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Understanding cryotherapy
How cryotherapy works at the cellular and physiological levels
Benefits of cryotherapy
The scientific verdict: What the research says
Risks and precautions
The future of cryotherapy in medical practice
References
Further reading
Cold has been used to treat illnesses since at least 450 BC when Hippocrates advised packing wounded soldiers in ice to delay death. In the s, wounded soldiers were cooled to promote recovery by reducing pain and bleeding.
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Later, people realized that cold-water drowning victims appeared to escape the effects of prolonged asphyxia. Therapeutic hypothermia was then used in various surgical procedures to avert hypoxia-related injury. This led to the current revival of interest in cryotherapy.
Cryotherapy is defined as the superficial application of cold to the body for therapeutic purposes. It leads to reduced core and tissue temperatures.
Cryotherapy may be local or systemic. Local cryotherapy (LC) employs ice compresses or ice massages as well as phase-change materials (PCM) and cryo-compression devices. Systemic cryotherapy may use immersion in cold and icy water (cold-water immersion, CWI) and convective cryotherapy, either whole-body or partial-body cryotherapy (WBC or PBC, respectively).
Both WBC and PBC involve standing fully within, or with the head and neck outside, respectively, a very cold chamber cooled by liquid nitrogen or cold air for 2-4 minutes, with minimal clothing.
Cryotherapy is linked to pain relief and functional improvement. The primary mechanism is by reducing sensory nerve transmission at the site, while the peripheral vasoconstriction slows down the metabolic rate in the tissues involved. By reducing oxidative stress, it reduces secondary ischemic injury and alleviates inflammation.
Cold-induced parasympathetic activation enhances long-term muscle recovery and improves sleep quality. Cryotherapy after strenuous exercise also relieves exercise-induced hyperthermia, thus reducing brain-mediated fatigue and cardiovascular strain.
Finally, PBC attracts more lymphocytes into the bloodstream and the injured tissues, promoting cell repair. Though often quoted, there is no evidence for a wash-out of inflammatory chemicals by vasodilation.
Cryotherapy proponents claim that 'the repeated shock-like cryogenic cold stimulus over the entire body surface induces reactions in the autonomic, endocrine, circulatory, neuromuscular and immunological systems, resulting in an adaptation that contributes to the restoration of the homeostatic state.'
Below are some of the potential benefits of cryotherapy:
A review of studies between and shows much promise for cryotherapy in pain relief. WBC is effective in inflammatory conditions like RA (80% of Dr. Yamaguchi's RA patients found full relief). LC or WBC/PBC are both useful in degenerative painful conditions like osteoarthritis.
Cryotherapy significantly improves post-exercise muscle soreness and fatigue and speeds up muscle recovery compared to other methods, including contrast or warm-water therapy, especially for endurance or intermittent training.
Some evidence suggests that WBC promotes persistent symptom relief and skin healing in atopic dermatitis.
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Cryotherapy appears to increase total antioxidant activity and normalize inflammatory markers, making it a potential adjunct in weight loss therapy.
Small studies suggest potential benefits from WBC 'as a short-term adjuvant therapy for depressive and anxious patients.'
There is little evidence beyond anecdotes for the use of cryotherapy as a cosmetic treatment, though it may ease the redness, bleeding, and pain associated with skin-ablative procedures.
With millions of cryotherapy sessions occurring worldwide each year, very few serious adverse reactions have been reported. Potential risks include frostbite, panniculitis after prolonged exposure, cold urticaria, bradycardia, nerve injuries, and transient reduction in muscle function due to the cooling. For properly screened patients, cryotherapy is likely to be safe with few and mild adverse effects.
With WBC, hypoxia, and suffocation may potentially occur due to the partial replacement of oxygen by nitrogen for cooling.
Cryotherapy patients must be screened for conditions like cryoglobulinemia and peripheral vascular conditions, including Raynaud's disease, to avoid thrombotic events. Pregnancy, cardiovascular risk factors, nerve damage and cold allergy, and peripheral numbness or open injuries contraindicate cryotherapy.
A rest period is mandatory to allow muscle and nerve function to recover before active or complex exercise.
Most cryotherapy centers being unregulated, protocols must be in place to ensure targeted physiological changes occur, detecting hypothermia and preventing prolonged cold exposure. Qualified attendance is mandatory for WBC/PBC, as well as hand/foot protection and active finger/toe movement.
Newer cryotherapy devices in use include cryo-compression devices to cool and compress injured areas for long periods, providing pain relief. These were first used after major joint surgery like knee replacement or spine surgery. They may not help restore muscle strength.
These use PCMs that change phase at specified temperatures with large latent heat. They may speed up muscle strength recovery and relieve soreness.
Future research should examine the use of various cryotherapy methods and media based on relative heat transfer and cooling efficiencies, as well as the area exposed, duration of cooling, and timing after acute injury.
Other applications of cryotherapy remain experimental at present. Large, well-designed trials are essential in this area.
While the place of cryotherapy in post-exercise soreness and muscle recovery seems evidence-based, 'Long-term effects, a standardized approach, and careful study of other chronic pain syndromes should be considered in future research to further support the use of cryotherapy in the management of chronic pain.'
Supervised cryotherapy may help selected patients with chronic musculoskeletal pain, obesity, or mood disorders as an adjunct to lifestyle modifications, moderate regular exercise, stress relief, and social support networks.
[Futher reading: Hypoxia]
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Doctors routinely use extremely cold temperatures to freeze off skin tags and warts and remove abnormal tissue and cancerous cells in certain types of cancers and low-risk tumors. This treatment is called cryotherapy and is performed using liquid nitrogen or argon gas. At home, it's common to use ice packs to treat pain, swelling, and inflammation. An ice pack can also be used to control minor bleeding.
More recently, a therapy called whole-body cryotherapy has gained popularity. This is a non-medical treatment usually offered in spas and wellness centers and involves subjecting the entire body to extreme temperatures.
Please continue reading to learn what happens during whole-body cryotherapy sessions and the health benefits of this treatment.
What is whole-body cryotherapy?
Whole body cryotherapy (WBC) is a treatment in which you sit in a cryogenic chamber or booth for 3-5 minutes to subject your body to extremely low temperatures ranging from -165F to -220F (-110C to -140C). You typically wear underwear and sit in the cold chamber for several minutes. Other versions of cold therapy include cold water immersion in an ice bath or localized cryotherapy using a wand to expose target areas such as painful joints to very cold temperatures.
How effective is full-body cryotherapy?
Some people believe whole body cryotherapy (WBC) treatment stimulates the body's natural healing abilities. However, many of the potential health benefits of cryotherapy treatment are not yet proven. More research is needed to answer the question: Is whole-body cryotherapy effective?
Nonetheless, the treatment is a minimally invasive procedure and is generally considered safe as an adjunct treatment when performed by trained providers. It may be an effective alternative treatment for a range of health conditions. It is important, however, to undergo cryotherapy under the supervision of experienced providers because it poses risks that can be life-threatening.
What are the long-term benefits of whole-body cryotherapy?
Provide pain relief
Sports medicine studies have shown that whole-body cryotherapy can help speed up muscle recovery from muscle damage due to intense exercise. It can, therefore, potentially enhance exercise performance in athletes. However, there is only anecdotal evidence of this being true. For example, one small study found that cold water immersion was more effective than whole-body cryotherapy in reducing muscle soreness.
Cryotherapy has also been found to relieve chronic pain caused by fibromyalgia, osteoarthritis, rheumatoid arthritis, chronic low back pain, ankylosing spondylitis, and certain autoimmune diseases. However, the treatment can only reduce pain for about 90 minutes. A study found there was no significant change in pain levels after 4 weeks of cryotherapy treatments. However, because localized cryotherapy reduces pain for a short time, this short-term pain relief can be used to encourage more intense participation in physical and occupational therapy by people with joint and muscle pain.
Reduce inflammation
Inflammation is a way for the body's immune system to respond to injury or fight infections. Inflammatory processes are believed to play a role in many diseases, including cancer, diabetes, and dementia. A study in rats showed that cryotherapy is useful in reducing inflammation, but it does not enhance muscle repair. It is unclear if these possible benefits are present in humans, and more research is needed.
Improve atopic dermatitis
Exposure to very cold temperatures can reportedly increase the body's anti-oxidative response. People who swim regularly in cold water have been found to have higher levels of anti-inflammatory cytokines in their bodies. One study found that people with moderate atopic dermatitis (eczema) who received whole-body cryotherapy three times a week for 4 weeks had an improvement in symptoms. Interestingly, women reported more benefits than men.
Treat migraine headaches
Migraine headaches occur when there is a narrowing of blood vessels in the skull. A small study found that localized cryotherapy to the neck region with a wrap can help these blood vessels expand and reduce migraine pain for 30 minutes but not completely eliminate it. Three-fourths of the participants in the study felt the treatment helped them.
Aid weight loss
Whole-body cryotherapy may help with weight loss because the cold temperatures increase metabolism and force the body to work harder to stay warm. However, one study found that 10 cryotherapy sessions made no significant difference in weight, fat mass, lean mass, or water weight. It is, therefore, unlikely that ice baths alone can help you lose weight.
Reduce anxiety and depression
Small studies have shown that whole-body cryotherapy treatments for 3 weeks can reduce anxiety and depression symptoms by 50%. However, further research and larger studies are needed to study the effects of cryotherapy on anxiety disorders and mood disorders.
Prevent dementia
Changes in circulation, oxidative stress, and inflammatory responses contribute to the development of dementias, including Alzheimer's disease. Since cryotherapy has anti-inflammatory and anti-oxidative effects, it is possible that whole-body cryotherapy may help in preventing age-related cognitive decline. However, this has not been proven.
Prevent and treat cancer
Medical cryotherapy procedures are used to freeze off cancer cells and abnormal tissue, both internally and externally. Given that cryotherapy has anti-inflammatory effects, it may play a role in preventing and treating cancer, but again, this is unproven.
What are the negative effects of whole-body cryotherapy?
Whole-body cryotherapy is not FDA-approved to treat any medical conditions, including pain, stress, anxiety, migraines, rheumatoid arthritis, fibromyalgia, Alzheimer's disease, or multiple sclerosis. This treatment lacks evidence and should be undertaken with caution.
Possible risks of whole-body cryotherapy include asphyxiation (lack of oxygen), especially when liquid nitrogen is used to achieve extremely low temperatures. The presence of nitrogen vapors in a closed room can lower oxygen levels and result in oxygen deficiency. This can lead to a loss of consciousness and even death. Other risks include frostbite and eye injuries from the extreme cold.
Who should not do whole-body cryotherapy?
Children, pregnant women, and people with high blood pressure, heart conditions, blood circulation problems, uncontrolled asthma, or health conditions like cold urticaria should not try cryotherapy techniques. In people with cardiovascular conditions, the cold temperature can make the blood vessels narrow and increase blood pressure. In skin conditions like cold urticaria, a reaction can develop within minutes of exposure to cold temperature. If someone has peripheral neuropathy, exposure to ice crystals can potentially cause further nerve damage.
Do not get carried away by medical spas advertising the benefits of cryotherapy. Always check with your healthcare provider before undergoing whole-body cryotherapy at a medical spa or wellness center.
References:
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