How cold water immersion, ice baths, and cryotherapy affect recovery and performance for running, OCR, and endurance sports
Thomas Solomon, PhD.
Updated onReading time approx 7 minutes (1500 words).
What you’ll learn:
Cold water immersion (aka an ice bath) and cryotherapy are ways of getting very cold on purpose after exercise — either in cold water or in super-cold dry air.
Cold water immersion can reduce muscle soreness and the feeling of fatigue, and it can help restore muscle power — especially if you’ve got another training session or race coming up soon.
But there’s a trade-off: doing ice baths every day might blunt strength and power gains. And, for whole-body cryotherapy (cold dry air), the evidence is currently too thin to be confident.
Curious about the how and why? Scroll down for the details, the nuances, and the nerdy bits.
The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.
What is cold water immersion?
You’ve seen it: CrossFit athletes dunking their arms in ice water after crushing Murph. Mo Farah lowering himself into an ice bath after a brutal interval session. Social media folks sliding into cryo-chambers like it’s a weekly spa appointment. Wim Hof doing Wim Hof things (often in underpants). It looks dramatic. It is dramatic. But why do people do it?
When you plunge into cold water, your body’s automatic wiring — the “do not die today” system — kicks in fast. You shiver (tiny muscle contractions that make heat), your heart rate and breathing rate jump up, and adrenaline (epinephrine) spikes. In other words: your body briefly acts like it’s doing a workout… even though you’re just sitting there, regretting your life choices.
But after that initial shock, your core temperature can drop back toward normal and the “rest-and-digest” side of your nervous system starts to take over and calm things down. (NOTE: The physiological responses of cold water immersion have been systematically reviewed in the British Journal of Sports Medicine). For many people, that whole process reduces the perception of soreness and fatigue — so it “feels” like recovery, even if the biology underneath is sometimes more complicated.
When it comes to performance, the story gets a bit nerdier: the overall evidence suggests cold water immersion can help restore muscle power (think sprinting and jumping), but effects on muscle strength and endurance are less convincing. Also, different studies use different water temperatures, different timings, and different outcome tests — so when you zoom in on the individual studies, it’s a mixed bag of “wow”, “meh”, and “wait, what de feck?”.
What is the scientific evidence on the effect of cold water immersion, ice baths, and cryotherapy on recovery and athletic performance?
Cold water immersion after exercise can reduce markers linked with muscle damage and it can reduce muscle soreness — especially in the first 4 days after a hard session. These effects have been reported across several reviews and meta-analyses (see Feng et al. 2024, Xiao et al. 2023, Moore et al. 2022, Wang et al. 2016, Hohenauer et al. 2015).
Cold water immersion can also help restore muscle power (e.g. sprint speed and jump height), particularly after high-intensity exercise (see Moore et al. 2022, & Poppendieck et al. 2013). However, cold water immersion after exercise does not seem to improve the recovery of muscle strength or endurance performance.
To achieve these effects, the current recommended cold water immersion/ice bath protocol is to immerse the body up to the neck in cold water at a temperature of between 10 and 15°C (50 to 59°F) for 5 to 15 minutes (see Machado et al. 2016). Also see Halson (2011) for a narrative reviewA narrative review describes an entire body of evidence to summarise what is known on a topic. However, instead of using a systematic approach, a narrative review takes a subjective approach that allows the author(s) to express their opinion on the topic. of the real-world practicalities (because “just get in the tub” is…not always that simple).
A study by Stephens et al. 2017 found that core temperature drops faster in people with lower body fat percentage. Translation: if you’re leaner, you may cool down quicker — so you should consider body composition when planning your cold water immersion approach, to stay safe and avoid hypothermia.
Unlike cold water immersion, simply icing a sore spot (local icing) does not reduce delayed onset muscle soreness (DOMS) or improve the restoration of performance after muscle-damaging exercise (see Nogueira et al. 2019).
Similar to cold water immersion, contrast water therapy (switching between cold and hot water) after exercise can reduce feelings of muscle soreness compared with passive recovery (see Bieuzen et al. 2013).
Due to the lack of precise details reported in many studies (e.g., temperature, duration, and exact setup), the lack of blindingBlinding is when people in a study don’t know which treatment they’re getting. It stops expectations or beliefs (from patients or researchers) from skewing the results. “Single-blind” means participants don’t know; “double-blind” means participants and researchers don’t know; “triple-blind” means that the participants, researchers, and data analysts are kept in the dark. The goal is simple: fair tests and trustworthy findings., and the fact that cold therapy is often combined with other recovery strategies, the overall quality of evidence in this field is limited — and more high-quality randomised controlled trialsThe “gold standard” approach for determining whether a treatment has a causal effect on an outcome of interest. In such a study, a sample of people representing the population of interest is randomised to receive the treatment or a no-treatment placebo (control), and the outcome of interest is measured before and after the exposure to treatment/control. are needed to strengthen confidence in the conclusions.
There is currently insufficient evidence (too few studies) to know whether whole-body cryotherapy — exposures to extremely cold dry air below -100°C (below -148°F) in a specialised chamber — reduces muscle soreness, improves feelings of recovery, or restores performance after exercise (see Feng et al. 2024, Costello et al. 2015). Some studies show cryotherapy can lower some inflammation markers (e.g., C-reactive protein) after exercise, but it’s unclear whether that change is actually helpful — and there are very few studies in this area (see Feng et al. 2024).
When different cold therapy methods are compared head-to-head, there is currently little difference between them (see Azevedo et al. 2022). But there are very few direct comparisons — and to make things extra confusing, “cryotherapy” sometimes gets used to mean cold water immersion in some papers. Scientists, please… what are you trying to do to me!?
Now for the MOST IMPORTANT thing to understand about cold water immersion: the difference between a single, one-off dunk (acute) and repeated, regular use (chronic). Same tool, different outcome…
— After resistance exercise, regular cold water immersion may reduce training adaptations. For example, it can blunt molecular signalling (Roberts et al. 2015) and suppress muscle protein synthesis (Fuchs et al. 2019) after a session. These effects were reviewed by Broatch et al. 2018. Furthermore, the 2021 meta-analysis from Malta et al. found that regular cold water immersion during resistance training blunts muscle mass and strength gains, including 1-rep max, maximum strength, strength endurance, and power.
— After endurance exercise, the inhibitory effect of cold therapy is less clear. Some evidence suggests that a single cold water immersion session after an endurance bout may actually increase molecular signals linked with mitochondrial biogenesis (see Broatch et al. 2018). But overall, regular cold therapy shows little to no effect on training-induced changes in molecular signalling or endurance performance, including time-trial performance and V̇O2maxYour maximal rate of oxygen consumption; a measure of cardiorespiratory fitness and maximal aerobic power, which contributes to endurance performance. (see Malta et al. 2021). All that said, there are only a few studies on these questions, so we’re gonna need more good research before anyone should get too confident.
— Therefore, after a hard effort or a big lifting session, sure: go take a dip in that cold lake (if ambient conditions permit and you’ve got warm, dry post-dip facilities available). But doing it every day is probably not a great idea if you’re chasing strength and power gains — because you might blunt the improvements you’re sweating so hard to earn.
Can cold water immersion, ice baths, and cryotherapy enhance recovery and athletic performance?
Cold water immersion (an ice bath) is likely to reduce muscle soreness and help restore muscle power after high-intensity exercise. For whole-body cryotherapy (cold dry air), there are currently too few studies to be confident about recovery or performance effects.
The effect sizeA standardized measure of the magnitude of an effect of an intervention. Unlike p-values, effect sizes show how large the effect is and indicate how meaningful it might be. Common effect size measures include standardised mean difference (SMD), Cohen’s d, Hedges’ g, eta-squared, and correlation coefficients. is moderate to large for muscle soreness, and small to moderate for performance (so: you’ll probably feel better, and you might perform a bit better, depending on the situation).
The effects look broadly similar between trained athletes and untrained people, and between males and females — but studies directly comparing groups are limited, and females are underrepresented in this research area. So yes, it probably applies…just with less certainty than we’d like.
Importantly, regular (daily) cold water immersion has a moderate detrimental effect on training-induced gains in strength, strength endurance, and power. So if you’re in a strength-building phase, daily ice baths are probably not your friend.
Keep in mind: there is high heterogeneityHeterogeneity shows how much the results in different studies in a meta-analysis vary from each other. It is measured as the percentage of variation (the I2 value). A rule of thumb: if I2 is roughly 25%, that indicates low heterogeneity (good), 50% is moderate, and 75% indicates high heterogeneity (bad). High heterogeneity means there’s more variability in effects between studies and, therefore, a less precise overall effect estimate. (variability) in effects between studies, a moderate to high risk of biasRisk of bias in a meta-analysis refers to the potential for systematic errors in the studies included in the analysis. Such errors can lead to misleading/invalid results, and unreliable conclusions. This can arise because of issues with the way participants are selected (randomisation), how data is collected and analysed, and how the results are reported., and possible publication biasPublication bias in meta-analysis occurs when studies with significant results are more likely to be published than those with non-significant findings, leading to distorted conclusions. This bias can inflate effect sizes and misrepresent the true effectiveness of interventions, making it crucial to identify and correct for it in research.. So, the overall certainty of evidenceCertainty of evidence tells us how confident we are that the published results accurately reflect the true effect. It’s based on factors like study design, risk of bias, consistency, directness, precision, and publication bias. Low certainty means more doubt and less confidence, and that future studies could easily change the conclusions. High certainty means that the current evidence is so strong and consistent that future studies are unlikely to change conclusions. is lowA low quality of evidence means that, in general, studies in this field have several limitations. This could be due to inconsistency in effects between studies, a large range of effect sizes between studies, and/or a high risk of bias (caused by inappropriate controls, a small number of studies, small numbers of participants, poor/absent randomization processes, missing data, inappropriate methods/statistics). When the quality of evidence is low, there is more doubt and less confidence in the overall effect of an intervention, and future studies could easily change overall conclusions. The best way to improve the quality of evidence is for scientists to conduct large, well-controlled, high-quality randomized controlled trials.. Therefore, additional high-quality randomised controlled trials are needed to increase confidence in the effect sizes reported in meta-analysesA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment..
How to use this: Use cold water immersion strategically — not as a daily religion. It makes the most sense when you need to feel better and restore muscle power quickly (for example, between close-together sessions or events). A common evidence-based approach is 10 to 15°C (50 to 59°F) for 5 to 15 minutes, immersed up to the neck. If you’re lean (core temperature can drop faster), be extra cautious. And if you’re in a strength/power-building block, don’t do daily ice baths unless you’re cool with blunting some of those hard-earned gains.
Information you can trust. All content on Veohtu is meticulously researched and written by Thomas Solomon, PhD. He does not sell supplements, recovery products, or ad space, and he has no sponsorships, brand affiliations, or ambassador roles. Everything you read reflects his independent views, shaped solely by peer-reviewed scientific evidence — and that will never change.
Full list of meta-analyses examining cold water immersion, ice baths, and cryotherapy for recovery
Here are the meta-analyses I've summarised above:
The effects of hydrotherapy and cryotherapy on recovery from acute post-exercise induced muscle damage-a network meta-analysis. Che net al. (2024) BMC Musculoskelet Disor.
A evidence-based approach to selecting post-exercise cryostimulation techniques for improving exercise performance and fatigue recovery: A systematic review and meta-analysis.. Feng et al. (2024) Heliyon.
Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis. Feiyan Xiao, Anastasiia V. Kabachkova, Lu Jiao, Huan Zhao, Leonid V. Kapilevich. Front Physiol. 2023
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. Emma Moore, Joel T Fuller, Clint R Bellenger, Siena Saunders, Shona L Halson, James R Broatch, Jonathan D Buckley. Sports Med. 2023
The effect of cold water immersion on the recovery of physical performance revisited: A systematic review with meta-analysis. Hui Cheng Choo, Marcus Lee, Vincent Yeo, Wayne Poon, Mohammed Ihsan. Sports Sci. 2022
Different Cryotherapy Modalities Demonstrate Similar Effects on Muscle Performance, Soreness, and Damage in Healthy Individuals and Athletes: A Systematic Review with Meta analysis. Klaus Porto Azevedo, Júlia Aguillar Ivo Bastos, Ivo Vieira de Sousa Neto, Carlos Marcelo Pastre, Joao Luiz Quagliotti Durigan. J Clin Med. 2022
Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Performance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression. Emma Moore, Joel T. Fuller, Jonathan D. Buckley, Siena Saunders, Shona L. Halson, James R. Broatch & Clint R. Bellenger. Sports Med. 2022
Comparison between cryotherapy and photobiomodulation in muscle recovery: a systematic review and meta-analysis. João Vitor Ferlito, Marcos Vinicius Ferlito, Ernesto Cesar Pinto Leal-Junior , Shaiane Silva Tomazoni, Thiago De Marchi. Lasers Med Sci. 2021
Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Yutan Wang, Sijun Li, Yuanyuan Zhang, Yanru Chen, Fanghong Yan, Lin Han, Yuxia Ma. Phys Ther Sport. 2021
The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis. Malta ES, Dutra YM, Broatch JR, Bishop DJ, Zagatto AM. Sports Med. 2021
The effects of cryotherapy on athletes' muscle strength, flexibility, and neuromuscular control: A systematic review of the literature. Kalli K, Fousekis K. J Bodyw Mov Ther. 2020
Effects of local cryotherapy for recovery of delayed onset muscle soreness and strength following exercise-induced muscle damage: systematic review and meta-analysis. Nogueira NM, Felappi CJ, Lima CS, Medeiros DM. Sport Sciences for Health. 2019
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, Douzi W, Theurot D, Bosquet L, Dugué B. Front Physiol. 2018
Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis. Machado AF, Ferreira PH, Micheletti JK, de Almeida AC, Lemes ÍR, Vanderlei FM, Netto Junior J, Pastre CM. Sports Med. 2016
The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis. Hohenauer E, Taeymans J, Baeyens JP, Clarys P, Clijsen R. PLoS One. 2015
Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Costello JT, Baker PR, Minett GM, Bieuzen F, Stewart IB, Bleakley C. Cochrane Database Syst Rev. 2015
Cooling and performance recovery of trained athletes: a meta-analytical review. Poppendieck W, Faude O, Wegmann M, Meyer T. Int J Sports Physiol Perform. 2013
Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis. Bieuzen F, Bleakley CM, Costello JT. PLoS One. 2013
Cold water immersion and recovery from strenuous exercise: a meta-analysis. Leeder J, Gissane C, van Someren K, Gregson W, Howatson G.
Br J Sports Med. 2012
Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: systematic review and meta-analysis.
Torres R, Ribeiro F, Alberto Duarte J, Cabri JM.
Phys Ther Sport. 2012
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Who is Thomas Solomon?
My knowledge has been honed following 20+ years of running, cycling, hiking, cross-country skiing, lifting, and climbing, 15+ years of academic research at world-leading universities and hospitals, and 10+ years advising and coaching in athletic performance and lifestyle change.
I have a BSc in Biochemistry, a PhD in Exercise Science, and over 90 peer-reviewed publications in medical journals.
I'm also an ACSM-certified Exercise Physiologist (ACSM-EP), an ACSM-certified Personal Trainer (ACSM-CPT), a VDOT-certified Distance Running Coach, and a UKVRN Registered Nutritionist (RNutr).
Since 2002, I’ve conducted biomedical research in exercise and nutrition and have taught and led university courses in exercise physiology, active recovery, biochemistry, and molecular medicine.
And, with my personal experience of competing on the track (800m to 10,000m), the road (5 k to marathon), on the trails, and in the mountains, by foot, bicycle, cross-country ski, and during obstacle course races (OCR), I deeply understand what it's like to train and compete — I've been there, done it, and gotten sweat, mud, and tears on my t-shirt.
Disclaimer: I occasionally mention brands and products, but it is important to know that I don't sell recovery products, supplements, or ad space, and I'm not affiliated with / sponsored by / an ambassador for / receiving advertisement royalties from any brands. I have conducted biomedical research for which I’ve received research money from publicly-funded national research councils and medical charities, and also from private companies, including Novo Nordisk Foundation, AstraZeneca, Amylin, the A.P. Møller Foundation, and the Augustinus Foundation. I’ve also consulted for Boost Treadmills and Gu Energy on R&D grant applications, and I provide research and scientific writing services for Examine.com. Some of my articles contain links to information provided by Examine.com but I do not receive any royalties or bonuses from those links. Importantly, none of the companies described above have had any control over the research design, data analysis, or publication outcomes of my work. I research and write my content using state-of-the-art, consensus, peer reviewed, and published scientific evidence combined with my empirical evidence observed in practice and feedback from athletes. My advice is, and always will be, based on my own views and opinions shaped by the scientific evidence available. The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.