Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials
Wang Y, Li S, Zhang Y, Chen Y, Yan F, Han L, Ma Y. Physical Therapy in Sport. 2021;48:177-187.
Both cold and heat therapy applied within 1 hour of exercise decreases delayed onset muscle soreness during the first day after exercise. However, heat therapy may be ideal for reducing pain after the first day.
Delayed onset muscle soreness is a common complaint following physical activity. Treatment strategies to prevent or reduce pain are crucial to allow people to resume activity. However, it remains unclear which treatment strategy may be ideal.
Wang and colleagues completed a systematic review and meta-analysis to identify the effects of heat and cold therapy to treat delayed onset muscle soreness.
The researchers searched 9 databases for randomized clinical trials published before December 2020. They identified 4138 studies and then screened them for inclusion. The researchers included clinical trials that treated adults with heat or cold therapy within 1 hour of exercise. After screening, they identified 32 studies for the final analysis.
The 32 studies included 1,098 people. The meta-analysis demonstrated that cold therapy effectively decreased pain associated with delayed onset muscle soreness during the first 24 hours after exercise. However, cold therapy was ineffective for pain after 24 hours post-exercise. These findings were consistent when examined among cold water immersion and other cold therapies (e.g., ice packs, ice massage). The authors found that heat therapy, specifically hot packs, effectively decreased pain associated with delayed onset muscle soreness during the first 24 hours after exercise and after 24 hours.
Interestingly, the authors found that both cold and heat therapy alleviated pain during the first 24 hours after exercise. However, pain associated with delayed onset muscle soreness often increases after the first day. Hence, heat therapy, especially hot packs, may be ideal for reducing the risk of delayed onset muscle soreness after the first day. Clinicians should note that the treatments were applied shortly after exercise, which may be an essential factor influencing the efficacy of these treatments. It would be interesting to see if newer meta-analysis methods (e.g., network meta-analysis) could offer more insights into whether certain heat therapies are genuinely better than other treatment options. Furthermore, it would be interesting to see if the timing of the intervention is critical. Finally, it should be noted that there was significant variability in the methodologies of the included studies. Hence, additional studies may be needed to clarify the optimal treatment strategies for these modalities (e.g., duration of treatment, tissue temperatures to achieve).
If a clinician’s goal is to reduce pain during the first day after exercise, then cold or heat therapy may help. However, if the goal is to reduce pain after the first day, then a heat pack within an hour after exercise may be ideal.
Questions for Discussion
Have you found either heat or cold therapy following exercise to be superior in decreasing the pain associated with delayed onset muscle soreness? What other factors do you feel are important when advocating for one treatment over another?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Cold-water Immersion for Preventing and Treating Muscle Soreness After Exercise
Colder May Not Be Cool for Recovery
Possible Keys For Running Away From Injury
Intramuscular Temperature Changes During and After Cryotherapy in Healthy Individuals
Massage May Attenuate Exercise-Induced Muscle Inflammation