A 23-year-old runner twisted (inverted) his right ankle during warm-up. He complains of pain and swelling over the lateral aspect of the right ankle. Walking is also difficult secondary to pain. Physical examination reveals swelling over the lateral aspect, which is painful to palpation.
Delayed-onset muscle soreness (DOMS) is a condition that presents within 24 to 48 hours after a bout of unaccustomed exercise. Pain is localised, and the condition usually resolves within 5 to 7 days without intervention. DOMS occurs more frequently with eccentric exercise. This type of exercise is associated with forcible lengthening of the contracting muscle (e.g., when lowering a weight). After DOMS develops, passive stretching and resumption of activity aggravate the pain. Palpation of the muscle is painful and is associated with a reduced ROM and prolonged strength loss. Laboratory testing reveals an elevated level of creatine kinase.