Treating injury with cold temperatures is a widely accepted therapy modality in both medicine and rehabilitation. In cryosurgery, for example,
Treating injury with cold temperatures is a widely accepted therapy modality in both medicine and rehabilitation. In cryosurgery, for example, tissue is destroyed by controlled freezing. Cryotherapy has been used in oncology, and the analgesic and anti-inflammatory properties of ice have been explored in rheumatology since 1978. The idea of treating certain ailments with cold is not new—according to a report published in the Journal of the Royal Society of Medicine, the health benefits of cold temperatures have been professed already by the Ancient Egyptians as well as Hippocrates.
Applying an ice-pack on an injured area to reduce swelling and pain is a popular extension of the premise that ice can heal. High-tech versions of cold-temperature treatments have now become widely promoted and are also available in non-medical settings. These treatments range from fatigue therapy to elite beauty treatments. Different types of cryotherapy are attracting people from all walks of life who hope to improve their health and well-being through these methods, as well as those attracted to the purported promise of preserving a youthful appearance.
Cold Water vs. Whole-Body Cryotherapy for Athletes
Whole-body cryotherapy (WBC) uses extreme temperatures to achieve desired health effects that range from managing inflammation and enhancing recovery to revitalizing one’s skin. In a cryotherapy chamber, temperatures can drop to a staggering 250 degrees below Fahrenheit, but generally they are kept at around -150 degrees.
The client engaging in this treatment is exposed for a few minutes, which purportedly suffices for the brain to activate a stimulating reaction (somewhat resembling a fight-or-flight response).
Athletes have been among the users of WBC and this form of therapy has been increasingly recognized by sports and exercise medicine as a method that improves recovery from various muscle injuries.
Although WBC is receiving more scientific attention, controlled studies with athletes are still lacking. It has been noted, however, that extremely cold temperatures can improve subjective recovery and muscle soreness. A randomized controlled trial that compared two different treatment approaches also showed that cryotherapy can help in the rehabilitation of adhesive capsulitis of the shoulder.
Dr. Chris Bleakley, who studies soft tissue injuries at the University of Ulster in Northern Ireland, explains that when an injury happens, healthy cells around the affected area can get starved and damaged, too. The theory behind WBC is that when cell tissue is cooled down, cells demonstrate better coping mechanisms, and have been shown in some cases to have a better chance at survival. However, Dr. Bleakley also warns that these theories do not always translate well into practice. For instance, ice is more effective in athletes who do not have a lot of body fat, and for treating more superficial injuries. Ankle injuries can be treated well with ice, but deep muscle injuries might be more resistant.
According to Bleakley, due to the extreme cooling sensation, the placebo effect might be playing an important role.
All in all, from a scientific perspective, the fact that a method feels good and is popular does not necessarily mean that it is supported by hard evidence. In the Open Access Journal of Sports Medicine, Bleakley and colleagues also conclude that less expensive forms of cryotherapy—such as ice-pack application and cold water-immersion—might have comparable physiological and functional effects to WBC and should not be disregarded. In January this year, another study supported the use of cold water over WBC in injury recovery. The study was published in the journal Medicine and Science in Sports and Exercise and was led by Dr. Chris Mawhinney of the Liverpool John Moores University.
It showed that cold water immersion was more effective in reducing blood flow and temperature compared to cryotherapy in a sample of men post exercise. These recent findings might have implications for future choice of different cooling techniques in sports medicine.
New Cryotherapy Devices with Skin Temperature Sensors
Different cryotherapy units are now commercially available and, when sold explicitly as medical devices, need to be regulated by the Food and Drug Administration (FDA). However, early this year, the FDA announced that, after reviewing the evidence for health benefits of cryotherapy, they cannot promote it as a safe and effective technique. They highlighted several risks, including frostbite, burns, eye injury and suffocation, and advised caution.
The Local Cryo-Stimulation Device (LCSD) is an example of a nitrogen device that is available for purchase. Advertised as the world’s first cryotherapy device that includes a sensor, LCSD is able to measures the user’s skin temperature, which acts as a safety precaution that prevents overcooling and frostbite. After media coverage of one cryotherapy fatality, safety and supervision have been increasingly emphasized. More studies are expected to tackle questions of the efficacy of cryotreatments, as well as critically look into the safety aspects of these evolving therapeutic methods.
New WBC technology that could increase the efficacy and safety of this technique is being developed. For instance, a group of French scientists has been working on a cryotherapy chamber that could help decrease the skin’s temperature in an optimal way, using higher temperatures than classical WBC chambers. Their novel technology is based on forced convection. Experiments showed it can reduce the body’s temperature after a 3-minute exposure to -40 degrees Fahrenheit in the same way as WBC chambers that use significantly lower temperatures. Also, this innovative technology does not use nitrogen, which purportedly makes it safer than current approaches.
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Bleakley CM, Bieuzen F, Davison GW, Costello JT. Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access Journal of Sports Medicine. 2014;5:25-36. doi:10.2147/OAJSM.S41655.
Bouzigon R, Arfaoui A, Grappe F, Ravier G, Jarlot B, Dugue B. Validation of a new whole-body cryotherapy chamber based on forced convection. Journal of Thermal Biology, 2017;65:138-144.
Cooper SM, Dawber RPR. The history of cryosurgery. Journal of the Royal Society of Medicine. 2001;94(4):196-201.
Ma S, Je H, Jeong J, Kim H, Kim H. Effects of Whole-Body Cryotherapy in the Management of Adhesive Capsulitis of the Shoulder. Archives of Physical Medicine & Rehabilitation, 2013;94(1):9-16.
Mawhinney C, Low D, Jones H, Green D, Costello J, Gregson W. Cold-Water Mediates Greater Reductions in Limb Blood Flow than Whole Body Cryotherapy. Medicine and Science In Sports and Exercise [serial online]. January 30, 2017.