To separate facts from assumptions, a recent systematic review published in Physical Education Theory and Methodology (Patel et al., 2025) exhaustively analyzed clinical trials published between 2000 and 2024. The research filtered and evaluated 12 scientific studies of the highest methodological quality and with complete reliability in their results, adding a total of 301 elite and competitive athletes from various disciplines.

Below, we break down the findings of this study to understand which benefits of immersion cryotherapy are actually supported by science and how they should be applied in clinical practice.

Findings with moderate to strong evidence

The systematic review identified key areas where cold baths show notable clinical consistency, especially within the window of 24 to 48 hours post-exercise .

1. Reduction of muscle pain (DOMS)

Delayed onset muscle soreness (so-called soreness) is one of the direct consequences of exercise-induced muscle damage (EIMD). The aggregate data confirm that cold water immersion exerts a marked analgesic effect .

• The studies analyzed show significant reductions in pain scores in overloaded muscle groups (such as quadriceps and calves) compared to passive rest.

2. Decrease in biomarkers of muscle damage

Beyond the athlete's perception, there are objective biochemical variables. Post-exercise immersion proved to be effective in mitigating the elevation in the blood of enzymes associated with the rupture of the muscle cell membrane, specifically:

• Creatine Kinase (CK): Showing significantly lower concentrations in athletes who used cold water immersion compared to control groups.

• Lactate Dehydrogenase (LDH): With measurable reductions within the first 48 hours in intermittent and high intensity sports.

3. Optimization of subjective recovery

Performance is not only mechanical, it is also psychological. Athletes who underwent cold immersion protocols consistently reported lower rates of perceived fatigue and a significantly higher psychological readiness score. This makes it an essential practical strategy during periods of high training load.

Physiological mechanisms: Why does it work?

The review details that the clinical benefits of immersing the body in water at low temperatures are due to the interaction of several combined physiological factors:

* Peripheral vasoconstriction: The thermal stimulus decreases local blood flow. This limits the formation of edema and stops the excessive infiltration of inflammatory cells into the damaged tissue. * Effect of hydrostatic pressure: By submerging the body (generally sitting up to the iliac crest), the water pressure favors venous return and lymphatic drainage, accelerating the elimination of metabolic byproducts. * Conduction analgesia: The decrease in tissue temperature decreases the speed of nerve conduction and reduces the sensitivity of nociceptors (pain receptors).

Scientific nuances: Where the evidence is variable or inconclusive

Following the rigor of the study by Patel et al. (2025), a sports health professional must know the limits of therapy so as not to prescribe incorrectly:

• Mixed neuromuscular performance: The effects on the speed of sprint or jumping ability (CMJ) are contextual. In congested competitive periods (such as tournaments) it helps maintain power. However, the application of extreme cold immediately before an explosive effort can temporarily impair muscle contractility and enzymatic efficiency.

• Systemic inflammatory markers: Although acute decreases in proinflammatory cytokines such as Interleukin-6 (IL-6) were observed in early stages, current scientific evidence regarding long-term systemic inflammation (assessed by C-reactive protein or CRP) remains limited and inconclusive.

Ideal dosage and methodological guidelines

One of the critical points pointed out by the researchers is the high variability in the results due to the lack of homogeneity in the protocols applied in the different gyms and clubs. Based on clinical trials that showed the best rates of benefit and lowest risk of adverse effects, the recommended guidelines are

Conclusion for the performance professional

Cold water immersion is not a universal miracle solution, but it is a biologically supported and highly effective tool when the priority objective is to mitigate muscle damage, reduce the perception of pain and return the athlete to their baseline state in demanding competitive calendars or high load blocks.

The key to success lies in the exact control of the variables: guaranteeing a constant temperature in the optimal therapeutic range (10-14ºC) and rigorous water hygiene. Monitoring and dosing the cold individually, combining it with correct nutrition and rest, will make a difference in the recovery of athletes.

Bibliographic reference
Patel, S., Shukla, A., Sharma, R., Chahal, A., & Das, R. (2025). Cold-Water Immersion and Athletic Recovery: A Systematic Review of Randomized Controlled Trials (2000-2024). Physical Education Theory and Methodology, 25(6), 1471-1482.

Medical notice and limitation of liability:This article constitutes an informative review of academic publications and contrasted scientific evidence. The information collected represents an interpretation of said data and has exclusively informative and educational purposes. If you suffer from any specific pathology or medical condition, it is essential that you consult with your doctor before starting cold water immersion therapy. Prolonged exposure to extreme temperatures can negatively affect health, so caution and dosage supervised by professionals are recommended.

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