Cold therapyOther
Cold therapy for post-exercise muscle soreness
Evidence review
Grade B· Moderate30 studiesLast reviewed November 8, 2026
Overview
This entry covers recovery after strenuous exercise in healthy people, not a chronic medical condition, and is included for completeness. A Cochrane review of 17 small trials (366 participants) found cold-water immersion at 41-59 F, mostly 50-59 F, reduced muscle soreness at 24-96 hours compared with rest. Many later meta-analyses agree on short-term soreness reduction (for example SMD -0.81 across 52 studies, Jeon 2026; g -0.40 across 30 RCTs, Zhu 2026), though several analyses show signs of publication bias and the effect shrank or lost significance after adjustment, with smaller and inconsistent effects on strength and power, a transient drop in jump performance immediately after immersion, and no clear advantage of colder water. Umbrella reviews rate most of this evidence low or critically low in quality and highly overlapping. Regular post-exercise cold immersion blunted gains in muscle strength and mass during strength training.
Key findings
- Cochrane, 17 trials, 366 participants: soreness SMD -0.55 (95% CI -0.84 to -0.27) at 24 h, -0.66 at 48 h, -0.93 at 72 h vs passive rest; no difference vs contrast or warm water (Bleakley 2012).
- 52 studies of single-session immersion: DOMS SMD -0.81, creatine kinase SMD -0.64; about 41 F water was no better than 50-59 F (Jeon 2026).
- 30 RCTs vs seated rest: DOMS g -0.40 (95% CI -0.64 to -0.16) and CK g -0.24, but CK lost significance after publication-bias adjustment and DOMS shrank to g -0.172; no effect on jump or isometric strength; partial immersion impaired immediate jump power (Zhu 2026).
- 22 RCTs vs passive recovery: soreness g -0.58 overall, but not significant after accounting for within-study dependency (g -0.363, 95% CI -0.842 to 0.115) (Zhu 2026).
- 32 RCTs: cold therapy reduced DOMS pain within 24 h (SMD -0.57), not beyond; heat also reduced pain, with no significant difference between cold and heat (Wang 2021).
- Umbrella review of 15 meta-analyses: quality low to critically low; soreness reduced up to 96 h, but strength and hypertrophy gains impaired with chronic use (Berjisian 2026).
- 12-week RCT, 21 men: post-exercise cold-water immersion blunted strength and muscle mass gains vs active recovery (Roberts 2015).
- Whole-body cryotherapy (cryo chamber) Cochrane: insufficient evidence; very low quality (Costello 2015).
Every study we reviewed
19 found benefit · 8 mixed results · 1 found harm · 2 found no effect
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 50 studies on exercise recovery, across all heat and cold therapies, including case reports and older work not graded here.
[1]Meta-analysisn = 366Benefit
Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise.
Bleakley C et al. Cochrane Database Syst Rev. 2012. PubMed 22336838 · DOI · Free full text
- Who
- healthy adults after exercise (17 small randomized or quasi-randomized trials)
- What
- cold-water immersion after exercise vs passive rest, contrast immersion, warm-water immersion and other comparators
- Protocol
- 41-59 °F · 5-24 continuous (mean 12.6) in 10 of 17 trials; others intermittent min
- Measured
- muscle soreness, fatigue, subjective recovery
- Result
- Vs passive intervention: soreness SMD -0.55 (95% CI -0.84 to -0.27) at 24 h, -0.66 (-0.97 to -0.35) at 48 h, -0.93 (-1.36 to -0.51) at 72 h, -0.58 (-1.00 to -0.16) at 96 h; fatigue MD -1.70 (-2.49 to -0.90). No difference vs contrast or warm-water immersion. Most trials did not actively monitor adverse events.
- Limitations
- Low study quality; no trial blinded participants and only one blinded outcome assessment; heterogeneous; 72% of trials had 20 or fewer participants; no active adverse-event surveillance; healthy volunteers (19% women); not a disease population.
[2]Meta-analysisn = 1,139Benefit
Impact of different doses of cold water immersion (duration and temperature variations) on recovery from acute exercise-induced muscle damage: a network meta-analysis.
Wang H et al. Front Physiol. 2025. PubMed 40078372 · DOI · Free full text
- Who
- healthy exercisers (55 RCTs)
- What
- cold-water immersion at different durations and temperatures after exercise
- Protocol
- 41-59 °F · 10-15 min
- Measured
- delayed onset muscle soreness, jump performance, creatine kinase
- Result
- Vs control, 10-15 min at 52-59 F reduced soreness (SMD -1.45, 95% CI -2.13 to -0.77) and 10-15 min at 41-50 F reduced soreness (SMD -1.12, 95% CI -1.78 to -0.47).
- Limitations
- Network meta-analysis of small trials; almost all participants men; outcomes within 48 h; adverse events not analysed.
[3]Systematic reviewMixed
Cold-Water Immersion for Post-exercise Recovery: An Overlap-Aware Umbrella Review.
Liang W et al. Sports Med Open. 2026. PubMed 42909756 · DOI · Free full text
- Who
- post-exercise CWI reviews (14 systematic reviews/meta-analyses)
- What
- post-exercise cold-water immersion
- Measured
- soreness, performance, inflammatory markers
- Result
- Soreness SMDs ranged -1.04 to -0.37 across reviews, but overlap was high (CCA 15.03% for soreness) and AMSTAR 2 confidence was critically low in 12 of 14 reviews; performance and biochemical outcomes were inconsistent.
- Limitations
- Review-of-reviews; underlying trials small and redundant; the four reviews giving soreness SMDs were not independent replications; no review reached moderate or high AMSTAR 2 confidence; adverse events not addressed.
[4]Randomized controlled trialn = 21Harm
Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training.
Roberts LA et al. J Physiol. 2015. PubMed 26174323 · DOI · Free full text
- Who
- Physically active men in 12-week strength training (24 randomized, 21 analysed; 3 withdrew for unrelated injuries) plus a 9-man biopsy study
- What
- 10 min cold-water immersion (legs, to the waist) vs active recovery (10 min low-intensity cycling) after each training session
- Protocol
- 50 °F · 10 min · 2/wk · 12 wk
- Measured
- strength, muscle mass, fiber size, satellite cells
- Result
- Muscle mass increased more with active recovery than cold immersion (+309 vs +103 g, P<0.001), as did strength (P<0.05); type II fiber area (+17.1%) and myonuclei per type II fiber (+26.1%) increased only with active recovery.
- Limitations
- Small; young men; comparator was active recovery rather than rest; per-protocol analysis; adaptation outcome rather than soreness.
[5]Meta-analysisn = 64No effect
Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults.
Costello JT et al. Cochrane Database Syst Rev. 2015. PubMed 26383887 · DOI · Free full text
- Who
- physically active young adults (4 lab RCTs)
- What
- WHOLE-BODY CRYOTHERAPY (cold air below -148 F in a chamber; not water immersion)
- Protocol
- below -148 (chamber air) °F · 3 min
- Measured
- muscle soreness, subjective recovery
- Result
- Very low quality evidence; soreness at 1 h SMD -0.77 (95% CI -1.42 to -0.12); at 24 h -0.57 (-1.48 to 0.33), 48 h -0.58 (-1.37 to 0.21) and 72 h -0.65 (-2.54 to 1.24), all including no difference. No trial actively monitored adverse events. Insufficient evidence of benefit.
- Limitations
- Different modality; 4 small trials (64 participants, almost all men) at high risk of bias with unblinded self-reported soreness.
[6]Systematic reviewn = 3,210Mixed
Strategic Application of Post-exercise Cold-Water Immersion to Enhance Performance Recovery and Adaptation: An Umbrella Review of 15 Published Systematic Reviews with Meta-analysis.
Berjisian E et al. Sports Med Open. 2026. PubMed 42816732 · DOI · Free full text
- Who
- Umbrella review of 15 meta-analyses (161 unique trials, 3,210 participants, 2,823 men) in healthy people
- What
- post-exercise cold-water immersion
- Protocol
- 41-59 °F · 10-15 min
- Measured
- recovery of performance, soreness, markers, and training adaptation
- Result
- Methodological quality low to critically low and certainty low to very low. CWI reduced muscle soreness up to 96 h and creatine kinase at 24-72 h, improved power at 24-48 h after some exercise, did not improve strength, and impaired strength and hypertrophy gains with chronic use.
- Limitations
- overlapping reviews; healthy exercisers
[7]Systematic reviewBenefit
Physical Therapies for Delayed-Onset Muscle Soreness: An Umbrella and Mapping Systematic Review with Meta-meta-analysis.
Wiecha S et al. Sports Med. 2025. PubMed 40120073 · DOI · Free full text
- Who
- umbrella review with meta-meta-analysis of 29 systematic reviews (863 RCTs) of physical treatments for delayed-onset muscle soreness in healthy adults
- What
- physiotherapy interventions including cooling therapy, cryostimulation and contrast therapy
- Measured
- delayed-onset muscle soreness
- Result
- 17 of 29 reviews critically low quality. Cooling therapy and cryostimulation reduced pain at several time points (Class III-IV evidence); pooled effects ranged from g 0.36 for cooling therapy to 1.82 for heat therapy.
- Limitations
- predominantly low-quality reviews; heterogeneity
[8]Meta-analysisBenefit
Temperature-dependent effects of post-exercise cold-water immersion on recovery: a systematic review and meta-analysis.
Jeon Y et al. BMC Sports Sci Med Rehabil. 2026. PubMed 42870311 · DOI · Free full text
- Who
- 52 studies of single-session CWI after exercise
- What
- post-exercise cold-water immersion at about 41, 50 or 59 F
- Protocol
- 41-59 °F
- Measured
- DOMS, creatine kinase, myoglobin
- Result
- DOMS SMD -0.81, CK SMD -0.64, myoglobin SMD -0.93 (all p<0.001). DOMS reduction numerically smaller at about 41 F (SMD -0.2) than 50 F (-0.8) or 59 F (-0.9); subgroup difference not significant (p=0.79). Substantial heterogeneity and wide prediction intervals.
- Limitations
- Not prospectively registered; high heterogeneity (DOMS I2 73.3%) with a prediction interval including no effect (-2.68 to 1.04); certainty moderate for DOMS and CK; adverse events not extracted.
[9]Meta-analysisn = 527Benefit
Effects of cold-water immersion at different body regions on post-exercise muscle damage recovery: a systematic review and meta-analysis.
Zhu Y et al. Front Sports Act Living. 2026. PubMed 41716304 · DOI · Free full text
- Who
- 30 RCTs (15 parallel, 15 crossover; 527 participants, 498 men) of single acute CWI vs seated passive rest
- What
- post-exercise cold-water immersion, whole-body or partial
- Measured
- creatine kinase, DOMS, jump, strength
- Result
- CWI reduced CK (g -0.24, 95% CI -0.37 to -0.10) and DOMS (g -0.40, -0.64 to -0.16) but not jump (g -0.02) or isometric strength (g 0.08). Partial immersion impaired immediate jump power (g -0.94); whole-body and partial immersion otherwise equivalent. After adjustment for publication bias the CK effect was no longer significant (g -0.086, 95% CI -0.210 to 0.037) and the DOMS effect shrank to g -0.172.
- Limitations
- Publication bias detected for CK and DOMS; CK benefit not robust; adverse-event reporting inconsistent (text says reported, table says not reported); small trials (7-60 participants), nearly all men.
[10]Meta-analysisn = 375Mixed
Temporal dynamics of muscle strength recovery following acute cold-water immersion: a systematic review and meta-analysis.
Zhu Y et al. PeerJ. 2026. PubMed 42473449 · DOI · Free full text
- Who
- 22 RCTs (375 participants, 362 men) of a single CWI bout vs passive recovery in healthy people
- What
- post-exercise cold-water immersion
- Measured
- strength, jump, soreness (VAS), creatine kinase over time
- Result
- No effect on isometric strength (g 0.08, 95% CI -0.11 to 0.26); transient jump impairment immediately after (g -0.68). Lower soreness overall (g -0.58, -0.99 to -0.16; very low certainty), but not significant once within-study dependency was accounted for (g -0.363, 95% CI -0.842 to 0.115, p=0.118); CK likewise (g -0.348, -0.791 to 0.095). CK reduction (g -0.43) also not robust after trim-and-fill (g -0.16, -0.44 to 0.12). No adverse reactions reported in any study.
- Limitations
- Heterogeneity; small-study effects for CK and soreness (Egger P<0.001); soreness benefit not robust to dependency adjustment; nearly all men.
[11]Meta-analysisn = 2,313Mixed
Cold water immersion protocol optimization across exercise modalities: a systematic review and network meta-analysis of resistance training, endurance exercise, and team sport applications.
Yu T et al. BMC Sports Sci Med Rehabil. 2026. PubMed 41845491 · DOI · Free full text
- Who
- 87 RCTs of post-exercise CWI at 68 F or colder in healthy athletes, 2014-2025
- What
- post-exercise cold-water immersion by temperature and duration
- Protocol
- 41-68 °F
- Measured
- modality-specific performance, damage markers, perceived recovery
- Result
- Passive recovery ranked best for resistance-training strength. Moderate-temperature, 10-15 min protocols improved muscle damage markers (g -0.51, 95% CrI -0.86 to -0.16) and perceived recovery (g -0.66, -0.98 to -0.33). Most networks low certainty with mostly indirect comparisons.
- Limitations
- Network meta-analysis with 69-85% of comparisons indirect; low certainty; 85% men; adverse events not analysed.
[12]Meta-analysisBenefit
Acute and Delayed Effects of Post-Exercise Recovery Strategies on Explosive Performance and Markers of Muscle Damage: A Systematic Review and Network Meta-Analysis.
Hou C et al. Healthcare (Basel). 2026. PubMed 42194413 · DOI · Free full text
- Who
- 22 randomized studies of team-sport athletes or active people doing team-sport-type exercise (network meta-analysis)
- What
- CWI vs massage vs active recovery vs passive control
- Protocol
- 50-59 °F · 10-15 min
- Measured
- jump, DOMS, creatine kinase at 0-24 h and 48-72 h
- Result
- CWI vs passive control: DOMS SMD -1.147 (95% CI -2.106 to -0.188) immediately, -2.187 (-3.193 to -1.182) at 24 h and -1.568 (-2.578 to -0.558) at 48 h; CK SMD -0.494 (-0.944 to -0.044) immediately. Massage also reduced DOMS; most effects diminished by 48-72 h.
- Limitations
- Sparse network with very large effect sizes and wide confidence intervals; no robust risk-of-bias sensitivity analysis or formal publication-bias testing; adverse events not reported.
[13]Meta-analysisn = 214Benefit
Effects of cold water immersion vs body cryotherapy on delayed onset muscle soreness and jump performance following acute strenuous exercise in physically active participants: A systematic review and meta-analysis.
Liu S et al. Medicine (Baltimore). 2026. PubMed 41578562 · DOI · Free full text
- Who
- 13 RCTs in physically active adults
- What
- CWI vs whole- or partial-body cryotherapy
- Protocol
- 41-59 °F · 5-15 min
- Measured
- DOMS and jump performance
- Result
- CWI relieved DOMS more than cryotherapy at 24 h (MD 1.07, 95% CI 0.70-1.43) but not at 48 h (MD 0.47, -0.04 to 0.98); cryotherapy had a small, fragile 24-h jump advantage (SMD 0.52).
- Limitations
- Small trials; head-to-head comparison only; no allocation concealment or assessor blinding reported; incomplete outcome data in 8 of 13 trials.
[14]Meta-analysisBenefit
The Impact of Cold-Water Immersion on Post-Match Recovery in Trained Soccer Players: A Systematic Review and Meta-Analysis.
Veen J et al. Scand J Med Sci Sports. 2026. PubMed 41490103 · DOI · Free full text
- Who
- 10 controlled trials in competitive soccer players after match play
- What
- post-exercise cold-water immersion
- Protocol
- 46-59 °F · 5-15 min
- Measured
- strength, jump, sprint, CK, DOMS at 24-72 h
- Result
- CWI improved strength recovery (SMD 1.02) and jump (SMD 0.38), reduced CK (SMD -0.77) and DOMS (SMD -1.04, 95% CI -1.91 to -0.17); DOMS was lower at 24 and 72 h but not at 48 h (p=0.56); sprint unaffected. All 95% prediction intervals included no effect.
- Limitations
- Few trials, almost all men; no participant or therapist blinding; wide prediction intervals.
[15]Meta-analysisn = 475Benefit
Comparison of the Effects of Cold-Water Immersion Applied Alone and Combined Therapy on the Recovery of Muscle Fatigue After Exercise: A Systematic Review and Meta-Analysis.
Ma J et al. Life (Basel). 2025. PubMed 40868853 · DOI · Free full text
- Who
- 24 studies of post-exercise recovery
- What
- CWI alone vs CWI combined with another therapy
- Protocol
- 41-59 °F · 1-20 min
- Measured
- DOMS, CRP, CK, jump
- Result
- DOMS reduced by CWI alone (SMD -0.37, 95% CI -0.65 to -0.10, after excluding an outlier trial) and CWI plus another therapy (SMD -0.68, -1.03 to -0.33); the CWI DOMS benefit was significant in athletes (SMD -0.47) but not non-athletes (SMD -0.29, -0.66 to 0.09); no effect of CWI alone on CK (SMD -0.01), jump or CRP.
- Limitations
- Heterogeneous combined therapies; CWI vs CWI-plus comparison indirect; seven trials had fewer than 10 participants; participants not blinded.
[16]Meta-analysisn = 499Benefit
A evidence-based approach to selecting post-exercise cryostimulation techniques for improving exercise performance and fatigue recovery: A systematic review and meta-analysis.
Feng C et al. Heliyon. 2024. PubMed 38933969 · DOI · Free full text
- Who
- 18 trials in healthy participants (479 men)
- What
- CWI, contrast water therapy or whole-body cryotherapy after exercise
- Measured
- muscle pain, fatigue, performance, inflammation
- Result
- All cryostimulation pooled: muscle pain SMD -0.45 (95% CI printed as -0.82 to 0.09, 8 trials); CWI vs control subgroup SMD -0.53 (95% CI -0.91 to -0.10). CWI did not change CRP (SMD -0.11, -0.98 to 0.76, 2 trials); the whole-body cryotherapy CRP reduction (SMD -1.36) came from a single trial. Contrast water therapy showed no significant effects; no significant effect of cryostimulation on peak power or jump.
- Limitations
- Mostly men; small trials; risk of bias mostly unclear or high (allocation concealment in one study); includes self-controlled trials; typesetting errors in reported confidence intervals.
[17]Meta-analysisn = 1,220Benefit
The effects of hydrotherapy and cryotherapy on recovery from acute post-exercise induced muscle damage-a network meta-analysis.
Chen R et al. BMC Musculoskelet Disord. 2024. PubMed 39294614 · DOI · Free full text
- Who
- 57 RCTs of exercise-induced muscle damage in healthy participants (network meta-analysis)
- What
- CWI, contrast water, thermoneutral/hot water immersion, cryotherapy
- Protocol
- 41-59 °F
- Measured
- CK, DOMS, jump
- Result
- Vs control, DOMS: CWI SMD -0.64 (95% CI -0.94 to -0.35), cryotherapy -0.81 (-1.27 to -0.35); CK: CWI -0.37 (-0.59 to -0.15); jump: CWI 0.37 (0.13 to 0.61), cryotherapy 0.45 (-0.11 to 1.00). Hot or thermoneutral water did not reduce DOMS. Rankings: contrast water best for CK (SUCRA 79.9%), cryotherapy best for DOMS (88.3%) and jump (83.7%, CI crossing zero).
- Limitations
- Network meta-analysis; participants could not be blinded; two trials at high risk from attrition; outcomes within 48 h.
[18]Meta-analysisBenefit
Effects of Cold-Water Immersion Compared with Other Recovery Modalities on Athletic Performance Following Acute Strenuous Exercise in Physically Active Participants: A Systematic Review, Meta-Analysis, and Meta-Regression.
Moore E et al. Sports Med. 2023. PubMed 36527593 · DOI
- Who
- 28 studies in physically active people after acute strenuous exercise
- What
- CWI vs other recovery modalities
- Measured
- performance, perceptual recovery, CK
- Result
- CWI was superior to other recovery methods for muscle soreness and similar for power and flexibility; air cryotherapy was better than CWI for strength recovery; water temperature and duration were rarely moderators.
- Limitations
- effect sizes not in abstract
[19]Meta-analysisMixed
Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis.
Xiao F et al. Front Physiol. 2023. PubMed 36744038 · DOI · Free full text
- Who
- 20 RCTs and crossover studies, 2002-2022
- What
- post-exercise cold-water immersion
- Measured
- DOMS, perceived exertion, jump, CK, lactate, CRP, IL-6
- Result
- DOMS lower immediately after CWI (SMD -0.59, 95% CI -0.90 to -0.28); at 24 h significant only with a fixed-effect model (random effects SMD -0.50, -1.05 to 0.04); no difference at 48 h. CK lower at 24 h (MD -86.04, -153.88 to -18.21). Jump reduced immediately (MD -2.71) but higher at 24 h (MD 4.77, 2.12 to 7.42). No effect on CRP or IL-6 over 48 h; immersion site and water temperature did not change effects.
- Limitations
- High risk of bias from lack of blinding; random allocation described in few trials; DOMS benefit limited to the immediate post-exercise period.
[20]Meta-analysisBenefit
What Parameters Influence the Effect of Cold-Water Immersion on Muscle Soreness? An Updated Systematic Review and Meta-Analysis.
Batista NP et al. Clin J Sport Med. 2023. PubMed 36399666 · DOI · Free full text
- Who
- 44 RCTs of athletes and non-athletes
- What
- CWI vs control, by temperature, duration and protocol
- Measured
- muscle soreness
- Result
- CWI was superior to control for immediate and delayed soreness regardless of water temperature or protocol; only short and medium immersion times were effective, and longer immersions showed no delayed benefit.
- Limitations
- effect sizes not in abstract
[21]Meta-analysisMixed
The effect of cold water immersion on the recovery of physical performance revisited: A systematic review with meta-analysis.
Choo HC et al. J Sports Sci. 2022. PubMed 36862831 · DOI
- Who
- 68 studies of CWI and recovery of physical performance
- What
- post-exercise cold-water immersion
- Measured
- time course of performance, CK, soreness
- Result
- CWI improved 1-h endurance recovery but impaired sprint (1 h) and jump (6 h); improved jump at 24 and 96 h and strength at 24 h, with lower CK (24-72 h) and soreness (1-72 h).
- Limitations
- effect sizes not in abstract
[22]Systematic reviewMixed
Analysis of Recovery Methods' Efficacy Applied up to 72 Hours Postmatch in Professional Football: A Systematic Review With Graded Recommendations.
Querido SM et al. Int J Sports Physiol Perform. 2022. PubMed 35961644 · DOI · Free full text
- Who
- 39 studies of recovery methods up to 72 h after matches in football and other team sports
- What
- sleep, nutrition, active recovery, CWI, massage
- Protocol
- 41-59 °F · 1-15 min
- Measured
- graded recommendations for physical, physiological and perceptual recovery
- Result
- No method was recommended for physical or physiological recovery; CWI and massage were recommended as beneficial for perceived recovery up to 72 h.
- Limitations
- graded narrative synthesis
[23]Meta-analysisBenefit
Influence of physical post-exercise recovery techniques on vagally-mediated heart rate variability: A systematic review and meta-analysis.
Laborde S et al. Clin Physiol Funct Imaging. 2024. PubMed 37754676 · DOI · Free full text
- Who
- 24 RCTs (17 meta-analyzed) of physical recovery techniques
- What
- post-exercise recovery techniques including CWI
- Measured
- vagally mediated heart rate variability (RMSSD)
- Result
- CWI had a moderate-to-large positive effect on RMSSD (g 0.75, 95% CI 0.42-1.07); other techniques had none.
- Limitations
- Surrogate autonomic outcome, not soreness; 28 of 34 trials at high risk of bias; possible small-study effect (Egger p=0.08).
[24]Meta-analysisn = 120No effect
Different Cryotherapy Modalities Demonstrate Similar Effects on Muscle Performance, Soreness, and Damage in Healthy Individuals and Athletes: A Systematic Review with Metanalysis.
Azevedo KP et al. J Clin Med. 2022. PubMed 35956058 · DOI · Free full text
- Who
- 7 trials in healthy individuals and athletes (6 in the quantitative analysis, 120 participants)
- What
- whole-body vs partial-body cryotherapy after exercise-induced muscle damage
- Measured
- performance, DOMS, damage markers
- Result
- Whole-body and partial-body cryotherapy produced similar effects on performance, soreness and damage markers (DOMS at 24 h SMD -0.25, 95% CI -0.66 to 0.15; at 48 h -0.08, -0.48 to 0.33).
- Limitations
- Cold-vs-cold comparison with no untreated control; low methodological quality (mean PEDro 4.3); low to very low GRADE certainty; inconsistent labelling of protocols.
[25]Systematic reviewBenefit
Whole-body Cryotherapy as a Recovery Technique after Exercise: A Review of the Literature.
Rose C et al. Int J Sports Med. 2017. PubMed 29161748 · DOI
- Who
- 16 studies of whole-body cryotherapy after damaging exercise in healthy, active people
- What
- whole-body cryotherapy at -166 to -310 F (-110 to -190 C)
- Protocol
- -310 to -166 °F
- Measured
- pain, function, inflammation
- Result
- Muscle pain was reduced in 80% of studies; multiple exposures more consistently improved pain, function and inflammatory markers; protocols too varied for recommendations.
- Limitations
- vote counting; heterogeneous protocols
[26]Meta-analysisn = 1,098Benefit
Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials.
Wang Y et al. Phys Ther Sport. 2021. PubMed 33493991 · DOI
- Who
- 32 RCTs in people with delayed-onset muscle soreness
- What
- cold or heat therapy within 1 h after exercise
- Measured
- DOMS pain
- Result
- Cold therapy reduced pain within 24 h (SMD -0.57, 95% CI -0.89 to -0.25) but not beyond 24 h; CWI SMD -0.48 (-0.84 to -0.13) within 24 h. Heat also reduced pain; no significant difference between cold and heat.
- Limitations
- quality limits noted by authors
[27]Meta-analysisBenefit
An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis.
Dupuy O et al. Front Physiol. 2018. PubMed 29755363 · DOI · Free full text
- Who
- 99 studies of recovery techniques after exercise
- What
- recovery techniques including immersion and cryotherapy
- Measured
- DOMS, fatigue, CK, IL-6, CRP
- Result
- Immersion, contrast water and cryotherapy (among others) produced small-to-large DOMS reductions (g -2.26 to -0.40); cold-water immersion specifically: DOMS -0.47 (95% CI -0.77 to -0.18; 34 groups, 379 participants) and perceived fatigue -1.16 (-1.94 to -0.39); massage was the most effective technique for DOMS and fatigue; cold exposure among the most effective for inflammatory markers.
- Limitations
- mixed designs including repeated-measures
[28]Meta-analysisn = 606Mixed
Effects of Cold Water Immersion and Contrast Water Therapy for Recovery From Team Sport: A Systematic Review and Meta-analysis.
Higgins TR et al. J Strength Cond Res. 2017. PubMed 27398915 · DOI
- Who
- 23 studies of recovery after team sport
- What
- CWI and contrast water therapy
- Measured
- neuromuscular recovery, sprint, perceived fatigue
- Result
- CWI benefited jump and all-out sprint at 24 h and perceived fatigue at 72 h, but not accumulated sprinting; contrast water therapy helped perceived fatigue but not neuromuscular recovery.
- Limitations
- soreness effects not reported in abstract
[29]Meta-analysisn = 169Benefit
Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis.
Machado AF et al. Sports Med. 2016. PubMed 26581833 · DOI · Free full text
- Who
- 9 RCTs (169 participants, 141 men) comparing CWI with passive recovery
- What
- CWI at various temperatures and durations
- Protocol
- 52-59 °F · 11-15 min
- Measured
- muscle soreness
- Result
- CWI was slightly better than passive recovery for immediate (MD 0.290, 95% CI 0.037-0.543) and delayed soreness (MD 0.315, 0.048-0.581); best results at 52-59 F (11-15 C) and 11-15 min, while 41-50 F (5-10 C) water and 5-10 min immersion were not significant; the one trial with immersion longer than 15 min was worse than passive recovery for delayed soreness (MD -2.200, 95% CI -4.169 to -0.231).
- Limitations
- Nine small trials, six of poor quality (mean PEDro 4.2); blinding often impossible; small effect.
[30]Meta-analysisBenefit
Cooling and performance recovery of trained athletes: a meta-analytical review.
Poppendieck W et al. Int J Sports Physiol Perform. 2013. PubMed 23434565 · DOI
- Who
- 21 RCTs in trained athletes
- What
- post-exercise cooling (CWI, cryochambers, cold packs)
- Measured
- performance recovery
- Result
- Average effect of cooling was small (2.4%, g 0.28); CWI g 0.34, cryochambers g 0.25, cold packs g -0.07; whole-body immersion more effective than limb-only (g 0.62 vs 0.10).
- Limitations
- performance outcomes, not soreness
Protocols used in the studies
Trials immersed participants after exercise in water at or below about 59-68 F, most often 10-15 minutes at 41-59 F (in the Cochrane review just over 75% of trials used 50-59 F, with continuous immersion of 5-24 minutes, mean 12.6), usually as a single session after a damaging bout of exercise. Reviews most often favored 11-15 minutes at 52-59 F (Machado 2016) or 10-15 minutes at 41-59 F (Berjisian 2026); colder water (about 41 F) was not more effective (Jeon 2026), and immersion longer than 15 minutes showed no delayed benefit (Batista 2023) or was worse than passive recovery in one trial (Machado 2016).
What is still unknown
Clinical importance of the soreness reduction; whether benefits exceed placebo, heat or warm water; effects in patients undergoing rehabilitation for diagnosed musculoskeletal conditions (not studied as cold plunge); trade-off with training adaptation; publication bias in the many overlapping meta-analyses.
Safety
Cautions for cold therapy in this condition
- Routine post-training cold immersion may blunt long-term strength and hypertrophy gains (Roberts 2015, PMID 26174323: muscle mass +103 vs +309 g with active recovery; Berjisian 2026, PMID 42816732); passive recovery ranked best for strength-focused training (PMID 41845491).
- Immersion transiently reduces jump and sprint performance in the first hours afterwards (PMIDs 42473449, 41716304, 36862831, 36744038).
- Most trials did not actively monitor adverse events (Bleakley 2012, PMID 22336838; Costello 2015, PMID 26383887), so short- and long-term safety in these trials is largely unknown.
- See general cold safety entry.
For clinicians
Suggested rationale
Cold-water immersion modestly reduces short-term soreness after strenuous exercise in healthy people (Bleakley 2012; Jeon 2026), but this is athletic recovery of a self-limited condition rather than treatment of a diagnosed disease, and on its own is unlikely to establish medical necessity.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: M79.10. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others