Cold-Water Immersion (Cryotherapy) for Preventing and Treating Muscle Soreness After Exercise

Executive summary

This is the reference standard against which any claim about cold plunging and muscle soreness should be measured.

Three authors independently assessed and extracted data from randomised and quasi-randomised trials comparing cold-water immersion after exercise against passive rest, contrast immersion, warm-water immersion, active recovery, compression, or a different dose of cold immersion. Seventeen small trials involving 366 participants in total were included.

Fourteen trials compared cold immersion with passive intervention. Pooled results showed statistically significant reductions in muscle soreness favouring cold immersion at 24 hours (SMD -0.55, 95% CI -0.84 to -0.27, 10 trials), 48 hours (SMD -0.66, 95% CI -0.97 to -0.35, 8 trials), 72 hours (SMD -0.93, 95% CI -1.36 to -0.51, 4 trials) and 96 hours (SMD -0.58, 95% CI -1.00 to -0.16, 5 trials). These results were heterogeneous.

The comparisons against other active interventions are where it gets interesting. Five studies compared cold immersion with contrast immersion and found no evidence of difference at any of four follow-up times. The same applied to four studies comparing cold with warm-water immersion.

The authors conclude there was some evidence that cold-water immersion reduces delayed-onset muscle soreness compared with passive interventions, and insufficient evidence to conclude on other outcomes or comparisons. They note that the majority of trials did not undertake active surveillance of pre-defined adverse events.

Why this research matters

Cold plunging for post-exercise soreness is the single most common reason people buy a plunge system, and this is the highest-quality synthesis of that specific question.

Its most commercially inconvenient finding is the one most often omitted: cold immersion was no better than warm-water immersion for soreness. If cold specifically is doing the work, that comparison should have shown a difference. It did not.

What the researchers found

Versus passive recovery (14 trials). Statistically significant reductions in muscle soreness favouring cold immersion: 24 hours SMD -0.55 (95% CI -0.84 to -0.27, 10 trials); 48 hours SMD -0.66 (95% CI -0.97 to -0.35, 8 trials); 72 hours SMD -0.93 (95% CI -1.36 to -0.51, 4 trials); 96 hours SMD -0.58 (95% CI -1.00 to -0.16, 5 trials). Results were heterogeneous.

Exploratory subgroup analyses found significantly larger effects in studies using cross-over designs or running-based exercise.

Pooled data from two studies found lower fatigue ratings after cold immersion (mean difference -1.70, 95% CI -2.49 to -0.90 on a 10-unit scale) and a non-significant trend toward improved physical recovery ratings (MD 0.97, 95% CI -0.10 to 2.05).

Versus contrast immersion (5 studies). No evidence of difference at any of four follow-up times. Versus warm-water immersion (4 studies). Similar findings - no evidence of difference at 24, 48 and 72 hours.

Versus active recovery, compression, or a second dose of cold immersion. Single trials only; no conclusions drawn.

What the results mean

Standardised mean differences between -0.55 and -0.93 are moderate to large effects on perceived soreness, and they held across four separate timepoints. That consistency is why cold immersion is taken seriously for this purpose at all.

But the comparator matters enormously. Cold beat doing nothing. It did not beat warm water, and it did not beat alternating hot and cold. If the mechanism were specifically cold-driven, those comparisons should have separated - and across nine studies they did not.

The honest reading is that immersion in water after exercise appears to reduce perceived soreness, and that the evidence does not establish cold as the necessary ingredient. The heterogeneity and low study quality mean even the size of the effect is uncertain.

Strengths and limitations

Strengths

• Cochrane methodology, the most rigorous standard in evidence synthesis.
• Independent duplicate data extraction by three authors.
• Multiple comparators assessed, not just placebo or rest.
• Outcomes assessed at four separate follow-up timepoints.
• Explicit reporting of heterogeneity and of low study quality.
• Flags the absence of adverse-event surveillance rather than treating silence as safety.

Limitations

• Seventeen trials with only 366 participants in total.
• Study quality rated low.
• Substantial heterogeneity in temperature, duration and frequency of immersion.
• Exercise protocols and settings varied between trials.
• Primary outcome is subjective soreness, which is vulnerable to lack of blinding - and immersion cannot be blinded.
• Some data were extracted from graphs or obtained through author correspondence.
• Now more than a decade old.

Evidence in context

Since 2012 the picture has become more complicated rather than clearer. A 2013 meta-analysis found contrast water therapy superior to passive recovery but with little advantage over other active recovery methods - the same pattern seen here. A 2018 meta-analysis of 99 studies comparing recovery techniques found massage, not cold, the most effective single method for soreness and perceived fatigue.

Meanwhile a 2015 randomised trial reported that cold immersion immediately after resistance training blunted strength and hypertrophy adaptation over 12 weeks, and a 2021 review reached a similar conclusion about chronic use during resistance training. That reframes the question from whether cold works to when it should be used.

A 2025 meta-analysis in healthy adults shifted the focus again toward stress, sleep and wellbeing rather than soreness. The soreness question itself has not been resolved by a larger or better trial.

Related research

1. Effects of cold-water immersion on health and wellbeing: a systematic review and meta-analysis Cain T, Brinsley J, Bennett H, et al. PLOS ONE 20(1):e0317615. 2025. PMID 39879231; PMC11778651; doi:10.1371/journal.pone.0317615.The most recent synthesis, examining general wellbeing rather than exercise soreness.
2. Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis Bieuzen F, Bleakley CM, Costello JT. PLOS ONE 8(4):e62356. 2013. PMID 23626806; PMC3633882; doi:10.1371/journal.pone.0062356.The equivalent analysis for contrast water therapy, reporting the same pattern of benefit over rest but not over other active methods.
3. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. Frontiers in Physiology 9:403. 2018. PMID 29755363; PMC5932411; doi:10.3389/fphys.2018.00403.Compares cold immersion directly against massage, compression and active recovery on shared measures.
4. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training Roberts LA, Raastad T, Markworth JF, et al. The Journal of Physiology 593(18):4285-301. 2015. PMID 26174323; PMC4594298; doi:10.1113/JP270570.The trial that reframed cold immersion timing around resistance training.
5. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise Kwiecien SY, McHugh MP. European Journal of Applied Physiology 121(8):2125-2142. 2021. PMID 33877402; doi:10.1007/s00421-021-04683-8.A review distinguishing cryotherapy for acute injury from routine post-exercise use.
6. Cold water immersion: kill or cure? Tipton MJ, Collier N, Massey H, Corbett J, Harper M. Experimental Physiology 102(11):1335-1355. 2017. PMID 28833689; doi:10.1113/EP086283.The safety counterpart, covering the hazards this review did not systematically assess.