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Delayed-onset muscle soreness is a common response to intense exercise, particularly movements with a strong eccentric component such as endurance running, resistance training, and plyometric exercise. Traditionally, the condition was attributed mainly to structural muscle damage and localised inflammation, but a growing body of evidence suggests it involves a far more complex set of neurophysiological processes, including inflammatory signalling, sensitisation of pain-detecting nerve fibres, disruption of proprioception, and adaptations within the central nervous system.
This systematic review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered with the International Prospective Register of Systematic Reviews, screened 1,183 articles to synthesise current understanding of these mechanisms and evaluate therapeutic recovery interventions. Across different exercise types, several recovery strategies demonstrated meaningful reductions in delayed-onset muscle soreness. Acupuncture produced the largest standardised mean difference of -0.89, outperforming both compression garments (standardised mean difference -0.44) and foam rolling (standardised mean difference -0.34). The review also noted that acupuncture may be particularly suited to recovery from plyometric exercise, which is characterised by proprioceptive disruption and sensitisation of nerve fibres.
The authors caution that the majority of included studies lacked extractable effect sizes, limiting the scope for formal meta-analysis, and that individual neurophysiological variation means no single strategy suits all athletes. Standardised outcome reporting and mechanistic biomarker research are recommended to strengthen future evidence.
Conclusion: This systematic review found acupuncture to be among the most effective interventions for reducing delayed-onset muscle soreness, though higher-quality and better-standardised research is needed to confirm and refine these findings.
Source: Jemni M, Quodling N, Hammami N and colleagues. Frontiers in sports and active living (2026). View on PubMed (PMID 42824430) · doi:10.3389/fspor.2026.1709704
