Does Cold Therapy Work?

Dr. Rich Joseph, MD MBA
Dr. Rich Joseph, MD MBA
10 minute read
March 30, 2023
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Seemingly everywhere you look these days, somebody is taking a cold plunge and raving about the energy boosting, mood enhancing, and muscle recovering effects. The market for at home and wellness center cold plunges is taking off.

Is the rage about cold plunging really worth it? Does deliberate cold exposure have any scientifically validated staying power for your health and fitness routine? Or is it just the next fad in an endless series of wellness trends and hacks that are here today and gone tomorrow? Here, we take a look at the different types of cold therapy, the performance impacts of cold therapy and the health impacts of cold therapy.

What Are The Different Types of Cold Therapy?

The practice of deliberate cold exposure has been around for millennia. But recent adaptations include ice baths, brisk daily showers, outdoor swims, cold water immersion therapy, and cryotherapy sessions.

- The majority of research to date comes from studies using cold water immersion (CWI) which is perhaps the most controllable method of cold therapy. CWI has been defined as submersion to the neck in water temperatures of less than 15°C (59 degrees Fahrenheit); however, primary research studies have employed lower temperatures between 8°C and 10°C, with others lowering water to 5°C.

- Cryotherapy –or whole-body cryotherapy (WBC), more specifically—is a newer form of deliberate cold exposure that entails exposing the body to subzero temperatures (as cold as -200 degrees Fahrenheit) in a special tank or chamber for 2 to 4 minutes. 

- It is important to note that given the relatively recent advent of WBC, most of the research on deliberate cold exposure comes from studying the effects of CWI on human subjects. Existing studies employing WBC are sparse, and much less well designed.

What Are The Performance Impacts of Cold Therapy?

- Regular and repeated cold exposure seems to confer an adaptive, increased tolerance to stress as evidenced by increased concentrations of antioxidants. Young men exposed to cryotherapy for 3 minutes at ­202°F (−130°C) every day for 20 days doubled the activity of one of the most potent antioxidant enzyme systems in the body called glutathione reductase and increased another potent antioxidant enzyme called superoxide dismutase by ~43%.

- Elite kayakers that engaged in whole body cryotherapy (­248 to ­284°F or ­120 to ­140°C) 3 minutes a day for 10 days increased the activity of superoxide dismutase by 36% and glutathione peroxidase by 68%.

- As a recovery tool following high intensity exercise (mainly running and athletic training), the existing literature, as reviewed in a comprehensive meta-analysis, shows that cold-water immersion is more likely to positively influence muscular power performance, muscle soreness, serum creatine kinase, and perceived recovery in the short term. Cold water immersion at lower temperatures and for shorter durations (i.e. <12mins) may be more effective for quick recovery, especially if you need to perform repeatedly over a short time span. . However, use of cold therapy is not positively adaptive, and may even be counterproductive in the long term, and particularly for physical training that targets strength and hypertrophy adaptations.

What Are The Health Impacts of Cold Therapy?

Cold exposure is commonly used as a therapeutic tool for musculoskeletal healing and management of chronic pain.

- In patients with osteoarthritis, whole-body cryotherapy has been shown to reduce the frequency and degree of pain perception and decrease reliance on analgesic medications; it improved the range of physical activity and had a positive effect on their overall well-being.

- In patients with systemic inflammatory conditions, such as rheumatoid arthritis, 10-day comprehensive therapies including different local cryotherapies for the patients with rheumatoid arthritis exhibited improvements.

- Some, albeit limited research, suggests effectiveness of cryogenic temperature interventions in inflammatory conditions like ankylosing spondylitis, fibromyalgia, multiple sclerosis, and chronic low back pain.

- The known increases in noradrenaline, beta-endorphin and dopamine due to a cold stimulus may have a positive effect on mental health and brain development. To date, however, there is no clinical evidence (other than case reports) that cold exposure can improve brain health or treat mental health conditions. The positive mental health aspect of regular winter swimmers is mostly based on questionnaires and anecdotal evidence.  That said, researchers are exploring the psychological effects of cold water exposure and have seen encouraging results on mood. And there is preliminary data to suggest that whole body cryotherapy can be a useful adjunctive therapy for depressive symptoms and anxiety disorders.

How Can Cold Therapy Help Me?

There is truth in the adage “that which does not kill you only makes you stronger.” Cold therapy, if employed strategically like other acute stresses such as intense exercise, can provide an adaptive stimulus for the body. Meaning the body will compensate by increasing the cellular and biochemical mechanisms needed to regain homeostasis and better handle this stress in the future. Presumably the body develops enhanced resilience to better manage and cope with unforeseen stressors in other parts of life as well. The hypothesis that adapting to the shock of cold water may improve a person’s ability to handle other life stressors seems both plausible and promising. Given the evidence to date, here are some basic concepts and biologically based suggestions for advantageous use:

- If you are tired, unfocused, and feeling sluggish, a strong dose of cold therapy can be a great pick-me-up to enhance your energy, mood, and productivity. But do not trade off cold therapy for sleep. That would be majoring in the minors of health and wellness.

- If cold is being used to enhance recovery and ease muscle soreness, your use of cold therapy would depend on your training goals. If you are an endurance athlete or in a competition that requires quick recovery, using cold therapy immediately after physical activity is a productive strategy. However, if you are primarily focused on muscular strength and hypertrophy, you would not want to employ cold exposure during post-training window where it would blunt or attenuate the inflammatory response, which is an essential stimulus for the adaptive response. 

- If regular cold exposure was being used to reduce pain from more chronic inflammation, you would want to employ this when inflammation is at its peak.

- If cold therapy helps ease your pain, lessen your depression, or better regulate your blood sugar, by all means use it! But do so safely and as part of a comprehensive treatment plan—not a standalone solution.

Curious about Cryotherapy at Restore? We can help get you started. 

Photo by Jenna Kahn.

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