Risks & Contraindications with Cold Water Immersion
Introduction
We love to talk about the benefits of cold water immersion, and there are plenty of great reasons to create a regular practice. However, there are potential risks that are important to know before we start.
We encourage people to go slow with their practice. Start with warmer temperatures and shorter times. Allow yourself to gradually adapt to the cold. Yes, push your edge psychologically. But going too far can create physical, mental and emotional stress that outweighs the benefits.
If you have any concerns, consult with a qualified health care practitioner or experienced coach before starting a cold water immersion practice. If you have any risk factors and choose to practice cold water immersion, have a buddy with you to help keep you safe.
Bio-Individuality
Each one of us has unique DNA, genetics, blood type, body type, body fat, health and fitness levels, diet, quality of sleep, and countless other variables that affect how we respond to cold water. This not only varies from one person to the next, but can vary in the same person from one day to the next.
Cold water immersion, while considered a beneficial stress, can become a detrimental stress if we push it too far. Each person needs to find the temperature, duration, and frequency that gives the best results.
The art of the practice is to tune into what you need on any given day and make adjustments as needed.
Hypothermia
Hypothermia is a condition that happens when your core body temperature decreases. Essentially, your body is losing heat faster than it can warm up. The symptoms of hypothermia range from mild to severe, and include shivering, confusion, loss of body control, and loss of consciousness. The final symptom is death.
Keep in mind that some of the data we have about cold water and hypothermia comes from reports from people in boating accidents. The coast guard and some universities have published information about expected survival times in cold water of various degrees. This information may not correlate well with a deliberate cold water immersion practice.
Cardiovascular Issues
Cold water immersion can stress your heart. If you have heart disease or hypertension, you might have an increased risk of irregular heart beat or an increase in blood pressure.
Possible contraindications for cold water immersion include:
- Coronary Artery Disease
- Stroke
- Heart Failure
- Hypertension
- Peripheral Artery Disease
- Aortic Aneurysm
- Arrhythmias
- Cardiomyopathy
- Family history of heart disease
Respiratory Issues
The initial shock of getting into cold water can cause rapid breathing which can aggravate respiratory problems, especially in individuals with pre-existing conditions. If you have any of the following issues, start with much warmer temperatures, consult with your doctor, or avoid cold water until you have your symptoms under control.
- Asthma
- COPD
- Chronic Bronchitis
- Emphysema
- Lung Cancer
- Cystic Fibrosis
- Pneumonia
- COVID-19
Peripheral Vasoconstriction
When you get into cold water, blood vessels in your arms, hands, legs, and feet constrict to conserve heat. This can increase the workload on your heart and potentially cause problems for people with weak or compromised circulatory systems.
The contraindications are the same as listed above for “Cardiovascular Issues.”
Drowning Risk
Being in water that is too cold for too long can cause muscle stiffness and decrease dexterity. This can result in accidents or drowning, especially if a person is new to cold water immersion or tired.
Rapid breathing (hyperventilation) and breath holds (ex. Wim Hof Method breathing) should never be practiced while in cold water because it can lead to loss of consciousness and drowning.
Scott Carney has cases of injuries and documented 13 deaths from people practicing the Wim Hof Method, particularly with combining hyperventilated breathing and cold water immersion. See this YouTube video for details. I have a friend in Austin who drowned after losing consciousness while practicing an extended breath hold (not the Wim Hof Method) in his hot tub. He left behind three children under the age of 11.
Never practice rapid breathing or breath holds while driving or in any other situation that could be unsafe for you or others if you lose consciousness. It doesn’t matter how many times you have practiced and felt “just fine.” All it takes is a perfect storm of conditions that you may not be aware of to lose consciousness.
If you choose to practice these kinds of breathing while in water, have an attentive safety buddy close by.
Skin Issues
While regular cold water immersion can be good for your skin, there are two main issues to be aware of.
Frost bite
If you are in water with ice, water that is below 32F (0C), or practicing any form of cold water immersion outside (ex. cold water swimming) with ambient temperatures colder than freezing, it is possible to get frost bite. Frost bite can also happen if you go barefoot or wear minimal clothing outside when the temperature is below freezing.
Frost bite occurs when the skin or underlying tissue freezes. Symptoms include cold skin, a prickling feeling, followed by numbness and inflamed or discolored skin.
Cold urticaria
Cold urticaria is a skin reaction to cold that appears within minutes after cold exposure. Symptoms can range from mild itchy welts (hives) to severe (low blood pressure, fainting or shock). Cold urticaria could be an allergic reaction to the cold, or caused by an underlying autoimmune issue.
Surfer’s Ear
If you practice cold water swimming or do regular head dunks in cold water, be sure to wear ear plugs. Otherwise, prolonged exposure over time to cold water can cause abnormal growth of bony lumps within the external ear canal.
This condition can make you more prone to ear infections and can lead to hearing loss.
Loss of Vision / Blindness
If you are swimming in very cold water long enough without goggles, it is possible to damage your eyes.
In March of 2000, Wim Hof’s first attempt to set the Guinness World Record for the farthest swim under ice failed when he began his swim without goggles. His corneas froze solid and he was temporarily blind.
Psychological / Emotional Trauma
Some people use cold water immersion to boost their confidence and mental toughness. While cold water immersion can provide those benefits, and is known to be a good stress, when overdone, it can become detrimental.
When someone gets into water that is too cold, for too long, or too often, it could induce a trauma response. There is a fine line between pushing the edge of your comfort zone and hurting yourself emotionally or physically.
When people cross the line, they may become resistant to a regular cold water immersion practice, or avoid it altogether, thus missing the benefits.
Children should not be forced, coerced, or shamed by parents or other adults to push for time. I’ve seen videos of parents offering rewards for young children for staying in longer. This is not recommended. See my article (linked below) about kids and cold plunging.
Social Disconnection
While cold water immersion is growing in popularity, there is still a risk that your family, spouse, or friends think you are crazy or have other unhelpful judgments. While they most likely have good intentions (keeping you safe), you might feel isolated or discouraged.
Find or create a supportive community of people who practice cold water understand your motivations and passion. You can join my free Facebook group here:
https://www.facebook.com/groups/chestfreezercoldplunge
Contraindications For Cold Water Immersion
Young Children and Infants
Children may be more susceptible to temperature changes, and cold water immersion may pose a risk to their well-being. This is not to say that children should not do cold water immersion. However, they should only be encouraged, not forced, and only be in cold water with the very close supervision of a responsible, mature adult.
For more information about kids and cold plunges, and keeping them safe, see my article here:
https://chestfreezercoldplunge.com/kids/
Elderly Individuals
As we age, our body can lose it’s ability to regulate our internal temperature, which is one of the bio-markers of aging. Elderly people just starting a cold water immersion practice can be more vulnerable to the effects of cold water and should start with warmer temperatures, shorter times, and have a safety buddy close by.
Pregnancy
As of 2023, I could find no studies on the effects of cold water immersion on pregnant women or the fetus. Exposure to extreme temperatures, whether hot or cold, could adversely affect the health of the mother and the baby she is carrying.
Certain Medical Conditions
People with conditions such as Raynaud’s disease, diabetes, or other circulatory disorders may be at increased risk. Again, consult with your health care practitioner.
Keep in mind that not all western medical doctors are familiar with cold water immersion. I have heard reports of people with Raynaud’s (and other diseases and conditions) overcoming their symptoms by using gradual cold water immersion.
Recommendations
Consult with a qualified health care practitioner. Keep in mind that not all western trained physicians are familiar with cold water immersion.
Find an experienced cold water immersion coach who can guide and support your safely through the process.