Cold Water Immersion for Muscle Soreness

Does cold water immersion after exercise reduce muscle soreness?

Cold water immersion immediately after exercise can improve perceived recovery and delay onset of muscle soreness in the 24 hours after high-intensity and resistance exercise. (Strength of Recommendation [SOR]: A, systematic review and meta-analysis.) Short immersion times (ie, less than 10 to 15 minutes) at temperatures below 59°F (15°C) have the most consistent benefits. (SOR: A, systematic review and meta-analysis.)

A 2022 systematic review with meta-analysis of 52 peer-reviewed, randomized controlled trials (RCTs; N = 1,191) investigated the differences in perceived recovery, muscle soreness, and exercise performance between use of cold water immersion and passive recovery.¹ Patients were older than 18 years and exercised regularly. The RCTs included various cold water immersion protocols within 15 minutes after strenuous exercise. Twenty studies (n = 619) assessed recovery after eccentric exercise, whereas the remaining 32 (n = 572) assessed recovery from high-intensity exercise. Passive recovery was used as the comparator intervention in all studies.

Multiple outcomes were analyzed for recovery measures, including exercise performance (eg, endurance, flexibility, muscular strength) and physiologic markers such as creatine kinase level. Outcome measures were assessed 1 hour, 24 hours, 48 hours, 72 hours, 96 hours, and 168 hours after exercise.

This review found that at 24 hours, cold water immersion improved perceived recovery after high-intensity exercise (standardized mean difference [SMD] = 0.66; 95% CI, 0.29 to 1.03; P = .001) but not after eccentric exercise (SMD = 0.15; 95% CI, –0.29 to 0.59; P = .49). Similarly, cold water immersion was effective at reducing delayed onset of muscle soreness 24 hours after high-intensity exercise (SMD = –0.89; 95% CI, –1.5 to –0.29; P = .003) but not after eccentric exercise (SMD = –0.51; 95% CI, –1.1 to 0.09; P = .09). Water temperature and exposure duration had no effects on recovery measures.

A 2023 systematic review with a meta-analysis of 44 peer-reviewed RCTs (N = 880) investigated the effects of cold water immersion compared with passive recovery on muscle soreness after strenuous exercise.² For the treatment groups, use of water temperatures lower than 59°F (15°C) was classified as cold water immersion. The review performed subgroup analyses of the effects of different water temperatures, immersion times, immersion protocols, and responses based on exercise type.

The review found that cold water immersion was more effective than passive recovery in terms of immediate (mean difference [MD] = 1; 95% CI, 0.58–1.4; P < .001) and delayed (MD = 1.1; 95% CI, 0.55–1.6; P < .001) effects. It also found that cold water immersion was superior to passive recovery regardless of water temperature (severe cold [41–48°F (5–9°C)]: MD = 0.99; 95% CI, 0.38–1.6; P = .001; moderate cold [50–59°F (10–15°C)]: MD = 1; 95% CI, 0.44–1.6; P = .001). For immersion duration, cold water immersion had positive effects on immediate and delayed onset of muscle soreness for short- (ie, less than 10 minutes; MD = 0.80; 95% CI, 0.18–1.41; P = .01) and medium-duration (ie, 10–15 minutes; MD = 1.6; 95% CI, 0.70–2.5; P = .001) immersion, but not for longer immersion (ie, greater than 15 minutes). The protocol analysis showed a decrease in immediate and delayed onset of muscle soreness regardless of immersion protocol (intermittent: MD = 1.5; 95% CI, 0.66–2.3; P = .001; continuous: MD = 0.92; 95% CI, 0.35–1.48; P = .001).