How to use cold water immersion with your physical therapy patients

muscle recovery

Underpinned by an ever-expanding body of scientific data, cold water immersion is rapidly growing in popularity as a treatment for post-exercise trauma, injury and chronic pain. As a physiotherapist, investing some time and money into providing cold water immersion therapy to your clients and patients- both as treatment and as preventative aid- can be very worthwhile.

But how do you use it in a physiotherapeutic context? What can it do for your patients?


Cold water immersion

There are a number of different health and fitness benefits your patients can enjoy with frequent exposure to cold water immersion.

It has been shown to boost circulation, strengthen the immune system, decrease symptoms of depression and anxiety, and decrease inflammation, among others, making it a perfect supplementary treatment for many injuries and common health conditions.

For those living an active lifestyle in particular, cold immersion therapy has been found to reduce inflammation, swelling and incidents of DOMS (delayed onset of muscle soreness), making it a worthwhile aid for recovery.

It has additionally been linked with increased metabolic function, improved sleep quality and an improvement to immune function. These will all tend to suffer under an active lifestyle; an improvement to each will represent an improvement to fitness and athleticism as a whole, meaning that an athlete attending a physiotherapy practice with access to cold water immersion therapy will stand to gain a lot.

As a recovery method for muscular and soft tissue trauma, such as incidents of DOMS, sprains, strains and inflamed tissue, cold water immersion is notable for its ability to:

Reduce oedemas
Decrease the perception of pain associated with muscular soreness
Decrease the perception of fatigue
Alter localised blood flow
Alter localised tissue and core temperature
Alter heart rate
Reduce muscle spasms
Reduce tissue inflammation
Reduce muscle damage
Improve range of motion
This means that you can open up your practice beyond simply treating injuries.

By incorporating cold water immersion into your practice, you can also work with athletes to help them improve their recovery efficacy and efficiency. This will lead to them being able to train harder, more often or for longer, in comfort. The above will all also decrease their risk of injury, meaning that they can train with confidence, knowing that their bodies can handle what they are doing.

Recovery is a critical part of training as it is used to minimise the risk of overtraining and injury, whilst promoting physical and psychological readiness. This becomes particularly important during intense training or competition periods to sustain an optimal state of performance (1). Understanding its importance has led to the use and development of many recovery techniques such as massage therapy, foam rolling, electrical stimulation, whole-body vibration, compression garments, hyperbaric oxygen therapy and water immersion therapy (including cold water, warm water, and contrast bathing).

Cold water immersion therapy has become a popular recovery method amongst physiotherapists and athletes for its ability to improve recovery time and reduce the delayed onset of muscle soreness (DOMS) after hard exercise, and to reduce recovery time and increase recovery efficiency when getting over and rehabilitating from injury. Indeed, it is being ever more widely recognised that cold water immersion therapy is a potent cure for many common injuries.

The following list of common injuries has been found to respond well to regular cold immersion therapy. It is based on a combination of feedback by customers using CryoTubs’ cold immersion therapy equipment and leading independent research:

Back pain
Brittle bone disease (pain management)
Post-ankle surgery
Post-knee surgery
Rheumatoid arthritis (for pain management & control of symptoms)
Non-specific pain conditions
Complex regional pain syndrome
Repetitive strain injury
Tendon & ligament injuries
Acute & chronic pain management
Golfer’s, pitcher’s and tennis elbow (both prevention & treatment) etc. and, of course,
Post-exercise recovery.

Therefore, cold water immersion therapy can and should be included in the rehabilitation of many injuries that a physiotherapist may commonly come up against in their day-to-day practices.

Alongside treating standard injuries through recovery, physiotherapists can also use cold water immersion with patients who suffer chronic pain (as above: non-specific pain conditions, rheumatoid arthritis, chronic pain management, and so on can all be treated to a high standard using cold water immersion therapy). Patients with chronic conditions have often been able to either lower or completely eliminate their dependence on painkillers and anti-inflammatory drugs through the anti-inflammatory, analgesic nature of cold immersion therapy’s effects.

This, as can be easily imagined, will result in a significant improvement in quality of life for those suffering chronic pain.


Practical Application
This should all represent quite a compelling case for including cold immersion therapy in a regular practice, as a treatment for exercise recovery, injury recovery and chronic pain rehabilitation/management. However, if we can take these benefits as given, we still need to explore exactly how a physiotherapist might go about incorporating the practical side of things into treatment.

If you aim to get the following practical facets right, you shouldn’t go too far wrong in eliciting the benefits that cold water immersion therapy can offer:



There is no agreed upon temperature for optimal results for any one individual goal. As mentioned above, the science is young- getting the specifics is very much work-in-progress. However, most practitioners agree that temperatures should range from around 8-15 degrees C, with an average of 11 degrees C.

Therefore, physiotherapists will want to keep to within these bounds with their patients, aiming at 11 degrees C as much as possible to get the most out of their practice.


Immersion depth

Hydrostatic pressure will likely form a large part of cold water immersion therapy’s efficacy. Therefore, practitioners will need to really get the depth right.

In order to maximise the hydrostatic pressure, and thus the potential for improvement, a patient should be submerged as fully and as deeply as possible. In addition, it’s usually a good idea to have the patient remain as upright as possible during immersion, as the objective of immersion is to move fluids from the periphery towards the thoracic region and immersion imposes an inward and upward force on the body.



Current research suggests that between 11-15 minutes will be the optimal duration for immersion.

There is a lower threshold of 10 minutes that therapy shouldn’t drop below, where possible. This will ensure the occurrence of blood plasma fractioning (movement of interstitial-intravascular fluid), thus optimising recovery as much as possible.

However, this isn’t always possible, especially for busy practices and/or those working with larger groups, such as sports teams. It should therefore be noted that, whilst being sub-optimal, the benefits of cold water immersion therapy have been reported from durations as low as one minute.

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