Post-Exercise Recovery Interventions in Competitive Athletes: A Systematic Review of Physiological and Performance Outcomes

Abstract

Background: Congested competitive calendars compress recovery between high-intensity efforts, making resolution of muscle damage, inflammation, and neuromuscular fatigue a determinant of performance and injury risk. Existing syntheses appraise modality families in isolation. Objective: To review post-exercise recovery interventions in competitive athletes across four domains (cryotherapy, manual therapy and compression, combined protocols, and nutritional strategies) for muscle damage markers, perceptual fatigue, and performance restoration. Methods: Following PRISMA 2020, Scopus was searched on 12 July 2026 (updated 10 September) for English-language studies published 2022-2026. Of 702 records, 687 were screened after deduplication, 47 were assessed in full text, and 25 were included. Quality was appraised with MMAT 2018 and AMSTAR 2. Heterogeneity precluded meta-analysis; thematic synthesis was used. Results: Cryotherapy, mostly cold-water immersion, was associated with reduced creatine kinase and soreness and improved neuromuscular and perceived recovery, moderated by exposure dose; network meta-analytic evidence favored 10-15°C for 10-15 min. Foam rolling and massage reduced perceived soreness; compression evidence was limited. Combined protocols outperformed single-modality comparators in all six direct comparisons, marginally in one. Nutrition was examined only within combined protocols or surveys (5 of 25 studies), and no study isolated hydration. Evidence came mainly from male team-sport athletes. Conclusions: Multimodal strategies appear more favorable than single-modality approaches, but without pooled estimates, these comparisons remain provisional. Priorities are sex-stratified trials, a standardized core outcome set, season-long designs, and validation of sensor-guided prescription.