Advances in Non-Pharmacological Strategies for DOMS: A Scoping and Critical Review of Recent Evidence

Background: Delayed Onset Muscle Soreness (DOMS) is a transient, exercise-induced condition characterized by muscle pain, stiffness, and functional impairment, particularly following eccentric or high-intensity physical activity. Recent advances in diagnostic imaging, neurophysiology, and therapeutic techniques have led to a reassessment of DOMS pathophysiology and management. Objective: This scoping review aims to critically evaluate non-pharmacological strategies for DOMS management, focusing on clinical studies published between 2020 and 2025. Emphasis is placed on physical, thermal, neurophysiological, and nutritional interventions in athletic populations. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Included studies were randomized controlled trials, systematic reviews, meta-analyses, and high-quality scoping reviews. Methodological quality was assessed using PEDro, AMSTAR 2, and ROBIS tools. Key outcome measures included pain (VAS), functional recovery (ROM, performance), biochemical markers (CK, IL-6), and neuromuscular activation (iEMG). Results: Twenty-five studies met the inclusion criteria. Emerging strategies such as cryosauna, vibration therapy, percussive massage, and polyphenol supplementation demonstrated significant benefits in reducing DOMS-related symptoms and enhancing recovery. Evidence supports the integration of multimodal, personalized interventions over monotherapies. Imaging techniques (7T MRI, ultrasound) confirmed microstructural muscle changes consistent with DOMS, strengthening diagnostic precision. Conclusions: Non-pharmacological approaches to DOMS have evolved considerably, highlighting the importance of combining mechanical, thermal, and nutritional modalities. Personalized, multimodal recovery strategies appear most effective for symptom relief and performance restoration. Future studies should aim to standardize treatment protocols and outcome measures to improve clinical applicability.