Effects of local cryotherapy for recovery of delayed onset muscle soreness and strength following exercise-induced muscle damage: systematic review and meta-analysis

  • Nathalia Mello Nogueira
  • Cassiele Janina Felappi
  • Cláudia Silveira Lima
  • Diulian Muniz MedeirosEmail author



The aim of the current study was to evaluate the effects of local cryotherapy on the main symptoms of exercise-induced muscle damage (EIMD) through a systematic literature review.


A search on Cochrane CENTRAL, MEDLINE (PubMed), Lilacs and PEDro databases was carried out from inception to March 2018. Studies that performed a protocol of muscle damage induction, and used local cryotherapy as intervention in comparison with control group/placebo were eligible. The studies should evaluate at least one of the outcomes of interest (delayed onset muscle soreness (DOMS) or muscle strength). Studies that did not evaluate any of the variables of interest or applied ice massage or other cooling modalities were excluded.


The search identified 221 studies, in which 7 studies met the eligibility criteria and were included. There was a mean PEDro score of 7.28, and all studies were ranked as high methodological quality. Meta-analysis showed local cryotherapy does not seem to be effective to accelerate recovery of DOMS (− 0.11; 95% CI − 0.8 to 0.57; I2: 79%) or muscle strength (− 0.59; 95% CI − 2.89 to 1.71; I2: 0%) following EIMD.


In conclusion, the results showed that local cryotherapy does not seem to contribute for the improvement of DOMS and muscle weakness associated with EIMD.


Eccentric contraction Eccentric protocol Creatine kinase Cold therapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present study did not require ethical approval.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Lieber RL, Fridén J (1993) Muscle damage is not a function of muscle force but active muscle strain. J Appl Physiol 74:520–526CrossRefGoogle Scholar
  2. 2.
    Nosaka K, Lavender A, Newton M, Sacco P (2003) Muscle damage in resistance training. Int J Sport Health Sci 1:1–8. CrossRefGoogle Scholar
  3. 3.
    Chapman DW, Newton MJ, McGuigan MR, Nosaka K (2011) Effect of slow-velocity lengthening contractions on muscle damage induced by fast-velocity lengthening contractions. J Strength Cond Res 25:211–219. CrossRefGoogle Scholar
  4. 4.
    Nosaka K, Newton M, Sacco P et al (2005) Partial protection against muscle damage by eccentric actions at short muscle lengths. Med Sci Sports Exerc 37:746–753. CrossRefGoogle Scholar
  5. 5.
    Proske U, Allen TJ (2005) Damage to skeletal muscle from eccentric exercise. Exerc Sport Sci Rev 33:98–104. CrossRefGoogle Scholar
  6. 6.
    Bleakley C, McDonough S, Gardner E et al (2012) Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Sao Paulo Med J. Google Scholar
  7. 7.
    Costello JT, Baker PRA, Minett GM et al (2015) Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database Syst Rev 9:CD010789. Google Scholar
  8. 8.
    Swenson C, Sward L, Karlsson J (1996) Cryotherapy in sports medicine. Scand J Med Sci Sports 6:193–200. CrossRefGoogle Scholar
  9. 9.
    Ascensão A, Leite M, Rebelo AN et al (2011) Effects of cold water immersion on the recovery of physical performance and muscle damage following a one-off soccer match. J Sports Sci 29:217–225. CrossRefGoogle Scholar
  10. 10.
    Ferreira-Junior JB, Bottaro M, Vieira CA et al (2014) Effects of partial-body cryotherapy (− 110 °C) on muscle recovery between high-intensity exercise bouts. Int J Sports Med. Google Scholar
  11. 11.
    Oakley ET, Pardeiro RB, Powell JW, Millar AL (2013) The effects of multiple daily applications of ice to the hamstrings on biochemical measures, signs, and symptoms associated with exercise-induced muscle damage. J Strength Cond Res 27:2743–2751. CrossRefGoogle Scholar
  12. 12.
    Hohenauer E, Costello JT, Stoop R et al (2018) Cold-water or partial-body cryotherapy? Comparison of physiological responses and recovery following muscle damage. Scand J Med Sci Sports. Google Scholar
  13. 13.
    Lombardi G, Ziemann E, Banfi G (2017) Whole-body cryotherapy in athletes: From therapy to stimulation. An updated review of the literature. Front Physiol. Google Scholar
  14. 14.
    Ferreira-Junior JB, Bottaro M, Vieira A et al (2015) One session of partial-body cryotherapy (− 110 °C) improves muscle damage recovery. Scand J Med Sci Sports. Google Scholar
  15. 15.
    Banfi G, Lombardi G, Colombini A, Melegati G (2010) Whole-body cryotherapy in athletes. Sports Med. Google Scholar
  16. 16.
    Bleakley CM, Bieuzen F, Davison GW, Costello JT (2014) Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access J Sports Med 5:25–36. CrossRefGoogle Scholar
  17. 17.
    Torres R, Ribeiro F, Alberto Duarte J, Cabri JMH (2012) Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis. Phys Ther Sport 13:101–114. CrossRefGoogle Scholar
  18. 18.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 89:873–880. Google Scholar
  19. 19.
    Robinson KA, Dickersin K (2002) Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol 31:150–153. CrossRefGoogle Scholar
  20. 20.
    Pedro T, Ap V, Delphi T (1999) PEDro scale. Physiother Evid Database. Google Scholar
  21. 21.
    Higgins JPT, Altman DG (2011) Higgins 2011 Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Cochrane Handb Syst Rev Interv.
  22. 22.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327:557–560. CrossRefGoogle Scholar
  23. 23.
    Selkow NM, Herman DC, Liu Z et al (2015) Blood flow after exercise-induced muscle damage. J Athl Train 50:400–406. CrossRefGoogle Scholar
  24. 24.
    Denegar CR, Perrin DH (1992) Effect of transcutaneous electrical nerve stimulation, cold, and a combination treatment on pain, decreased range of motion, and strength loss associated with delayed onset muscle soreness. J Athl Train 27:200–206Google Scholar
  25. 25.
    Lima CS, Medeiros DM, Prado LR et al (2017) Local cryotherapy is ineffective in accelerating recovery from exercise-induced muscle damage on biceps brachii. Sport Sci Health. Google Scholar
  26. 26.
    de Paiva PRV, Tomazoni SS, Johnson DS et al (2016) Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial. Lasers Med Sci 31:1925–1933. CrossRefGoogle Scholar
  27. 27.
    De Marchi T, Schmitt VM, Machado GP et al (2017) Does photobiomodulation therapy is better than cryotherapy in muscle recovery after a high-intensity exercise? A randomized, double-blind, placebo-controlled clinical trial. Lasers Med Sci 32:429–437. CrossRefGoogle Scholar
  28. 28.
    Hohenauer E, Clarys P, Baeyens J-P, Clijsen R (2017) The effect of local cryotherapy on subjective and objective recovery characteristics following an exhaustive jump protocol. PLoS One. Google Scholar
  29. 29.
    Wilcock IM, Cronin JB, Hing WA (2006) Physiological response to water immersion: a method for sport recovery? Sports Med 36:747–765. CrossRefGoogle Scholar
  30. 30.
    Algafly AA, George KP (2007) The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 41:365–369. (discussion 369) CrossRefGoogle Scholar
  31. 31.
    Hohenauer E, Taeymans J, Baeyens JP et al (2015) The effect of post-exercise cryotherapy on recovery characteristics: a systematic review and meta-analysis. PLoS One. Google Scholar
  32. 32.
    Hausswirth C, Louis J, Bieuzen F et al (2011) Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners. PLoS One. Google Scholar
  33. 33.
    Klimek A, Lubkowska A, Szyguła Z et al (2010) Influence of the ten sessions of the whole body cryostimulation on aerobic and anaerobic capacity. Int J Occup Med Environ Health. Google Scholar
  34. 34.
    Fonda B, Sarabon N (2013) Effects of whole-body cryotherapy on recovery after hamstring damaging exercise: a crossover study. Scand J Med Sci Sports. Google Scholar
  35. 35.
    Takeda M, Sato T, Hasegawa T et al (2014) The effects of cold water immersion after rugby training on muscle power and biochemical markers. J Sports Sci Med 13:616Google Scholar
  36. 36.
    Wilson LJ, Cockburn E, Paice K et al (2018) Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control. Eur J Appl Physiol 5:10. Google Scholar
  37. 37.
    Cheung K, Hume PA, Maxwell L (2003) Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med 33:145–164. CrossRefGoogle Scholar
  38. 38.
    Cleak MJ, Eston RG (1992) Delayed onset muscle soreness: mechanisms and management. J Sports Sci. Google Scholar
  39. 39.
    Mawhinney C, Low DA, Jones H et al (2017) Cold water mediates greater reductions in limb blood flow than whole body cryotherapy. Med Sci Sports Exerc. Google Scholar
  40. 40.
    Selfe J, Alexander J, Costello JT et al (2014) The effect of three different (− 135 °C) whole body cryotherapy exposure durations on elite rugby league players. PLoS One. Google Scholar
  41. 41.
    Gregson W, Black MA, Jones H et al (2011) Influence of cold water immersion on limb and cutaneous blood flow at rest. Am J Sports Med. Google Scholar
  42. 42.
    Chen TC, Lin KY, Chen HL et al (2011) Comparison in eccentric exercise-induced muscle damage among four limb muscles. Eur J Appl Physiol 111:211–223. CrossRefGoogle Scholar
  43. 43.
    Newton MJ, Morgan GT, Chapman DW, Nosaka KK (2008) Comparison of responses to strenuous eccentric exercise of the elbow flexors between resistance-trained and untrained men. J Strength Cond Res 22:597–607. CrossRefGoogle Scholar
  44. 44.
    Powers SK, Ji LL, Kavazis AN, Jackson MJ (2011) Reactive oxygen species: impact on skeletal muscle. Compr Physiol. Google Scholar
  45. 45.
    Powers SK, Jackson MJ (2008) Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiol Rev. Google Scholar
  46. 46.
    Bleakley CM, Davison GW (2010) What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Br J Sports Med. Google Scholar
  47. 47.
    Roberts LA, Raastad T, Markworth JF et al (2015) Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. J Physiol. Google Scholar
  48. 48.
    Fröhlich M, Faude O, Klein M et al (2014) Strength training adaptations after cold-water immersion. J Strength Cond Res. Google Scholar
  49. 49.
    Yamane M, Ohnishi N, Matsumoto T (2015) Does regular post-exercise cold application attenuate trained muscle adaptation? Int J Sports Med. Google Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Escola de Educação Física, Fisioterapia e DançaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  2. 2.Programa de pós graduação em Ciências da Reabilitação, Departamento de FisioterapiaUniversidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreBrazil

Personalised recommendations