Cold therapy for osteoarthritis (including spinal osteoarthritis)
Evidence review
Overview
Cold-therapy studies in osteoarthritis have used whole-body cryotherapy (WBC), a few minutes of cold air at about -166 F in a chamber, which is a different method from a home cold plunge. Uncontrolled and non-randomized studies, mostly in spinal osteoarthritis and combined with exercise, report reductions in pain and analgesic use. One randomized study in older women with lumbar spondyloarthrosis found reduced red-cell elasticity after WBC with exercise, which its authors considered a possible perfusion concern. No randomized trial with clinical outcomes and no cold-water immersion study was found.
Key findings
- Uncontrolled survey, n=50 (spinal, knee and hip OA): 78% reported significant improvement after a 10-day WBC cycle, 4% none (Chruściak 2016).
- Non-randomized controlled trial, n=48 degenerative lumbar spine: pain fell 1.5 points with WBC plus exercise vs 0.6 with exercise alone (Szpruch 2018).
- Uncontrolled, n=30 lumbar spine OA: low back pain VAS fell (p<0.0001) after WBC with exercise (Barłowska-Trybulec 2022).
- Randomized, n=94 older women with spondyloarthrosis: WBC plus exercise lowered erythrocyte elasticity; authors call WBC's benefit debatable (Kulis 2017).
- No cold-water immersion or cold plunge study in OA identified.
Every study we reviewed
4 found benefit · 2 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 17 studies on osteoarthritis, across all heat and cold therapies, including case reports and older work not graded here.
Subjective evaluation of the effectiveness of whole-body cryotherapy in patients with osteoarthritis.
Chruściak T et al. Reumatologia. 2016. PubMed 28115779 · DOI · Free full text
- Who
- Patients with osteoarthritis: 31 spinal, 10 knee, 9 hip (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber, 10-day cycle
- Measured
- Patient-rated improvement, pain frequency and intensity (modified Laitinen), analgesic use
- Result
- Patients rated significant improvement in 39 (78%), improvement in 9 (18%) and no improvement in 2 (4%); authors report less pain and analgesic use
- Limitations
- Uncontrolled questionnaire study; subjective outcomes; 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
Effect of whole-body cryotherapy on the rheological parameters of blood in older women with spondyloarthrosis.
Kulis A et al. Clin Hemorheol Microcirc. 2017. PubMed 28482621 · DOI
- Who
- Women aged 65-70 with lumbar spondyloarthrosis (Poland)
- What
- WHOLE-BODY CRYOTHERAPY alone (n=22), kinesiotherapy alone (n=23) or both (n=24), randomly assigned, vs untreated controls (n=25)
- Protocol
- 2 wk
- Measured
- Blood rheology: plasma viscosity, erythrocyte elongation and aggregation, fibrinogen
- Result
- Only the WBC plus kinesiotherapy group showed significant decreases in erythrocyte elongation (elasticity) and aggregation indices; authors call the benefit of WBC in these patients debatable because reduced erythrocyte elasticity may impair perfusion
- Limitations
- Laboratory outcomes only; untreated control not randomized; WBC, not cold-water immersion
Impact of regular cold exposure on electrical skin resistance in patients with joint degenerative diseases.
Machnia M et al. Clin Physiol Funct Imaging. 2024. PubMed 37861346 · DOI · Free full text
- Who
- Patients with degenerative joint disease described as chronic inflammatory disease patients (France/Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber, 3 min at -166 F (-110 C), before daily exercise vs exercise alone
- Protocol
- -166 °F · 3 min · daily/wk
- Measured
- Electrical skin resistance (sympathetic activity) and severe mental-stress classification
- Result
- Number of patients classified with severe mental stress fell, and skin resistance rose, only in the WBC group; larger rise in men and patients under 60
- Limitations
- Surrogate autonomic outcome; allocation not described; diagnoses not specified in abstract; WBC, not cold-water immersion
Cryotherapy decreases histamine levels in the blood of patients with rheumatoid arthritis.
Wojtecka-Lukasik E et al. Inflamm Res. 2010. PubMed 20020313 · DOI
- Who
- Patients with rheumatoid arthritis (44) and osteoarthritis (45) (Poland)
- What
- WHOLE-BODY CRYOTHERAPY chamber (20 RA, 17 OA) vs conventional physiotherapy (24 RA, 28 OA)
- Protocol
- -220 to -256 °F · 2-3 min · daily/wk · 4 wk
- Measured
- Blood histamine, neutrophil activation and cartilage-metabolism markers at 3 months
- Result
- WBC reduced blood histamine in RA (p<0.001), lasting at least 3 months; histamine unchanged in OA; other markers changed non-significantly; no changes with physiotherapy
- Limitations
- Laboratory outcomes only; no clinical outcomes in abstract; allocation not described; WBC, not cold-water immersion
Protocols used in the studies
Whole-body cryotherapy chambers at -166 F (-110 C) or -220 to -256 F (-140 to -160 C), 2-3 minutes once daily, 10 sessions over about 2 weeks (one study 4 weeks), usually followed by exercise or kinesiotherapy. No cold-water immersion protocol has been tested in osteoarthritis.
What is still unknown
No RCT with clinical outcomes; whether WBC adds to exercise in knee or hip OA; whether cold-water immersion has any effect; durability; vascular safety in older patients.
Safety
Cautions for cold therapy in this condition
- Reduced erythrocyte elasticity after WBC with exercise in women aged 65-70 raised a possible perfusion concern (PMID 28482621).
- Osteoarthritis 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
Small, mostly uncontrolled studies report less pain after whole-body cryotherapy combined with exercise in spinal and peripheral osteoarthritis (Chruściak 2016; Szpruch 2018); the evidence is preliminary, concerns a cold-air chamber, and does not establish benefit for cold-water immersion.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: M17.9, M16.9, M47.816, M19.90. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others