Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis

Objective: To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis. Methods: Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers. Results: A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first. Conclusion: Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness. Lay abstract The effects of different methods of cold and heat therapy on pain in patients with delayed onset muscle soreness are debated, and there is uncertainty regard­ing the most effective of these therapies. The aim of this study was to evaluate the effects of different cold and heat treatments on pain in patients with delayed onset muscle soreness. Using network meta-analysis and rank­ing, it was found that, within 48 h post-exercise, use of hot-pack was superior to other interventions, whereas, over 48 h post-exercise, cryotherapy was the optimal intervention for pain relief in patients with delayed onset muscle soreness.