Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis.
Yutan Wang, Hongmei Lu, Sijun Li and 7 others
PMID 34636405WHAT IT FOUND
Hot packs reduced pain best within 48 hours, while whole-body cryotherapy was most effective after 48 hours.
However, study quality was low, blinding was poor, and results for newer cold therapies relied on very few trials, so these rankings are unstable.
Key findings
01Hot packs were ranked first for pain relief at both 24 and 48 hours post-exercise.
02Whole-body cryotherapy (CRYO) was ranked first for pain relief at follow-ups over 48 hours.
03Most included studies had weak blinding and allocation, which likely overestimated the effects of these subjective pain outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The majority of included trials had weak blinding and allocation concealment, which tends to overestimate treatment effects, especially for subjective outcomes like pain. The number of studies for specific interventions (like hot packs and CRYO) was small, making the rankings unstable. There was no standardization of intervention protocols (e.g., temperature, duration) across the included studies. Most participants were young adults or athletes, which may limit generalizability to older or more sedentary populations. Publication bias was suspected based on asymmetrical funnel plots.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not interpret the top ranking of hot packs or cryotherapy as proof of superior efficacy. The analysis included many studies with poor blinding, which likely inflated the perceived benefits of these subjective pain treatments. Additionally, the evidence for these specific modalities came from a small number of trials with inconsistent protocols.