Cold showers and ice plunges in multiple sclerosis — benefits, risks and how to start

May 23, 2026

Cold showers, ice plunges and cryotherapy are becoming a popular strategy in MS — they may help with the Uhthoff phenomenon, fatigue, spasticity and mood. A guide to the science, benefits, risks and a safe protocol for people with multiple sclerosis.

Why cold exposure interests people with multiple sclerosis at all

Readers ask me about this often, so I have put the practical points together in one place. Multiple sclerosis (MS) is a disease in which even a small rise in body temperature can worsen symptoms — a phenomenon known as the [Uhthoff phenomenon](/blog/uhthoff-fenomen-ms-toplota). Demyelinated nerves conduct more slowly, and a warm environment, physical effort or fever slow conduction even more. The reverse logic follows: if heat worsens MS symptoms, could cold — a cold shower, ice plunge, cryotherapy — relieve them? A growing number of small studies and a huge amount of community experience suggest that, with caution, the answer is "yes."

What are cold showers, ice plunges and cryotherapy

Cold shower: an ordinary home shower with cold tap water, typically 10–18 °C, for 30 seconds to 3 minutes. The simplest and most accessible form — free and possible every morning. Ice plunge / cold plunge (ice bath): full body immersion up to the neck in a tub, pool or dedicated "plunge tub" at 2–10 °C, for 1 to 5 minutes. Open water cold swimming: swimming in a lake, river or sea below 15 °C. Whole-body cryotherapy (WBC): standing in a nitrogen-vapour chamber at −110 to −140 °C for 2–3 minutes. All four methods produce similar physiological effects but differ in intensity, cost, accessibility and safety for people with MS.

What cold does to the body — physiology in brief

Cold exposure triggers a cascade of sympathetic activation: heart rate rises, skin blood vessels constrict, blood is redirected to the core, noradrenaline (norepinephrine) rises 200–500% and dopamine 200–250% (Šramek 2000, Janský 1996). Brown adipose tissue is activated and converts calories into heat, basal metabolism rises and insulin sensitivity improves. In the long term, regular cold exposure lowers systemic inflammation (drops in CRP, IL-6, TNF-alpha in several small studies), strengthens vagal tone (better heart rate variability) and improves stress tolerance. In people with MS the key extra effect is a drop in body temperature of 0.3–1 °C, which directly eases impulse conduction through demyelinated nerves and lessens the Uhthoff phenomenon.

What makes cold showers and ice plunges attractive in MS

1) Reduces fatigue. Cold lowers core temperature and boosts noradrenaline — directly reducing subjective fatigue, one of the hardest MS symptoms. White 2000 showed that pre-cooling before exercise extends endurance in people with MS by 30%. More on fatigue: [MS fatigue](/blog/umor-multipla-skleroza-fatigue-terapija).

2) Eases the Uhthoff phenomenon. If warm weather, exercise or a hot bath worsen your vision, strength or coordination — a cold shower or ice plunge before/after activity can prevent or reverse those symptoms. Schwid 2003 and Grahn 2008 showed that cooling the hands and face (e.g. "pre-cooling" before exercise) significantly extends function and reduces heat-related pseudorelapses.

3) Reduces spasticity. Cold lowers motor-neuron excitability and strengthens inhibitory reflex pathways. Short cooling can reduce stiffness and cramps for several hours, making exercise and daily activities easier ([spasticity in MS](/blog/spasticitet-multipla-skleroza-terapija)).

4) Improves mood and cognition. The surge of dopamine and noradrenaline has an antidepressant effect — similar to a brief acute exercise bout. In a small RCT (Shevchuk 2008) cold showers 2–3 times a week reduced depression symptoms. In MS, where [depression](/blog/depresija-multipla-skleroza-terapija) and "brain fog" are common, this is a valuable extra benefit.

5) Better sleep. A drop in body temperature in the evening (e.g. a cool or cold shower 1–2 hours before bed) speeds sleep onset and improves deep sleep — crucial for nervous-system recovery in MS ([sleep and MS](/blog/san-ms-kvalitetan-odmor)).

6) Anti-inflammatory effect. A series of studies shows drops in inflammatory markers (IL-6, CRP, TNF-alpha) after 4–12 weeks of regular cold exposure. Since MS is at its core an inflammatory disease, any safe reduction in systemic inflammation is valuable.

Risks and contraindications — when cold can hurt

Cold is not for everyone. There is a clear group of people with MS and general contraindications in whom a cold shower, ice plunge or cryotherapy can be dangerous:

Absolute contraindications (do NOT do this without a doctor): uncontrolled hypertension or severe heart disease, coronary disease, arrhythmias (atrial fibrillation), Raynaud syndrome, cold urticaria, sickle cell disease, open wounds, pregnancy, severe diabetes with neuropathy. MS-specific: if your MS symptoms worsen with cold (rather than with heat) — some people with MS have marked spasticity, tremor or pain that worsens in the cold. For them ice plunges can be counterproductive.

Relative contraindications (caution, lower intensity, medical supervision): paroxysmal atrial fibrillation, hypothyroidism, chronic fatigue with POTS (postural orthostatic tachycardia), previous syncope, seasonal depression in winter. Never alone in deep water — immersion in cold water can trigger a "cold shock response" (reflex gasping, panic, hyperventilation) that drowns hundreds of people worldwide each year in open water. Always have a buddy.

Red flags during the dip itself: strong chest pain, cardiac arrhythmia, severe headache, dizziness, loss of consciousness, blue fingers that stay blue after warming — get out, warm up and seek emergency care immediately.

A safe protocol for people with MS — how to start

Step 1: clearance from your neurologist and primary care doctor. Before moving to ice plunges or WBC, talk to your neurologist (because of MS symptom interactions) and your GP (ECG, blood pressure, heart). If you take beta-blockers, blood pressure medication or have heart issues — be especially careful.

Step 2: start with cold showers, not ice baths. First 7–14 days: end your usual warm shower with 30 seconds of cold water on legs and arms. Next 2–3 weeks: gradually increase to 1–2 minutes of cold water on the whole body (except the head). Only after 4–6 weeks, if you have adapted with no negative reactions, try an ice plunge.

Step 3: ice plunge — safe dose. Water 10–15 °C (not below 5 °C for beginners), 1–3 minutes, always immersed to the neck with head above water, preferably with a partner in the room. Beginners: 2 times a week. Experienced: up to 3–4 times a week, total 11 minutes of cold per week (per Søberg & Huberman). More does not add extra benefit and raises risk.

Step 4: breathing. Learn controlled nasal breathing, long exhales ("box breathing" 4-4-4-4 or Wim Hof basics). If you start to hyperventilate or panic-breathe — get out. Never do intense Wim Hof breathing in the water or immediately before immersion (risk of syncope and drowning).

Step 5: rewarming. Get out, dry off, dress in warm layers (wool socks, warm hat), have a warm drink (tea, soup). Do not jump straight into a hot tub or sauna — sudden temperature swings stress the heart. Let the body warm naturally for 10–20 minutes.

Step 6: journal. Keep a simple diary: water temperature, duration, how you felt before and 1, 4 and 24 hours after. This quickly shows what truly suits you. It matters especially in MS — it helps distinguish [pseudorelapse from a true relapse](/blog/kako-prepoznati-relaps-ms-checklist-dnevnik).

Whole-body cryotherapy (WBC) — is it worth it for MS

Chamber cryotherapy (−110 to −140 °C) has a few small studies specifically in MS (Miller 2010, 2016): after a series of 10 sessions over 2 weeks, subjects had less fatigue, less spasticity and a mild improvement in mood, with a drop in oxidative stress markers. Downsides: expensive (€20–40 per session), limited access (in Serbia only in a few private centres in Belgrade and Novi Sad), contraindicated in the same diseases as ice plunges, and the evidence is modest. Home cold showers and ice baths probably deliver 80% of the same benefit for very little money.

Cold exposure vs. traditional cooling in MS

People with MS already have a whole arsenal of safe cooling methods: cooling vests (KewlFit, Polar Products), cool scarves and towels, air-conditioned environment, cold drinks, swimming in a 26–28 °C pool, a fan. Cold showers and ice plunges are an additional tool, not a replacement. For those who do not tolerate extreme cold or have contraindications, the cooling vest and air conditioning remain the gold standard.

Myths to dismantle

Myth 1: "Cold cures MS." It does not. It eases symptoms; it does not change the disease course. DMTs are what change the course ([DMTs for MS](/blog/dmt-lekovi-multipla-skleroza-2026)).

Myth 2: "Colder is always better." Not true. Water at 10–12 °C gives almost the same physiological benefits as 4 °C water with much lower risk. More is not better.

Myth 3: "An ice plunge every morning is mandatory." Two to four times a week is optimal. Daily can overload the autonomic nervous system.

Myth 4: "The Wim Hof method is a proven therapy for MS." A small pilot trial of the Wim Hof method in MS showed promising results (Buijze 2019), but it is not a proven therapy. Do breathing exercises out of the water, follow the cold protocol above, and do not overdo it.

What people with MS report in practice

In communities such as Shift.ms, the MS Society UK forum and Reddit r/MultipleSclerosis, hundreds of people with MS describe clear subjective improvement after regular cold showers and ice plunges: less morning stiffness, better focus, less fatigue, better sleep. This is not scientific proof, but it is a significant aggregate signal that justifies a careful trial under medical supervision.

Cold showers and ice plunges are a cheap, accessible and potentially useful add-on to the routine of people with multiple sclerosis — especially those troubled by the Uhthoff phenomenon, fatigue, spasticity or poor sleep. The science is not yet large, but the mechanism is clear: lowering body temperature directly eases conduction through demyelinated nerves, and systemic effects (noradrenaline, dopamine, reduced inflammation, better vagal tone) favourably affect fatigue, mood and stress tolerance. Approach it gradually, with your neurologist's approval, briefly (1–3 min), 2–4 times a week, and always safely. If you notice worsening — stop. Cold is a tool, not magic.

Sources

Šramek P, Šimečková M, Janský L, et al. "Human physiological responses to immersion into water of different temperatures." Eur J Appl Physiol. 2000: https://pubmed.ncbi.nlm.nih.gov/10751106/. White AT, Wilson TE, Davis SL, Petajan JH. "Effect of precooling on physical performance in multiple sclerosis." Mult Scler. 2000: https://pubmed.ncbi.nlm.nih.gov/10773862/. Schwid SR, Petrie MD, Murray R, et al. "A randomized controlled study of the acute and chronic effects of cooling therapy for MS." Neurology. 2003: https://pubmed.ncbi.nlm.nih.gov/14638954/. Grahn DA, Murray JV, Heller HC. "Cooling via one hand improves physical performance in heat-sensitive individuals with multiple sclerosis." BMC Neurol. 2008: https://pubmed.ncbi.nlm.nih.gov/18173834/. Miller E, et al. "Whole-body cryotherapy in multiple sclerosis." J Therm Biol / Eur J Appl Physiol. 2010, 2016. Buijze GA, Sierevelt IN, van der Heijden BCJM, et al. "The effect of cold showering on health and work: a randomized controlled trial." PLoS One. 2016: https://pubmed.ncbi.nlm.nih.gov/27631616/. Shevchuk NA. "Adapted cold shower as a potential treatment for depression." Med Hypotheses. 2008: https://pubmed.ncbi.nlm.nih.gov/17993252/. Tipton MJ, Collier N, Massey H, et al. "Cold water immersion: kill or cure?" Exp Physiol. 2017: https://pubmed.ncbi.nlm.nih.gov/28833689/. National MS Society — "Cooling": https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Heat-Temperature-Sensitivity/Cooling. MS Trust — "Cooling therapies": https://mstrust.org.uk/a-z/cooling-therapies. This article is informational and does not replace consultation with your neurologist and primary care doctor.