Whole-Body Cryotherapy in Multiple Sclerosis: Safety, Efficacy, and the Latest Evidence

Updated August 2026

Introduction

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system. Alongside neurological disability, people with MS commonly experience fatigue, weakness, spasticity, pain, impaired balance and psychological symptoms, all of which can affect mobility, participation and quality of life. Rehabilitation therefore plays an important role alongside disease-modifying and symptom-directed medical treatment. [1]

Whole-body cryotherapy—also called whole-body cryostimulation (WBC) in much of the scientific literature—involves exposing the body to very cold, dry air for a short period. Most MS studies have used temperatures of approximately −110°C to −160°C for 2–3 minutes, usually delivered as a course of 10–30 sessions. [1]

Interest in WBC for MS partly comes from the observation that many people with MS are sensitive to increases in temperature, but the proposed effects of WBC extend beyond simple cooling. Researchers have investigated changes in fatigue, mobility, strength, spasticity, mood, pain, sleep and biochemical markers. [1]

The evidence, however, needs to be interpreted carefully. Most MS studies remain small, protocols vary substantially, follow-up is usually short, and relatively few well-controlled trials have been conducted. The current evidence therefore supports WBC primarily as a possible adjunct to rehabilitation, rather than as a stand-alone treatment or a therapy that changes the course of MS. [1–4]

What the evidence currently suggests

• Fatigue and functional status: several studies report improvements, although much of this evidence comes from small or non-randomized studies. [1,8]
• Strength and mobility: combining WBC with exercise may produce useful improvements, but the newest 2026 study found that differences between treatment groups were limited and emphasized that exercise remains the foundation of MS rehabilitation. [2]
• Pain and sleep: a 2025 study found short-term improvements after 10 WBC sessions, although several effects were no longer significant at follow-up. [3]
• Balance: a 2025 randomized study found only small improvements in postural stability and concluded that WBC without targeted exercise was insufficient to produce clear rehabilitation benefits. [4]
• Mood and psychological well-being: earlier comparative research suggests potential benefits, particularly when WBC is combined with exercise. [1,9]
• Disease progression: there is currently no evidence that WBC reduces relapses, suppresses MRI disease activity or acts as a disease-modifying treatment. [1–5]
• Safety: WBC appears reasonably well tolerated in appropriately selected patients, but medical screening and adherence to contraindications are essential. [1,6,7]

How Might Whole-Body Cryotherapy Affect MS Symptoms?

The biological rationale for WBC is plausible, but it is important to distinguish proposed mechanisms from clinically proven mechanisms.

Cooling and temperature-sensitive symptoms

Temperature can influence neurological function in MS, and heat sensitivity is common. Even relatively small increases in body temperature can temporarily worsen neurological symptoms in susceptible patients. This provides a rationale for cooling strategies in MS. [1]

However, this does not mean that the effects reported after WBC are simply the result of reversing heat-related conduction problems. The MS trials conducted so far have not established improved nerve conduction as the mechanism responsible for WBC-related clinical changes. [1]

Oxidative stress

Oxidative stress is involved in MS pathophysiology, and this has been one of the more extensively investigated biological targets of WBC. Some MS studies have reported increases in total antioxidant status or changes in antioxidants such as uric acid following a course of WBC. [1]

The findings are not consistent across every biochemical marker. The 2024 scoping review found that some antioxidant measures changed while other markers—including several antioxidant enzymes, nitric oxide, metalloproteinases and routine blood parameters—did not demonstrate consistent significant changes. [1]

It is therefore reasonable to say that WBC may influence antioxidant responses, but current evidence does not demonstrate that it reduces central nervous system inflammation or protects neurons from MS-related damage. [1]

Inflammation and neuroendocrine responses

Extreme cold produces cardiovascular, autonomic, neuromuscular and endocrine responses, and WBC has been associated with changes in inflammatory and stress-related pathways in other populations. However, direct evidence demonstrating a clinically meaningful anti-inflammatory effect in people with MS remains limited. [1,7]

Statements that WBC “reduces MS inflammation,” “protects myelin,” or “slows neurodegeneration” therefore go beyond what the clinical evidence currently supports. [1]

A newer biomarker finding: vitamin D

A 2025 study investigated 20 WBC sessions in women with MS and found a statistically significant increase in serum vitamin D levels in the WBC-treated MS group. The sample was small—15 women with MS received WBC—and the study was designed around a laboratory outcome rather than clinical symptoms. [5]

This is an interesting physiological finding, but it should not yet be interpreted as evidence that WBC improves MS outcomes through vitamin D or that it can be used to treat vitamin D deficiency. [5]

What Does the Clinical Evidence Show?

Fatigue

Fatigue is one of the symptoms for which WBC has shown the most consistent positive signal.

A frequently cited 2016 study examined people with MS who received ten daily WBC sessions at −110°C or colder. Participants reported improvements in fatigue and functional status, with some of the largest changes occurring among those with greater fatigue at baseline. [8]

The 2024 scoping review reached a similar overall conclusion after examining 13 MS publications: WBC was associated with reductions in fatigue and improvements in functional status in several of the included studies. [1]

However, the evidence should not be interpreted as proof that WBC is an established treatment for MS fatigue. Many of the studies were small, some lacked robust untreated control groups, and WBC was frequently combined with exercise or other rehabilitation. [1,8]

The more appropriate conclusion is that WBC may be useful for fatigue in selected patients, particularly as part of a rehabilitation programme, but larger controlled trials are still needed. [1]

Muscle strength, mobility and the importance of exercise

The relationship between WBC and exercise has become particularly important in the newer literature.

A 2019 comparative study divided 60 people with MS into WBC, exercise and combined WBC-plus-exercise groups. Improvements were reported in several outcomes, with the combined group demonstrating the most notable overall changes in psychological well-being and function. [9]

More recently, a 2026 study of 60 people with MS again compared WBC plus exercise, WBC alone and exercise alone. Improvements in knee flexor and extensor performance were observed particularly in the combined group, while selected improvements also occurred in the WBC-only and exercise-only groups. [2]

Importantly, the authors emphasized that the differences between groups were limited. Their conclusion was not that cryotherapy should replace exercise, but that appropriately selected exercise remains the foundation of rehabilitation and WBC may act as an adjunct. [2]

This is probably the most clinically useful interpretation of the current evidence: if WBC has a role in MS rehabilitation, it is more convincing as something used around active rehabilitation than as a passive treatment delivered on its own. [1,2,9]

Balance

The 2025 balance study provides another useful warning against viewing WBC as a stand-alone rehabilitation intervention.

Fifty-one people with MS completed the study. Participants receiving WBC underwent 20 sessions without subsequent targeted kinesiotherapy. The researchers reported reductions in EDSS and Modified Ashworth Scale scores, but changes in postural stability were relatively small. [4]

The authors ultimately concluded that WBC without subsequent targeted exercise was not sufficient to produce clear and measurable balance rehabilitation benefits. [4]

For physiotherapists, this finding reinforces the idea that a temporary physiological response to cold should not be confused with motor learning, balance training or task-specific rehabilitation. [4]

Spasticity

Several WBC studies included in the 2024 review reported improvements in functional or neurological outcomes that included measures related to spasticity. The 2025 balance study also found reductions in Modified Ashworth Scale scores following 20 WBC sessions. [1,4]

Related evidence comes from a 2024 randomized trial of airflow cryotherapy combined with physiotherapy in 32 people with MS. The combined treatment produced larger reductions in calf spasticity and H/M ratio than physiotherapy alone. However, this intervention should not be treated as direct evidence for whole-body chamber cryotherapy because the study investigated airflow cryotherapy rather than the standard whole-body protocol reviewed elsewhere. [10]

Overall, cold-based interventions may temporarily reduce spasticity in some patients, but evidence specifically supporting WBC for spasticity remains limited. [1,4,10]

Pain and sleep

One of the important additions to the evidence base since the earlier literature is a 2025 study examining pain, sleep, function and quality of life.

Thirty people with MS underwent ten WBC sessions over two weeks at temperatures of approximately −120°C to −130°C. Immediately after treatment, the MS group demonstrated statistically significant improvements in pain intensity, the 30-Second Chair Stand Test, one quality-of-life measure and Pittsburgh Sleep Quality Index scores. [3]

The follow-up results were less convincing. Many of the immediate improvements were no longer maintained ten days later, although some functional and quality-of-life outcomes remained improved. [3]

The study also did not include an untreated MS control group: the comparison group consisted of people without neurological disease who also received WBC. This means the study supports a potential short-term effect, but cannot establish with the same confidence as a controlled trial how much of the change was specifically caused by WBC. [3]

WBC therefore appears promising for short-term pain and sleep management, but evidence regarding the size and durability of the effect remains preliminary. [3]

Mood and psychological well-being

Psychological outcomes have also been investigated.

The 2019 three-group study found improvements in psychological well-being, anxiety and depressive symptoms across different treatment conditions, with the combination of exercise and WBC generally producing the strongest overall response. [9]

The 2024 scoping review similarly concluded that WBC studies had reported improvements in mental well-being, mood and anxiety. [1]

These findings are encouraging, but WBC should not be presented as a treatment for clinical depression or anxiety in MS. The studies mainly investigated psychological outcomes within broader rehabilitation programmes and were not designed as psychiatric treatment trials. [1,9]

Does Whole-Body Cryotherapy Change MS Disease Progression?

There is currently no convincing evidence that WBC is a disease-modifying treatment for MS. [1–5]

The existing clinical literature has mainly studied fatigue, strength, mobility, psychological well-being, pain, sleep, spasticity and laboratory biomarkers. Studies have not demonstrated that WBC reduces MS relapse rates, prevents new MRI lesions or slows neurological progression over clinically meaningful long-term periods. [1–5]

Changes in biomarkers such as antioxidant status, uric acid or vitamin D are scientifically interesting, but biomarker changes should not be interpreted as evidence that WBC is suppressing MS disease activity. [1,5]

WBC should therefore never be presented as an alternative to disease-modifying therapy. Its possible role is symptom management and rehabilitation support. [1–5]

Safety of Whole-Body Cryotherapy

The available MS-specific literature is reassuring but not sufficient to describe WBC as risk-free.

The 2024 MS scoping review reported no adverse effects in the included MS studies. [1] That finding reflects what was reported in those studies; it does not prove that adverse events cannot occur.

A broader 2023 safety review of whole-body cryotherapy identified 16 documented adverse events across five case reports and two randomized trials. After examining the circumstances surrounding these cases, the authors concluded that the risks of properly performed WBC appeared acceptable when contraindications and appropriate safety procedures were followed. [7]

It is also important to distinguish true whole-body cryotherapy performed in a controlled cryochamber from partial-body cryotherapy using vaporized liquid nitrogen. The safety literature notes that these procedures are physiologically and technically different, although adverse events from the two have sometimes been discussed together. [7]

For clinical use, WBC should therefore be treated as a medical or rehabilitation intervention requiring appropriate screening, supervision and dosing, rather than simply as a wellness treatment. [6,7]

Contraindications: Who Should Not Receive WBC?

In 2025, a multidisciplinary international panel published an updated position paper on contraindications to WBC. The recommendations were developed from a systematic literature review followed by a Delphi consensus process. [6]

The final recommendations include both temporary and permanent contraindications. [6]

Important temporary contraindications include:

• acute illness or infection;
• fever;
• significant skin lesions;
• pregnancy;
• severe anaemia or significant thrombocytopenia;
• clinically important electrolyte abnormalities;
• blood pressure ≥160/100 mmHg, or low blood pressure accompanied by signs of haemodynamic instability;
• current treatment with specified cardiotoxic or spasmogenic medications;
• ongoing antineoplastic treatment;
• general malaise, dizziness, nausea, weakness or shivering;
• significant cold intolerance or inability to tolerate the chamber safely. [6]

Important permanent contraindications include:

• ischaemic heart disease and haemodynamic instability;
• uncontrolled hypertension;
• decompensated heart failure and several significant structural cardiac disorders;
• uncontrolled tachyarrhythmias and certain conduction disorders;
• pacemakers or implantable cardiac defibrillators;
• significant peripheral arterial disease;
• recent venous thromboembolism or pulmonary embolism;
• certain cold-related immunological disorders such as cryoglobulinaemia;
• uncontrolled thyroid disease and specified forms of diabetes;
• significant renal or respiratory insufficiency;
• severe asthma or advanced COPD;
• autonomic or sympathetic nervous system disorders;
• polyneuropathy;
• recent stroke;
• epilepsy or seizures;
• cognitive or psychiatric conditions that prevent informed consent or safe adherence to instructions;
• specific active or uncontrolled cancers;
• severe purulent or gangrenous skin disease. [6]

The complete contraindication assessment is more detailed than this summary. The 2025 position paper specifically recommends an individualized medical assessment rather than relying only on a checklist, because combinations of risk factors may make WBC inappropriate even when an individual factor is not an absolute contraindication by itself. [6]

This issue is especially relevant in neurological rehabilitation, where autonomic dysfunction, sensory impairment, cardiovascular comorbidity or altered temperature perception may influence an individual’s response to extreme cold. [6]

What WBC Protocol Is Supported by Research?

There is no established optimal WBC protocol for multiple sclerosis. [1]

Across the studies summarized in the 2024 review:

• treatment courses ranged approximately from 10 to 30 sessions;
• exposure generally lasted 2–3 minutes;
• temperatures ranged roughly from −110°C to −160°C;
• many protocols used daily weekday sessions;
• several studies followed WBC with approximately 15–30 minutes of exercise or physiotherapy. [1]

More recent trials remain within a similar range. The 2025 pain and sleep study used ten sessions at approximately −120°C to −130°C over two weeks, while the 2025 balance study examined the effects of 20 sessions. [3,4]

These numbers describe research protocols, not a proven dose-response relationship. There is currently insufficient evidence to say that 20 treatments are better than 10, that colder temperatures produce larger clinical effects, or that repeated long-term courses prevent the return of symptoms. [1,3,4]

The current rehabilitation evidence actually points toward a more important variable: what the patient does alongside the cryotherapy. Both the 2025 balance findings and the 2026 exercise comparison support integrating WBC with active, targeted rehabilitation rather than relying on WBC alone. [2,4]

Practical Physiotherapy Perspective

For a physiotherapist considering WBC as part of MS rehabilitation, the most evidence-consistent approach is to regard it as an optional adjunct, not the treatment itself. [1,2,4]

If a patient experiences a short-term reduction in fatigue, pain or muscle tone following WBC, that period may potentially provide an opportunity to perform meaningful rehabilitation such as strengthening, gait practice, transfers, balance exercises or task-specific training. This rehabilitation rationale is consistent with the studies in which WBC has generally performed best when incorporated alongside active exercise. [1,2,9]

However, WBC should not displace interventions with stronger evidence for improving physical function in MS, particularly appropriately prescribed exercise and task-specific rehabilitation. The newest 2026 evidence specifically reinforces this point. [2]

Outcome monitoring is also important. Rather than assuming treatment is working because a patient feels temporarily refreshed after cold exposure, clinicians can track patient-specific outcomes such as fatigue, pain, walking performance, sit-to-stand capacity, strength or participation. The WBC literature itself has used tools including the Fatigue Severity Scale, Rivermead Mobility Index, Timed Up and Go, 30-Second Chair Stand Test and MS-specific quality-of-life measures. [1–4,8]

The Bottom Line

Whole-body cryotherapy is an interesting adjunctive treatment in MS rehabilitation, but the evidence is considerably more nuanced than many commercial claims suggest.

The strongest current interpretation is that WBC may provide short-term improvements in symptoms such as fatigue, pain, sleep, psychological well-being and selected functional outcomes in some people with MS. [1–3,8,9]

At the same time, newer evidence prevents us from concluding that WBC alone substantially improves all aspects of MS rehabilitation. A 2025 randomized study found only slight improvement in balance when WBC was used without targeted exercise, while the newest 2026 study again emphasized exercise as the foundation of rehabilitation and found relatively limited differences between WBC, exercise and combined groups. [2,4]

There is also no evidence that WBC alters the underlying course of MS, and it should not replace disease-modifying medication, symptom-directed medical care or active rehabilitation. [1–5]

For appropriately screened patients who are interested in trying it, WBC can reasonably be considered a complementary modality within a broader rehabilitation programme. Medical screening is essential, particularly because the 2025 international consensus identifies important cardiovascular, metabolic, respiratory, neurological, immunological and other contraindications. [6]

In short, whole-body cryotherapy may help create a better window for rehabilitation in selected people with MS—but based on the evidence available in 2026, the active rehabilitation remains more important than the cold exposure itself. [1–4]

References

1. Alito A, et al. Whole-Body Cryostimulation in Multiple Sclerosis: A Scoping Review. Journal of Clinical Medicine. 2024;13(7):2003. doi:10.3390/jcm13072003. PMID: 38610768.

2. Pawik M, Pawik Ł, Dziubek W, et al. Combined Whole-Body Cryotherapy and Exercise vs Exercise Alone for Lower Limb Strength and Mobility in Multiple Sclerosis. Medical Science Monitor. 2026;32:e952326. doi:10.12659/MSM.952326. PMID: 42538730.

3. Zielińska-Nowak E, Lipert A, Kikowski Ł, Miller E. Impact of Whole-Body Cryotherapy on Pain, Sleep Quality, Functional Status, and Quality of Life in Multiple Sclerosis: A Comparative Study with Follow-Up. Journal of Personalized Medicine. 2025;15(2):46. doi:10.3390/jpm15020046. PMID: 39997323.

4. Staszkiewicz R, Rusek S, Lubkowska A, Szyguła Z. Effect of Whole-Body Cryotherapy on Body Balance in Patients with Multiple Sclerosis. Acta of Bioengineering and Biomechanics. 2025. doi:10.37190/abb-02584-2025-02. PMID: 40544467.

5. Ptaszek B, Podsiadło S, Czerwińska-Ledwig O, et al. Whole-Body Cryotherapy Affects Blood Vitamin D Levels in People with Multiple Sclerosis. Journal of Clinical Medicine. 2025;14(9):3086. doi:10.3390/jcm14093086. PMID: 40364117.

6. Capodaglio P, Alito A, Dugué BM, et al. Contraindications to Whole-Body Cryostimulation (WBC): A Position Paper from the WBC Working Group of the International Institute of Refrigeration and the Multidisciplinary Expert Panel. Frontiers in Rehabilitation Sciences. 2025;6:1567402. doi:10.3389/fresc.2025.1567402. PMID: 40303546.

7. Legrand FD, Dugué B, Costello J, et al. Evaluating Safety Risks of Whole-Body Cryotherapy/Cryostimulation (WBC): A Scoping Review from an International Consortium. European Journal of Medical Research. 2023. doi:10.1186/s40001-023-01385-z. PMID: 37770960.

8. Miller E, Kostka J, Włodarczyk T, et al. Whole-Body Cryostimulation (Cryotherapy) Provides Benefits for Fatigue and Functional Status in Multiple Sclerosis Patients: A Case-Control Study. Acta Neurologica Scandinavica. 2016. doi:10.1111/ane.12557. PMID: 26778452.

9. Pawik M, Kowalska J, Rymaszewska J. The Effectiveness of Whole-Body Cryotherapy and Physical Exercises on the Psychological Well-Being of Patients with Multiple Sclerosis: A Comparative Analysis. Advances in Clinical and Experimental Medicine. 2019. doi:10.17219/acem/104529. PMID: 30968613.

10. Abdelhakiem H, Mahmoud NF, Saleh MS, et al. Effect of Cryotherapy in Controlling Spasticity of Calf Muscles in Patients with Multiple Sclerosis. NeuroRehabilitation. 2024. doi:10.3233/NRE-240006. PMID: 38875049.