After a strenuous workout, the muscles can feel fatigued and sore. The soreness that occurs a couple of days after exercise is known as delayed-onset muscle soreness, or DOMS. Research demonstrates that DOMS is discomfort caused by microscopic tears in muscle fibers resulting from exercise and inflammation.1
Muscle damage due to exercise causes the release of reactive oxygen species and cytokines (COX-1 and COX-2), promoting an inflammatory response.2 The inflammatory response to strenuous exercise can result in redness, swelling and pain in the affected area, as well as a decrease in muscle function and athletic performance.1-2 The structural impact DOMS can have on muscles can lead to a decrease in athletic performance.
Suppressing Inflammatory Markers
Several strategies have been demonstrated to minimize the impact of DOMS on performance. One such strategy is the implementation of turmeric/curcumin as a supplement.
Curcumin is a natural polyphenolic substance that can be extracted from turmeric.3 Research on curcumin has demonstrated its anti-inflammatory and antioxidant properties.3 Curcumin has the potential to suppress inflammatory markers, including NF-B, IL-6 and TNF-ɑ.2-3
Curcumin has demonstrated the ability to suppress the expression of COX-2, which in turn reduces the release of prostaglandins and leads to a reduction in muscle damage.4 Similar inflammatory markers have been found in response to strenuous exercise, leading to DOMS.2-3 The dosage of curcumin and the timing of its administration have varied throughout the studies.2-3,5
One such study observed downhill running and had subjects take 200 mg twice daily (morning and evening) beginning two days before exercise and continuing for 24 hours post-exercise.4 The study demonstrated a significant reduction in DOMS for the lower extremities.5
Another study, which included subjects ingesting a single dose of 500 mg of curcumin within one hour before downhill running, also demonstrated a significant reduction in DOMS.5 Additionally, a study observed that 10 men who performed strength-like exercise and ingested 150 mg of curcumin immediately after exercise had a significant reduction in DOMS.5
Yoon, et al. (2020), suggested supplementing with curcumin before and after exercise for up to 3-4 days after exercise. The recommended dosage is between 150-1,500 mg and at times can be as high as 5 g over a single dose or over 2-3 doses during the day.5 For example, if a person were going to take 1,500 mg of curcumin, they may be better suited to break up the dosage into three 500 mg doses to be taken throughout the day.5 Curcumin supplementation has been shown to decrease muscle soreness, improve performance and reduce inflammatory blood markers.4
Risk Considerations
The notion that turmeric is a natural supplement with no risks is an erroneous one. Similar to any other food, substance or medicine, individual differences and tolerances may exhibit significant variability. Additionally, each individual may have differences in pharmacokinetics, which include absorption, distribution, metabolism, and excretion of a supplement.
For this reason, understanding pharmacological principles and their applications is essential if a chiropractor is recommending supplements. A key concept that pertains to absorption that chiropractors should be aware of is that when supplements enter the system enterally, they must pass through the liver. This is known as the first-pass effect, and what remains available in circulation after the first-pass effect is known as bioavailability.
Recommending supplements with greater bioavailability means they translate into higher serum concentrations. Curcumin, when combined with piperine – a compound present in black pepper – has been found to increase bioavailability by 20-fold.6
Curcumin supplementation has become increasingly popular, but as mentioned earlier, side effects have been reported. Curcumin may lead to the development of kidney calculi in patients who are susceptible due to higher urinary oxalate excretion.7 In animal studies, curcumin has been found to act as an iron chelator; therefore, it would be reasonable to avoid or be cautious with higher doses in patients who present with chronic anemia or subclinical iron deficiency.7
Supplement-drug interactions are another concern due to pharmacokinetic interactions. One specific example is how curcumin reduces the effectiveness of tamoxifen, an estrogen receptor antagonist medication used in certain types of breast cancer treatments.7 Gastrointestinal side effects are the most frequently reported in the literature.8 Some of these include dyspepsia, nausea, abdominal pain, diarrhea, discolored stools, and emesis.8
Chiropractors can use core principles of pharmacology when advising what and how much to take of a supplement. Exact dosages have been challenging to predict due to the aforementioned variability among individuals; however, the goal is to achieve the most therapeutic benefit with the fewest side effects.9 This can be achieved by starting at a low dose while monitoring for tolerance, and then adjusting the dosage as needed while the patient is monitored for a therapeutic response.
Take-Home Points
While delayed-onset muscle soreness is a common consequence of strenuous exercise, the use of curcumin as a natural supplement offers promising anti-inflammatory and antioxidant effects that may help reduce muscle soreness and support athletic recovery. Research has demonstrated that curcumin can suppress key inflammatory markers and improve outcomes when appropriately dosed and timed around exercise.
However, despite its potential benefits, curcumin is not without risks. Individual variability in absorption, metabolism and tolerance – along with potential side effects and drug interactions – demonstrates the importance of safe, effective, and rational use of drugs and supplements when making recommendations. Chiropractors must consider factors such as bioavailability, dosing strategies, and patient-specific health conditions to ensure safe and effective use.
By combining clinical judgment with evidence-based guidelines, practitioners can better support their patients in managing post-exercise inflammation while minimizing potential adverse effects.
References
Recent laws in New Jersey and California represent a disturbing trend that will negatively impact a practice’s ability to collect monies from patients, as well as expose them to significant penalties if the practice does not follow the mandatory guidelines to a T. Please be aware that a similar law may be coming to your state. The time to act is before the law is passed.
With estimates showing over 30 million Americans affected by peripheral neuropathy – and a significant portion underdiagnosed – it’s increasingly likely that chiropractors are already treating these patients. What’s missing is structured recognition, comprehensive management and targeted tools to slow progression, improve function and support systemic health.
Each year, ICD-10-CM is updated on Oct. 1. For 2026, there are 74,179 total codes, with 487 additions, 28 deletions and 38 revisions. Code changes are based on date of service, not the claim submission date. Services performed on/after Oct. 1 must use the new codes. While no changes affect the common spinal or extraspinal codes most frequently used by DCs, several updates may still affect your claims – particularly for comorbidities, referred pain, or trauma cases.
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