An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis
One article on PainSci cites Dupuy 2018: A Deep Dive into Delayed-Onset Muscle Soreness
PainSci notes on Dupuy 2018:
Many massage therapists jumped to cite this scientific paper because it seemed to confirm their bias that massage helps post-exercise muscle soreness. Such papers are literally good for business. Unfortunately, it’s a classic “garbage in, garbage out” meta-analysis that shows nothing, except maybe the opposite of the “positive” conclusion. Just read the fine print! There’s a strong and classic pattern of publication bias in the data, with better quality studies finding nothing of interest, and the shittier ones consistently skewing towards the positive.
Alex Hutchinson wrote about this paper for Outside, and included a terrific summary of how publication bias is exposed by funnel plots (a must-read for anyone trying to make sense of research). This kind of thing is the legacy of decades of publish-or-perish pressure in academia. Recovery science is a mess, most of the studies are just junk, and so most meta-analyses are too… and there’s a lot of them. John Ioannidis:
The production of systematic reviews and meta-analyses has reached epidemic proportions. Possibly, the large majority of produced systematic reviews and meta-analyses are unnecessary, misleading, and/or conflicted.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
INTRODUCTION: The aim of the present work was to perform a meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), perceived fatigue, muscle damage, and inflammatory markers after physical exercise.
METHOD: Three databases including PubMed, Embase, and Web-of-Science were searched using the following terms: ("recovery" or "active recovery" or "cooling" or "massage" or "compression garment" or "electrostimulation" or "stretching" or "immersion" or "cryotherapy") and ("DOMS" or "perceived fatigue" or "CK" or "CRP" or "IL-6") and ("after exercise" or "post-exercise") for randomized controlled trials, crossover trials, and repeated-measure studies. Overall, 99 studies were included.
RESULTS: Active recovery, massage, compression garments, immersion, contrast water therapy, and cryotherapy induced a small to large decrease (-2.26 < g < -0.40) in the magnitude of DOMS, while there was no change for the other methods. Massage was found to be the most powerful technique for recovering from DOMS and fatigue. In terms of muscle damage and inflammatory markers, we observed an overall moderate decrease in creatine kinase [SMD (95% CI) = -0.37 (-0.58 to -0.16), I2 = 40.15%] and overall small decreases in interleukin-6 [SMD (95% CI) = -0.36 (-0.60 to -0.12), I2 = 0%] and C-reactive protein [SMD (95% CI) = -0.38 (-0.59 to-0.14), I2 = 39%]. The most powerful techniques for reducing inflammation were massage and cold exposure.
CONCLUSION: Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage, or water immersion.
related content
- “The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses,” John P A Ioannidis, Milbank Q, 2016.
- “Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis,” Jianmin Guo, Linjin Li, Yuxiang Gong, Rong Zhu, Jiake Xu, Jun Zou, and Xi Chen, Front Physiol, 2017.
Specifically regarding Dupuy 2018:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.