Cold Water Therapy for Ankylosing Spondylitis: Yay or Nay?

Contents:

Cold therapy has benefits, but it’s not without risks, especially for those with autoimmune conditions. Here’s what to consider:

Cardiovascular Risks & Cold Shock

Cold exposure triggers vasoconstriction, leading to a spike in blood pressure and heart rate. This is particularly risky for:

People with heart disease or circulation issues

Those prone to high blood pressure

Anyone new to cold exposure, who may experience cold shock

🚨 Cold shock can be fatal. Always check with your doctor before trying cold therapy.

Stress Load – Can Cold Exposure Overload the Body?

Cold therapy stimulates the sympathetic nervous system (fight-or-flight mode), which can be beneficial in moderation but dangerous if overdone.

Many people with AS already have a high stress burden.

Excessive cold exposure can overtax the nervous system, leading to fatigue and immune dysregulation.

✅ If you’re in a flare-up, focus on relaxation first. Introduce cold therapy only when your body is stable.

Immune System Response – Could Cold Therapy Trigger a Flare?

Cold therapy activates the immune system, which is great for some but can worsen inflammation in others.

Some people report that cold exposure triggers flares in inflammatory arthritis.

🚨 Takeaway: Start slow, monitor how your body reacts, and adjust accordingly.

Why Open-Water Swimming Is the Most Extreme Risk

Swimming in cold lakes, rivers, or the ocean is the riskiest form of cold exposure because:

Unpredictable temperatures can cause cold shock and loss of muscle control.

Currents and waves increase the drowning risk.

Hypothermia sets in faster in open water.

🚨 Never swim alone in cold water. Always have a safety plan and a trained partner.

Despite the risks, when done safely, cold exposure has notable benefits for inflammatory arthritis and AS.

Inflammation Reduction & Pain Relief

🔹 Cold exposure lowers inflammatory cytokines (TNF-alpha, IL-6), helping reduce joint inflammation and stiffness. (Bleakley et al., 2012; Peake et al., 2017).

🔹 Cold numbs nerve endings, reducing pain perception. (Costello et al., 2012).

Circulation & Muscle Recovery

🔹 Alternating cold and warm therapy (contrast therapy) helps improve blood flow and muscle recovery. (Wilcock et al., 2006).

Mental Resilience & Immune Balance

🔹 Cold exposure stimulates endorphin and norepinephrine release, improving mood and focus. (Shevchuk, 2008).

🔹 Some studies suggest it may help regulate the immune system, which could be beneficial in autoimmune conditions. (Buijze et al., 2016).

Step 1: Start with Your Feet & Legs

💡 Why? Research suggests that easing into cold exposure allows the body to acclimate, reducing the intensity of the initial stress response (cold shock).

✅ Common Approach:

Begin by immersing only your feet and lower legs in cold water for 30-60 seconds.

If using a shower, let cold water run over your legs first, then your arms.

Once comfortable, gradually progress to full-body exposure.

Step 2: Cold Showers – A Recommended Entry Point

Cold showers are often suggested as an accessible way to introduce cold therapy while helping the body adapt to temperature stress.

✅ How Experts Suggest Starting:

1️⃣ End a warm shower with 30 seconds of cold water.

2️⃣ Gradually increase exposure time by 10-15 seconds per session, aiming for 1-2 minutes.

3️⃣ Breathe slowly and deeply—long exhales may help regulate the body’s response.

4️⃣ Eventually, some suggest starting the shower with cold water instead of ending with it.

📌 Dr. Søberg’s research suggests that approximately 11 minutes of cold exposure per week may provide benefits such as reduced inflammation and improved metabolism (Søberg, 2021).

Step 3: Cold Plunges – How to Approach Them Cautiously

Cold plunges—immersion in ice baths, lakes, or controlled cold tubs—are often cited as one of the most effective but intense forms of cold therapy. Many sources advise caution when starting.

✅ What’s Commonly Recommended:

1️⃣ Begin with 1-2 minutes in water between 10-15°C (50-59°F).

2️⃣ Maintain slow, deep breathing to help regulate the nervous system.

3️⃣ Increase duration gradually, working up to 3-5 minutes in colder water (5-10°C / 41-50°F).

4️⃣ If uncontrollable shivering begins, experts advise exiting—this may signal an increased risk of hypothermia.

5️⃣ Warm up naturally afterward—sudden heat exposure, such as a hot shower, could cause abrupt blood pressure changes. Instead, movement and warm beverages are often recommended for gradual rewarming.

📌 Studies indicate that natural rewarming after cold exposure may enhance circulation and brown fat activation more effectively than immediate heat exposure (Søberg, 2021; Huttunen et al., 2001).

Step 4: Frequency & Duration – What Research Suggests

Cold therapy does not have to be extreme to be effective. Even short, controlled exposure may offer measurable health benefits.

🔹 Cold Showers: 2-4 times per week, 1-3 minutes per session.

🔹 Cold Plunges: 1-3 times per week, 2-5 minutes per session.

🔹 Total Weekly Exposure: Research from Dr. Søberg suggests that 11-15 minutes of cold exposure per week may be optimal for metabolic and immune benefits.

🚨 Experts advise listening to your body—if symptoms like excessive stress, fatigue, or prolonged shivering occur, adjusting exposure time may be necessary.

Step 5: Safety First – Never Cold Swim Alone

Open-water swimming is considered the most extreme form of cold exposure due to unpredictable water temperatures, currents, and the risks associated with full-body immersion.

✅ General Safety Guidelines:

Never swim alone—having a trained partner or safety support is advised.

Limit time in cold water, starting with 2-3 minutes max.

Have a clear exit strategy—hypothermia can impair judgment.

Avoid sudden immersion—cold shock can trigger involuntary gasping and hyperventilation.

📌 Research published in the Journal of Physiology found that sudden immersion in water below 15°C (59°F) can increase drowning risk due to cold shock response (Tipton et al., 2017).

Key Takeaways from Cold Therapy Research

Experts emphasize that cold therapy can offer various health benefits, but proper technique and gradual exposure are essential.

🔹 Start small—progress from feet and legs to full-body exposure.

🔹 Cold showers are a common and accessible starting point.

🔹 Cold plunges should be brief and controlled—typically no more than 5 minutes in extreme cold.

🔹 Open-water cold swimming should never be done alone, and safety measures are crucial.

🔹 Pay attention to bodily signals—if cold exposure feels overwhelming or causes persistent discomfort, adjustments may be necessary.

By following best practices and referencing expert insights, cold therapy can potentially be a safe and beneficial practice for overall wellness.

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