Cold Water Immersion or Contrast Hot/Cold Water Immersion Therapy – Does This Reduce Pain?

Dear Pain Matters blog readers,

Summer is fast approaching ‘Down Under’ (where I live, in Sydney, Australia).  As such, I am swimming and snorkelling almost daily in the ocean.  Yesterday, I even tried surfing!

Why am I telling you all this??

Well….Full immersion of the face in cold water (via a jump into the ocean, or otherwise) immediately activates the Mammalian Diving Response.  Why is this interesting? Read on…..

Did you know that our Mammalian Diving Response is the most powerful Autonomic Nervous System reflex known?  For example, this reflex immediately causes:

– Decreased heart rate;

– Vasoconstriction in the periphery (shunting of blood away from the arms and legs, and into the heart, brain and other organs); and

– Apnea/breath-holding, while underwater.

The Mammalian Diving Response can immediately be activated during a ‘relaxing’ cold plunge pool immersion, and also while snorkelling, free diving, and scuba diving in the ocean.

James Nestor, author of Deep, describes the Mammalian Diving Response in the following awe-inspiring 3-minute YouTube:

In sports medicine, Contrast Cold/Warm Water Baths (including full-body immersion) are often used to treat soft tissue and joint injuries.  This treatment promotes alternating vasodilation/vasoconstriction (almost like a ‘pumping action’).  This therapy can reduce swelling, pain and muscle spasm, while also increasing peripheral circulation.

A Turkish review paper discussed the benefits of Cold and Heat Therapy in Fibromyalgia patients.  

Mankind has practised Ice Cold/Cold/Cool/Warm/Hot Water Immersion Therapy (Contrast Water Immersion Therapy) for as long as we can remember.  For example, native Indians often soaked in natural hot springs and washed in cold lakes and rivers.

Immersion in plunge pools with varying water temperatures can give our Autonomic Nervous System a very good work-out.  Blood circulation is re-directed back and forth, from the legs/arms to the heart, brain and other organs (while immersed in cold water), and back to the legs and arms (while immersed in warm water).

You could think of Contrast Hot/Cold Water Immersion Therapy as being like a gym workout for your Autonomic Nervous System!

Immersion in cooler/cold water is a quick, simple, and effective way to re-activate our parasympathetic nervous system (including efferent vagus nerve).  It causes our heart rate to slow and our breathing rate to decrease.  At the same time, blood circulation is diverted away from our arms and legs, and into our organs including heart and brain.

Chronic pain conditions are often associated with localised inflammation, an overactive sympathetic nervous system, an underactive parasympathetic nervous system including reduced efferent vagal output, and reduced heart rate variability.


Would Cool Water Therapy (including brief facial immersion) lead to increased parasympathetic nervous system activity, reduced inflammation, and reduced pain?  

Could Contrast Cold/Warm/Hot Water Therapy also result in decreased pain?  

Under what circumstances does increased pain occur?

NOTE:  When warranted, this water-based therapy should always be medically supervised.

Wishing you all a good weekend!

Sabina Walker


(1) Cochrane; Alternating hot and cold water immersion for athlete recovery: A review; Physical Therapy in Sport (2004), 5, Pages 26-32.

Click to access 345485hot%20and%20cold%20baths.pdf

(2) Al Haddad et al; Effect of cold or thermoneutral water immersion on post-exercise heart rate recovery and heart rate variability indices; Autonomic Neuroscience: Basic and Clinical (2010), 156(1-2), Pages 111-116.

(3) Buchheit et al; Effect of cold water immersion on postexercise parasympathetic reactivation; American Journal of Physiology. Heart and Circulatory Physiology (2009), 296(20), Pages H421-427.

(4) Aysegul Jale Sarac and Ali Gur; Complementary and Alternative Medical Therapies in FibromyalgiaCurrent Pharmaceutical Design (2006), 12, 47-57 47

Click to access 19239028.pdf

(5) Panneton et al; Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving. Front Physiol. 2014 Jan 28;5:8. doi: 10.3389/fphys.2014.00008


(From a free-diving perspective) 

(6) Nestor, James; Deep – Freediving, Renegade Science and What the Ocean Tells Us About Ourselves; 2014

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