Impact of different cryotherapy interventions on post-exercise acute delayed-onset muscle soreness, athletic performance, and inflammatory biomarkers: a systematic review and network meta-analysis

Background Cryotherapy is a widely used physical recovery modality in post-exercise settings; however, systematic evidence identifying the optimal cryotherapy modality based on continuous time-course outcome assessments remains limited. Methods To investigate the comparative effectiveness of different cryotherapy modalities—whole-body cryotherapy (WBC), cold water immersion (CWI), contrast water therapy (CWT), and local cold therapy (LCT)—on delayed-onset muscle soreness (DOMS), countermovement jump, and inflammatory biomarkers (creatine kinase, interleukin-6, and C-reactive protein) at multiple post-intervention time points (immediate, 1 h, 24 h, 48 h, and 72 h), using a systematic review and network meta-analysis approach. A systematic search was conducted in the Web of Science, PubMed, Cochrane Library, Embase, and EBSCO databases for studies published between January 1, 2010, and November 1, 2025. Results A total of 51 randomized controlled trials comprising 1,243 participants were included. The effects of cryotherapy demonstrated a pronounced time-dependent pattern. Compared with control conditions, no cryotherapy modality significantly reduced DOMS immediately after exercise. CWI significantly attenuated DOMS at 1 h [MD = −1.09, 95% CI (−1.93, −0.24), P < 0.05] and 24 h [MD = −0.89, 95% CI (−1.33, −0.45), P < 0.05], whereas LCT produced the greatest reduction at 48 h [MD = −1.17, 95% CI (−2.19, −0.16), P < 0.05]. Regarding inflammatory biomarkers, WBC resulted in the largest reductions in CK levels at 48 h [MD = −118.24, 95% CI (−173.49, −63.00), P < 0.05] and 72 h [MD = −135.03, 95% CI (−204.40, −65.66), P < 0.05]. CWI was the most effective modality for suppressing IL-6 immediately post-exercise [MD = −0.32, 95% CI (−0.58, −0.06), P < 0.05] and at 24 h [MD = −0.46, 95% CI (−0.92, −0.01), P < 0.05]. In terms of exercise performance, WBC significantly improved countermovement jump performance at 1 h [MD = 9.15, 95% CI (5.12, 13.17), P < 0.05], 24 h [MD = 10.70, 95% CI (1.16, 20.42), P < 0.05], and 48 h [MD = 10.50, 95% CI (3.37, 17.62), P < 0.05], with sustained benefits observed up to 72 h . Conclusion Cryotherapy is an effective strategy for promoting the recovery of physiological indicators following acute exercise, with its efficacy demonstrating pronounced time-dependent characteristics. Systematic Review Registration Identifier, 2026 CRD420261300174.