Objective: The aim of this study was to systematically evaluate the differences in efficacy of Cold-Water Immersion (CWI) applied to different body regions for post-exercise muscle damage recovery. Methods: The PRISMA guidelines were followed. Databases including PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to October 20, 2025. Randomized controlled trials (RCTs) comparing single acute CWI with seated passive rest were included. Methodological quality and risk of bias were assessed using the PEDro scale and RoB 2 tool, respectively. Data analysis was performed using Stata-MP 18.0 software. Results: Thirty RCTs were included, and the overall quality was high. The meta-analysis showed that CWI significantly reduced post-exercise CK levels (g = -0.24; 95% CI: -0.37 to -0.10, P < 0.01) and alleviated DOMS (g = -0.40; 95% CI: -0.64 to -0.16, P < 0.01) compared to the control group. However, no statistically significant benefits were observed for the recovery of CMJ (g = -0.02; 95% CI: -0.17 to 0.13, P > 0.05) or MVIC (g = 0.08; 95% CI: -0.08 to 0.23, P > 0.05). Subgroup analysis indicated no significant difference between whole-body and partial immersion at any follow-up time point (0-72 h) (between-group P > 0.05). Notably, a significant inhibitory effect on immediate (0 h) explosive power (CMJ) was shown by partial CWI (g = -0.94, P < 0.01). The primary biochemical and subjective benefits were concentrated at 24 h. Robustness of the main results was confirmed by sensitivity analysis, though potential publication bias was detected for CK. Conclusion: Biochemical (CK) and subjective (DOMS) recovery were effectively improved by CWI. However, muscle strength (MVIC) was not synchronously enhanced, and explosive power (CMJ) was immediately inhibited. The equivalence of therapeutic efficacy between whole-body and partial immersion was confirmed as a core finding. Consequently, partial immersion is considered the optimal strategy combining efficacy and safety. It is suitable for accelerating next-day recovery. However, it should be used with caution during intervals involving continuous explosive power output. Systematic Review Registration: PROSPERO CRD420251171826.
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