Objective: The aim of this study was to systematically review the literature on acupuncture for delayed-onset muscle soreness (DOMS) and report upon study quality and treatment outcomes. Design: Systematic review. Data sources: Searches were conducted in the following electronic databases from their inception to 31 March 2018: CINAHL, MEDLINE, Allied and Complementary Medicine (AMED) and SPORTDiscus. Reference lists of all included studies and relevant reviews were hand-searched for additional studies. Eligibility criteria for selecting studies: Randomised controlled trials (RCTs) that evaluated the effectiveness of acupuncture in DOMS in adults measuring the pre-specified primary outcome (pain) were included. Data collection and analysis: Data were extracted using pre-defined extraction forms and the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist. Quality of studies was evaluated based on the Cochrane risk of bias assessment. Results: Five RCTs investigating laboratory-induced DOMS in the upper limbs with a total sample size of 182 healthy participants were included. Of the included studies, three reported superiority of acupuncture over no treatment in DOMS pain reduction as measured by visual analogue scale, pressure pain threshold or electrical pain threshold, while two studies yielded non-significant results. All studies demonstrated risk of bias in one or more areas, commonly lack of blinding of participants and personnel. Summary/conclusion: There is conflicting to limited evidence to support the effects of acupuncture on the relief of pain associated with DOMS. The findings were confounded by methodological limitations and reporting insufficiency. More rigorous, high-quality, and well-reported RCTs are required to further evaluate the effectiveness of acupuncture for DOMS.