Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 33493991 · doi:10.1016/j.ptsp.2021.01.004
What was done
A systematic review and meta-analysis of randomized controlled trials (PROSPERO CRD42020170632) evaluating the effect of cold and heat therapy on delayed onset muscle soreness (DOMS). Nine databases were searched up to December 2020. Thirty-two RCTs involving 1,098 participants were included, assessing thermal modalities applied within 1 hour post-exercise.
What was found
Cold therapy applied within 1 hour post-exercise significantly reduced DOMS pain within 24 hours (SMD -0.57, 95% CI -0.89 to -0.25, P = 0.0005) but not after 24 hours (P = 0.05). Subgroup analysis within 24 hours showed significant pain reduction for cold water immersion (SMD -0.48, 95% CI -0.84 to -0.13, P = 0.008) and other cold therapies (SMD -0.68, 95% CI -1.28 to -0.08, P = 0.03). Heat treatment significantly reduced pain both within 24 hours (SMD -1.17, 95% CI -2.62 to -0.09, P = 0.03) and over 24 hours (SMD -0.82, 95% CI -1.38 to -0.26, P = 0.004). Hot packs produced the largest reduction (≤24 hours: SMD -2.31, 95% CI -4.33 to -0.29, P = 0.03; >24 hours: SMD -1.78, 95% CI -2.97 to -0.59, P = 0.003), while other thermal modalities were not statistically significant (P > 0.05). Direct comparison showed no statistically significant difference in pain reduction between cold and heat therapy (P = 0.16).
Why it matters
Applying cold water immersion or hot packs within one hour of exercise provides effective short-term relief for DOMS pain, with hot packs showing extended benefits beyond 24 hours.
Limits
The abstract does not specify participant demographics, fitness levels, exercise protocols, or individual trial quality scores. Confidence intervals for heat modalities were very wide, indicating substantial imprecision, and functional recovery outcomes beyond pain ratings were not reported.
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