens.⁠¹ The soreness comes late. That review places the peak at 48 to 72 hours after the exercise,⁠¹ and another review places the peak at 24 to 48 hours.⁠²

Put simply: having more muscle soreness on day two than on day one is the normal course. Still having muscle soreness after 48 hours falls within the period the first review describes.

What muscle soreness does to your strength

Soreness is only part of the story. DOMS also brings less strength, a limited and painful range of motion and swelling, and it often makes sports performance worse.⁠¹ This applies just as much to athletes as to people who exercise little.⁠²

For you, this means a hard workout on a muscle that is still sore starts with a weaker muscle. Expect less from that muscle on that day.

Exercising with sore muscles after 48 hours: is it OK?

Thuisarts, the public website of the Nederlands Huisartsen Genootschap, is clear about ordinary muscle soreness: it is not a problem, and you can simply keep moving.⁠³ Sore muscles after exercise usually mean you have had a good workout, and the soreness goes away on its own.⁠⁶ If you are in a lot of pain, Thuisarts advises waiting until the pain eases, which can take 1 or 2 days. After that, start gently and do a little more each time, rest after every workout, and stop and rest if something hurts.⁠³

One study tested what light movement does. 14 people did two hard eccentric workouts for the elbow flexors, 2 to 4 weeks apart. Then, on each of the four days after the hard workout, one arm did light exercises (600 gentle bending and straightening movements), while the other arm did nothing. Straight after the light exercises, muscle soreness and tenderness were each about 40% lower. The muscle itself recovered no differently in the two arms.⁠⁴

For you, this means gentle movement makes sore muscles feel better for a while. The muscle does not recover any faster. A light workout on day two is for your comfort, and the hard workout can wait until the soreness has eased.

What helps muscle soreness ease

A systematic review pooled 99 studies on the techniques people use after exercise, and its analysis of muscle soreness covered 1,188 participants. Active recovery, massage, compression garments, water immersion, contrast baths and cryotherapy all reduced muscle soreness, some by a little and some by a lot. Massage came out strongest for muscle soreness and fatigue. Compression garments and water immersion both brought relief as well, but less strongly.⁠⁷

Active recovery is simply light movement, exactly what Thuisarts recommends. Massage and compression are options, but muscle soreness also goes away without massage or compression.⁠⁶

Why it hurts less next time

13 older adults living at home, with an average age of 67.6, did the same eccentric exercise twice, 14 days apart. After the first session, their muscles were clearly more sensitive to pressure after 24 hours, and their eccentric strength was 13% lower. After the second session, the tenderness did not clearly increase and their strength did not drop.⁠⁵

In plain words: the muscle got used to a load it already knew. That fits the advice to start gently and build up. Thuisarts also advises adults to be active for at least 2.5 hours a week, spread over several days, and to strengthen their muscles and bones twice a week.⁠⁶

When it is more than muscle soreness

In rare cases, hard exercise leads to a condition called exertional rhabdomyolysis. A population study followed the 144,248 residents of Olmsted County, Minnesota, from 2003 to 2015. The condition occurred in about one person per year for every 100,000 residents: 20 cases in total, 90% of them men, with an average age of about 31. Everyone had pain or cramp in the affected muscles. Almost 3 in 10 had blood in their urine (dark urine), almost a quarter had weakness and almost 1 in 5 had swelling. Three quarters were admitted to hospital, usually for 2 days, and everyone recovered with no lasting effects.⁠⁸ A Dutch review notes that the condition only becomes visible 24 to 48 hours after the exercise, and rarely leads to kidney failure that needs temporary dialysis. Changes in the urine after exercise should be gone after 24 to 72 hours of rest, and if they are not, the cause needs to be looked into.⁠⁹

For you, this means the condition is rare and comes on a day or two after the exertion, in the same period as ordinary muscle soreness. What sets the condition apart from ordinary muscle soreness are signs alongside the tenderness, such as dark urine or weakness.

Thuisarts names the moments to contact your GP or a physiotherapist: you make a movement and immediately feel severe pain in a muscle or joint, you can no longer walk properly or use your arm properly, or it hurts when you press on a tendon.⁠¹⁰

In summary

Muscle soreness comes late and often peaks around the second day, which is why you can still be sore after 48 hours.⁠¹ Sore muscles are weaker for a while.⁠¹ You can keep moving gently. Light movement makes sore muscles feel better for a while, but it does not speed up recovery.⁠⁴ If you are in a lot of pain, wait a day or two.⁠³ Repeating the same workout gave clearly less soreness, because the muscle got used to the load.⁠⁵ Sudden severe pain, trouble walking or using an arm, and pain when you press on a tendon are reasons to contact your GP.⁠¹⁰