Years ago, when Peyton Manning was still the star quarterback for the Indianapolis Colts, I recall a TV commercial showing him sitting in a large tub of ice water. It was after a game in which he must have been sacked several times because he was lamenting he was immersed in ice cold water to try to regain muscle flexibility and reduce his pain from being tackled so often. Curiously enough, that scene had nothing at all to do with the product the commercial was promoting, and I thought at the time, do athletes really sit in ice water like that? And why? Well, they certainly do, and so much so that a one-page article on “Cold Water Immersion” appeared in the April 2025 issue of American Family Physician, the scientific journal of the American Academy of Family Physicians.
Cold Therapy dates back to 300 B.C. when Hippocrates used it for the acute pain and swelling of a traumatic injury and for chronic pain. For centuries, cold water immersion treatments have remained effective for the relief of muscle soreness and other bodily soft tissue trauma. Scientific investigation has revealed that cold therapy provides “systemic anti- inflammatory relief,” increases the body’s immune response, and stimulates the parasympathetic (our “automatic” functioning) nervous system. It is the anti-inflammatory effect that is the central factor in the use of cold water immersion.
Muscle injury and soreness are due to trauma or overuse. The main factor causing symptoms is the inflammation that results from the physical insult. Inflammation causes swelling and fluid collection in the injured areas. Cold therapy ”reduces localized inflammation…..by reducing swelling.” It also stimulates the immune response to set healing in motion.
The important fact about cold water immersion is that “less is better!” By that, I mean shorter immersion times (less than 10-15 minutes at 59°F ) have been shown to be the most beneficial. The conclusions were reached after patients were subjected to vigorous exercise and then either received cold water therapy or were passively observed (received no treatment). Different exposure times were tested, and shorter times were clearly more helpful.
Compared to Passive Therapy (no treatment):
After 24 hours, cold water therapy “improved perceived recovery.” Patients felt better!
After 24 hours, cold water therapy “reduced delayed onset of muscle soreness.” After exercise, you always feel sore the next day, or later.
Cold water therapy was more effective than passive therapy in terms of immediate or delayed effects, regardless of water temperature.
Cold water therapy had positive effects on immediate and delayed onset muscle soreness for short duration (<10 min), and medium duration (10-15 min) exposures, but NOT for longer duration (greater than 15 min) exposure.
Short term treatments with cold water immersion are thus definitely helpful for reducing acute muscle soreness, recovering from acute muscle trauma or overuse injury, and lead to faster recovery after these insults. Inflammation is suppressed, blood vessel are constricted, swelling is reduced, and mood and stress are improved. Recovery is sped up and return to normal activity is enhanced.
Dr. G’s Opinion: The thought of completely immersing myself in freezing cold ice water is frightening. I’ve swum in swimming pools filled with water straight from an underground spring, and the water was so cold, adjusting to the temperature was very difficult. Staying in an ice bath for 10-15 minutes seems nearly impossible for this warm-blooded guy, but athlete’s subject themselves to it all the time. I think it’s really for younger people because for an elderly person, there is a real risk of seriously dangerous hypothermia. We old folks are not as adaptable to extreme temperature exposure as are young people so the risk is huge. So, remember, soak 10-15 minutes at 59° and no longer.
References: Cardon B, Pulsipher T. “Cold Water Immersion for Muscle Soreness” Am Fam Phys 2025 April;111(4):366.
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