The effects of creatine supplementation on markers of exercised-induced muscle damage: A systematic review and meta-analysis of human intervention trials.

Northeast, B and Clifford, T. Int J Sport Nutr Exerc Metab. 2021. [Epub Ahead of Print].

Take-Home Message

Despite widespread creatine supplementation among active individuals, creatine supplementation may not improve recovery from exercise-induced muscle damage.


Exercise-induced muscle damage is common following strenuous activity and can result in decreased performance. Creatine supplementation may improve recovery from exercise-induced muscle damage. However, despite widespread use of creatine supplementation, this benefit remains unclear.

Study Goal

Northeast and Clifford completed a systematic review and meta-analysis to investigate if creatine supplementation decreased the effects of exercise-induced muscle damage.


The researchers performed a systematic literature search and identified 424 studies before screening for 5 inclusion criteria: (1) included adult participants; (2) provided creatine timing, frequency, dosing, and duration before or after exercise; (3) included a comparator group; (4) reported post-exercise changes (strength recovery, muscle soreness, oxidative stress, inflammation, etc.); and (5) randomized controlled trial study design. A total of 13 studies met the inclusion criteria. Study quality was assessed for each study using the Cochrane Collaboration Risk of Bias Tool. Each author scored the included studies independently.


The included trials consisted of 142 and 136 participants in the creatine and control groups, respectively. The clinical trials included both trained and untrained participants and varied in creatine supplement timing, frequency, dosing, and duration. Of the 13 studies included, the duration of creatine supplementation ranged from 5 to 25 days. Five studies reported supplementation both before and after exercise, while 8 studies reported supplementation only after exercise. Nine studies reported doses that were independent of body weight or body mass while 4 studies reported doses based on the body weight or body mass of the participants. Overall, creatine supplementation had no significant impact on recovery of muscle strength, range of motion, reduction of muscle soreness, or improving muscle metabolism.


Ultimately, this meta-analysis failed to identify any clinical benefit for using creatine to attenuate the effects of exercise-induced muscle damage. However, we should remember that the authors focused on creatine supplementation’s effect on recovery and offered no insights into the effects on changes in strength or lean muscle mass. Systematic reviews and meta-analyses, like this one, can offer a helpful big picture of the effect of creatine supplementation on recovery. However, this meta-analysis is limited because many of the trials were of poor quality and varied in dosing. With such variability in doses and duration, the authors could not analyze the benefits of one strategy over another. More high-quality trials may be needed to assess the effect of different creatine supplementation regimens (e.g., dosing, timing) on exercised-induced muscle damage.  

Clinical Implications

Clinicians should advise people that it remains unclear if any specific creatine supplementation regimen improves recovery after exercise-induced muscle damage.

Questions for Discussion

Have your athletes used creatine supplementation to aid in recovery? If so, did you feel that the results aligned with the findings of this study?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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