Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis.

Anyone who has trained hard and woken up sore the next day has experienced delayed onset muscle soreness, and clinicians have long tried different physical therapy tools to ease it. This systematic review and meta-analysis pooled a large number of randomized trials that induced muscle damage in healthy participants and then tested various non-drug, non-nutritional interventions, applied right after the damage occurred, against a no-treatment control. Across 121 included studies, several approaches, including contrast techniques, cryotherapy, phototherapy, vibration, ultrasound, massage, active exercise, and compression, showed a statistically significant advantage over control in reducing DOMS-related pain.

What makes this interesting is the sheer breadth of interventions tested with a broadly consistent direction of benefit. However, the authors themselves describe the evidence as low quality, and most comparisons showed very high statistical inconsistency between studies, meaning the true size of any benefit remains uncertain.

If you have ever felt that deep muscle soreness a day or two after an intense workout, you know how uncomfortable and limiting it can be. Researchers wanted to know whether common physical therapy treatments, things like cold therapy, massage, light therapy, vibration, ultrasound, compression, or simply doing gentle exercise, could ease this soreness when started right after the muscle-damaging activity happened. Pooling findings from a very large group of trials in healthy people, the review found that each of these approaches was associated with less pain compared to doing nothing.

That is a broadly encouraging pattern across many different techniques. But there is an important catch: the individual studies varied a great deal in their results, and the researchers rated the overall evidence as low quality. That means the true benefit of any single approach is still uncertain, and this review does not tell us which treatment worked best or whether combining them would help more.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This meta-analysis synthesized 121 randomized controlled trials in healthy participants with experimentally induced muscle damage, comparing various post-exercise physical therapy and nutritional-adjacent interventions against untreated control groups for DOMS pain outcomes. Statistically significant pooled effects favoring intervention over control were reported for contrast techniques (p=0.002, I²=60%), cryotherapy (p=0.002, I²=100%), phototherapy (p=0.0001, I²=95%), vibration (p=0.004, I²=96%), ultrasound (p=0.02, I²=97%), massage (p<0.00001, I²=94%), active exercise (p=0.0004, I²=93%), and compression (p=0.002, I²=93%). The extremely high heterogeneity across nearly every comparison (I² ranging from 60% to 100%) substantially limits confidence in the pooled estimates, and the authors explicitly characterize the overall evidence as low quality.

No single intervention was directly compared against another within this synthesis, so relative superiority cannot be inferred from these control comparisons. Clinicians should interpret these findings as an aggregate signal across a large but methodologically variable evidence base rather than as a ranked or high-certainty recommendation for any specific modality.