MOD209 – Cryotherapy

Definition

Cryotherapy, derived from the Greek words “cryo” meaning cold and “therapeia” meaning cure, is the therapeutic application of extreme cold temperatures to the body, either locally or systemically. This modality encompasses a range of techniques, from the traditional application of ice packs to advanced whole-body cryotherapy (WBC) chambers that envelop the body in ultra-low temperatures. Cryotherapy is used to treat various conditions, manage pain, reduce inflammation, and promote overall wellness and recovery.

Explanation

Cryotherapy works by exposing the body or specific body parts to very low temperatures, typically ranging from -100°C to -140°C (-148°F to -220°F), for short durations, usually between 2 to 4 minutes. This extreme cold triggers several physiological responses in the body:

1. Vasoconstriction: The cold causes blood vessels to constrict, reducing blood flow to the exposed areas.
2. Vasodilation: After the cold exposure, blood vessels dilate, increasing blood flow and promoting circulation.
3. Analgesic Effect: Cold temperatures can numb nerve endings, providing pain relief.
4. Anti-inflammatory Response: The cold can reduce inflammation by decreasing the release of inflammatory mediators.
5. Metabolic Boost: The body’s attempt to rewarm itself can increase calorie burn and metabolic rate.
6. Endorphin Release: The shock of cold can trigger the release of endorphins, potentially improving mood and energy levels.

Cryotherapy can be applied in several ways:

• Localised Cryotherapy: This involves applying cold to specific areas of the body using ice packs, cold sprays, or specialised devices that deliver targeted cold therapy.
• Whole-Body Cryotherapy (WBC): The individual stands in a cryochamber or cryosauna that exposes the entire body (except the head) to extremely cold air.
• Partial-Body Cryotherapy: Similar to WBC, but the head and neck are not exposed to the cold air.
• Cryosurgery: A medical procedure where extreme cold is used to destroy abnormal tissue, such as warts or certain types of cancer.

The underlying principle of cryotherapy is that controlled exposure to extreme cold can stimulate the body’s natural healing processes, reduce pain and inflammation, and promote overall wellness. The rapid cooling and subsequent rewarming are thought to trigger various physiological responses that can benefit health and recovery.

Cryotherapy sessions are typically brief due to the extreme temperatures involved. For WBC, sessions usually last between 2 to 4 minutes, while localised treatments may last longer, often following a protocol of 20 minutes on, 20 minutes off.

It’s important to note that while cryotherapy has gained popularity, particularly in sports medicine and wellness circles, its use should be approached with caution. Proper training, equipment, and safety protocols are essential to prevent adverse effects such as frostbite or cold burns.

Wim Hof Method Comparison:

The Wim Hof Method, pioneered by Wim Hof (nicknamed “The Iceman”), combines cold exposure with specific breathing techniques and meditation practices. While Cryotherapy primarily focuses on the physical benefits of brief, intense cold exposure in a controlled environment, the Wim Hof Method takes a more holistic approach. It integrates controlled breathing exercises and mental focus techniques to enhance the effects of cold exposure, potentially offering broader physiological and psychological benefits beyond what Cryotherapy alone might provide.

CWI Comparison:

Cold Water Immersion (CWI), a practice involving submersion in cold water, shares similarities with Cryotherapy in its use of cold as a therapeutic tool. However, CWI typically involves longer exposure times and full-body immersion, often in natural settings like lakes or the sea. In contrast, Cryotherapy uses extremely cold air in a specialised chamber for shorter durations, usually 2-4 minutes. While both methods aim to reduce inflammation and promote recovery, CWI may offer additional benefits such as improved cardiovascular function due to the hydrostatic pressure of water immersion, which is absent in Cryotherapy.

Evidence to Efficacy

There is evidence regarding the efficacy of cryotherapy, particularly whole-body cryotherapy (WBC). Which presents a complex picture with some studies showing positive effects, while others indicate limited impacts.

Pain Management and Recovery: A systematic review by Bleakley et al. (2014) in the British Journal of Sports Medicine found insufficient evidence to determine whether WBC reduces self-reported muscle soreness or improves subjective recovery after exercise compared with passive rest or no intervention.

Physiological Effects: Banfi et al. (2010) observed that WBC modifies many important biochemical and physiological parameters in human athletes, including a decrease in proinflammatory cytokines, adaptive changes in antioxidant status, and positive effects on muscular enzymes associated with muscle damage

Chronic Pain Conditions: A narrative review by Bouzigon et al. (2020) in the journal “Pain and Therapy” found that both local and non-local cryotherapy applications show promise in reducing chronic pain associated with various chronic diseases, particularly those of rheumatic and degenerative origin.

Post-Operative Recovery: A randomised clinical trial by Adie et al. (2012) involving 133 total knee replacement patients found that immediate cryotherapy led to significantly less post-operative pain at 3 days compared to no cryotherapy or delayed cryotherapy. The study also reported improvements in knee swelling, range of motion, and functional recovery in the cryotherapy groups.

Mental Health: A systematic review and meta-analysis by Rymaszewska et al. (2021) published in Complementary Therapies in Medicine found that WBC may have potential benefits for mental health. Compared to control groups, those treated with cold therapy showed improved quality of life and reduced symptoms of depression.

In conclusion, while there is evidence supporting the efficacy of cryotherapy for certain conditions, particularly in pain management and post-exercise recovery. The current evidence suggests that cryotherapy can be a useful adjunct therapy.

The Neuroscience

Cryotherapy influences various physiological systems through exposure to extreme cold temperatures. The following mechanisms explain its effects:

Vasoconstriction and Vasodilation: Cold exposure causes initial vasoconstriction followed by vasodilation upon rewarming, improving circulation and potentially reducing inflammation.

Analgesic Effect: Extreme cold slows nerve conduction velocity, reducing pain signal transmission and increasing pain threshold.

Endorphin Release: Cold stress triggers the release of endorphins and norepinephrine, potentially improving mood and pain tolerance.

Inflammatory Response Modulation: Cryotherapy alters the inflammatory cascade, reducing the release of inflammatory mediators and potentially decreasing swelling.

Metabolic Rate Increase: The body’s effort to maintain core temperature in response to cold increases calorie expenditure and potentially boosts metabolism.

Autonomic Nervous System Activation: Cold exposure stimulates the sympathetic nervous system, potentially improving alertness and energy levels.

Oxidative Stress Reduction: Cryotherapy influences the balance of oxidants and antioxidants in the body, potentially reducing oxidative stress.

Mitochondrial Function: Cold exposure stimulates mitochondrial biogenesis and enhances mitochondrial function, potentially improving cellular energy production.

Hormonal Changes: Cryotherapy influences the release of various hormones, including cortisol and testosterone, potentially affecting stress response and recovery.

Brown Adipose Tissue Activation: Extreme cold activates brown fat, increasing thermogenesis and potentially influencing body composition.

These mechanisms provide a framework for understanding how cryotherapy influences human physiology. They draw from various fields including thermophysiology, neurobiology, and endocrinology, offering explanations for the effects of the practice.

Governing Body

There is no specific governing body for cryotherapy in the UK. However, several organisations provide guidance and training:

The Chartered Society of Physiotherapy (CSP) Offers guidelines on the use of cryotherapy in physiotherapy practice.

The International Institute of Cryotherapy (IIC)  Offers training and certification in whole-body cryotherapy.

What Good Looks Like

When you experience a good Cryotherapy session, you’ll notice several key elements that set it apart:

• As you enter the cryotherapy chamber or cryosauna, you’ll feel a sudden blast of extremely cold air, typically between -100°C and -160°C (-148°F to -256°F).
• You’ll be wearing minimal clothing, such as shorts for men or shorts and a sports bra for women, along with protective gear like gloves, socks, and ear coverings to safeguard your extremities.
• The session will be brief, typically lasting between 2 to 4 minutes, which is sufficient to trigger the desired physiological responses without causing harm.
• During the session, you’ll feel an intense cold sensation across your skin, often accompanied by a tingling or numbing feeling.
• You might notice your breathing becoming more rapid initially, but you’ll be encouraged to take slow, deep breaths to help manage the cold shock.
• Throughout the session, you’ll maintain verbal communication with the technician outside the chamber, ensuring your safety and comfort.
• As the session progresses, you may experience a rush of adrenaline and endorphins, often described as an invigorating or euphoric sensation.
• Upon exiting the chamber, you’ll feel an immediate warming sensation as your body begins to return to normal temperature.
• After the session, you’ll likely notice increased energy levels, reduced muscle soreness (if you had any), and a general sense of well-being.
• You may be offered a brief period on a vibration plate or in an infrared sauna to enhance circulation and continue the warming process.

Remember, a good Cryotherapy experience leaves you feeling energized, refreshed, and with a sense of physical rejuvenation, often with noticeable reductions in pain or inflammation if those were present before the session.

What to Ask a Practitioner

What type of cryotherapy equipment do you use, and why did you choose this particular system?

Desired answer: They should be able to explain the specific type of cryotherapy system (e.g., whole-body cryochamber, localized cryotherapy device) and its advantages in terms of safety, effectiveness, and client comfort.

How do you determine the appropriate treatment protocol for each client?

Desired answer: The practitioner should describe a personalized approach, considering factors like the client’s health status, fitness level, treatment goals, and any contraindications.

What safety measures do you have in place during cryotherapy sessions?

Desired answer: They should detail specific safety protocols, including constant monitoring, emergency procedures, and protective equipment provided to clients.

What kind of results can I expect, and how long might it take to see these results?

Desired answer: They should provide realistic expectations based on your specific goals, emphasizing that results can vary and may require multiple sessions.

Are there any potential side effects or risks I should be aware of?

Desired answer: The practitioner should be transparent about possible side effects (e.g., temporary skin redness, tingling sensation) and any rare but serious risks.

How do you stay updated on the latest research and developments in cryotherapy?

Desired answer: They should mention ongoing education, attendance at conferences, or membership in professional organizations related to cryotherapy or sports medicine.

Self Study Resources

If a practitioner is not needed (e.g., for at-home cold therapy practices), here are some reliable resources:

The Cold Plunge Cryotherapy Book by  Hunter Hazelton

What Doesn’t Kill Us by Scott Carney – a book exploring the science behind cold exposure

CryoPlanet – a reputable supplier of at-home cryotherapy devices with educational resources

The American Cryotherapy Association for general information and safety guidelines

Remember, while at-home cold therapy can be beneficial, whole-body cryotherapy should only be performed under professional supervision due to the extreme temperatures involved.

Related Therapies:

Cold Water Immersion (MOD031): The practice of immersing the body in cold water to stimulate physical and mental health benefits.

Heat Therapy (MOD210): Use of heat to treat muscles, joints, and tissues to increase blood flow, reduce pain, and improve flexibility.

Massage Therapy (MOD097): This hands-on therapy involves manipulating the body’s soft tissues to relieve tension, reduce pain, and promote relaxation. It can enhance the effects of Reiki by addressing physical discomfort and improving circulation.

Acupuncture (MOD007): A traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to balance energy flow (Qi) and promote healing. Acupuncture can complement Reiki by addressing energetic blockages.

Physiotherapy (MOD207): A healthcare profession that assesses, diagnoses, treats, and works to prevent disease and disability through physical means, using evidence-based techniques to promote movement, reduce pain, restore function, and prevent disability.

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