Diving into the world of science for the first time did not feel much more different than jumping into ice-cold water for the first time. Both experiences are somewhat challenging and at the same time can be life changing for patients and physiotherapists. With this blogpost I would like to share with you all the insights I gained while I was writing my bachelor’s thesis about the effectiveness of traditional Finnish winter swimming on chronic pain as part of my physiotherapy studies at Satakunta University of Applied Science in Finland.

In my Bachelor thesis, I tried to look at the effectiveness of traditional Finnish winter swimming on chronic pain from as many different perspectives as possible. That was when I realized that science is a process that will never end once it is begun. Being scientifically active means to decide that you are willing to research for knowledge, but knowledge is endless. Sometimes we get valuable answers, unexpected, unwanted, more, less, significant, or insignificant answers and sometimes we don’t get answers at all, which is an answer too. Every answer can be knowledge and often results or conclusions are the current status of something rather than the final truth.

Before I continue with the content and outcome of my research, I would like to mention the most relevant statement resulting from my thesis:

Winter swimming can lead to an overall improvement in well-being

This statement broadly indicates the positive potential of bringing blue exercising closer to physiotherapy, but it also made me question what “WELLBEING” means for me. These are some of the personal answers I came up with along the way:

Well-being is not a luxury good, but a valuable treasure.

Well-being is within me, but it is connected to so much on the outside.

Well-being is an adjective, but it is also a verb.

In order, to create well-being, responsibility, awareness, and action are needed,

it needs an appetite for change and commitment,

it needs knowledge and education,

Sandra Hernegger (PT, BSc)

Sandra Hernegger (PT, BSc)

Sandra is an Austrian SPA- and Massage-Therapist, who moved to Finland where she is currently studying physiotherapy and became a winter-swimming instructor. Her strong desire to travel has connected her deeper with natural and alternative treatments. Sandra is constantly evolving her knowledge about human-nature interactions, which she wants to apply into physiotherapy.

it needs collaboration and cohesion in the form of communities, national and international support and regulating, transparent pioneers and policymakers,

it needs sustainable, adaptive behavior,

a balance in giving and taking and

a world in which indigenous, traditional knowledge and life experiences of elders are combined with modern knowledge and both receive recognition.

By choosing well-being, I choose health.

I make decisions not solely for me but for everyone and

on this path I walk hand in hand with many others,

because one alone will probably never reach their goal or is the path itself already the goal because it is also an ongoing process?

And might connectedness to everything be the missing puzzle piece that provide well-being?

I believe, to make well-being accessible to all of us, we should not only be aware of what well-being means to ourselves, but above all, we should communicate our perceptions and knowledge in order to understand our needs and integrate well-being for all of us. Just like our body, that likes to speak and listen to us when there is something important to communicate.

Pain can be a good example for that. Pain is our body´s natural warning signal that enables us to detect harmful stimuli or injuries and allows us to respond to them. The experience of pain is unique, not always dependent on injury and if pain occurs chronically, its causes, treatment solutions and health in general form a complex network of interdependencies, that is difficult to structure and understand as whole. Chronic pain affects approximately 20% of people worldwide. An individual treatment approach, which includes multifactorial treatment components and all aspects of the pain condition, is recommended according to the literature (Pocinki, 2014; Denison et al., 2004).

In my thesis I summarize important physiological and therapeutic information about pain and pain management and explain the positive and negative interaction between environment and health. Furthermore, I inform about the effects and application of winter swimming and water therapy, which is much more a tradition than a trend. The Edwin Smith Papyrus, Hippocrates and popular hydro therapists like Pastor Sebastian Kneipp or Doctor Vincenz Prießnitz already mentioned and emphasized the positive effects of cold water throughout the last centuries (Reger et al., 2022; Wang et al., 2006; Tipton et al., 2017). In Finland and Estonia, the tradition of winter swimming is called “avantouinti” and often connected with the traditional sauna practice, which has been described as a sacred space of nature (Unesco Intangible Cultural Heritage, 2022.)  Many other Northern, Eastern and European countries also engage in winter swimming as a tradition (Knechtle et al., 2020).

The two studies analyzed in the context of the literature review presented relevant data stating that exposure of the body to cold water can lead to pain reduction or better pain tolerance and relieve tension and fatigue in some cases. However, the body reacts sensitively to internal and external factors and cold-water exposure causes individual physiological responses. In general, it can be said that winter swimming can lead to an overall improvement in well-being, can cause an increase in norepinephrine in the blood and so potentially has a positive effect on pain tolerance and perception (Huttunen et al., 2004; Leppäluoto et al. 2007).

From a physiotherapeutic and patient point of view, I believe winter swimming can be wonderfully integrated as a therapeutic method into a treatment plan. As a nonindividual application, it promotes a sense of community and interaction with nature, which requires responsibility for oneself and others, as well as the environment we live in. It trains body awareness, and it makes the therapy approach of going from “supervised towards independent” realizable. Safety forms the foundation of this method and is extensively described in the thesis. I believe that such a time-saving practice, that additionally lends itself to group supervision could be easily integrated into the everyday life of patient and therapist. My thoughts are that if we put “nature and environment” into our physiotherapeutic toolbox, we as therapists, become the medium that make these natural resources accessible for patients. That might optimize the utilization of therapy, which can be described as the readiness of the therapist to respond constructively to whatever exists in the environment (Zeig, 2013).

Working on this thesis encouraged me to take responsibility for my own health and the health of nature, and it showed me how important it is for us health professionals to set a responsible example of what we advise our patients to do.


The full-text thesis can be access via: 

Hernegger, S. (2022). Incorporating traditional Finnish Winter Swimming into Physiotherapy for treating Chronic Pain: a Systematized Literature Review (Bachelor Thesis). Satakunta University of Applied Sciences, Finland.  https://urn.fi/URN:NBN:fi:amk-202304276636


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Stilwell, P., & Harman, K. (2019). An enactive approach to pain: beyond the biopsychosocial model. Phenomenology and the Cognitive Sciences, 18(4), 637–665. https://doi.org/10.1007/s11097-019-09624-7

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Huttunen, P., Kokko, L., & Ylijukuri, V. (2004). Winter swimming improves general well-being. International Journal of Circumpolar Health, 63(2), 140–144. https://doi.org/10.3402/ijch.v63i2.17700 

Knechtle, B., Waśkiewicz, Z., Sousa, C. V., Hill, L., & Nikolaidis, P. T. (2020). Cold Water Swimming-Benefits and Risks: A Narrative Review. International Journal of Environmental Research and Public Health, 17(23). https://doi.org/10.3390/ijerph17238984

Reger, M., Kutschan, S., Freuding, M., Schmidt, T., Josfeld, L., & Huebner, J. (2022). Water therapies (hydrotherapy, balneotherapy or aqua therapy) for patients with cancer: A systematic review. Journal of Cancer Research and Clinical Oncology, 148(6), 1277–1297. https://doi.org/10.1007/s00432-022-03947-w 

Tipton, M. J [M. J.], Collier, N., Massey, H., Corbett, J., & Harper, M. (2017). Cold water immersion: Kill or cure? Experimental Physiology, 102(11), 1335–1355. https://doi.org/10.1113/EP086283 

Wang, H., Olivero, W., Wang, D., & Lanzino, G. (2006). Cold as a therapeutic agent. Acta Neurochirurgica, 148(5), 565-70. https://doi.org/10.1007/s00701-006-0747-z

Leppäluoto, J., Westerlund, T., Huttunen, P., Oksa, J., Smolander, J., Dugué, B., & Mikkelsson, M. (2008). Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females. Scandinavian Journal of Clinical and Laboratory Investigation, 68(2), 145–153. https://doi.org/10.1080/00365510701516350

Pocinki, A. (2014). Breaking the Cycle of Chronic Pain, Poor Sleep, Depression and Fatigue. Bobby Jones Chiari & Syringomyelia Foundation

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