Evidence and sources

Most clinics in this sector do not have a page like this. We think you should be able to read the research yourself and make up your own mind, so here is what it says — the encouraging parts and the disappointing parts.

Start here: what the regulator says

The Advertising Standards Authority and the Committee of Advertising Practice publish standing guidance for businesses like ours. It says:

The ASA and CAP have yet to see convincing evidence that cryotherapy is effective.

ASA/CAP, Health: Cryotherapy

We are quoting our own regulator saying our sector has not proved its case. We do that deliberately, because you will find it eventually and it is better that you find it from us.

The ASA has ruled against cryotherapy businesses for claiming to treat conditions including rheumatoid arthritis, osteoarthritis and multiple sclerosis, and for weight-loss and skin-rejuvenation claims. That is why you will not find any of those claims on this site.

What the clinical guidelines say

NICE (UK). The current guideline for osteoarthritis in over-16s, NG226, puts therapeutic exercise, weight management where appropriate, and topical anti-inflammatory drugs for knee osteoarthritis at the centre of care. It explicitly recommends against offering a number of electrotherapies — TENS, therapeutic ultrasound, interferential therapy, laser therapy, pulsed short-wave therapy and neuromuscular electrical stimulation — as well as acupuncture and dry needling.

Thermal treatments — heat and cold — are not in that do-not-offer list. NICE does not specifically endorse them either. They are simply not among the things it tells clinicians to stop doing.

NHS. The NHS page on osteoarthritis treatment says that applying hot or cold packs to the joints can relieve the pain and symptoms in some people. That is about hot and cold packs at home rather than clinical cold-therapy equipment, and we are not going to pretend the two are the same thing — but it is the mainstream position that cold has a place.

American College of Rheumatology. The 2019 ACR / Arthritis Foundation guideline for hand, hip and knee osteoarthritis conditionally recommends thermal interventions — applied heat or cold — for small improvements in pain and function. Conditionally recommended is the guideline’s way of saying: reasonable to consider, modest expected benefit, evidence of limited quality. The full guideline is Kolasinski et al., Arthritis & Rheumatology, 2020.

What the trials say

Knee osteoarthritis

A 2025 systematic review and meta-analysis in Pain Practice pooled the randomised trials of cryotherapy in knee osteoarthritis. It reported a statistically significant reduction in pain compared with control groups, but no statistically significant effect on physical function, and only a single trial looking at muscle strength. Dias R et al., Pain Practice, 2025

A randomised controlled trial reported in the Journal of Physiotherapy reached a blunter conclusion, summarised in its own title: short-term cryotherapy did not substantially reduce pain, and had unclear effects on physical function and quality of life, in people with knee osteoarthritis. Journal of Physiotherapy, 2019

Those two findings are not as contradictory as they look — a pooled analysis of several small trials can find a modest average effect that any one trial is too small to detect. But together they are a fair summary of the state of play: possibly a small benefit for pain; no good evidence of benefit for function or quality of life.

After knee replacement surgery

Cold therapy has been more extensively studied in post-surgical rehabilitation than in long-term arthritis. A 2024 meta-analysis in Orthopaedic Surgery examined cryotherapy for rehabilitation after total knee arthroplasty. This is a different clinical situation from ours and we mention it only for completeness — if you have recently had joint surgery, your surgical team’s advice takes precedence over anything on this page.

What this adds up to

Honestly: cold therapy for long-term joint pain is a low-risk intervention with a small and uncertain chance of helping with pain, and little evidence of helping with movement or quality of life. It has not been shown to change the underlying condition, and it is not a substitute for exercise, weight management or the medication your GP has prescribed.

Some people find it worth doing anyway. Some do not. The only way to find out which you are is to try it properly, for long enough, with someone recording what happens — which is why we do the assessment, set a frequency and run the progress reviews.

If, after reading this page, you would rather put the money towards something with a stronger evidence base — a course of supervised exercise, for instance — we think that is a perfectly sensible decision and we will not try to talk you out of it.

Safety research

• Report of a case of cold urticaria following cryotherapy — the case report that underpins part of our screening.
• Contraindications to whole-body cryostimulation: a consensus (2025).
• Our own Is it suitable for me? page sets out how we screen.

How to read a claim about cryotherapy

If you are comparing clinics, three questions are worth asking anyone:

1. What evidence do you hold for that claim? Under the UK advertising code, a business making a health claim must hold the evidence before it advertises. It is entirely fair to ask to see it.
2. Is a registered health professional supervising this? For conditions where you would normally see a doctor, the code requires it. Ask which register, and check the number.
3. What happens if it does not work for me? A clinic that has no answer to this has not thought about it.

We check these sources and update this page at least once a year. If you think anything here is out of date or wrong, please tell us — we would rather know.