The Effects of Lumbar Delayed Onset Muscle Soreness on Clinical, Biomechanical and Neuromuscular Outcomes: A Systematic Review and Meta-Analysis.

BACKGROUND AND

OBJECTIVE

Low back pain is multifactorial, making it difficult to isolate pain-related motor adaptations. Experimental pain models may help clarify these mechanisms. This systematic review evaluates lumbar delayed onset muscle soreness (DOMS) as a movement-evoked pain model and its effects on clinical, biomechanical and neuromuscular outcomes.

DATABASES AND DATA TREATMENT: The meta-analysis (PROSPERO: CRD420251051399) included studies of healthy adults with experimentally induced DOMS, with outcomes assessed within 5 days under the influence of DOMS. Databases (MEDLINE, SCOPUS, CINAH) were searched (9/12/2025), with manual screening. Independent study selection, data extraction and risk-of-bias assessment (NIH Quality Assessment Tool) were performed. Random-effects meta-analysis calculated standardized mean differences (SMDs). Sensitivity analyses and GRADE (Cochrane) assessed robustness and evidence certainty.

RESULTS

Eighteen studies were included (452 participants). DOMS significantly increased low back pain intensity (SMD: Day 1 with DOMS = 1.12, Day 2 = 0.94, Day 3 = 0.69, Day 4 = 0.49) and soreness (Day 1 = 1.94, Day 2 = 1.66, Day 3 = 0.88, Day 4 = 0.59). Pressure pain thresholds decreased significantly (Day 1 = -0.47, Day 2 = -0.44). Trunk extension maximal voluntary contraction decreased significantly (Day 1 = -0.67, Day 2 = -0.95, Day 3 = -0.84, Day 4 = -0.38), while trunk flexion range of motion and flexion relaxation ratios remained unchanged.

CONCLUSIONS

Lumbar DOMS replicates low back pain features, movement-evoked pain, increased sensitivity and reduced muscle function, providing a non-invasive model to study short-term neuromuscular adaptations in a controlled setting.

SIGNIFICANCE STATEMENT: This review highlights lumbar DOMS as a safe, non-invasive model to study short-term neuromuscular adaptations to pain to better understand pain mechanism. This synthesis provides foundational work for future studies using DOMS to explore LBP mechanisms. By clarifying its strengths (e.g., ecological validity for acute pain) and limitations (e.g., short duration, lack of pain-related psychological factors), we aimed to guide more standardized applications of this model in pain research.