Cold therapy for spinal cord injury (tetraplegia and paraplegia)
Evidence review
Overview
One randomized trial has tested cold exposure in people with chronic spinal cord injury: 62 adults (37% tetraplegia) were assigned to a 7-week Wim Hof Method program with cold showers, the same program of breathing and mindset training without cold, or usual care. Mental health, the primary outcome, did not differ between groups. Compared with usual care, the cold-exposure group reported less pain interference and improved inspiratory flow and fasting glucose, but the two program groups did not differ from each other. Cold showers at home averaged 58 F (14.6 C) and were tolerated without serious adverse events or autonomic dysreflexia.
Key findings
- Primary outcome MHI-5: no difference between groups (de Groot 2026, n=62)
- Cold-exposure program vs usual care: lower pain interference (p=0.027), FIV1 +27% and peak inspiratory flow +23% (both p=0.02), fasting glucose -6% (p=0.006)
- No significant differences between the programs with and without cold exposure
- No serious adverse events; no autonomic dysreflexia during cold showers or optional ice baths; 3 participants partly discontinued because of adverse experiences
Every study we reviewed
1 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 13 studies on spinal cord injury and spasticity, across all heat and cold therapies, including case reports and older work not graded here.
The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury-Results of a randomized controlled trial.
de Groot S et al. Clin Rehabil. 2026. PubMed 41810770 · DOI
- Who
- Adults with chronic spinal cord injury (>=1 year; 37% tetraplegia, 41% motor complete) at a rehabilitation centre (Netherlands)
- What
- 7-week Wim Hof Method program with weekly supervised sessions and daily home practice: breathing and mindset training plus progressive cold exposure (cold cloths in weeks 1-2, then home cold showers from 30 s rising to 150 s, mean water temperature 58.3 F (14.6 C); optional ice bath) vs the same program without cold vs usual care
- Protocol
- 58.3 °F · 2.5 min · 7/wk · 7 wk
- Measured
- Mental Health Inventory (MHI-5); secondary: pain, spasticity, pulmonary function, inflammatory and metabolic markers, body composition, sleep, stress
- Result
- No between-group difference in MHI-5. Versus usual care, the cold-exposure group had lower pain interference (p=0.027), higher FIV1 (+27%, p=0.02) and peak inspiratory flow (+23%, p=0.02) and lower fasting glucose (-6%, p=0.006). The two program groups did not differ significantly. 8 dropouts in the no-cold program vs 1 in each other group.
- Limitations
- Primary outcome null; many secondary outcomes without correction for multiple testing; cold combined with breathing and mindset training; home cold showers not standardized; adherence declined after week 3.
Protocols used in the studies
Home cold showers progressing from 30 seconds to 150 seconds at an average 58.3 F (14.6 C), after 2 weeks of washing with cold cloths, daily for 7 weeks, combined with breathing and mindset training and weekly supervised group sessions; 14 of 21 participants also took an optional ice bath.
What is still unknown
Whether cold exposure adds anything to breathing exercise in spinal cord injury; effects on spasticity and neuropathic pain in larger trials; safe exposure limits by injury level, including autonomic dysreflexia risk with colder immersion.
Safety
Cautions for cold therapy in this condition
- People with a history of severe autonomic dysreflexia, cardiac arrhythmia or cardiac disease were excluded; no autonomic dysreflexia occurred during cold showers or ice baths and there were no serious adverse events (PMID 41810770).
- Reported experiences included tingling, headache and lightheadedness (largely during the breathing exercises); 3 of 21 in the cold group partly stopped the program because of adverse experiences (PMID 41810770).
- Impaired sensation and thermoregulation below the injury make the response to cold harder to judge; the trial introduced cold gradually, starting with sensate body parts, with a supervised first shower.
- See general-safety.
For clinicians
Suggested rationale
In a randomized trial in chronic spinal cord injury (de Groot 2026), a 7-week program of breathing exercises with progressive home cold showers did not improve mental health, its primary outcome, but improved pain interference, inspiratory flow and fasting glucose compared with usual care; it did not differ from the same program without cold, so any benefit cannot be attributed to cold exposure itself.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: G82.50, G82.20. Examples only; the clinician assigns the code.
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