Key Takeaway
Among 10 recovery modalities, contrast water therapy ranked 2nd for DOMS pain relief within 24 hours (behind hot pack), based on 59 RCTs with 1,367 participants.
Summary
This network meta-analysis compared 10 different cold and heat therapies for DOMS pain relief across 59 randomized controlled trials involving 1,367 patients. Therapies included contrast water therapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and others.
Within 24 hours post-exercise, hot pack was most effective for pain relief, followed by contrast water therapy. At 48 hours, hot pack still led with a novel cryotherapy modality ranking second. Beyond 48 hours, cryotherapy demonstrated superior effectiveness.
The results suggest contrast therapy is among the more effective recovery modalities in the acute window, though simple heat application may be equally or more effective for immediate pain relief. The authors note limited study quality across the literature and call for better-designed research.
Methods
- Network meta-analysis of 59 RCTs (1,367 patients)
- 10 treatment modalities compared
- Outcomes assessed at <24h, 24-48h, and >48h post-exercise
- SUCRA rankings used to rank interventions
Key Results
- Within 24h: hot pack ranked 1st, contrast water therapy 2nd
- Within 48h: hot pack 1st, novel cryotherapy 2nd
- Beyond 48h: novel cryotherapy most effective
- Contrast therapy consistently ranked in top half across timepoints
Figures
Figure 1
Figure 2
Figure 3
Figure 4
Limitations
- Limited quality of included studies
- Heterogeneous protocols across studies (different temperatures, durations)
- Some interventions had very few studies in the network