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How to get the most out of recovery - the latest evidence base

Training has long been perceived as whoever works hardest gets the most reward. I often see people who are forever hammering themselves in the gym and not finding the improvements they are looking for. There are a number of reasons as to why this may be the case, but more often than not, a big factor that is being neglected is their recovery. So, I thought I’d have a look at the latest evidence base and share with you how the most effective forms of recovery can help to get you back in the gym feeling fresher and having capacity to push towards your goals. It’s time to work smarter rather than harder.

Exercise-induced soreness can lead to a reduction in muscle force, a disturbed sense of joint position, decreased physical performance and/or an increased risk of injury (Dupuy et al, 2018). It is therefore important for us to understand how to optimise recovery periods and alleviate symptoms of the dreaded DOMS (delayed onset of muscle soreness) and reduce the feeling of fatigue.

Complete recovery is defined as the return to homeostasis of various physiological systems following metabolic and inflammatory changes and muscle damage post-exercise. Several kinds of recovery interventions have been proposed to improve recovery after physical exercise including the following:

  • Hydration

  • Nutrition

  • Sleep

  • Massage

  • Compressive socks

  • Water immersion

  • Cold exposure/cryotherapy

  • Stretching

  • Electrostimulation

  • Active recovery

Without doubt the most important three to get on top of are hydration, nutrition and sleep. These are also probably the easiest aspects to mange, yet are often overlooked due to time constraints and busy schedules. The necessary individual requirements (dosage) of these three factors is dependent on the type of activity being performed, an individual’s norms, hormonal status, etc, etc. Trying to advise on dosage of these factors within this one blog post would therefore be unachievable, but it is worth tracking down specialist advice should you have further questions about these.

With regards to the other recovery modalities we can turn to the literature a little more easily. A systematic review by Dupuy et al (2018) scoured the evidence base for their effects on DOMS and perceived fatigue, as well as on inflammatory and muscle damage markers. It was highlighted that massage had the most beneficial effects on DOMS and perceived fatigue regardless of the subjects (athletes or sedentary subjects). Compression garments (ie compression socks) and cold water immersion also had beneficial effects on the same markers, but with a less pronounced effect. Active recovery, contrast water therapy (switching between warm and cold water) and cryotherapy (cold therapy) had a positive impact only on DOMS. Other strategies such as stretching and electrostimulation did not appear to have a significant impact on DOMS, but had some effects on circulating inflammatory markers in the blood.

Below we provide a little more detail about the dosage of some of the recovery strategies:


A 20–30 min massage that is performed immediately following or up to 2 h after exercise has been shown to effectively reduce DOMS for 24 hours after exercise (Torres et al., 2012). A recent meta-analysis also reported that massage decreases DOMS for 72 hours after exercise (Guo et al., 2017).

Compression Garments

It has been shown that wearing a whole-body compression garment over a 24-h period after intense heavy resistance training significantly reduces perceived fatigue (Kraemer et al., 2010).

Cold Water Immersion (CWI)

An exposure of 11–15 degrees celsius over 11–15 min was considered to be the optimal circumstance to obtain a positive impact of CWI after exercise to reduce DOMS (Machado et al., 2016). In the Dupuy et al (2018) study, they observed that only immersion in water with a temperature lower than 15 degrees celsius had a positive impact on inflammatory markers.

Active Recovery (AR)

Dosage of AR is a little trickier, as by the very nature of the term, active recovery can mean a whole range of things. For some it may be gently floating around in a pool for an hour, for others it may mean gently cycling for a few mins. Within the Dupuy et al (2018) review, when scrutinizing the scientific literature, no extra beneficial effect of AR was observed after high-intensity eccentric exercise when compared with the benefits obtained from massage and electrostimulation.

One study found that after a rugby contest, 1 hour of low-intensity aquatic exercise had no impact on circulating inflammatory markers (Suzuki et al., 2004), whereas in another, 7 minutes of low- intensity exercise enhanced inflammatory marker clearance (Gill et al., 2006). It may therefore be the case that less is more when thinking about AR.


For some time, stretching immediately after intense physical exercise has not been recommended, as it may even increase the symptoms of DOMS (Smith et al, 1993). However, the recent study by Dupuy et al (2018) found no significant difference to symptoms either way. It therefore seems that stretching has little benefit as a recovery strategy.

Electrostimulation and Cryotherapy

A small nod to these two aspects. Unfortunately, the current evidence base is hard to decipher. Some studies show benefits after using these two modalities, others do not. This is probably due to the limitations of comparing studies, which have used different protocols. Recommending a certain dosage is therefore tricky to do.

I hope this has shed some light and helps to positively impact your training. Aim to work smarter as opposed to harder and experiment with each of the recovery strategies discussed. Find what works for you and go with it. You may notice that you find more benefit from one aspect, whereas your training partner may gain more from another. It is all part of the journey of becoming a more independent and robust mover/athlete.

Feel, Think, Move

Until next time,

James Boyd

References (should you want to do more reading of your own)

Dupuy, O. et al (2018) An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis Frontiers in Physiology 9, 403, 1-15

Gill, N. D. et al (2006) Effectiveness of post- match recovery strategies in rugby players. Br. J. Sports Med. 40, 260–263

Guo, J. et al. (2017) Massage alleviates delayed onset muscle soreness after strenuous exercise: a systematic review and meta-analysis. Front Physiol. 8, 747

Kraemer, W. J. et al (2010) Effects of a whole body compression garment on markers of recovery after a heavy resistance workout in men and women. J. Strength Cond. Res. 24, 804–814

Machado, A. F. et al (2016) Can water temperature and immersion time influence the effect of cold water immersion on muscle soreness? A Systematic Review and Meta-Analysis. Sports Med. 46, 503–514

Smith, L. et al (1993) The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase. Res. Q. Exerc. Sport 64, 103–107

Suzuki, M. et al (2004) Effect of incorporating low intensity exercise into the recovery period after a rugby match. Br. J. Sports Med. 38, 436–440

Torres, R. et al (2012)Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis. Phys. Ther. 13, 101–114

Mindfully Active Physio


Mindfully Active Physio at

Koru Gym

Peek Business Park, Woodside 

Bishops Stortford, CM23 5RG

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