They May Be a Hot Trend but Cold Plunges Require Caution

What’s up with all these people around the world submerging themselves in tubs of ice water and posting photos of their ice baths on social media, you may wonder? The #coldplunge hashtag reportedly has already garnered more than a billion views on TikTok, and there are hundreds of cold plunge tub brands cluttering the aisles of online shopping sites.

The teeth-chattering trend has been boosted by a mix of celebrities, athletes and social media influencers who claim it can aid with post-workout recovery, reduce inflammation and boost immunity. According to some, cold plunges can also benefit the mind by improving clarity and reducing depression and anxiety.

Resource editors spoke with Luis Rodriguez, M.D., FAMSSM, a primary care sports medicine physician with Baptist Health Orthopedic Care who specializes in non-surgical treatments for acute, overuse and chronic orthopedic problems, as well as medical concerns related to physical activity and the practice or sports. Dr. Rodriguez offered his perspective on cold plunges, as well as some tips on how to do it safely should you decide to try it yourself.

Resource: What exactly is a cold plunge?

Luis Rodriguez, M.D., FAMSSM, a primary care sports medicine physician with Baptist Health Orthopedic Care

Dr. Rodriguez: A cold plunge is the practice of submerging one’s whole body in cold water. It is also known as cold water immersion or ice water immersion.

Resource: What are the benefits of a cold plunge? 

Dr. Rodriguez: Popular anecdotal benefits include less pain and soreness during the recovery phase after exercise, and faster recovery. Cold water immersion has mainly been sought by athletes as a way of restricting inflammation and limiting cellular stress responses after exercise. This would then assist during the recovery phase, potentially helping with muscle fatigue and soreness, and facilitate conditioning by getting the body ready to exercise again faster. These physiological benefits have been demonstrated in some studies but one study showed no benefit compared to active recovery, such as stationary cycling at a self-selected low intensity. Furthermore, regular practice of cold water immersion was actually shown in one study to reduce gains in muscle strength and mass after three months of resistance training.

Resource: Say you don’t have ice or a tub. In terms of the benefits provided, is jumping into a cold lake, for instance, better than simply taking a cold shower?

Dr. Rodriguez: Theoretically, as long as the whole body is uniformly exposed to cold water, the benefits should be the same. It may of course be more difficult to achieve that uniform exposure with a shower compared to full body immersion in a tub, lake or pool.

Resource: What’s the safest way to do a cold plunge?

Dr. Rodriguez: I recommend starting slowly with brief, controlled exposures then progressively increasing the frequency and the duration of the immersions to allow for acclimatization. Water temperature should be kept between 10-15 degrees Celsius, or 50-59 degrees Fahrenheit. Although some literature suggests it can be done for up to 15 minutes, 10 minutes is probably the maximum amount of time you want to spend in cold water immersion. Anything beyond that is, in all likelihood, appropriate only for well-acclimated individuals. Also, the head and face should never be submerged and it should never be done alone in case any complications develop, such as hypothermia or loss of consciousness.

Resource: What should someone do to recover after taking a cold plunge? 

Dr. Rodriguez: After cold water immersion, you should always get out of your cold, wet clothes and into dry, warmer ones. Also, drinking a warm beverage and staying in a warmer environment will help the recovery.

Resource: Are there any risks associated with doing a cold plunge? 

Dr. Rodriguez: There are some risks associated with this practice and it’s important to note that there may be a way to achieve similar benefits with other modalities such as active recovery. However, if cold plunges are your modality of choice, make sure you are fully aware of all the potential risks and complications. According to the American Heart Association, plunging the body into cold water triggers a sudden, rapid increase in breathing, heart rate and blood pressure known as the cold shock response. This can be dangerous and could, for example, cause a person to drown within seconds if they involuntarily gasp while their head is submerged in the water.

Also, within minutes the loss of heat begins causing other problems, as blood rushes away from the extremities to the body’s core in order to protect vital organs. That leaves the arms and legs without good circulation, which can lead to a loss of strength and coordination. It also can lead to hypothermia, making it harder to think clearly or move well. Other potential complications include syncope (passing out) and hyperventilation. Preparing the body for cold water immersion by, for example, applying cold water to the neck or exposing your lungs to cold air may help mitigate the risk. Also, acclimatization by repeat exposure appears to help. 

Resource: Are there people who should avoid taking cold plunges? 

Dr. Rodriguez: You should always consult with your doctor before considering cold plunges, especially if you have known medical problems. Some contraindications to cold plunge therapy would include a history of heart disease; Raynaud’s phenomenon, which is caused by over-sensitive blood vessels in the body’s extremities; peripheral vascular disease, as can be seen in diabetes; impaired sensation; cold allergy or hypersensitivity; severe cold-induced urticaria, a skin reaction to cold that appears within minutes after cold exposure; and other more complex medical conditions including cryoglobulinemia and paroxysmal cold hemoglobinuria.

Resource: For those struggling with the extreme heat we’ve been experiencing this summer, would cold plunges be an effective way to quickly cool off?

Dr. Rodriguez: Although it may be a very effective treatment for specific medical emergencies and may have some proposed physiological benefits, cold water immersion is not a safe way to cool off in hot weather, as there are definitely some potential side effects and complications associated with this practice. I would recommend that you first try more conventional ways of decreasing your body temperature, such as moving to a shaded area or an air-conditioned environment; using a fan or other method to increase air circulation on your skin’s surface; maintaining proper hydration, and removing excess garments or clothing.