Sauna Or Ice Bath First? The Science of Contrast Therapy Order

Sauna Or Ice Bath First? The Science of Contrast Therapy Order

The Evidence-Based Answer

The conventional practice in contrast therapy — and the sequence used in most published protocols — is to start with the sauna and finish with the cold. The standard sequence is: sauna → cool-down → cold plunge (repeat 2–3 rounds, usually ending cold).

It is worth being straight with you about the evidence here: we could not find controlled trials that directly compare hot-first against cold-first. The published contrast-therapy research tests contrast therapy as a whole against passive rest or against cold-water immersion alone — it does not isolate the order as a variable (Bieuzen et al., 2013; Higgins et al., 2017). So "sauna first" is best described as the convention the research protocols happen to use, and a sequence that makes mechanistic sense — not a sequence proven superior in a head-to-head test. Anyone telling you the order is settled science is going beyond what the studies show.

What we can say with more confidence is that the sequence you choose should follow your goal, and that the ending temperature has real, documented trade-offs.

Why the Standard Sequence Is Sauna First, Cold Last

The standard sequence (sauna → cold) is built on several plausible physiological rationales. These are mechanism-level arguments rather than outcomes proven by order-comparison trials:

  1. Vasodilation followed by vasoconstriction: Heat from the sauna opens blood vessels and drives blood to the periphery; the subsequent cold causes vasoconstriction. Alternating hot and cold immersion produces repeated shifts in peripheral blood flow, and this circulatory "pumping" is the mechanism most often proposed for contrast therapy's effects (Mooventhan & Nivethitha, 2014). Whether performing it in this order produces more cardiovascular benefit than the reverse has not been tested.
  2. Noradrenaline response: Cold-water immersion produces a large, measurable rise in plasma noradrenaline — roughly two- to three-fold at 20°C and substantially greater at 14°C — alongside increased alertness (Šrámek et al., 2000). Finishing on the cold exposure means this response is the one you carry out of the session. That the timing can be "optimised" by ordering, however, is an inference, not a measured finding.
  3. Alertness and energy: Ending cold tends to leave people feeling alert and energised, consistent with the catecholamine and subjective-arousal changes recorded after immersion (Šrámek et al., 2000). This is the most defensible practical reason to end cold — and it is a preference-and-feel argument, not a therapeutic claim.
  4. Practicality: Sauna first gets you warm and loose before the demanding part of the session, and the cold is easier to tolerate on a pre-heated body.

An important caveat about "cold reduces inflammation"

Finishing cold is often sold as "capping the session with an anti-inflammatory effect". That framing is not supported by the current evidence and we have removed it from our own advice. A 2025 systematic review and meta-analysis found that cold-water immersion is associated with an acute increase in some inflammatory markers in the hours immediately after immersion, with any reduction appearing only later (Cain et al., 2025). Cold-water immersion does reliably reduce perceived soreness and improve subjective recovery (Bleakley et al., 2012) — but "reduces soreness" and "reduces inflammation" are not the same claim, and only the first is well supported.

There is also a well-documented trade-off. Repeated cold-water immersion performed straight after resistance training attenuates the anabolic signalling and the long-term strength and hypertrophy adaptations from that training (Roberts et al., 2015). If your session follows strength work and your goal is to build muscle, ending cold is the wrong call — and that is one of the clearest order-relevant findings in the literature.

When to Start With Cold

Starting with a cold plunge before the sauna has specific practical applications. These are reasoned uses rather than trial-tested protocols, so treat them as options to experiment with:

  • Morning cold exposure for alertness: Some people prefer cold first for an immediate alerting effect, then sauna for warmth and relaxation. The alerting response to cold immersion itself is documented (Šrámek et al., 2000); the ordering preference is personal.
  • After hypertrophy-focused training: If you want the sauna's heat exposure without blunting the training adaptation, putting the cold first (or leaving it out entirely on strength days) is the more conservative choice given the attenuation findings (Roberts et al., 2015).
  • Evening sessions: Some practitioners end warm and let the body cool passively, on the reasoning that a falling core temperature accompanies sleep onset. We have not been able to source a trial testing contrast-therapy order against sleep outcomes, so we present this only as a plausible rationale and not as an evidence-backed recommendation.

Standard Contrast Therapy Protocol

The protocols below reflect the ranges commonly used in the contrast-therapy and cold-immersion literature (Bieuzen et al., 2013; Higgins et al., 2017). Note that for cold-water immersion specifically, a 2025 network meta-analysis found the recovery benefit clusters around moderate temperatures and moderate durations — colder and longer is not better (Wang, Wang & Pan, 2025).

Recovery Protocol (Post-Exercise)

  1. Sauna: 15–20 minutes at 80–90°C
  2. Cold plunge or cold shower: 2–5 minutes at 10–15°C
  3. Rest: 2–5 minutes
  4. Repeat 2–3 rounds
  5. End cold — unless the session followed strength training and muscle growth is the goal (Roberts et al., 2015)

General Wellness Protocol

  1. Sauna: 15–20 minutes
  2. Cold immersion: 2–5 minutes
  3. Passive rest (room temperature): 5–10 minutes
  4. Optional: repeat 1–2 more rounds
  5. End cold or at room temperature — your preference

What the Research Shows About Contrast Therapy Outcomes

A 2013 systematic review and meta-analysis by Bieuzen, Bleakley and Costello in PLOS ONE found that contrast water therapy was more effective than passive recovery for reducing exercise-induced muscle soreness and strength loss. Two caveats travel with that result, and the authors state both: contrast water therapy showed no clear advantage over cold-water immersion alone, and the included trials were assessed as being at high risk of bias (Bieuzen et al., 2013).

A later systematic review and meta-analysis of team-sport athletes reached a similarly measured conclusion: both cold-water immersion and contrast water therapy showed benefits for recovery markers at some time points, with the effects varying by outcome and timing rather than being uniform (Higgins et al., 2017).

So the honest summary is: contrast therapy beats doing nothing for post-exercise soreness and perceived recovery, it does not clearly beat a plain ice bath, the underlying trial quality is modest, and the order question sits outside what any of these reviews tested. See: Contrast Therapy Explained.

On the heat side, regular sauna bathing has been associated with lower cardiovascular and all-cause mortality in long-term Finnish observational cohort data (Laukkanen et al., 2015), and a systematic review of regular dry sauna bathing reported generally favourable findings alongside a call for better-quality trials (Hussain & Cohen, 2018). These are observational associations, not proof that sauna use causes the outcomes — and they concern sauna use generally, not contrast therapy or its sequencing.

Practical Considerations for Australian Users

  • Allow the sauna to reach full temperature before beginning (20–45 minutes pre-heat for traditional sauna)
  • Have water accessible during and after each round — sauna bathing causes meaningful fluid loss through sweating (Hannuksela & Ellahham, 2001)
  • Keep the transition from sauna to cold reasonably brief. The "under two minutes" figure widely repeated online is practice convention, not a tested threshold — we have not found evidence that a specific transition window changes outcomes
  • A cool shower is a reasonable substitute if a cold plunge is not available
  • Never perform contrast therapy alone. Sudden cold-water immersion triggers the cold-shock response, and simultaneous cold and heat-related autonomic stimulation has been proposed as a mechanism behind some immersion deaths (Shattock & Tipton, 2012; Knechtle et al., 2020)

Frequently Asked Questions

How long between sauna and ice bath?

Most protocols move from sauna to cold within a couple of minutes, and that is a sensible default. Be aware that no study has tested transition time as a variable, so treat any precise number you see quoted — including ours — as convention rather than a proven optimum.

How many rounds of contrast therapy?

Two to three rounds is the range most commonly used in published contrast-therapy protocols (Bieuzen et al., 2013). Whether more rounds add anything has not been established, so there is no reason to push past what feels manageable.

Can you do contrast therapy every day?

Daily heat-and-cold bathing is long-established in Nordic culture, and reviews of regular sauna bathing and of habitual cold-water exposure in healthy adults have not identified daily use as harmful in itself (Hussain & Cohen, 2018; Knechtle et al., 2020; Espeland, de Weerd & Mercer, 2022). That said, the evidence base for daily contrast therapy specifically is thin. Stay well hydrated, and if you are lifting for muscle growth, keep the cold away from the hours right after your strength sessions (Roberts et al., 2015).

Is contrast therapy safe?

For most healthy adults it is generally well tolerated, but it is not risk-free. Both halves of the session produce substantial acute haemodynamic changes, and cold immersion in particular carries the cold-shock response and, in some circumstances, a risk of autonomic conflict (Shattock & Tipton, 2012; Knechtle et al., 2020). Sauna bathing has its own recognised contraindications and cautions (Hannuksela & Ellahham, 2001). If you have a cardiovascular condition, are pregnant, or take medication that affects heart rate or blood pressure, speak with your doctor before starting — and never do it alone.

References

  • Bieuzen F, Bleakley CM, Costello JT (2013). Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis. PLOS ONE. PMID: 23626806
  • Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW (2012). Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews. PMID: 22336838
  • Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B (2025). Effects of cold-water immersion on health and wellbeing: a systematic review and meta-analysis. PLOS ONE. PMID: 39879231
  • Wang H, Wang L, Pan Y (2025). Impact of different doses of cold water immersion (duration and temperature variations) on recovery from acute exercise-induced muscle damage: a network meta-analysis. Frontiers in Physiology. PMID: 40078372
  • Higgins TR, Greene DA, Baker MK (2017). Effects of cold water immersion and contrast water therapy for recovery from team sport: a systematic review and meta-analysis. Journal of Strength and Conditioning Research. PMID: 27398915
  • Hussain J, Cohen M (2018). Clinical effects of regular dry sauna bathing: a systematic review. Evidence-Based Complementary and Alternative Medicine. PMID: 29849692
  • Espeland D, de Weerd L, Mercer JB (2022). Health effects of voluntary exposure to cold water — a continuing subject of debate. International Journal of Circumpolar Health. PMID: 36137565
  • Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, Cameron-Smith D, Coombes JS, Peake JM (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. The Journal of Physiology. PMID: 26174323
  • Laukkanen T, Khan H, Zaccardi F, Laukkanen JA (2015). Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Internal Medicine. PMID: 25705824
  • Šrámek P, Šimečková M, Janský L, Šavlíková J, Vybíral S (2000). Human physiological responses to immersion into water of different temperatures. European Journal of Applied Physiology. PMID: 10751106
  • Shattock MJ, Tipton MJ (2012). 'Autonomic conflict': a different way to die during cold water immersion? The Journal of Physiology. PMID: 22547634
  • Knechtle B, Waśkiewicz Z, Sousa CV, Hill L, Nikolaidis PT (2020). Cold water swimming — benefits and risks: a narrative review. International Journal of Environmental Research and Public Health. PMID: 33276648
  • Hannuksela ML, Ellahham S (2001). Benefits and risks of sauna bathing. The American Journal of Medicine. PMID: 11165553
  • Mooventhan A, Nivethitha L (2014). Scientific evidence-based effects of hydrotherapy on various systems of the body. North American Journal of Medical Sciences. PMID: 24926444

This article is for informational purposes only and does not constitute medical advice.

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