Sauna for spinal cord injury (tetraplegia and paraplegia)
Evidence review
Overview
Small laboratory studies show that people with tetraplegia or paraplegia can complete a supervised sauna session or hot-water immersion without syncope, with rises in heart rate, core temperature and interleukin-6 similar to those after exercise. People with cervical injury had blunted sympathetic responses (no catecholamine rise) and a fall in diastolic pressure after sauna. Cerebrovascular function was unchanged by mild heating. In a German study of a single 185 F sauna, skin temperature rose more in people with spinal cord injury than in controls, and low paraplegia was followed by hemoconcentration and higher blood viscosity. No study has tested regular sauna or heat therapy for cardiovascular, functional or symptom outcomes in spinal cord injury.
Key findings
- Sauna at 185 F up to 15 min, 6 tetraplegic and 4 paraplegic subjects: heart rate rose, diastolic pressure fell in tetraplegics after the sauna, no syncope (Gerner 1992)
- 60-min hot-water immersion, cervical SCI: IL-6 rose 133% without a catecholamine response (Leicht 2015)
- 60-min lower-limb immersion at 104 F, 15 cervical SCI: no change in cerebrovascular function; MAP +6 mmHg vs -8 mmHg in controls (Coombs 2019)
- Single 15-min sauna at 185 F, 19 people with SCI vs 22 controls: larger skin-temperature rise (up to 109.4 F), hemoconcentration and higher blood viscosity in low paraplegia, higher basal muscle electrical activity (Seidel 1992)
Every study we reviewed
5 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 13 studies on spinal cord injury and spasticity, across all heat and cold therapies, including case reports and older work not graded here.
The effects of sauna on tetraplegic and paraplegic subjects.
Gerner HJ et al. Paraplegia. 1992. PubMed 1635790 · DOI
- Who
- 6 tetraplegic and 4 paraplegic adults
- What
- dry sauna lying supine, after 20 min at 86 F, followed by 15 min at 86 F
- Protocol
- 185 °F · up to 15 min · single session/wk
- Measured
- heart rate, blood pressure, rectal and skin temperature, sweat rate, blood chemistry, catecholamines
- Result
- Heart rate rose significantly in both groups; no significant change in systolic pressure; diastolic pressure fell in tetraplegic subjects after the sauna; no syncope.
- Limitations
- single session; 10 subjects; physiological outcomes only; abstract truncated
Hot water immersion induces an acute cytokine response in cervical spinal cord injury.
Leicht CA et al. Eur J Appl Physiol. 2015. PubMed 26105530 · DOI · Free full text
- Who
- 7 men with motor-complete cervical SCI and 8 able-bodied men
- What
- head-out hot-water immersion at 3.6 F (2 C) above resting esophageal temperature
- Protocol
- 60 min · single session/wk
- Measured
- plasma cytokines and catecholamines
- Result
- IL-6 rose 133 +/- 144% (P=0.001), IL-8 14% and IL-1ra 18% in both groups; catecholamines were reduced in cervical SCI and did not increase with immersion.
- Limitations
- single session; small; immune markers only
Differences in serum IL-6 response after 1 °C rise in core body temperature in individuals with spinal cord injury and cervical spinal cord injury during local heat stress.
Hashizaki T et al. Int J Hyperthermia. 2018. PubMed 30303416 · DOI · Free full text
- Who
- 9 with cervical SCI, 10 with thoracic/lumbar SCI, 8 able-bodied
- What
- lower-body heating with a hot water-perfused suit until core temperature rose 1.8 F (1 C)
- Protocol
- single session/wk
- Measured
- serum IL-6, plasma adrenaline, TNF-alpha, CRP, cardiac output
- Result
- IL-6 rose in all groups but the percentage rise was lower in cervical SCI; adrenaline rose in able-bodied and thoracic/lumbar SCI but not in cervical SCI; cardiac output and heart rate rose in all groups.
- Limitations
- single session; small; mechanistic outcomes
Cerebrovascular function is preserved during mild hyperthermia in cervical spinal cord injury.
Coombs GB et al. Spinal Cord. 2019. PubMed 31289366 · DOI
- Who
- 15 people with cervical SCI and 15 uninjured controls
- What
- lower-limb hot-water immersion
- Protocol
- 104 °F · 60 min · single session/wk
- Measured
- cerebral artery velocities, neurovascular coupling, carotid flow, pulse-wave velocity
- Result
- Mean arterial pressure rose in SCI (+6 mmHg) and fell in controls (-8 mmHg; P=0.01); no change in intracranial artery measures or neurovascular coupling in SCI.
- Limitations
- single session; physiological outcomes
The Acute Effect of Hot Water Immersion on Cardiac Function in Individuals with Cervical Spinal Cord Injury.
Kouda K et al. J Clin Med. 2024. PubMed 39768517 · DOI · Free full text
- Who
- 8 men with motor-complete cervical SCI and 9 healthy controls
- What
- head-out hot-water immersion at 3.6 F (2 C) above resting esophageal temperature
- Protocol
- 60 min · single session/wk
- Measured
- echocardiographic diastolic and systolic function
- Result
- Body temperature and heart rate rose with stable blood pressure in both groups; in cervical SCI only late diastolic inflow (A) and isovolumic acceleration improved, without the improvement in left-ventricular diastolic function seen in controls.
- Limitations
- single session; small; physiological outcomes
Changes in selected functional parameters in people with spinal cord injury after sauna
Seidel E et al. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 1992. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Veränderungen ausgewählter Funktionsparameter bei Querschnittgelähmten nach Sauna
- Who
- 19 people with paraplegia or tetraplegia and 22 healthy controls (Germany)
- What
- Single 15-min dry sauna at 185 F (85 C), 5-10% relative humidity, in a multi-person sauna
- Protocol
- 185 °F · 15 min
- Measured
- Thermoregulation, hemorheology, muscle mechanical and electromyographic parameters
- Result
- Skin temperature rose significantly more than in controls, to as high as 109.4 F (43 C); muscle temperature did not differ by lesion level; low paraplegia was followed by hemoconcentration and higher blood viscosity; basal muscle electrical activity rose significantly after sauna. The authors judged supportive sauna in paraplegia unproblematic and well dosed.
- Limitations
- Single session; no figures in the abstract; injury levels and completeness not detailed; physiological outcomes only.
Protocols used in the studies
Single sessions only: dry sauna at 185 F (85 C) for up to 15 minutes lying supine or in a multi-person sauna; head-out hot-water immersion at 3.6 F (2 C) above resting core temperature for 60 minutes; lower-limb immersion at 104 F (40 C) for 60 minutes; or a water-perfused suit raising core temperature by 1.8 F (1 C). No repeated-session protocol has been studied.
What is still unknown
Whether repeated passive heating improves cardiovascular or metabolic risk markers in SCI, as hypothesized; safe exposure limits by injury level; risk of autonomic instability; supervision requirements.
Safety
Cautions for sauna in this condition
- In cervical SCI, sympathetic (catecholamine) responses to heat are absent or blunted (PMIDs 26105530, 30303416), and diastolic pressure fell after sauna in tetraplegic subjects (PMID 1635790); monitor blood pressure and limit exposure.
- Impaired sweating, temperature sensation and mobility below the injury raise the risk of overheating, burns from hot surfaces and difficulty leaving the heat; sessions should be supervised and short.
- After a single 185 F sauna, skin temperature in people with spinal cord injury rose significantly more than in controls (up to 109.4 F), and low paraplegia was followed by hemoconcentration and higher blood viscosity (Seidel 1992, DOI 10.1055/s-2008-1062125); fluid intake and limited exposure are reasonable precautions.
- See general-safety.
For clinicians
Suggested rationale
Single-session studies (Gerner 1992; Leicht 2015) show that people with tetraplegia and paraplegia tolerated supervised sauna or hot-water immersion and had exercise-like cytokine and heart-rate responses, but no study has tested repeated heat therapy for a clinical outcome in spinal cord injury; any use is an extrapolation and requires supervision because thermoregulation is impaired.
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.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others