TENS versus foam rolling for recovery after eccentric exercise–induced muscle damage in elite female volleyball players: an exploratory randomized controlled trial

Abstract Background Delayed-onset muscle soreness (DOMS) compromises performance and prolongs recovery in elite athletes. Transcutaneous electrical nerve stimulation (TENS) and foam rolling (FR) are widely used but have never been directly compared in elite female volleyball players. This study compared the effects of these two supplements on biochemical and functional recovery following eccentric exercise-induced muscle damage in elite female volleyball players. Methods As part of this exploratory pilot study, thirty elite female volleyball players (age 23.4 ± 2.8 years; height 178.6 ± 5.4 cm; body mass 68.2 ± 6.1 kg; training experience 8.3 ± 2.1 years in Iran’s Premier League) were randomly assigned 1:1:1 to TENS ( n = 10), FR ( n = 10), or control (CON; n = 10) groups using concealed computer-generated allocation. DOMS was induced by five sets of 15 eccentric leg-press repetitions at 110% concentric one repetition maximum. TENS (120–150 Hz, 100 µs, 10–30 mA, 20 min) was applied to the dominant quadriceps and hamstrings. FR (20 min) targeted the quadriceps, hamstrings, iliotibial band, gastrocnemius, and gluteals muscles. Serum creatine kinase (CK), vertical jump height, and anaerobic peak power (Running based Anaerobic Sprint Test) were measured at baseline and 1, 24, and 48 h postexercise. Mixed-design repeated-measures ANOVA with Bonferroni-adjusted pairwise comparisons was used. Results CK showed a significant Group × Time interaction ( p < 0.001, η² p = 0.24). TENS lowered CK vs. CON at 1 h (− 186 U/L, 95% CI − 289 to − 83; p = 0.001, d = 1.98), 24 h (− 312 U/L, 95% CI − 442 to − 182; p = 0.001, d = 2.32), and 48 h. FR lowered CK vs. CON only at 48 h (− 166 U/L, 95% CI − 273 to − 59; p = 0.003, d = 1.32). Vertical jump recovery at 48 h was superior in both interventions vs. CON (TENS + 4.8 cm, 95% CI 2.1–7.5, p = 0.001, d = 1.11; FR + 3.7 cm, 95% CI 1.4–6.4, p = 0.001, d = 0.85), reaching 96.3% and 95.7% of baseline vs. 85.8% in CON. No group differences were observed for anaerobic power (Group × Time p = 0.086, η² p = 0.08). Muscle soreness was lower in both active groups than in the CON group at 48 h ( p < 0.01, d ≥ 1.48). Conclusions In this pilot cohort, TENS and FR improved recovery relative to control with different CK temporal patterns but comparable vertical jump restoration at 48 h. However, given the exploratory nature of the study, these results should be interpreted as preliminary. TENS had earlier CK reductions, relevant for 24-h recovery windows; however, both produced comparable functional recovery by 48 h, and neither showed consistent superiority across outcomes. FR offers a practical, cost-effective alternative to achieve equivalent functional restoration within 48 h. Trial registration ClinicalTrials.gov, NCT07438197, registered on 22/02/2026. Retrospectively registered.