Whole- Body Cryotherapy

Cryotherapy:

Written by: Hillary Pham and Jae Chang

Cryotherapy, otherwise known as cold therapy, is a technique that exposes the body to cold temperatures for a period of time. It is similar to the idea of using an ice pack or an ice towel that would be typically used when there is a physical injury or pain to an individual. However, in this case, the cold temperature is exposed to the majority of the body instead. By practicing this method of medicine, the cold helps to reduce the recovery time for sport players as part of the treatment during physical injuries. The theory behind cryotherapy is that its use provides anti-inflammatory and analgesic properties of ice to induce healing. Ultimately, it can help to reduce the pain effectively and rapidly. With the decrease in temperature at the tissue injury sites, it allows for a neuromuscular action causing a relaxation at the muscles. This allows for the pain threshold to increase, but the motor performance and inflammatory reaction to decrease instead during a painful injury. To be more specific, cryotherapy reduces blood flow to the site of injury, downregulate inflammatory and pain inducing prostaglandins, and reduce the nerve ending’s conductivity to pain.

There are two methods that are typically seen with cryotherapy. The first is when an individual is placed inside a chamber standing straight, with the head exposed over the top of the chamber. This allows for the body and chest region of the body to only be exposed to the cold temperatures. On the other hand, the other method is when an individual is placed in a chamber again, but in this method, the entirety of the body is exposed to the cold temperatures, including the head as well. Overall, both methods are similar however, the choice of cryotherapy method is dependent on the request of the individual’s needs.

This cryotherapy method is commonly done to professional athletes for treatment of injuries or trauma. It is commonly practiced in sport medicine today since the cold method appears to be safe and effective by clinical researchers. It is beneficial to individuals with minimal side effects, which is favorable overall. However, it is vital to note that any prolonged exposure than what is recommended by professionals to the low temperatures should be completely avoided. This can cause serious side effects like frostbite and hypothermia, which can cause detrimental nerve injuries to the body.

Aside from cryotherapy being used to treat inflammation and physical injury, cryotherapy is also an available treatment for localized prostate cancer. Although the use of cryotherapy for prostate cancer is still under evaluation, it is still an available option if the patient wants minimally invasive therapy. The procedure involves either freezing the whole prostate gland to perform whole gland therapy or only the cancer or focal therapy. Unfortunately, several studies have concluded with very low quality evidence that whole gland cryotherapy has uncertain effects on cancer outcomes, quality of life, and major adverse events.

Additionally, cryotherapy is often used postoperatively in orthopedics to decrease analgesic use, limit blood loss, and increase range of motion. Ultimately, it is used during surgical recovery. For cryotherapy used postoperatively, the three types used are compressive cryotherapy, continuous flow cryotherapy, and application of ice; these three methods aim to reduce inflammation of the surgical site, reduce pain, and support recovery process. However, whether the use of cryotherapy postoperatively can result in significant improvements in patient outcomes still remain unclear. As with its use to treat athletes in muscle pain, the commonly associated side effects include frostbite, tissue necrosis, compartment syndrome, and perniosis.

Overall, the benefit of cryotherapy remains unclear. While it does seem to have potential results in reducing inflammation and musculoskeletal pain, its use in postoperative settings or for prostate cancer is unclear. Healthcare practitioners must be wary of the potential side effects that may occur from cryotherapy, as it may cause tissue necrosis, hypothermia, and frostbite. Therefore, the use of cryotherapy should be patient specific and should be up to the discretion of the healthcare provider to weigh the pros and cons before recommending it to patients.

References:

Patel, K., Bakshi, N., Freehill, M. T., & Awan, T. M. (2019). Whole-body cryotherapy in sports medicine. Current sports medicine reports, 18(4), 136-140.

Swenson, C., Swärd, L., & Karlsson, J. (1996). Cryotherapy in sports medicine. Scandinavian journal of medicine & science in sports, 6(4), 193-200.

Mercader C, Musquera M, Franco A, Alcaraz A, Ribal MJ. Primary cryotherapy for localized prostate cancer treatment. Aging Male. 2020 Dec;23(5):1460-1466. doi: 10.1080/13685538.2020.1796960. Epub 2020 Nov 16. PMID: 33191831.

Jung JH, Risk MC, Goldfarb R, Reddy B, Coles B, Dahm P. Primary cryotherapy for localised or locally advanced prostate cancer. Cochrane Database Syst Rev. 2018 May 30;5(5):CD005010. doi: 10.1002/14651858.CD005010.pub3. PMID: 29845595; PMCID: PMC6494517.

Cryotherapy has become increasing popular in recent years within sports medicine. Generally, it is the use of extreme cold to freeze and remove abnormal tissue. However, athletes use this method to recover from injuries as well as maintain peak physical health even while on off-season. Commonly used are liquid nitrogen or argon gas. Exposure to cryotherapy mimics exercise since it affects myokines expression in an exercise-like fashion as indicated by source 1, which also discusses relief of inflammation, pain, muscle spasms, and swelling. When it comes to an alternative to surgery, it is minimally invasive and able to remove damaged or diseased without open surgery. Essentially, cells die as temperatures drop. Frozen skin will blister and peel off so that healthy cells can grow instead, and most people recover with little pain as indicated by source 2. We’re still learning about cryotherapy as there is not enough evidence to confirm the long term effects.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411446/

2. https://my.clevelandclinic.org/health/treatments/21099-cryotherapy

3. https://www.ncbi.nlm.nih.gov/books/NBK482319/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956737/

Cryotherapy is a treatment that freezes and destroys tissue using liquid nitrogen, dimethyl ether propane, or carbon dioxide snow. One of the uses of cryotherapy is wart removal. Warts are a common skin disorder caused by human papillomaviruses (HPVs) and are usually benign and disappear without treatment. Patients may seek treatment for wart removal because of their unsightly appearance or pain. There are OTC cryotherapy treatments and also more expensive in-office cryotherapy treatments. In-office cryotherapy typically utilizes liquid nitrogen which freezes tissue to lower temperatures, while OTC cryotherapy contains dimethyl ether and propane which freeze tissue at gentler temperatures. For warts, cryotherapy freezes the wart tissue and the formation of microthrombi leads to local ischemic necrosis and destruction of the HPV-infected keratinocytes. When using OTC cryotherapy, it is applied directly to the wart, taking care to avoid the healthy skin around the wart. A blister will form under the wart, and after about 10 days, the wart should fall off on its own. If using OTC cryotherapy products, they should only be used on warts on the hands or feet, not the face, nails, or genitals. Self-treatment with OTC cryotherapy may be repeated every 2 weeks if the wart is still unresolved, but should not exceed 4 treatments or for longer than 12 weeks without a proper medical evaluation. Aggressive cryotherapy treatment done at a medical provider’s office has been shown to be more effective but has an increased incidence of adverse events such as pain, blistering, and scarring. A systematic review of topical treatments for cutaneous warts shows that there are no significant differences in effectiveness between cryotherapy vs placebo and cryotherapy vs salicylic acid. Only one trial showed cryotherapy to be better than salicylic acid and placebo for hand warts. It is also uncertain whether cryotherapy has any effect on the recurrence of warts after treatment.

References:

1. Loo SK, Tang WY. Warts (non-genital). BMJ Clin Evid. 2014;2014:1710. Published 2014 Jun 12.

2. Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012;(9):CD001781. Published 2012 Sep 12. doi:10.1002/14651858.CD001781.pub3

3. Adkins DM. Chapter 43: Warts. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 19th Edition. Published 2017 Dec 26. doi:10.21019/9781582122656.ch43

Whole body cryotherapy is a new trend that takes the idea of using ice packs to reduce inflammation in a localized area to the next level. Whole body cryotherapy involves a person stepping into a chamber that reaches temperatures ranging between negative 200 to negative 300 degrees Fahrenheit generated by liquid nitrogen for two to four minutes. A person stands in the chamber with minimal clothing which can include socks, gloves, approved underwear and bra, and sometimes protection for their ears, nose, and mouth.

Cryotherapy is advertised on the internet as a potential cure for chronic diseases such as asthma, pain, multiple sclerosis, migraines, rheumatoid arthritis, and more. This type of treatment claims to improve circulation, increase metabolism, improve recovery, and soreness from working out and relieve joint and body pain. Due to the increased interest, the FDA informally reviewed the medical literature available on this trend and found very little evidence about its safety and effectiveness in treating the conditions it is promoted to.

It is not known the effects these drastically cold temperatures can have on a person's blood pressure, heart rate, and metabolism. At this point, there is not enough evidence publicly available to confirm the benefits of cryotherapy. However, the potential risks are clear. The risk of hypoxia from oxygen deficiency, frostbite, burns, and eye injury are all possibilities from the liquid nitrogen used for the cooling of the chambers. A patient should consult their doctor before starting this type of therapy.

In a study done in 2015, 64 physically active predominantly young adults were divided into 2 parallel groups to assess the effects of whole body cryotherapy for preventing and treating muscle soreness after exercise. In conclusion, there was insufficient evidence to determine whether whole body cryotherapy reduces self-reported muscle soreness or improved subjective recovery after exercise. This lack of evidence is important given the potential adverse events from exposure to extremely low temperatures.

In a study done in 2018, 60 patients tried whole body cryotherapy for short term treatment for depression and anxiety. Although the study had several limitations, positive results were seen after patients when through daily whole body cryotherapy treatments for Monday thru Friday for 3 consecutive weeks.

Although there are limited studies on the benefits of whole body cryotherapy, I believe there could be potential benefits for people suffering from ongoing chronic conditions. From my research, there will hopefully be more studies done in the future to further assess the benefits of this type of treatment. I hope as people find out about new trends, similar to this, they do their research to fully understand the potential danger and harm they can cause to their bodies.

References:

Costello JT, Baker PR, Minett GM, Bieuzen F, Stewart IB, Bleakley C. Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database Syst Rev. 2015;(9):CD010789. Published 2015 Sep 18. doi:10.1002/14651858.CD010789.pub2

Rymaszewska J, Ramsey D, Chładzińska-Kiejna S. Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders. Arch Immunol Ther Exp (Warsz). 2008;56(1):63-68. doi:10.1007/s00005-008-0006-5

Whole Body Cryotherapy (WBC): A Trend that Lacks Evidence, Poses Risks. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/whole-body-cryotherapy-wbc-cool-trend-lacks-evidence-poses-risks. Accessed January 15, 2021.

Cryotherapy or cryogenic therapy is a form of treatment that consists of putting the naked body in freezing or near freezing temperatures. Cryotherapy can include smaller scale cryotherapies such as an ice bath or cryotherapy facials, or it could include larger scale whole body cryotherapy which involves sitting or standing in a cryochamber for two to five minutes. During the whole-body cryotherapy process, an individual will expose his or her or her body to liquid nitrogen in subzero temperatures typically between negative 100 and negative 140 Degrees Celsius. Patient are required to wear minimal clothing such as socks, gloves, approved underwear and possibly protection from the ears, nose, and mouth. Whole body cryotherapy is not regulated by the FDA, and has not been approved as a safe, effective treatment for any medical condition yet. However, there are some known health benefits of cryotherapy such as reduced inflammation, pain relief, and muscle recovery.

Whole body cryotherapy could be a potentially quicker solution for pain relief and muscle recovery that would normally require ice packs or ice baths. In a 2014 study, participants had showed that cryotherapy had a small impact on pain relief and muscle recovery compared to cold water immersion or local ice pack application alone. Using cryotherapy can cause blood vessels to constrict which reduces blood flow and alleviates pain, swelling, and inflammation The study revealed that cryotherapy can decrease proinflammatory cytokines, cause adaptive changes in antioxidant status, and have positive effects on the muscular enzymes associated with muscle damage such as creatine kinase and lactate dehydrogenase. There have been certain studies that led to theories of whole-body cryotherapy treating mental health conditions. In a 2008 study, 60 patients used whole body cryotherapy as a short-term treatment for depression and anxiety. These study participants claimed to feel a sense of euphoria upon exiting the cryochamber. The theory that cryotherapy helps with depression and anxiety stems from the fact that when the body experiences extreme cold, even for a short period of time, it sends a message to the endocrine system that the body may be in danger. This triggers the classic fight or flight response, which in turn causes the body to release endorphins and positive hormones. This theory states that cryotherapy acts to jumpstart the production of endorphins in people who traditionally have difficulty with regulating mood.

Even though cryotherapy does contain some positive health benefits in certain populations, individuals with health conditions such as hypertension, heart disease, seizures , and anemia should not use cryotherapy. Whole body cryotherapy can cause adverse side effects such as redness or skin irritation, an allergic reaction to the cold, frostbite, or even skin burns. There were even incidents where individuals exposed themselves for longer than two to three minutes as recommended and died from severe hypothermia. One reliable way to monitor the environment of the cryochamber is to use an oxygen monitor or oxygen deficiency monitor. An oxygen deficiency monitor continuously measures the amount of oxygen in the environment, and sets off an alarm if the oxygen levels fall below a safe level.

Rymaszewska, Joanna et al. “Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders.” Archivum immunologiae et therapiae experimentalis vol. 56,1 (2008): 63-8. doi:10.1007/s00005-008-0006-5

Rose C, Edwards KM, Siegler J, Graham K, Caillaud C. Whole-body Cryotherapy as a Recovery Technique after Exercise: A Review of the Literature. Int J Sports Med. 2017 Dec;38(14):1049-1060. doi: 10.1055/s-0043-114861. Epub 2017 Nov 21. Review. PubMed PMID: 29161748.

Cryotherapy

Cryotherapy is also known as “cold therapy” where the body is exposed to cold temperatures for several minutes. It can be administered through ice packs, ice massage, ice baths, and even probs into the tissue. Some benefits of cryotherapy include:

1. reducing migraine symptoms

2. numbing nerve irritation

3. help treat mood disorders

4. reducing arthritis pain

5. help treat low-risk tumors

6. help prevent dementia and Alzheimer’s disease

7. treat atopic dermatitis and other skin condition

Going into atopic dermatitis specifically, cryotherapy is known to improve antioxidant levels in the blood, so it can reduce inflammation and help treat certain skin conditions.

https://www.healthline.com/health/cryotherapy-benefits#benefits

https://jamanetwork.com/journals/jamadermatology/fullarticle/419737

Cryotherapy has traditionally been applied using ice packs or cold baths. Recently, whole-body cryotherapy has become a popular method of cryotherapy. This involves exposure to extremely cold dry air (usually between −100°C and −140°C) in an environmentally controlled room for short periods of time (typically between 2 and 5 minutes). This therapy was originally developed to treat chronic medical conditions, such as multiple sclerosis and rheumatoid arthritis. However, athletes are now employing this therapy to treat acute sports injuries. The therapy has claimed to decrease tissue temperature, reduce inflammation, analgesia, and enhance recovery following exercise.

A systematic search was conducted to investigate the effect of whole-body cryotherapy on subjects who were injured after exercise. The results show that muscle pain was reduced by 80% of studies following the whole- body cryotherapy. Two applied studies found the recovery of athletic capacity and performance improved, variables of this nature were also improved in 71% of studies using controlled exercise. These results suggest that "whole-body cryotherapy may improve recovery from muscle damage, with multiple exposures more consistently exhibiting improvements in recovery from pain, loss of muscle function, and markers of inflammation and damage".

Bleakley, C. M., Bieuzen, F., Davison, G. W., & Costello, J. T. (2014). Whole-body cryotherapy: empirical evidence and theoretical perspectives.Open access journal of sports medicine,5, 25–36. https://doi.org/10.2147/OAJSM.S41655

Rose C, Edwards KM, Siegler J, Graham K, Caillaud C. Whole-body Cryotherapy as a Recovery Technique after Exercise: A Review of the Literature. Int J Sports Med. 2017 Dec;38(14):1049-1060. doi: 10.1055/s-0043-114861. Epub 2017 Nov 21. Review. PubMed PMID: 29161748.