Cryotherapy—the therapeutic application of extreme cold—has moved from the fringes of alternative medicine into the mainstream. From professional athletes stepping into nitrogen-cooled chambers to weekend warriors using ice packs after a tough workout, cold therapy is everywhere. But what does the science actually say? And more importantly, who should avoid it?
This guide explores the evidence-based benefits of cryotherapy, explains how it works at a physiological level, and outlines the critical precautions and contraindications you need to know before stepping into the cold.
What Is Cryotherapy?
Cryotherapy involves exposing the body to extremely low temperatures for a short period. It comes in several forms:
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Whole-body cryotherapy (WBC): Standing in a chamber or cryo-cabin where the air is cooled to between -110°C and -140°C (-166°F to -220°F) for two to four minutes.
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Partial-body cryotherapy: Exposing only the lower body or specific regions to cold air.
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Local cryotherapy: Applying cold to isolated areas using ice packs, cold-water immersion, or localized devices.
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Cold-water immersion (CWI): Submerging the body or limbs in cold water at 10–15°C (50–59°F).
During whole-body cryotherapy, you wear minimal clothing—gloves, socks, and a woolen headband covering the ears, plus a nose and mouth mask—to reduce the risk of cold-related injury.
How Cryotherapy Works: The Physiological Principles
The benefits of cryotherapy stem from the body's "emergency reaction" to extreme cold. When the skin is rapidly cooled:
1. Vasoconstriction and Reduced Inflammation
Cold exposure causes blood vessels to constrict, reducing local blood flow. This decreases inflammatory reactions, swelling, and the sensation of heat in injured tissues. When you leave the cold environment, blood flows back to peripheral areas, bringing oxygen and nutrients that support tissue repair.
2. Nervous System and Hormonal Effects
Cold exposure activates the sympathetic nervous system, triggering changes in hormone and neurotransmitter levels. Research has linked cryotherapy to higher testosterone levels and lower cortisol levels, which may support athletic performance and recovery.
3. Anti-Inflammatory Mechanisms
Cryotherapy has been shown to reduce markers of innate immune response, suggesting a genuine anti-inflammatory effect. It also reduces muscle inflammation and soreness after exercise by decreasing inflammatory markers, increasing antioxidant activity, and calming the nervous system.
4. Pain Modulation
Cold exposure reduces peripheral nerve conduction velocity and may influence pain-modulating pathways. However, the precise mechanisms remain incompletely understood.
Evidence-Based Benefits of Cryotherapy
While many claims about cryotherapy remain unproven, several benefits have scientific support.
1. Pain Relief
Cryotherapy has demonstrated significant pain-relieving effects across multiple conditions. Clinical research has found that whole-body cryotherapy significantly reduces pain in patients with chronic pain conditions, with meaningful reductions reported on standard pain scales.
In knee osteoarthritis, systematic reviews of controlled trials have found that cryotherapy significantly reduces pain intensity, particularly when combined with exercise therapy. For chronic inflammatory diseases, whole-body cryotherapy has shown strong therapeutic effects on pain scores and disease activity measures. In neurological conditions like multiple sclerosis, whole-body cryotherapy has demonstrated potential benefits for managing pain and sleep quality.
2. Muscle Recovery and Reduced Soreness
For athletes and active individuals, cryotherapy is primarily used to accelerate recovery and reduce delayed-onset muscle soreness (DOMS). Post-exercise cold exposure has been shown to reduce perceived muscle soreness after training. Cold-water immersion after a workout has been positively linked to multiple performance measures, including muscular power, muscle soreness, and perceived recovery.
Cryotherapy may also help athletes recover faster and return to training sooner by reducing post-workout muscle soreness and inflammation. When done immediately after exercise, the most substantial benefits occur within 24 to 96 hours.
However, it is important to note that research on whether cryotherapy actually quickens muscle recovery is mixed. Some evidence suggests that while cryotherapy improves the perception of recovery and soreness, this does not necessarily translate into enhanced functional recovery.
3. Skin and Inflammatory Conditions
Cryotherapy has shown promise for certain skin conditions. Skin cooling is believed to have anti-inflammatory effects and can reduce peripheral nerve conduction velocity. Local cryotherapy has shown promise in reducing itch severity in inflammatory skin conditions, and whole-body cryotherapy may confer similar benefits.
4. Psychological Well-Being
Some studies have found that participants receiving whole-body cryotherapy report improved mood and a greater sense of well-being. Given the role of psychology in performance and daily life, reduced stress and improved mood may represent meaningful benefits.
5. Potential Benefits for Metabolic Health
Some research has explored the metabolic effects of cold therapy. While early findings have investigated blood glucose responses and brown adipose tissue activation, conclusive evidence for significant weight loss or metabolic improvements remains limited. More research is needed in this area.
What the Research Does NOT Support
It is equally important to understand what cryotherapy has not been proven to do.
Weight Loss: Despite popular claims, whole-body cryotherapy does not appear to significantly enhance weight loss or metabolic outcomes.
Superiority Over Ice Packs: No evidence exists that whole-body cryotherapy works better to relieve muscle soreness or reduce tissue temperature than cold-water immersion or ice-pack application. Ice packs and ice baths offer similar physical benefits at a much lower cost.
Cosmetic Skin Benefits: There is minimal research on the cosmetic skin benefits of cryotherapy treatments. While it can be theorized that reduced inflammation and oxidative stress might improve skin appearance, no studies currently back this claim.
Functional Recovery: While cryotherapy may reduce perceived soreness, this does not necessarily translate into enhanced functional recovery or improved next-day performance.
Precautions and Contraindications: Who Should NOT Use Cryotherapy
Cryotherapy is not for everyone. The extreme cold can worsen certain health conditions and may be dangerous for some individuals.
Absolute Contraindications
Clinical guidelines identify the following as absolute contraindications to whole-body cryotherapy:
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Cold intolerance or hypersensitivity
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Raynaud's disease — a condition where cold causes blood vessels to spasm, reducing blood flow to extremities
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Cold urticaria — an allergic reaction to cold exposure causing hives
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Cryoglobulinemia — a condition where abnormal proteins in the blood precipitate in cold temperatures
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Cardiovascular diseases, including:
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Unstable angina or coronary artery disease
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Aortic valve stenosis and mitral valve stenosis
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History of heart attack or poor circulation
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Severe hypertension (high blood pressure)
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Acute respiratory disorders or lung disease
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Wounds, ulcers, or skin lesions in the treatment area
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Nervous system diseases including neuropathy
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Blood flow disturbances or venous system inflammation
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Sickle cell anemia
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Uncontrolled seizures or epilepsy
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Pregnancy (generally advised against)
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Hypothermia (below-normal body temperature)
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Use of antipsychotic medications or alcohol intoxication
Relative Contraindications
Some conditions require caution and medical consultation:
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Age above 65 years
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Venous thrombosis or history of peripheral arterial embolism
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Claustrophobia (fear of enclosed spaces)
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Excessive emotional lability or excitability
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Immunosuppression
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Previous cold injury at the treatment site
Precautions for Local Cryotherapy (Skin Treatments)
For localized cryotherapy used to treat skin lesions, additional precautions apply:
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Do not use on undiagnosed skin lesions or melanomas, as histopathological confirmation may be necessary
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Avoid in patients with darker skin tones due to the risk of hypopigmentation (loss of skin color)
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Avoid in patients with poor wound healing or adverse reactions to cryotherapy
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Avoid in areas with compromised circulation
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Avoid certain sensitive areas: corners of eyes, folds of skin between nose and lip, skin surrounding nostrils, and skin overlying nerves
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Exercise caution in young children, especially under age 7, as it may be too painful
Safety Considerations and Potential Side Effects
Even for healthy individuals, cryotherapy carries risks.
Short-Term Side Effects
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Temporary spike in blood pressure: Acute exposure to a cold environment causes a stress reaction and a temporary jump in blood pressure
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Pain, swelling, and redness at the treatment site
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Blisters and ulcers leading to pain and infection
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Scarring, especially if freezing is prolonged or affects deeper skin areas
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Changes in skin color (skin may turn white)
Serious Adverse Events
Regulatory bodies have issued warnings about whole-body cryotherapy devices, noting reported incidents of adverse events. While serious adverse events appear to be rare given how widely whole-body cryotherapy is used globally, the risk is not zero.
Practical Guidelines for Safe Use
If you are considering cryotherapy and have no contraindications, follow these guidelines:
1. Get medical clearance first. Always consult your healthcare provider before starting cryotherapy, especially if you have any underlying health conditions.
2. Choose a reputable facility. Ensure the facility is professionally managed, clean, and has staff trained in cryotherapy safety protocols.
3. Start gradually. If using cold-water immersion, build your resistance to the cold gradually rather than jumping into extreme temperatures.
4. Limit session duration. Whole-body cryotherapy sessions typically last only 2 to 4 minutes. Longer exposure increases the risk of cold injury.
5. Wear appropriate protective gear. Gloves, socks, and ear protection are essential to prevent frostbite on extremities.
6. Be aware of your body's signals. If you experience dizziness, numbness, severe pain, or difficulty breathing, end the session immediately.
7. Do not use cryotherapy as a substitute for medical treatment. It is a complementary tool, not a cure for any disease.
Conclusion
Cryotherapy offers genuine benefits for pain relief, muscle recovery, and inflammatory conditions, supported by a growing body of scientific evidence. It has shown particular promise for chronic pain conditions like osteoarthritis and inflammatory diseases, as well as for reducing post-exercise muscle soreness.
However, cryotherapy is not a miracle cure. Many popular claims—such as significant weight loss or cosmetic skin improvements—lack scientific support. And for some people, cryotherapy can be genuinely dangerous.
The key takeaway is this: cryotherapy can be a valuable tool when used appropriately, by the right people, under the right conditions. If you have cardiovascular disease, Raynaud's, cold allergies, or any of the other contraindications listed above, stay away. If you are healthy and curious, consult your doctor first, start slowly, and always prioritize safety over novelty.
Cold therapy has been used for centuries—from ancient Greece to modern cryo-chambers—and it will likely remain a popular wellness tool. But like any therapy, it works best when you understand both its power and its limits.