Exercise Induced muscle damage (EIMD) following strenuous unaccustomed exercise is common among recreational and professional athletes. Many articles assess the effects of combining different physiotherapeutic modalities e.g. (exercise, cold water immersion, massage, compression therapy and electrotherapy) treating EIMD.

The purpose of this review was to systematically review and critically appraise the controlled clinical trials that compared combined intervention treatments to standalone treatment after exercise induced muscle damage (EIMD).

Six electronic databases (PubMed, PEDro, Embase, Cochrane, Web of Science (WOS) and EBSCO) were searched from inception until March 21, 2020. Further, manual search of the bibliography of all eligible articles was done.

Articles were categorized based on the combined treatment into three categories: exercise and massage, cryotherapy, cold water immersion (CWI) and exercise. Study quality was assessed using PEDro scale. Meta-analysis was conducted to compare the effect of exercises combined with other treatment against exercises alone as measured by blood lactate and heart rate.
Twelve studies were included in the quality assessment. The majority of the studies were of moderate to high quality. Meta-analysis showed that exercises combined with hydrotherapy significantly decreased blood lactate and heart rate compared to exercises alone with 95% confidence interval (95% CI).

There is some evidence of moderate to high quality supporting the efficacy of combined treatment in treating EIMD more than that of single treatment. But still more clinical trials with larger sample size, specific baseline similarity of the groups is needed to confirm results.