Neuromuscular fatigue management strategies in male semi-professional soccer players: a mini-review

This mini-review aims to examine fatigue management strategies that specifically target neuromuscular fatigue in soccer players. A literature search identified five studies involving male semi-professional players (mean age ranging from 21.8 ± 0.9 to 25± 3 years), all of which used a randomized crossover design. One study applied a real competitive match, while four used the Loughborough Intermittent Shuttle Test (LIST) to simulate match demands. Neuromuscular outcomes included maximal voluntary contraction (MVC), voluntary activation (VA), quadriceps potentiated twitch force (Qtw,pot), and electromyography (EMG) parameters, including the root mean square (RMS) normalized to the maximal compound muscle action potential (Mmax) (RMS/Mmax). This review identifies five potential strategies for managing neuromuscular fatigue: cold water immersion (CWI), phase change material (PCM) garments, ischemic preconditioning (IPC), chronic beetroot juice supplementation (BEET), and acute acetaminophen ingestion (ACT). Preliminary results suggest that CWI and BEET may influence both central and peripheral components, whereas PCM, IPC, and ACT primarily affect markers associated with the central drive at specific assessment intervals. Implementing these strategies may accelerate neuromuscular recovery, attenuate fatigue onset, help maintain force production, and potentially optimize subsequent performance. This mini-review provides preliminary evidence-informed recommendations for the stakeholders in the soccer industry, from players to conditioning coaches, and highlights precautions regarding their potential misapplication or excessive use.

Central fatigue; Peripheral fatigue; Therapy; Supplementation; Football

[1] Marqués-Jiménez D, Calleja-González J, Arratibel I, Delextrat A, Terrados N. Fatigue and recovery in soccer: evidence and challenges. The Open Sports Sciences Journal. 2017; 10: 52–70.

[2] Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference to development of fatigue. Journal of Sports Sciences. 2003; 21: 519–528.

[3] Ispirlidis I, Fatouros IG, Jamurtas AZ, Nikolaidis MG, Michailidis I, Douroudos I, et al. Time-course of changes in inflammatory and performance responses following a soccer game. Clinical Journal of Sport Medicine. 2008; 18: 423–431.

[4] Allen DG, Lamb GD, Westerblad H. Skeletal muscle fatigue: cellular mechanisms. Physiological Reviews. 2008; 88: 287–332.

[5] Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiological Reviews. 2001; 81: 1725–1789.

[6] Thomas K, Dent J, Howatson G, Goodall S. Etiology and recovery of neuromuscular fatigue after simulated soccer match play. Medicine & Science in Sports & Exercise. 2017; 49: 955–964.

[7] Daab W, Bouzid MA, Zghal F, Gernigon M, Rebai H, Abaïdia A, et al. Ischemic preconditioning delayed neuromuscular fatigue development during a simulated soccer match. Journal of Science and Medicine in Sport. 2025; 28: 770–777.

[8] Brownstein CG, Dent JP, Parker P, Hicks KM, Howatson G, Goodall S, et al. Etiology and recovery of neuromuscular fatigue following competitive soccer match-play. Frontiers in Physiology. 2017; 8: 831.

[9] Claudino JG, Cronin J, Mezêncio B, McMaster DT, McGuigan M, Tricoli V, et al. The countermovement jump to monitor neuromuscular status: a meta-analysis. Journal of Science and Medicine in Sport. 2017; 20: 397–402.

[10] Farina D, Holobar A, Merletti R, Enoka RM. Decoding the neural drive to muscles from the surface electromyogram. Clinical Neurophysiology. 2010; 121: 1616–1623.

[11] Vøllestad NK. Measurement of human muscle fatigue. Journal of Neuroscience Methods. 1997; 74: 219–227.

[12] Carroll TJ, Taylor JL, Gandevia SC. Recovery of central and peripheral neuromuscular fatigue after exercise. Journal of Applied Physiology. 2017; 122: 1068–1076.

[13] Place N, Maffiuletti NA, Martin A, Lepers R. Assessment of the reliability of central and peripheral fatigue after sustained maximal voluntary contraction of the quadriceps muscle. Muscle & Nerve. 2007; 35: 486–495.

[14] Behrens M, Husmann F, Gube M, Felser S, Weippert M, Bruhn S, et al. Intersession reliability of the interpolated twitch technique applied during isometric, concentric, and eccentric actions of the human knee extensor muscles. Muscle & Nerve. 2017; 56: 324–327.

[15] Farina D, Madeleine P, Graven-Nielsen T, Merletti R, Arendt-Nielsen L. Standardising surface electromyogram recordings for assessment of activity and fatigue in the human upper trapezius muscle. European Journal of Applied Physiology. 2002; 86: 469–478.

[16] Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, et al. Standards for quantification of EMG and neurography. Clinical Neurophysiology. 2019; 130: 1688–1729.

[17] Farina D, Blanchietti A, Pozzo M, Merletti R. M-wave properties during progressive motor unit activation by transcutaneous stimulation. Journal of Applied Physiology. 2004; 97: 545–555.

[18] Lanfranchi C, Rodriguez-Falces J, Place N. The first and second phases of the muscle compound action potential in the thumb are differently affected by electrical stimulation trains. Journal of Applied Physiology. 2024; 136: 1122–1128.

[19] Silva JR, Rumpf MC, Hertzog M, Castagna C, Farooq A, Girard O, et al. Acute and residual soccer match-related fatigue: a systematic review and meta-analysis. Sports Medicine. 2018; 48: 539–583.

[20] Dupont G, Nedelec M, McCall A, McCormack D, Berthoin S, Wisløff U. Effect of 2 soccer matches in a week on physical performance and injury rate. The American Journal of Sports Medicine. 2010; 38: 1752–1758.

[21] Daab W, Zghal F, Nassis GP, Rebai H, Moalla W, Bouzid MA. Chronic beetroot juice supplementation attenuates neuromuscular fatigue etiology during simulated soccer match play. Applied Physiology, Nutrition, and Metabolism. 2024; 49: 105–113.

[22] Brownstein CG, Ansdell P, Škarabot J, McHugh MP, Howatson G, Goodall S, et al. The effect of phase change material on recovery of neuromuscular function following competitive soccer match-play. Frontiers in Physiology. 2019; 10: 647.

[23] Bouchiba M, Bragazzi NL, Zarzissi S, Turki M, Zghal F, Grati MA, et al. Cold water immersion improves the recovery of both central and peripheral fatigue following simulated soccer match-play. Frontiers in Physiology. 2022; 13: 860709.

[24] Bouchiba M, Turki M, Zarzissi S, Zghal F, Trabelsi O, Rebai H, et al. Acute acetaminophen ingestion improves the recovery of neuromuscular fatigue following simulated soccer match-play. Journal of Science and Medicine in Sport. 2025; 28: 189–197.

[25] White GE, Wells GD. Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme Physiology & Medicine. 2013; 2: 26.

[26] Endoh T, Nakajima T, Sakamoto M, Komiyama T. Effects of muscle damage induced by eccentric exercise on muscle fatigue. Medicine & Science in Sports & Exercise. 2005; 37: 1151–1156.

[27] Kaufman MP, Iwamoto GA, Longhurst JC, Mitchell JH. Effects of capsaicin and bradykinin on afferent fibers with ending in skeletal muscle. Circulation Research. 1982; 50: 133–139.

[28] Delliaux S, Brerro-Saby C, Steinberg JG, Jammes Y. Reactive oxygen species activate the group IV muscle afferents in resting and exercising muscle in rats. Pflügers Archiv: European Journal of Physiology. 2009; 459: 143–150.

[29] Nybo L, Nielsen B. Hyperthermia and central fatigue during prolonged exercise in humans. Journal of Applied Physiology. 2001; 91: 1055–1060.

[30] Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen PB. Effect of a 5-min cold-water immersion recovery on exercise performance in the heat. British Journal of Sports Medicine. 2010; 44: 461–465.

[31] Wang H, Wang L, Pan Y. Impact of different doses of cold water immersion (duration and temperature variations) on recovery from acute exercise-induced muscle damage: a network meta-analysis. Frontiers in Physiology. 2025; 16: 1525726.

[32] Pitman BM, Semmler JG. Reduced short-interval intracortical inhibition after eccentric muscle damage in human elbow flexor muscles. Journal of Applied Physiology. 2012; 113: 929–936.

[33] Dantzer R. Cytokine-induced sickness behavior: mechanisms and implications. Annals of the New York Academy of Sciences. 2001; 933: 222–234.

[34] Carmichael MD, Davis JM, Murphy EA, Brown AS, Carson JA, Mayer EP, et al. Role of brain IL-1β on fatigue after exercise-induced muscle damage. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2006; 291: R1344–R1348.

[35] Pethick J, Casselton C, Winter SL, Burnley M. Ischemic preconditioning blunts loss of knee extensor torque complexity with fatigue. Medicine & Science in Sports & Exercise. 2021; 53: 306–315.

[36] Marocolo M, Hohl R, Arriel RA, Mota GR. Ischemic preconditioning and exercise performance: are the psychophysiological responses underestimated? European Journal of Applied Physiology. 2023; 123: 683–693.

[37] Duchateau J, Hainaut K. Behaviour of short and long latency reflexes in fatigued human muscles. The Journal of Physiology. 1993; 471: 787–799.

[38] Gandevia SC, Allen GM, Butler JE, Taylor JL. Supraspinal factors in human muscle fatigue: evidence for suboptimal output from the motor cortex. The Journal of Physiology. 1996; 490: 529–536.

[39] Taylor JL, Todd G, Gandevia SC. Evidence for a supraspinal contribution to human muscle fatigue. Clinical and Experimental Pharmacology and Physiology. 2006; 33: 400–405.

[40] Cruz R, Tramontin AF, Oliveira AS, Caputo F, Denadai BS, Greco CC. Ischemic preconditioning increases spinal excitability and voluntary activation during maximal plantar flexion contractions in men. Scandinavian Journal of Medicine & Science in Sports. 2024; 34: e14591.

[41] Ferguson SK, Hirai DM, Copp SW, Holdsworth CT, Allen JD, Jones AM, et al. Impact of dietary nitrate supplementation via beetroot juice on exercising muscle vascular control in rats. The Journal of Physiology. 2013; 591: 547–557.

[42] Vanhatalo A, Fulford J, DiMenna FJ, Jones AM. Influence of hyperoxia on muscle metabolic responses and the power-duration relationship during severe-intensity exercise in humans: a 31P magnetic resonance spectroscopy study. Experimental Physiology. 2010; 95: 528–540.

[43] Bender D, Townsend JR, Vantrease WC, Marshall AC, Henry RN, Heffington SH, et al. Acute beetroot juice administration improves peak isometric force production in adolescent males. Applied Physiology, Nutrition, and Metabolism. 2018; 43: 816–821.

[44] Rojas-Valverde D, Montoya-Rodríguez J, Azofeifa-Mora C, Sanchez-Urena B. Effectiveness of beetroot juice derived nitrates supplementation on fatigue resistance during repeated-sprints: a systematic review. Critical Reviews in Food Science and Nutrition. 2021; 61: 3395–3406.

[45] Amann M, Dempsey JA. Locomotor muscle fatigue modifies central motor drive in healthy humans and imposes a limitation to exercise performance. The Journal of Physiology. 2008; 586: 161–173.

[46] Clifford T, Bell O, West DJ, Howatson G, Stevenson EJ. The effects of beetroot juice supplementation on indices of muscle damage following eccentric exercise. European Journal of Applied Physiology. 2016; 116: 353–362.

[47] Jädert C, Petersson J, Massena S, Ahl D, Grapensparr L, Holm L, et al. Decreased leukocyte recruitment by inorganic nitrate and nitrite in microvascular inflammation and NSAID-induced intestinal injury. Free Radical Biology and Medicine. 2012; 52: 683–692.

[48] Anderson BJ. Paracetamol (acetaminophen): mechanisms of action. Paediatric Anaesthesia. 2008; 18: 915–921.

[49] Jóźwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Poloniae Pharmaceutica. 2014; 71: 11–23.

[50] Amann M, Dempsey JA. Ensemble input of group III/IV muscle afferents to CNS: a limiting factor of central motor drive during endurance exercise from normoxia to moderate hypoxia. Advances in Experimental Medicine and Biology. 2016; 49: 325–342.

[51] Mauger AR, Hopker JG. The effect of acetaminophen ingestion on cortico-spinal excitability. Canadian Journal of Physiology and Pharmacology. 2013; 91: 187–189.

[52] Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, et al. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. The Journal of Physiology. 2015; 593: 4285–4301.

[53] Fröhlich M, Faude O, Klein M, Pieter A, Emrich E, Meyer T. Strength training adaptations after cold-water immersion. Journal of Strength and Conditioning Research. 2014; 28: 2628–2633.

[54] Barnett A. Using recovery modalities between training sessions in elite athletes: does it help? Sports Medicine. 2006; 36: 781–796.

[55] Shiffman S, Rohay JM, Battista D, Kelly JP, Malone MK, Weinstein RB, et al. Patterns of acetaminophen medication use associated with exceeding the recommended maximum daily dose. Pharmacoepidemiology and Drug Safety. 2015; 24: 915–921.

[56] Esh CJ, Mauger AR, Palfreeman RA, Al-Janubi H, Taylor L. Acetaminophen (paracetamol): use beyond pain management and dose variability. Frontiers in Physiology. 2017; 8: 1092.

[57] Lundberg TR, Howatson G. Analgesic and anti-inflammatory drugs in sports: implications for exercise performance and training adaptations. Scandinavian Journal of Medicine & Science in Sports. 2018; 28: 2252–2262.

[58] Vermeer IT, van Maanen JM. Nitrate exposure and the endogenous formation of carcinogenic nitrosamines in humans. Reviews on Environmental Health. 2001; 16: 105–116.

[59] Berends JE, van den Berg LMM, Guggeis MA, Henckens NFT, Hossein IJ, de Joode MEJR, et al. Consumption of nitrate-rich beetroot juice with or without vitamin C supplementation increases the excretion of urinary nitrate, nitrite, and N-nitroso compounds in humans. International Journal of Molecular Sciences. 2019; 20: 2277.

[60] IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC monographs on the evaluation of carcinogenic risks to humans. Ingested nitrate and nitrite, and cyanobacterial peptide toxins. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 2010; 94: v–vii, 1–412.

[61] Ward MH, Jones RR, Brender JD, de Kok TM, Weyer PJ, Nolan BT, et al. Drinking water nitrate and human health: an updated review. International Journal of Environmental Research and Public Health. 2018; 15: 1557.

[62] Marocolo M, Souza HLR, Surke P, Ferrauti A. Potential short- and long-term physiological effects of ischemic preconditioning as an ergogenic aid: revisiting foundational mechanisms and applications. Sports Medicine. 2025; 55: 1547–1557.

[63] Marocolo M, Marocolo IC, da Mota GR, Simão R, Maior AS, Coriolano HJ. Beneficial effects of ischemic preconditioning in resistance exercise fade over time. International Journal of Sports Medicine. 2016; 37: 819–824.

[64] Caru M, Levesque A, Lalonde F, Curnier D. An overview of ischemic preconditioning in exercise performance: a systematic review. Journal of Sport and Health Science. 2019; 8: 355–369.

[65] Kwiecien SY, O’Hara DJ, McHugh MP, Howatson G. Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise. European Journal of Applied Physiology. 2020; 120: 413–423.