Author(s): WIECHA, S., POSADZKI, P., ZAJAC, J., WISNIOWSKI, P., PAWLICZEK, P., CIESLINSKI, M., PRILL, R., CIESLINSKI, I., PLASZEWSKI, M., Institution: AKADEMIA WYCHOWANIA FIZYCZNEGO JÓZEFA PIŁSUDSKIEGO W WARSZAWIE , Country: POLAND, Abstract-ID: 852

INTRODUCTION:
Delayed onset muscle soreness (DOMS) commonly arises from intense and unfamiliar physical exertion, leading to diminished muscular strength, heightened soreness, and inflammation. Various systematic reviews (SRs) evaluate diverse physical therapy (PT) approaches aimed at reducing DOMS. Nevertheless, these SRs frequently yield conflicting findings, hindering the formulation of therapeutic strategies by clinicians.
METHODS:
An umbrella review method with meta-meta-analysis has been utilized to evaluate the efficacy and safety of PTs in reducing DOMS. Medline, Embase, Cochrane Database of Systematic Reviews, PEDro, and Epistemonikos were searched from 1998 until May 2023. SRs of RCTs of any treatment used by physical therapists or physiotherapists to reduce DOMS in healthy adults have been eligible. AMSTAR-2 has been used to evaluate the risk of bias of the included SRs. An evidence map categorized interventions based on the effect size and strength of evidence (Class I-V based on the number of cases, p-value, heterogeneity, Egger’s test, and excess of significance bias).
RESULTS:
Twenty-nine SRs (24 with meta-analysis) meet inclusion criteria, including 863 unique RCTs. Interventions were diverse, including 24 different PTs. The quality of SRs was generally low, with only 7% rated as high quality.

With the highest strength of evidence, significant effects in pain reduction were observed immediately after post-exercise intervention in contrast therapy (Class II), massage therapy at 24 hours (Class II), compression, contrast therapy, Kinesio taping, and cryotherapy at 48 hours (Class III), Kinesio taping at 72 hours (Class III), while compression, phototherapy, and contrast therapy showed effectiveness at 96 hours (Class IV). The effect size (Hedges’ g) varied widely for individual therapies from 0.36 [95%CI 0.46, 3.18] for cold therapy to 1.82 [95%CI 0.46, 3.18] for heat therapy, with a prominent increase in the 95%CI as the effect size increased.
CONCLUSION:
This is the first umbrella review to analyze the effects of different therapeutic interventions on pain reduction in DOMS. In the analyzed SRs, therapies were not directly compared with each other or ranked by the strength of scientific evidence. The overlap between SRs varied, indicating differences in search strategies. The analyses reveal a wide disparity in the effectiveness of PTs and an overall low strength of scientific evidence for most therapies. This may be attributed to the high methodological heterogeneity of first-line studies and the significant internal variation in the therapies applied.