PNF Versus Cryotherapy in Delayed Onset Muscle Soreness

Efficacy of Proprioceptive Neuromuscular Facilitation Versus Cryotherapy and Placebo on Delayed Onset Muscle Soreness: A Randomized Pilot Clinical Trial

This randomized, double-blind, single-center pilot clinical trial evaluated three interventions for delayed onset muscle soreness in the hamstring muscles.

Twenty-nine untrained adults were included. Delayed onset muscle soreness was induced using two eccentric hamstring exercises. Participants were then assigned to one of three groups: proprioceptive neuromuscular facilitation, local cryotherapy, or placebo consisting of water with sugar.

The main outcome was pressure pain threshold in the hamstring muscles. Other outcomes included knee range of motion, hamstring strength, pain intensity, perceived exertion, and blood lactate levels. Measurements were taken before the eccentric exercise, 24 hours after exercise before treatment, immediately after treatment, and 48 hours after exercise.

Study Overview

• Status: Completed
• Conditions: Delayed Onset Muscle Soreness (DOMS)
• Intervention / Treatment: Other: Proprioceptive Neuromuscular Facilitation; Other: Local Cryotherapy; Other: Placebo: Water With Sugar

• Study Type: Interventional
• Enrollment (Actual): 29
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Madrid
    • Madrid, Madrid, Spain, 28015
      • Clínica Universitaria Salus Infirmorum, Universidad Pontificia de Salamanca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults aged between 18 and 45 years.
• Participants who did not usually perform physical exercise or whose exercise was not focused on the lower limbs.
• Participants who had previously experienced delayed onset muscle soreness and were familiar with its effects.

Exclusion Criteria:

• Musculoskeletal injury of the lower limb.
• Pregnancy.
• Diabetes.
• Cardiovascular problems.
• History of cancer.
• Autoimmune diseases, including Raynaud disease or rheumatoid arthritis.
• Sensory disorders.
• Skin disorders.
• Skin conditions.
• Peripheral venous or lymphatic vascular insufficiency.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Proprioceptive Neuromuscular Facilitation; Participants received a proprioceptive neuromuscular facilitation intervention targeting the hamstring muscles 24 hours after eccentric exercise-induced delayed onset muscle soreness.	Other: Proprioceptive Neuromuscular Facilitation; A contract-relax-antagonist-contract proprioceptive neuromuscular facilitation technique was applied to the hamstring muscles. The protocol included isometric hamstring contraction, rest, quadriceps contraction, and passive movement into a deeper hamstring stretch. The protocol was repeated twice on each leg.
Experimental: Cryotherapy; Participants received local cryotherapy over the hamstring muscles 24 hours after eccentric exercise-induced delayed onset muscle soreness.	Other: Local Cryotherapy; Participants were placed in prone position and an ice pack was applied over the hamstring muscles for 20 minutes. A thin cloth was placed between the ice pack and the skin to avoid direct contact.
Placebo Comparator: water with sugar; Participants received a placebo intervention consisting of water with sugar 24 hours after eccentric exercise-induced delayed onset muscle soreness.	Other: Placebo: Water With Sugar; Participants consumed 200 mL of water with 5 g of dissolved sugar after the eccentric exercise protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Pressure Pain Threshold in the Hamstring Muscles	Pressure pain threshold was assessed using a pressure algometer over three points of maximum pain in the hamstring muscles. Three measurements were taken and the mean value was calculated.	Baseline, 24 hours after eccentric exercise before treatment, immediately after treatment, and 48 hours after eccentric exercise

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Active Knee Range of Motion	Active knee flexion and extension range of motion were assessed using a manual goniometer.	Baseline, 24 hours after eccentric exercise before treatment, immediately after treatment, and 48 hours after eccentric exercise
Change in Hamstring Muscle Strength	Maximum hamstring strength was assessed using a handheld dynamometer.	Baseline, 24 hours after eccentric exercise before treatment, immediately after treatment, and 48 hours after eccentric exercise
Change in Blood Lactate Concentration	Blood lactate concentration was measured using a Lactate Edge device.	Before exercise, immediately after exercise, and 48 hours after exercise
Change in Pain Intensity	Pain intensity was assessed using the 11-point Numeric Pain Rating Scale. Scores range from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.	Baseline, 24 hours after eccentric exercise before treatment, immediately after treatment, and 48 hours after eccentric exercise
Perceived Exertion After Eccentric Exercise	Perceived exertion was assessed using the Modified Borg Rating of Perceived Exertion Scale after completion of the eccentric exercise protocol. Scores range from 0 to 10, where 0 indicates no exertion and 10 indicates maximal exertion. Higher scores indicate greater perceived exertion and therefore a worse outcome.	Immediately after eccentric exercise

Collaborators and Investigators

• Sponsor: Universidad Pontificia de Salamanca
• Investigators: Principal Investigator: Sara Perpiña Martínez, PhD, Universidad Pontificia de Salamanca

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): April 26, 2025
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: May 28, 2026
• First Submitted That Met QC Criteria: May 28, 2026
• First Posted (Actual): June 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Physical therapy; Blood lactate; Muscle strength; Cryotherapy; Range of motion; PNF; Hamstrings; Proprioceptive neuromuscular facilitation; Pain intensity; Pressure pain threshold; Eccentric exercise; Delayed onset muscle soreness; DOMS
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Physical Therapy Modalities; Carbohydrates; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Exercise; Sugars; Muscle Stretching Exercises
• Other Study ID Numbers: UPSA-DOMS-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data related to the outcomes reported in the study may be shared upon reasonable request to the principal investigator. Data will only be shared for academic and research purposes, after approval by the study team, and in accordance with applicable data protection regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No