Pain management interventions for combat sport and martial arts athletes including pencak silat: a systematic review

Juanda Putra

doi:10.32698/03622

Pain management interventions for combat sport and martial arts athletes including pencak silat: a systematic review

Juanda Putra⁽¹⁾,
(1) Universitas Negeri Padang

Indonesia

Corresponding Author

DOI : https://doi.org/10.32698/03622

Full Text:

Language : en

Abstract

Combat and martial arts, including Pencak silat, expose athletes to repetitive high-impact loading that generates acute pain, delayed-onset muscle soreness, and cumulative musculoskeletal strain, yet the evidence base for managing this pain remains fragmented. This systematic literature review synthesised controlled evidence on pain-management and recovery interventions in combat and martial arts athletes. The review followed the PRISMA 2020 framework, searching Scopus, PubMed, and ScienceDirect for records published between 2002 and 2026. A total of 1,444 records were identified; after removing 16 duplicates and screening 1,428 titles and abstracts, 52 reports were assessed in full text and 7 studies met all eligibility criteria. Methodological quality was appraised with the Mixed Methods Appraisal Tool. The included studies evaluated dry needling and manual therapy, cryotherapy and compression, topical pharmacological gels, and neurodynamic mobilisation, consistently reporting raised pressure-pain thresholds, improved perfusion, and attenuated soreness relative to sham or passive control. No study specifically recruited Pencak silat athletes, exposing a critical evidence gap. These findings support multimodal, mechanism-targeted pain care while underscoring the urgent need for Pencak-Silat-specific controlled trials. Future research should standardise outcomes and prioritise underrepresented traditional martial arts.

Keywords

Pencak silat; Combat sports; Pain management; Rehabilitation; Athletes.

References

Aghajani, R., Dehghani, E., Khonji, M. S., Naghdi, S., Nakhostin Ansari, N., Dommerholt, J., & Nakhostin-Ansari, A. (2025). Effect of dry needling on quadriceps muscles fatigue in taekwondo players: A protocol for a triple-blinded randomized controlled trial. Contemporary Clinical Trials Communications, 45, 101476. https://doi.org/10.1016/j.conctc.2025.101476

Aydın, S., Eken, Ö., & Aldhahi, M. I. (2026). Acute effects of squat loading intensity on performance in competitive judo athletes. Scientific Reports, 16(1). https://doi.org/10.1038/s41598-026-39312-x

Bromley, S., Drew, M., Talpey, S., McIntosh, A., & Finch, C. (2018). Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System. JMIR Human Factors, 5(4). https://doi.org/10.2196/humanfactors.9541

Castropil, W., Mauad, J., Medina, G., & Schor, B. (2026). “Fighter’s shoulder” part I: impact on shoulder motion and scapular movement in judo and jiu-jitsu athletes. JSES International, 10(2). https://doi.org/10.1016/j.jseint.2025.101416

de Souza, J. M. C., Faim, F. T., Nakashima, I. Y., Altruda, C. R., Medeiros, W. M., & da Silva, L. R. (2011). Lesions in Shotokan Karate and Jiu-Jitsu - direct trauma versus indirect. Revista Brasileira de Medicina do Esporte, 17(2), 107–110. https://doi.org/10.1590/S1517-86922011000200007

Dergaa, I., Ghram, A., Romdhani, M., Souissi, A., Ammar, A., Farahat, R. A., Fessi, M. S., Irandoust, K., Taheri, M., Masmoudi, T., Dergaa, M. A., Souissi, N., Hammouda, O., Weiss, K., Chamari, K., Ben Saad, H., & Knechtle, B. (2024). Does wet-cupping therapy improve repeated sprint ability, perceived wellness, and rating of perceived exertion in young active males?. Sports Medicine and Health Science, 6(4), 378–384. https://doi.org/10.1016/j.smhs.2023.09.007

Fares, M. Y., Stadler, R., Mao, J., Ghanem, D., Boufadel, P., Daher, M., Parmar, T., Kobayashi, E. F., Khan, A. Z., Kassam, H. F., & Abboud, J. A. (2025). Return to Sport After Shoulder Injuries in Mixed Martial Arts: Implications on Longevity and Performance. Journal of Clinical Medicine, 14(11). https://doi.org/10.3390/jcm14113767

Finnegan, E., Daly, E., & Ryan, L. (2025). Contrasting Realities in Injury Management: Strategies Employed by Performance Nutritionists and Dietitians in Ireland (Part A). Current Developments in Nutrition, 9(9), 107507. https://doi.org/10.1016/j.cdnut.2025.107507

Fonseca, L. B., Brito, C. J., Silva, R. J., Silva-Grigoletto, M. E., da Silva, W. M., Jr., & Franchini, E. (2016). Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in jiu-jitsu athletes. Journal of Athletic Training, 51(7), 540–549. https://doi.org/10.4085/1062-6050-51.9.01

Franzò, M., Pica, A., Pascucci, S., Marinozzi, F., & Bini, F. (2023). Hybrid System Mixed Reality and Marker-Less Motion Tracking for Sports Rehabilitation of Martial Arts Athletes. Applied Sciences (Switzerland), 13(4). https://doi.org/10.3390/app13042587

Glińska-Wlaź, J., Huzarska-Rynasiewicz, I., Warzocha, T., Grymanowski, J., & Wlaź, Ł. (2025). Coping pain strategies, aggression and anxiety in professional martial arts athletes. Journal of Physical Education and Sport, 25(4), 870–876. https://doi.org/10.7752/jpes.2025.04094

Hlasho, T. S., Mathunjwa, M. L., Shaw, B., & Shaw, I. (2024). A Systematic Review of the History of Judo in South Africa: Implication for the Future. The Open Public Health Journal, 17. https://doi.org/10.2174/0118749445313228240905071906

Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., & Vedel, I. (2018). Mixed Methods Appraisal Tool (MMAT), version 2018. Canadian Intellectual Property Office, Industry Canada.

Howitt, S. D., Welsh, P., & DeGraauw, C. (2023). Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes. Journal of Manipulative and Physiological Therapeutics, 46(3), 182–189. https://doi.org/10.1016/j.jmpt.2023.11.001

Kandakurti, P. K., Muthukrishnan, R., Arulsingh, W., & Hazari, A. (2025). Effect of neuromeningeal mobilization and postural re-education exercises for persistent hamstring strain: A case report. Journal of Medical Case Reports, 19(1), 133. https://doi.org/10.1186/s13256-025-05179-1

Kiehl, D., Purcell, J., Pezzullo, L., Nixon, R. M., Martenson, M., Vincent, K. R., & Vincent, H. K. (2025). Ten-year patterns of emergent concussion injuries among various martial arts disciplines. Injury, 56(6), 112289. https://doi.org/10.1016/j.injury.2025.112289

Kusuma, M. N. H. (2023). INVESTIGATING THE CAUSATIVE FACTOR OF MUSCULOSKELETAL INJURY FOR INDONESIAN TRADITIONAL MARTIAL ARTS. Physical Education Theory and Methodology, 23(2), 185–191. https://doi.org/10.17309/tmfv.2023.2.05

Kużdżał, A., Clemente, F. M., Kawczyński, A., Ryszkiel, I., & Trybulski, R. (2024b). Comparing the effects of compression contrast therapy and dry needling on muscle functionality, pressure pain threshold, and perfusion after isometric fatigue in forearm muscles of combat sports athletes: A single-blind randomized controlled trial. Journal of Sports Science and Medicine, 23(1), 548–558. https://doi.org/10.52082/jssm.2024.548

Kużdżał, A., Clemente, F. M., Klich, S., Kawczyński, A., & Trybulski, R. (2024a). Combination of manual therapy and dry needling effectively improves acute neck pain and muscular tone and stiffness in combat sports athletes: A randomized controlled study. Journal of Sports Science and Medicine, 23(4), 852–862. https://doi.org/10.52082/jssm.2024.852

Kızılay, F., & Cengiz, D. U. (2023). A comparison of functional vestibulo-ocular reflex and proprioception in athletes of combat sports and ball sports. Heliyon, 9(7), e17540. https://doi.org/10.1016/j.heliyon.2023.e17540

Li, D., Li, H., & Hang, Y. (2025). Hybrid feature-time series neural network for predicting ACL forces in martial artists with resistive braces after reconstruction. Frontiers in Bioengineering and Biotechnology, 13. https://doi.org/10.3389/fbioe.2025.1579472

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100

Litwiniuk, A., Bujak, Z., Mastalerz, A., Różański, P., Romero Ramos, O., & Niźnikowski, T. (2023). COMPARISON OF MAINTAINING OF BODY BALANCE IN COMBAT SPORTS BETWEEN EXPERTS AND NON-EXPERTS. Journal of Kinesiology and Exercise Sciences, 33(102), 21–27. https://doi.org/10.5604/01.3001.0053.5974

Liu, J. (2022). EFFECT OF STRENGTH TRAINING ON NECK INJURIES PREVENTION IN MARTIAL ARTS ATHLETES. Revista Brasileira de Medicina do Esporte, 28(5), 523–524. https://doi.org/10.1590/1517-8692202228052022_0028

Liu, T. (2022). IMPACT OF POSTURE AND RECOVERY METHODS ON SPORTS INJURIES. Revista Brasileira de Medicina do Esporte, 28(6), 719–722. https://doi.org/10.1590/1517-8692202228062022_0059

Lopes, L., Monte, J. T., Rodrigues, S., Marangoni, C. B., Sousa, M. D., Calçada, E., Ibarra, L., & Machado, J. (2023). Individualized acupuncture for unilateral musculoskeletal pain: The advanced mathematical model. Brain Behavior and Immunity Integrative, 2, 100010. https://doi.org/10.1016/j.bbii.2023.100010

Lv, C., & Zhang, J. (2022). STUDY ON SPINAL CURVATURE CHANGES IN KUNG FU PRACTITIONERS. Revista Brasileira de Medicina do Esporte, 28(6), 834–836. https://doi.org/10.1590/1517-8692202228062022_0043

Mack, A. Q., Ankem, H. K., Kyin, C., Jimenez, A. E., Saks, B. R., Sabetian, P. W., Knott, P., Lall, A. C., & Domb, B. G. (2022). Hip Pain Increases With Age and Experience Level in Adult Karate Athletes: A Statewide Survey Study. Arthroscopy, Sports Medicine, and Rehabilitation, 4(2), e325–e333. https://doi.org/10.1016/j.asmr.2021.10.003

Mathunjwa, M. L., Mahlangu, S., & Haddad, M. (2025). Evaluating the Impact of Massage Therapy on Performance and Well-Being in Taekwondo Practitioners: A Systematic Review. International Journal of Environmental Research and Public Health, 22(5). https://doi.org/10.3390/ijerph22050742

Meyers, M. C., Higgs, R., LeUnes, A. D., Bourgeois, A. E., & Laurent, C. M. (2015). Pain-coping traits of nontraditional women athletes: Relevance to optimal treatment and rehabilitation. Journal of Athletic Training, 50(10), 1034–1041. https://doi.org/10.4085/1062-6050-50.8.04

Moreira, S. R., de Oliveira, A. C., & Armstrong, A. (2022). Capoeira: hypothesis on health rehabilitation and quality-of-life maintenance. Revista da Associacao Medica Brasileira, 68(11), 1530–1536. https://doi.org/10.1590/1806-9282.20220360

Nakatani, M., Takai, Y., & Kanehisa, H. (2024). Resistance training leading to repetition failure increases muscle strength and size, but not power-generation capacity in judo athletes. PLoS One, 19(8), e0307841. https://doi.org/10.1371/journal.pone.0307841

Nery, L. C., Junior, C. C. P., Saragiotto, B. T., Scoz, R. D., Marson, R. A., Baltazar Mendes, J. J., Alves Ferreira, L. M., & Amorim, C. F. (2023). Prevalence and Profile of Musculoskeletal Injuries in High-Performance Professional Brazilian Jiu-Jitsu Athletes. The Open Sports Sciences Journal, 16. https://doi.org/10.2174/1875399X-v15-e221226-2022-23

Niño, A., Villa-Vicente, J. G., & S Collado, P. (2022). Functional Capacity of Tai Chi-Practicing Elderly People. International Journal of Environmental Research and Public Health, 19(4). https://doi.org/10.3390/ijerph19042178

Ohji, S., Aizawa, J., Hirohata, K., Ohmi, T., Mitomo, S., Koga, H., & Yagishita, K. (2021). Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 25, 1–7. https://doi.org/10.1016/j.asmart.2021.03.001

Ostapiuk-Karolczuk, J., Dziewiecka, H., Bojsa, P., Cieślicka, M., Zawadka-Kunikowska, M., Wojciech, K., & Kasperska, A. (2025). Biochemical and psychological markers of fatigue and recovery in mixed martial arts athletes during strength and conditioning training. Scientific Reports, 15(1), 24234. https://doi.org/10.1038/s41598-025-09719-z

Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. Systematic Reviews, 5, 210. https://doi.org/10.1186/s13643-016-0384-4

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Pariyavuth, P., Lee, J. K. W., Tan, P. M. S., Vichaiwong, K., Mawhinney, C., & Pinthong, M. (2023). Practical internal and external cooling methods do not influence rapid recovery from simulated taekwondo performance. Journal of Exercise Science & Fitness, 21(3), 286–294. https://doi.org/10.1016/j.jesf.2023.05.003

Pucsok, J., Balogh, L., & Gara, S. (2023). Occlusion and KAATSU training effects on strength–endurance development in combat sport athletes: a pilot study. Journal of Physical Education and Sport, 23(8), 2174–2182. https://doi.org/10.7752/jpes.2023.08249

Purcell, C., Fullen, B., Barry Walsh, C., Van Oirschot, G., Ward, T., & Caulfield, B. (2024). ‘Another world of pain’ - Athlete and sport physiotherapist perspectives on the unique experience of pain in sport. BMJ Open Sport and Exercise Medicine, 10(3). https://doi.org/10.1136/bmjsem-2024-002020

Purnomo, E., Setyawati, H., Kristiyanto, A., Kusuma, D. W. Y., & Kusumadewi, N. I. (2026). Psychological skill configurations and rehabilitation readiness among injured pencak silat athletes: A person-centered analysis. Journal of Coaching and Sports Science, 5(2), 1–17. https://doi.org/10.58524/jcss.v5i2.1051

Sairyo, K., & Nagamachi, A. (2016). State-of-the-art management of low back pain in athletes: Instructional lecture. Journal of Orthopaedic Science, 21(3), 263–272. https://doi.org/10.1016/j.jos.2015.12.021

Santacaterina, F., Tamantini, C., Camarro, G., Miccinilli, S., Bressi, F., Zollo, L., Sterzi, S., & Bravi, M. (2025). Is Brazilian Jiu-Jitsu a Traumatic Sport? Survey on Italian Athletes’ Rehabilitation and Return to Sport. Journal of Functional Morphology and Kinesiology, 10(3). https://doi.org/10.3390/jfmk10030286

Saremi, M., Shahriari, F., Hemmatinafar, M., Rezaei, R., Niknam, A., Nordvall, M., Wong, A., & Bagheri, R. (2025). Low-Dose Caffeine Supplementation Is a Valuable Strategy for Increasing Time to Exhaustion, Explosive Power, and Reducing Muscle Soreness in Professional Male Kickboxers. Current Developments in Nutrition, 9(1), 104538. https://doi.org/10.1016/j.cdnut.2024.104538

Savenko, A., Chernozub, A., Turkmen, M., Olkhovyi, O., Shtefiuk, I., & Korchagin, M. (2025). Readaptation of the functional reserves of elite mixed martial arts athletes during long-term rehabilitation after musculoskeletal injuries. Fizicna Reabilitacia ta Rekreacijno-Ozdorovci Tehnologii, 10(6), 457–466. https://doi.org/10.15391/prrht.2025-10(6).08

Tak, I. J. R., Weerink, M., & Barendrecht, M. (2020). Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study. Physical Therapy in Sport, 45, 30–37. https://doi.org/10.1016/j.ptsp.2020.06.003

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, 45. https://doi.org/10.1186/1471-2288-8-45

Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management, 14(3), 207–222. https://doi.org/10.1111/1467-8551.00375

Trybulski, R., Stanula, A., Żebrowska, A., Podleśny, M., & Hall, B. (2024). Acute effects of the dry needling session on gastrocnemius muscle biomechanical properties, and perfusion with latent trigger points: A single-blind randomized controlled trial in mixed martial arts athletes. Journal of Sports Science and Medicine, 23(1), 136–146. https://doi.org/10.52082/jssm.2024.136

Trybulski, R., Klich, S., Valera-Calero, J. A., Kawczyński, A., Fernández-de-las-Peñas, C., & Kużdżał, A. (2025). Effect of pneumatic and cold compression on muscle performance and recovery in combat sports athletes. Scientific Reports, 15(1), 44993. https://doi.org/10.1038/s41598-025-29014-1

Turnagöl, H. H., Koşar, Ş. N., Güzel, Y., Aktitiz, S., & Atakan, M. M. (2021). Nutritional Considerations for Injury Prevention and Recovery in Combat Sports. Nutrients, 14(1). https://doi.org/10.3390/nu14010053

Twohey, E. E., Hasley, I. B., Shaeffer, P. J., Ceremuga, G. A., Firkins, S. A., Stringer, G. C., Vaz Carneiro Filho, M. R., Hollman, J. H., Savica, R., & Finnoff, J. T. (2023). Mixed Martial Arts: Comparing the King-Devick and Sport Concussion Assessment Tool 5 in knockouts, technical knockouts and choke holds. Archives of Rehabilitation Research and Clinical Translation, 5(4), 100301. https://doi.org/10.1016/j.arrct.2023.100301

Unalmis, Y., & Muniroglu, S. (2023). Examination of the effect of fascial therapy on some physical fitness parameters in taekwondo athletes. Sports Medicine and Health Science, 5(4), 299–307. https://doi.org/10.1016/j.smhs.2023.09.010

Wąsacz, W., Rydzik, Ł., Pałka, T., Ostrowski, P., & Ambroży, T. (2026). The Effect of the Experimental Training Program ‘Grappler Quest’ on the Motor Fitness of Brazilian Jiu-Jitsu Athletes. Journal of Clinical Medicine, 15(13). https://doi.org/10.3390/jcm15135176

Wetzel, D., Menke, W., Dieter, R., Smasal, V., Giannetti, B., & Bulitta, M. (2002). Escin/diethylammonium salicylate/heparin combination gels for the topical treatment of acute impact injuries: A randomised, double blind, placebo controlled, multicentre study. British Journal of Sports Medicine, 36(3), 183–188. https://doi.org/10.1136/bjsm.36.3.183

Wu, Q., Liu, Y., & Zhao, B. (2025). Electromyographic analysis of fatigue and synergistic activation in striking and supporting legs during continuous side-kicks in elite Sanda athletes. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-29199-5

Yang, Y., McCluskey, S., Bydon, M., Singh, J. R., Sheeler, R. D., Nathani, K. R., Krieger, A. C., Mehta, N. D., Weaver, J., Jia, L., DeCelle, S., Schlagal, R. C., Ayar, J., Abduljawad, S., Stovitz, S. D., Ganesh, R., Verkuilen, J., Knapp, K. A., Yang, L., & Härtl, R. (2024). A Tai chi and qigong mind-body program for low back pain: A virtually delivered randomized control trial. North American Spine Society Journal (NASSJ), 20, 100557. https://doi.org/10.1016/j.xnsj.2024.100557

Zhang, Y., Ran, J., Xia, W., Liu, C., Deng, C., & Li, X. (2023). Beneficial effects of Chinese martial arts on the lumbar spine: A case series analysis of intervertebral disc, paraspinal muscles and vertebral body. Heliyon, 9(12), e23090. https://doi.org/10.1016/j.heliyon.2023.e23090