Cold therapy for chronic low back pain
Evidence review
Overview
Cold-therapy studies in chronic low back pain have used whole-body cryotherapy (WBC), 2-3 minutes of cold air at about -202 to -256 F in a chamber, which is a different method from a home cold plunge. In a single-arm study of 41 patients, 20 WBC sessions over 5 weeks were followed by lower pain and disability scores. In older men, WBC before exercise improved lumbar mobility more than exercise alone, and daily sessions outperformed twice-weekly sessions. In 69 older women with lumbar spine arthritis, quality of life improved similarly with cryotherapy, cryotherapy plus exercise, and exercise alone, and the authors questioned the value of cryotherapy. Pain outcomes have not been tested against a no-WBC control in a randomized trial, and no cold-water immersion study was found.
Key findings
- Single-arm, n=41: 20 WBC sessions at -256 F over 5 weeks reduced pain, Oswestry and Roland-Morris scores (p<0.001); no adverse events (Salas-Fraire 2023).
- RCT, n=96 older men: WBC before exercise increased lumbar range of motion and lowered erector spinae activity vs exercise alone (Giemza 2014).
- RCT, n=80 older men: daily WBC improved back pain status; twice weekly did not (Giemza 2015).
- Uncontrolled, n=42: pain and lumbar mobility improved in men (p<0.05) but not women (Śliwiński 2017).
- Three-arm study, n=69 women aged 65-70 with lumbar arthritis: SF-36v2 quality of life improved in all groups (cryotherapy, cryotherapy plus kinesitherapy, kinesitherapy), with no advantage reported for cryotherapy (Kulis 2019).
- No cold-water immersion or cold plunge study in chronic low back pain identified.
Every study we reviewed
5 found benefit · 2 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 17 studies on low back and spinal pain, across all heat and cold therapies, including case reports and older work not graded here.
Effect of cryotherapy on the lumbar spine in elderly men with back pain.
Giemza C et al. Aging Male. 2014. PubMed 24304196 · DOI · Free full text
- Who
- Men aged 65-75 with chronic lumbar pain longer than 3 months (Poland)
- What
- WHOLE-BODY CRYOTHERAPY before gym exercise vs the same exercise alone
- Measured
- Lumbar spine mobility, erector spinae surface EMG
- Result
- WBC group had significantly lower erector spinae activity and a significant increase in lumbar range of motion compared with exercise alone; pain not reported in abstract
- Limitations
- Indexed as randomized; randomization not described in abstract; pain not an abstract outcome; older men only; WBC, not cold-water immersion
Effect of frequent WBC treatments on the back pain therapy in elderly men.
Giemza C et al. Aging Male. 2015. PubMed 25133646 · DOI · Free full text
- Who
- Men aged 65-77 with chronic low back pain longer than 3 months (Poland)
- What
- WHOLE-BODY CRYOTHERAPY twice weekly (n=40) vs daily through the week (n=40)
- Protocol
- 2 vs daily/wk
- Measured
- Back pain condition (measures not detailed in abstract)
- Result
- No significant improvement with twice-weekly WBC; significant improvement with daily WBC (no numeric results in abstract)
- Limitations
- Compares two WBC frequencies without a no-WBC control; outcome measures not specified in abstract; older men only; WBC, not cold-water immersion
Efficacy of whole-body cryotherapy in the treatment of chronic low back pain: Quasi-experimental study.
Salas-Fraire O et al. J Orthop Sci. 2023. PubMed 34736843 · DOI
- Who
- Adults aged 18-65 with chronic low back pain (Mexico)
- What
- WHOLE-BODY CRYOTHERAPY chamber at -256 F (-160 C), 20 sessions over 5 weeks
- Protocol
- -256 °F · 4/wk · 5 wk
- Measured
- Pain NRS, Oswestry Disability Index, Roland-Morris, serum cytokines
- Result
- Pain, ODI and Roland-Morris scores fell from first to last session (p<0.001); pain fell significantly after 4 sessions; IL-2 fell (p=0.046) and IL-10 rose (p=0.003); no adverse events
- Limitations
- Single-arm quasi-experimental design; no control for natural course or placebo; WBC, not cold-water immersion
[The role of whole-body cryotheraphy in the treatment of people with degenerative spine disease].
Szpruch R et al. Wiad Lek. 2018. PubMed 30684327
- Who
- Patients with degenerative lumbar spine disease (Poland)
- What
- WHOLE-BODY CRYOTHERAPY, 10 sessions each followed by 30 min kinesiotherapy (n=24) vs kinesiotherapy alone (n=24)
- Measured
- Pain (numeric scale, Laitinen), lumbar mobility (Schober)
- Result
- Numeric pain score fell 1.5 points with WBC vs 0.6 with kinesiotherapy alone; Laitinen score fell 1.0 vs 0.5; lumbar flexion improved 0.8 vs 0.5 cm; between-group statistics not reported in abstract
- Limitations
- Not randomized; no between-group p values in abstract; Polish-language; WBC, not cold-water immersion
Effect of whole body cryotherapy on low back pain and release of endorphins and stress hormones in patients with lumbar spine osteoarthritis.
Barłowska-Trybulec M et al. Reumatologia. 2022. PubMed 36186838 · DOI · Free full text
- Who
- Patients with lumbar spine osteoarthritis and low back pain (Poland)
- What
- WHOLE-BODY CRYOTHERAPY series combined with therapeutic exercise
- Measured
- Low back pain VAS, beta-endorphin, cortisol, adrenaline
- Result
- Low back pain VAS fell (p<0.0001); cortisol rose (p=0.0009); beta-endorphin (p=0.10) and adrenaline (p=0.08) changes not significant
- Limitations
- Uncontrolled; combined with exercise; WBC, not cold-water immersion
[The influence of pain aliments and vertebral mobility in patients after whole body cryotherapy].
Śliwiński Z et al. Wiad Lek. 2017. PubMed 28713078
- Who
- Adults aged 45-65 with low back pain of different causes (Poland)
- What
- WHOLE-BODY CRYOTHERAPY, 30 sessions each followed by 30 min kinesiotherapy
- Measured
- Pain VAS, lumbar mobility (Schober)
- Result
- Pain and lumbar mobility improved significantly in men (p<0.05) but not in women (p>0.05)
- Limitations
- Uncontrolled; Polish-language; combined with exercise; WBC, not cold-water immersion
The assessment of pelvic statics in patients with spinal overload syndrome treated in whole-body cryotherapy.
Sliwiński Z et al. Ortop Traumatol Rehabil. 2005. PubMed 17615517
- Who
- Adults aged 23-77 with spinal overload syndrome and lumbosacral pain (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber at -202 F (-130 C), 3 min daily for 20 days, each followed by supervised kinesiotherapy
- Protocol
- -202 °F · 3 min
- Measured
- Pelvic ligament pressure pain, pelvic muscle tension
- Result
- Pressure pain in pelvic ligaments fell by about 20% and tension in pelvic muscles by about 30%
- Limitations
- Uncontrolled; 20 patients; combined with kinesiotherapy; WBC, not cold-water immersion
The influence of cryotherapy and kinesitherapy on lower back pain reduction and im-provement of quality of life in elderly women
Kulis A et al. Rehabilitacja Medyczna. 2019. Not in PubMed: source · DOI
- Who
- Women aged 65-70 with lumbar spine arthritis (spondyloarthrosis) undergoing physical therapy for back pain (Poland)
- What
- WHOLE-BODY CRYOTHERAPY alone vs whole-body cryotherapy plus kinesitherapy vs kinesitherapy alone, weekdays for 2 weeks
- Protocol
- 5/wk · 2 wk
- Measured
- Quality of life (SF-36v2) on the first and last day of therapy
- Result
- Quality of life improved significantly in all three groups; the abstract reports no advantage for cryotherapy, and the authors conclude that physical activity reduces pain and improves quality of life and question the value of cryotherapy for this purpose
- Limitations
- Abstract does not describe allocation (a 2017 report on the same 69 women, PMID 28482621, states they were randomly divided) or give between-group statistics; pain results not reported in the abstract; 2 weeks; WBC, not cold-water immersion
Protocols used in the studies
Whole-body cryotherapy chambers at -202 F (-130 C) to -256 F (-160 C), about 3 minutes per session, from 10 to 30 sessions (daily, or 4 per week over 5 weeks), usually followed by 30-60 minutes of exercise. Daily sessions outperformed twice-weekly sessions in one trial. No cold-water immersion protocol has been tested.
What is still unknown
No randomized, controlled pain outcome; durability after a course ends; whether cold-water immersion has any effect; which back pain subgroups respond.
Safety
Cautions for cold therapy in this condition
- No adverse events were reported over 20 sessions at -256 F (PMID 34736843).
- Back pain patients are often older with cardiovascular comorbidity; cold exposure acutely raises blood pressure (Radtke 2016, PMID 26152773).
- 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
Uncontrolled data show lower pain and disability after a 5-week course of whole-body cryotherapy in chronic low back pain (Salas-Fraire 2023), and a randomized trial in older men found greater lumbar mobility when WBC preceded exercise (Giemza 2014), but in older women with lumbar arthritis exercise alone improved quality of life as much as cryotherapy (Kulis 2019); the evidence concerns a cold-air chamber and does not establish benefit for cold-water immersion.
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