Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: Systematic review and meta-analysis

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Sø 2. Physioblog Andreas Bjerregaard 3.Søernesfysioterapi
  • International journal of sports physiology and performance 7(4):357-66 · December 2012


The aim with this study was to assess whether some modalities currently used in physiotherapy such as massage, cryo-therapy, stretching and low-intensity exercise are effective for treating the signs and symptoms of exercise-induced muscle damage.


Skærmbillede 2015-12-08 kl. 21.46.52Randomized controlled trials (RCTs), written in English or Portuguese, that included physiotherapeutic interventions [i.e., massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18-60 years old) of both gender] were searched on electronic databases including MEDLINE, CINHAL, EMBASE, PEDro and SPORTDiscus.

Inclusion criteria

  • Type of participants: conducted on adult subjects of both genders; age range of 18e60 years old
  • Type of study: randomized controlled trials
  • Methodological quality: only studies with a score of at least three on the PEDro scale
  • Type of interventions: the use of only one physiotherapeutic intervention per group
  • Study purpose: to determine the effectiveness of physiotherapeutic interventions on exercise-induced muscle damage or on delayed onset muscle soreness
  • Language: articles written in English or Portuguese

The meta-analysis was only performed on “muscle soreness” and “muscle strength” because they were the only variables with enough detailed data


25 studies were included; 9 analysed the effects of massage, 10 examined the effects of cryotherapy, 9 investigated the effects of stretching and 7 focused on low-intensity exercise intervention.

  • 9 RCTs for assessing the effectiveness of massage after exercise-induced muscle damage, six found positive effects on “muscle soreness”.
  • 10 RCTs valuating the effectiveness of cryotherapy were found. Only one study examined the effect of ice massage while the others studied the effect of cold-water immersion. No study was found to analyse the effect of spray or ice packs on “muscle soreness.
  • 9 RCTs were found that evaluated the effects of muscle stretching after exercise-induced muscle damage.

Effects of massage

The meta-analysis showed that massage applied after exercise is effective on “muscle soreness” only after 24 h. In fact, 4 RCTs studying the effect of massage (total sample size 30) had sufficient data to make the meta-analysis possible at 24 h. The overall effects suggest a significant positive effect with a difference of 0.33 cm on a 10-cm VAS.

The heterogeneity between the studies at 48 h made it difficult to clarify the true effect of massage after exercise-induced muscle damage at 48 h;

Effect of cryotherapy

The evidence in this review does not support the use of cryotherapy on the variables assessed. Indeed, only 4 RCTs found positive effects for cryotherapy contrasted against six other studies demonstrating no effect on all variables assessed. The analysis of trials that assessed “muscle soreness” using the VAS showed no statistically significant overall effect at 1 and 24 h. Although the overall effect of cryotherapy after 48 and 72 h was statistically significant. These results should not be considered reliable because a significant statistical heterogeneity among the trials in each of the assessed moments was found.


In general, the results suggest that massage is the only effective intervention, while the cryotherapy intervention has little evidence supporting its use. Other interventions such as stretching or low- intensity exercise have no scientific evidence to sustain their validity.

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