Muscle soreness: what really works?

Two days after a tough training session, walking down a flight of stairs becomes a real struggle. Everyone has their own remedy: stretching, having a cold shower, getting a massage, or popping an ibuprofen. Research has tested just about everything people do in the gym — and the results are nothing like what you hear in the changing rooms. One of the most popular methods is completely ineffective, and another actually causes you to lose muscle.

What doesn’t work: stretching

Let’s start with the most common practice. As early as 1989, a study involving 62 volunteers divided into four groups compared static stretching and warm-up exercises in terms of their effect on muscle soreness following strenuous exercise: there was no significant difference in peak muscle pain.

Thirty-two years later, a meta-analysis of randomised trials revisited the issue of post-exercise stretching. Verdict: no effect on strength recovery compared with passive recovery, and no effect on muscle soreness at 24, 48 or 72 hours. The authors consider the available evidence to be insufficient and heterogeneous, with very low certainty.

Something that helps a bit: a cold bath

As for the cold, there is evidence to support it. A 2016 meta-analysis concluded that immersion in cold water is slightly more effective than passive recovery at alleviating both immediate and delayed muscle pain. It even provides the optimal formula: water at between 11 and 15 °C, for 11 to 15 minutes.

Another meta-analysis, published in 2015, confirms a reduction in muscle soreness at 24, 48 and 96 hours, as well as a decrease in perceived exertion at 24 hours. Following a football match, a 10-minute immersion at 10 °C lowered creatine kinase, myoglobin and C-reactive protein levels, and reduced muscle soreness in the quadriceps and calves at 24 hours.

Massage: effective for pain relief, but not for performance

Massage is one of the best-documented methods. A 2005 study found a reduction in muscle soreness of around 30 per cent following eccentric exercise, with less muscle swelling and a decrease in creatine kinase levels. Another study, from 2003, found a significant reduction in pain intensity 48 hours after exercise.

But the same pattern emerges: in the 2005 study, massage had no significant effect on strength recovery or range of motion. In the 2003 study, neither maximum torque, range of motion nor mood showed any change.

Foam rolling: small but effective

This may well be the biggest surprise in this literature review. A 2019 meta-analysis quantified the benefits of using a foam roller after exercise:

Two separate studies point to the same conclusion: in 2015, foam rolling significantly improved quadriceps pressure sensitivity and limited the decline in sprint performance, power and strength endurance; in 2014, it reduced muscle pain at all measurement points whilst improving range of motion and jump height at the 48-hour mark.

Compression clothing

A 2014 meta-analysis found that they had a moderate effect, and — unusually for this article — on performance as well, not just on pain.

A word of caution: a 2010 study on sprinting and plyometric exercises found only minimal effects on performance, with no significant difference in concentric strength or sprinting performance. The only benefit was a reduction in perceived pain 24 hours later.

The costly mistake: anti-inflammatory drugs

That is the real catch in this article. A 2002 study administered either a placebo, ibuprofen (1,200 mg per day) or paracetamol (4,000 mg per day) following intense eccentric exercise, and measured muscle protein synthesis.

In the placebo group, protein synthesis increased by 76 per cent. In both groups receiving medication, it remained unchanged — the muscle-building response was suppressed. And worse still: neither ibuprofen nor paracetamol reduced perceived muscle pain or creatine kinase levels compared with the placebo. You lose the anabolic response without even gaining any pain relief.

To be honest, the literature is not unanimous. A 2011 study of older adults found the opposite: when combined with exercise, paracetamol and ibuprofen produced greater muscle mass (+12.5 per cent and +10.9 per cent) and strength (+19 kg) than a placebo. Different population, different duration — the debate remains unresolved. But automatically taking an anti-inflammatory after every session is not a neutral decision.

The thing that brings the most relief is free

The 2003 review puts it bluntly: exercise is the most effective way to temporarily relieve muscle soreness. Moving the sore muscle makes the pain go away — at least for the duration of the exercise.

The practical advice that goes with this is just as simple: for 1 to 2 days after a session that has left you with sore muscles, reduce the intensity and duration of your workout, or focus on other parts of your body.

In summary

It’s worth making one thing clear about almost all these methods: they focus on how you feel, rather than on what your muscles are actually doing. That’s no small thing — feeling less discomfort means you can get back to training sooner. But none of them is a substitute for pacing your progress.

And if you want to know how far you can push a series without knackering yourself out for three days, we discuss this in ‘Series, Repetitions or Time Under Tension’.

Every figure in this article is taken from the studies listed below, summarised on the basis of their abstracts alone. This content is for information purposes only and is not a substitute for medical advice: if you have any questions about taking a medicine, speak to a pharmacist or a doctor. A sharp, localised pain, or one that lasts for more than a few days, is not ordinary muscle soreness and warrants professional advice.