Acupuncture-Related interventions for exercise-induced delayed-onset muscle soreness in active adults: A systematic review and meta-analysis for sport rehabilitation

Background Delayed-onset muscle soreness (DOMS) is a common post-exercise condition that can impair athletic performance, training quality, and rehabilitation. Objective To evaluate the efficacy and safety of acupuncture-related interventions for exercise-induced DOMS in active adults. Methods PubMed, Embase, Cochrane Library, and CNKI were searched from inception to December 2025, with a manual reference-list update in January 2026. Randomized controlled trials comparing acupuncture-related interventions with sham/placebo or no treatment in healthy adults with exercise-induced DOMS were eligible. Nine RCTs met the eligibility criteria, and seven contributed compatible pain data to meta-analysis. Two reviewers independently extracted data, assessed risk of bias using RoB 2, and rated evidence certainty with GRADE. Pain intensity on a 0–10 visual analogue scale was pooled using random-effects models. Results Across seven RCTs, acupuncture-related interventions reduced DOMS pain at 24 h (MD −0.62, 95% CI −1.01 to −0.23), 48 h (MD −0.71, 95% CI −1.20 to −0.22), and 72 h (MD −0.84, 95% CI −1.35 to −0.32). Heterogeneity was low (I 2 = 0%, 3%, and 23%, respectively). None of the pooled estimates reached commonly cited 1.0- or 1.3-point pain thresholds, and no DOMS-specific minimal clinically important difference has been established. Evidence certainty was moderate. Conclusion Acupuncture-related interventions may provide modest short-term reductions in DOMS pain, but their clinical importance remains uncertain. The evidence base is small and does not support dry-needling-specific conclusions. Larger, rigorously controlled, modality-specific RCTs are needed.