Cold therapy for ankylosing spondylitis / axial spondyloarthritis
Evidence review
Overview
Most cold-therapy studies in ankylosing spondylitis used whole-body cryotherapy (WBC), a 2-3 minute exposure to cold air at about -166 F in a chamber, which is a different method from a home cold plunge. A 2026 meta-analysis of 5 studies (310 patients) found WBC added to exercise improved disease activity (BASDAI, ASDAS), function and pain without a change in CRP, and a Russian randomized trial (n=82) found lower BASDAI and pain with WBC added to balneotherapy and exercise, with differences still present at 5-6 months. The only study including cold-water immersion, an 8-week program combining ice-water immersion and cold showers with breathing exercises and meditation (n=24), lowered ESR and ASDAS-CRP within the program group, but cold could not be isolated. Most trials were unblinded and short, and a 2026 reanalysis of one cohort found no effect on blood inflammatory indices.
Key findings
- Meta-analysis, 5 studies, n=310: WBC improved BASDAI (p<0.001), ASDAS (p=0.015), BASFI (p=0.006) and pain (p=0.005); no change in CRP (p=0.684) (Saidane 2026).
- Randomized trial, n=82: WBC added to balneotherapy, exercise and massage lowered BASDAI from 3.88 to 2.25 vs 3.94 to 3.13 without WBC (p<0.05), with differences in BASDAI and BASMI still present at 5-6 months (Kulikov 2016).
- Controlled trial, n=92: all groups improved over 8 days; only WBC at -166 F lowered BASDAI more than exercise alone (p=0.024); -76 F did not (Romanowski 2020).
- WBC 3 min daily plus kinesiotherapy for 10 weekdays: BASDAI fell about 40% vs about 15% with kinesiotherapy alone (Stanek 2015).
- Randomized congress report, n=47 spondyloarthritis: 6 WBC sessions added to inpatient therapy improved pain, BASDAI, BASFI and BASMI vs baseline, with TNF-alpha lower at 3 months (Oehler 2016).
- Open-label randomized trial, n=24: an 8-week program of breathing exercises, ice-water immersion (32-34 F, up to 5 min weekly) plus cold showers, and meditation lowered ESR (median 16 to 9 mm/h, p=0.040) and ASDAS-CRP (3.1 to 2.3, p=0.044) within the program group, with no excess adverse events (Buijze 2019).
- Post hoc reanalysis, n=32: no baseline-adjusted effect of WBC on blood-count inflammatory indices (Stanek 2026).
Every study we reviewed
10 found benefit · 3 mixed results · 1 found no effect
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 23 studies on ankylosing spondylitis, across all heat and cold therapies, including case reports and older work not graded here.
Efficacy of Whole-Body Cryotherapy in Ankylosing Spondylitis: A Systematic Review with Meta-Analysis.
Saidane O et al. J Integr Complement Med. 2026. PubMed 41084233 · DOI
- Who
- Patients with ankylosing spondylitis (5 studies)
- What
- WHOLE-BODY CRYOTHERAPY chamber (cold air), mostly added to exercise therapy
- Protocol
- 1.3-3 min
- Measured
- BASDAI, ASDAS, VAS pain, BASFI, CRP
- Result
- WBC improved BASDAI (p<0.001), ASDAS (p=0.015), BASFI (p=0.006) and VAS pain (p=0.005); no effect on CRP (p=0.684); tau-squared estimated as zero
- Limitations
- Pooled studies include non-randomized controlled trials from a small number of research groups; pooled effect sizes not given in abstract; short-term outcomes; WBC, not cold-water immersion
[Muscular disorders associated with ankylosing spondylitis and their correction with the help of whole body cryotherapy].
Kulikov AG et al. Vopr Kurortol Fizioter Lech Fiz Kult. 2015. PubMed 26595964 · DOI
- Who
- Patients with ankylosing spondylitis and associated muscular disorders (Russia)
- What
- WHOLE-BODY CRYOTHERAPY (air chamber) added to mineral baths, physiotherapy, exercise and spinal massage vs the same program without WBC
- Measured
- Functional muscle testing, muscle strength and extensibility, BASMI, BASFI
- Result
- Greater improvement in functional muscle testing parameters (p<0.05), muscle strength and extensibility with WBC added; no numeric between-group effect sizes in abstract
- Limitations
- Russian-language; multicomponent program; outcome is functional muscle testing rather than disease activity; WBC, not cold-water immersion
The impact of whole-body cryotherapy on parameters of spinal mobility in patients with ankylosing spondylitis.
Stanek A et al. Ortop Traumatol Rehabil. 2005. PubMed 17611448
- Who
- Men with ankylosing spondylitis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber, 10 sessions each followed by kinesiotherapy vs kinesiotherapy alone
- Measured
- Spinal mobility parameters
- Result
- Spinal mobility improved in both groups; percentage changes, mainly lumbar and thoracic mobility, were larger with WBC plus kinesiotherapy (no p values for between-group comparison in abstract)
- Limitations
- Small; abstract says 'randomly divided', but the same group later described a 32-man cohort allocated by alternation (Stanek 2026); unblinded; WBC, not cold-water immersion
Is the whole-body cryotherapy a beneficial supplement to exercise therapy for patients with ankylosing spondylitis?
Romanowski MW et al. J Back Musculoskelet Rehabil. 2020. PubMed 31594196 · DOI
- Who
- Patients with ankylosing spondylitis at a rheumatology centre (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber at -166 F (-110 C) or -76 F (-60 C), each with exercise therapy, vs exercise therapy alone
- Protocol
- -166 or -76 °F
- Measured
- BASDAI, ASDAS-CRP, back pain, morning stiffness, BASFI, BASMI, CRP
- Result
- All three programs reduced disease activity, pain and stiffness and improved function and mobility; CRP unchanged; only the -166 F arm had lower BASDAI than exercise alone (p=0.024); the -76 F arm did not differ
- Limitations
- Allocation method not stated (not described as randomized); 8-day follow-up; WBC, not cold-water immersion
The Effect of Whole-Body Cryotherapy at Different Temperatures on Proinflammatory Cytokines, Oxidative Stress Parameters, and Disease Activity in Patients with Ankylosing Spondylitis.
Straburzyńska-Lupa A et al. Oxid Med Cell Longev. 2018. PubMed 30402204 · DOI · Free full text
- Who
- Patients with ankylosing spondylitis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber at -166 F (-110 C) or -76 F (-60 C) vs exercise therapy without WBC
- Protocol
- -166 or -76 °F
- Measured
- BASDAI, ASDAS-CRP, CRP, IL-8, IL-17, oxidative stress markers
- Result
- BASDAI, ASDAS-CRP and IL-8 fell in all groups; post-therapy BASDAI was lower in the -166 F group than the non-WBC group; lipid peroxidation (TBARS) rose significantly in the -166 F group
- Limitations
- Allocation not described as randomized; overlapping research group with Romanowski 2020; short-term; WBC, not cold-water immersion
Can Whole-Body Cryotherapy with Subsequent Kinesiotherapy Procedures in Closed Type Cryogenic Chamber Improve BASDAI, BASFI, and Some Spine Mobility Parameters and Decrease Pain Intensity in Patients with Ankylosing Spondylitis?
Stanek A et al. Biomed Res Int. 2015. PubMed 26273618 · DOI · Free full text
- Who
- Patients with ankylosing spondylitis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY closed chamber, 3 min daily then 60 min kinesiotherapy, vs kinesiotherapy alone
- Protocol
- 3 min · 5/wk · 2 wk
- Measured
- BASDAI, BASFI, pain, spinal mobility
- Result
- BASDAI fell about 40% with WBC plus kinesiotherapy vs about 15% with kinesiotherapy alone; BASFI fell about 30% vs 16%
- Limitations
- Group sizes and statistics not in abstract; allocation not described; WBC, not cold-water immersion
Decreased Oxidative Stress in Male Patients with Active Phase Ankylosing Spondylitis Who Underwent Whole-Body Cryotherapy in Closed Cryochamber.
Stanek A et al. Oxid Med Cell Longev. 2018. PubMed 29854091 · DOI · Free full text
- Who
- Men with active-phase ankylosing spondylitis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY closed chamber, 3 min daily then 60 min kinesiotherapy (n=16), vs kinesiotherapy alone (n=16)
- Protocol
- 3 min
- Measured
- Oxidative stress markers, BASDAI, BASFI
- Result
- Oxidative stress markers (TOS, OSI) fell and total antioxidant status rose with WBC; BASDAI and BASFI fell in both groups with larger changes in the WBC group
- Limitations
- Small; allocation not described in abstract; likely the same cohort as other Stanek reports; mechanistic emphasis; WBC, not cold-water immersion
Whole-Body Cryotherapy Decreases the Levels of Inflammatory, Oxidative Stress, and Atherosclerosis Plaque Markers in Male Patients with Active-Phase Ankylosing Spondylitis in the Absence of Classical Cardiovascular Risk Factors.
Stanek A et al. Mediators Inflamm. 2018. PubMed 29483842 · DOI · Free full text
- Who
- Men with active-phase ankylosing spondylitis without classical cardiovascular risk factors (Poland)
- What
- WHOLE-BODY CRYOTHERAPY followed by kinesiotherapy vs kinesiotherapy alone
- Measured
- hsCRP, IL-6, oxidative stress, lipids, plaque markers, BASDAI, BASFI
- Result
- hsCRP fell with WBC without change in IL-6; BASDAI and BASFI fell in both groups with larger changes after WBC; lipid and plaque markers fell in both groups, more with WBC
- Limitations
- Indexed as randomized in PubMed but randomization not described in abstract; group sizes not given; surrogate cardiovascular markers only; WBC, not cold-water immersion
The Impact of Whole-Body Cryotherapy on Endothelium Parameters in Patients with Ankylosing Spondylitis.
Stanek A et al. Antioxidants (Basel). 2023. PubMed 36830079 · DOI · Free full text
- Who
- Patients with ankylosing spondylitis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY, 3 min, followed by 60 min exercise training vs exercise training alone
- Protocol
- 3 min
- Measured
- Endothelial and oxidative stress markers (hsCRP, sP-selectin, sVCAM-1, neopterin)
- Result
- hsCRP, sP-selectin, sVCAM-1 and neopterin fell significantly after WBC; oxidative stress markers fell in both groups, more with WBC
- Limitations
- Laboratory outcomes only; group sizes not given in abstract; WBC, not cold-water immersion
Complete Blood Count-Derived Inflammatory Indices Following Whole-Body Cryotherapy Combined with Kinesiotherapy Versus Kinesiotherapy Alone in Men with Ankylosing Spondylitis.
Stanek A et al. J Clin Med. 2026. PubMed 42941409 · DOI · Free full text
- Who
- Men with ankylosing spondylitis (Poland), post hoc analysis
- What
- WHOLE-BODY CRYOTHERAPY plus kinesiotherapy (n=16) vs kinesiotherapy alone (n=16), allocated by alternation
- Measured
- Blood-count inflammatory indices (NLR, PLR, MLR, SII, SIRI)
- Result
- No baseline-adjusted between-group difference for any index before or after false-discovery correction; MLR adjusted difference -0.033 (95% CI -0.074 to 0.008; p=0.115); index changes not correlated with hsCRP, BASDAI or pain
- Limitations
- Exploratory post hoc analysis; allocation by alternation, not randomization; laboratory outcomes only; WBC, not cold-water immersion
[Whole-body cryotherapy in patients with inflammatory rheumatic disease. A prospective study].
Braun KP et al. Med Klin (Munich). 2009. PubMed 19337708 · DOI
- Who
- 48 patients with rheumatoid arthritis and 12 with ankylosing spondylitis (Germany)
- What
- WHOLE-BODY CRYOTHERAPY chamber twice daily (mean 15.8 sessions)
- Measured
- DAS28 and pain VAS (RA); BASDAI (AS); discontinuation
- Result
- RA: DAS28 3.9 to 3.4 and VAS 51.4 to 37.9 (both p<0.01); AS: BASDAI 4.4 to 3.1 (p=0.01); 13 of 60 (21.7%) stopped because of adverse effects
- Limitations
- Uncontrolled; German-language; high discontinuation rate; WBC, not cold-water immersion
An add-on training program involving breathing exercises, cold exposure, and meditation attenuates inflammation and disease activity in axial spondyloarthritis - A proof of concept trial.
Buijze GA et al. PLoS One. 2019. PubMed 31790484 · DOI
- Who
- Patients with moderately active axial spondyloarthritis (ASDAS >2.1, hs-CRP >=5 mg/L), Netherlands
- What
- 8-week add-on program of breathing exercises, cold-water exposure and meditation (n=13) vs an 8-week control period (n=11), controls then crossed over to the program; cold exposure was weekly supervised whole-body immersion in ice water at 32-34 F (0-1 C) up to 5 minutes plus daily home cold showers at 50-57 F (10-14 C) up to 5 minutes
- Protocol
- 32-34 (immersion); 50-57 (showers) °F · up to 5 min · 1 immersion + daily showers/wk · 8 wk
- Measured
- Safety (primary); hs-CRP, serum calprotectin, ESR; ASDAS-CRP, BASDAI (exploratory)
- Result
- No difference in adverse events (12 events in 10 program participants vs 9 in 7 controls, p=0.268); ESR fell from median 16 to 9 mm/h with the program (p=0.040) vs 14 to 16 mm/h in controls (p=0.406); ASDAS-CRP 3.1 to 2.3 within the program group (p=0.044); calprotectin trend (p=0.064); no change in hs-CRP
- Limitations
- Open-label proof-of-concept trial, not powered for efficacy; within-group comparisons; cold-water immersion cannot be separated from breathing exercises and meditation; 8 weeks
Ankylosing spondylitis: new approaches to rehabilitation treatment
Kulikov AG et al. Fizioterapiya, Bal'neologiya i Reabilitatsiya. 2016. Not in PubMed: sourceRussian publication; title and summary translated by SaunaLMN. Original title: Анкилозирующий спондилит: новые подходы к восстановительному лечению
- Who
- Patients with ankylosing spondylitis (62 men, 20 women, aged 18-74) at a Moscow rehabilitation centre, on stable medication
- What
- WHOLE-BODY CRYOTHERAPY (two-stage cold-air chamber: pre-chamber -67 to -85 F for 30-40 s, then main chamber -166 to -175 F for 80-180 s) added to mineral or radon baths at 98.6 F, exercise therapy and spinal massage (n=40) vs the same program without cryotherapy (n=42)
- Protocol
- -166 to -175 °F · 1.3-3 min
- Measured
- BASDAI, day and night spinal pain, stiffness, BASFI, BASMI, chest expansion, muscle testing, EQ-5D; follow-up at 5-6 months
- Result
- BASDAI 3.88 to 2.25 with cryotherapy vs 3.94 to 3.13 without (between-group p<0.05); daytime spinal pain 3.38 to 2.16 vs 3.98 to 3.07 (between-group p<0.05); night pain, BASMI and chest expansion improved significantly only with cryotherapy; stiffness and BASFI improved in both groups. At 5-6 months (31 vs 32 patients) BASDAI 2.66 vs 3.68 and BASMI 3.57 vs 4.24 (p<0.05); improvement maintained in 65.9% vs 41.5% (p<0.05)
- Limitations
- Simple randomization, unblinded; results as mean +/- SE; multicomponent program; about a quarter of patients missing at follow-up; same centre and authors as the 2015 trial (PMID 26595964) and a 2014 report of 42 patients, so cohorts probably overlap; Russian-language full text (translated by us); WBC, not cold-water immersion
Serial whole-body cryotherapy in spondyloarthritis
Oehler M et al. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2016. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Serielle Ganzkörperkältetherapie (sGKKT) bei Spondyloarthritiden (SpA)
- Who
- Inpatients with spondyloarthritis receiving multimodal rheumatology complex therapy (Germany)
- What
- WHOLE-BODY CRYOTHERAPY, 6 sessions in 14 days, added to multimodal inpatient rheumatology therapy (n=26) vs multimodal therapy alone (n=21)
- Protocol
- 3/wk · 2 wk
- Measured
- Pain (VAS), BASDAI, BASFI, BASMI, BAS-G, TNF-alpha; after therapy and at 3 months
- Result
- With cryotherapy, pain (p<0.001 after therapy, p<0.003 at 3 months), BASDAI (p<0.001/p<0.002), BASFI and BASMI (each p<0.001) and BAS-G (p=0.015/p<0.001) improved vs baseline, and TNF-alpha fell at 3 months (p<0.003); the authors report a significant gain in functional capacity vs control. Between-group statistics for the other outcomes not given
- Limitations
- Congress abstract; mostly within-group p values; unblinded; WBC, not cold-water immersion; a pooled 2017 congress report of the same RA and AS cohorts (DOI 10.1055/s-0037-1605399, not counted separately) states that pain relief was not observed in the control groups; German-language abstract (translated by us)
Protocols used in the studies
Whole-body cryotherapy chambers at -166 to -175 F (-110 to -115 C) for about 1.5-3 minutes, once daily for 8-10 sessions or 6 sessions over 2 weeks, usually followed by exercise or added to inpatient rehabilitation; one trial also tested -76 F (-60 C), which did not outperform exercise alone. An uncontrolled German series used twice-daily sessions (mean about 16). The one cold-water protocol, within a multicomponent program, was weekly supervised whole-body immersion in 32-34 F (0-1 C) water built up to 5 minutes plus daily cold showers at 50-57 F (10-14 C) up to 5 minutes, for 8 weeks.
What is still unknown
Whether cold-water immersion alone affects disease activity in AS; whether benefits of whole-body cryotherapy last beyond the 3-6 months studied; effects in patients on biologic therapy; blinded trials with independent replication outside the few research groups involved.
Safety
Cautions for cold therapy in this condition
- In an 8-week program including weekly ice-water immersion and daily cold showers, adverse events did not differ from the control period (12 vs 9 events, p=0.268); one participant stopped because of an adverse event (PMID 31790484).
- In an uncontrolled series of 60 patients with RA or AS receiving twice-daily WBC, 13 (21.7%) stopped because of adverse effects (PMID 19337708).
- WBC at -166 F increased lipid peroxidation (TBARS) in one AS trial (PMID 30402204).
- Some patients were anxious before cryotherapy chamber sessions; tolerance was otherwise reported as good (Kulikov 2016).
- AS can involve aortic valve disease and conduction abnormalities; cold exposure acutely raises blood pressure (Radtke 2016, PMID 26152773), so cardiac history should be reviewed.
- Whole-body cryotherapy contraindications and adverse events (16 documented across case reports and RCTs) are specific to cold-air chambers and do not transfer directly to cold-water immersion (Legrand 2023, PMID 37770960). See general cold safety entry.
For clinicians
Suggested rationale
As an adjunct to exercise therapy in AS, whole-body cryotherapy at -166 F has been associated with reductions in disease activity and pain in randomized and controlled trials and a meta-analysis (Saidane 2026; Kulikov 2016), and an 8-week program that combined cold-water immersion with breathing exercises and meditation lowered ESR and ASDAS-CRP in a small open-label trial (Buijze 2019); this evidence concerns supervised cold-air chambers or a multicomponent program and does not isolate the effect of a home cold plunge.
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