The following cryotherapy research studies provide scientific information about the benefits and effects of cryothearpy for a variety of applications from athletic recovery, to treatment of depressive disorders, and therapeutic relief for patients with multiple sclerosis as well as rheumatoid arthritis.
Cryotherapy: Physiological Considerations and Applications to Physical Therapy
Whole-body cryostimulation is a factor that can influence many physiological and biochemical indicators in the human body. Triggering physiological defensive mechanisms in response to a repeated external stressor (cold) may be widely used in medicine, physiotherapy, sport and athlete recovery. However, it is important to select an appropriate duration, form and number of cryostimulations, according to the needs of each patient. The aforementioned literature data very often relates to different procedures and methodologies. Hence the results are often inconsistent and do not always give a clear view of the discussed problem. It is hard to conclude on the real effectiveness of cryostimulation when it is accompanied by daily physical training which is in itself a stressogenic factor for the human body. In order to achieve a precisely determined effect of cryostimulation on athletes or patients, one should use appropriate methods. In addition, there exists the problem of immersion in cold water which is accompanied by another stressor – i.e. hydrostatic pressure, depending on the depth of immersion. There exists no single agreed recommendation concerning the number of cryostimulations in a series. Usually, 10 daily sessions are applied, although this is less related to therapeutic reasons than economic ones. It is also not widely agreed how many cryostimulations give real and sustained beneficial effects and whether the adaptive changes in subjects depend on the number of sessions, although this correlation seems very likely. Because the interest in using cold temperatures in medicine, physiotherapy, sport and athlete recovery is constantly growing, and knowledge in this field is still far from satisfactory, any new research on the use of cryogenic temperatures is a welcome and precious source of information from the point of view of physiotherapeutic practice.
Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy.
Among the physical treatments to reduce pain, ice has had its place for many years. Experience tells us that ice has a strong short-term analgesic effect in many painful conditions, particularly those related to the musculoskeletal system. Serial applications may also be helpful. The scientific evidence from clinical trials is, however, fragmental. This applies both for acute and serial cold-induced analgesia. The mechanisms by which cryotherapy might elevate pain threshold include an antinociceptive effect on the gate control system, a decrease in nerve conduction, reduction. in muscle spasms, and prevention of edema after injury. It is concluded that ice may be useful for a variety of musculoskeletal pains, yet the evidence for its efficacy should be established more convincingly. J Pain Symptom Manage 1994;9:56-59.
Thermal, circulatory, and neuromuscular responses to whole-body cryotherapy
The purpose of this study was to examine thermal (body temperature, thermal sensation and comfort ratings), circulatory (blood pressure, heart rate variability) and neuromuscular performance responses to whole-body cryotherapy (WBC, -110 °C). Altogether 66 healthy subjects were exposed to WBC for two minutes. The acute and long-term changes were examined, when the subjects were exposed to WBC three times a week during three months. Skin temperatures decreased very rapidly during WBC, but remained such a high level that there was no risk for frostbites. The effects on rectal temperature were minimal. Repeated exposures to WBC were mostly well tolerated and comfortable and the subjects became habituated at an early stage of trials. WBC increased both systolic (24 mmHg) and diastolic (5 mmHg) blood pressures temporarily. Adaptation of blood pressure was not found during three months. The acute cooling-related increase in high-frequency power of RR-intervals indicated an increase in cardiac parasympathetic modulation, but after repeated WBC the increase was attenuated. The repeated WBC exposure-related increase in resting low frequency power of RR-intervals resembles the response observed related to exercise training. There are signs of neuromuscular adaptation, especially in dynamic performance. A single WBC decreased flight time in drop-jump exercise, but after repeated WBC these changes were almost vanished. This adaptation was confirmed by the change of the activity of the agonist muscle, which increased more and the change of the activity of antagonist muscle, which increased less/did not change after repeated WBC indicating reduced co-contraction and thus, neuromuscular adaptation.
Effect of short-term cryostimulation on antioxidative status and its clinical applications in humans.
Whole body cryostimulation (WBCT) is becoming popular in medicine and sport as an adjuvant form of treatment since late 1970s. Only a few works concerning antioxidant protection after WBCT have been published. The aim of this study was to determine the eVect of a ten 3-min-long exposures (one exposure per day) to cryo- genic temperature (-130°C) on the level of total antioxidant status (TAS), activity of selected antioxidant enzyme superoxide dismutase (SOD) and main non-enzymatic anti- oxidant—uric acid (UA) in WBCT study group (man n = 24; female n = 22) and non-WBCT control subjects (man n = 22; female n = 26). Moreover, we evaluated the lipid peroxidation measured as thiobarbituric acid reactive substances products. Their blood samples were collected twice at an interval of 10 days in both study group and control subjects. The activity of antioxidant enzyme and lipid peroxidation was assayed in erythrocytes, while the con- centration of uric acid was measured in plasma. After completing a total of ten WBCT sessions a signifcant increase (p < 0.001) of TAS and UA levels in plasma (p < 0.001) in comparison to non-WBCT was observed. Our data showed that there was statistically signiWcant increase of the activities of SOD in erythrocytes obtained from WBCT study group compared to non-WBCT controls after 10 days of treatment (p < 0.001). It was concluded that expositions to extremely low temperatures use in cryostimulation improve the antioxidant capacity of organism.
Impact of 10 Sessions of Whole Body Cryostimulation on Cutaneous Microcirculation Measured by Laser Doppler Flowmetry
The aim of the present study was to evaluate the basic and evoked blood flow in the skin microcirculation of the hand, one day and ten days after a series of 10 whole body cryostimulation sessions, in healthy individuals. The study group included 32 volunteers – 16 women and 16 men. The volunteers underwent 10 sessions of cryotherapy in a cryogenic chamber. The variables were recorded before the series of 10 whole body cryostimulation sessions (first measurement), one day after the last session (second measurement) and ten days later (third measurement). Rest flow, postocclusive hyperaemic reaction, reaction to temperature and arterio–venous reflex index were evaluated by laser Doppler flowmetry. The values recorded for rest flow, a post-occlusive hyperaemic reaction, a reaction to temperature and arteriovenous reflex index were significantly higher both in the second and third measurement compared to the initial one. Differences were recorded both in men and women. The values of frequency in the range of 0,01 Hz to 2 Hz (heart frequency dependent) were significantly lower after whole-body cryostimulation in both men and women. In the range of myogenic frequency significantly higher values were recorded in the second and third measurement compared to the first one. Recorded data suggest improved response of the cutaneous microcirculation to applied stimuli in both women and men. Positive effects of cryostimulation persist in the tested group for 10 consecutive days.
Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi-Exposures following Severe Exercise
The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n=11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-a), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p,0.05). Indeed, IL-1b (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p,0.05), TNF-a, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.
The influence of single whole-body cryostimulation treatment on the dynamics and the level of maximal anaerobic power
Objectives: The objective of this work was to determine the dynamics of maximal anaerobic power (MAP) of the lower limbs, following a single whole body cryostimulation treatment (WBC), in relation to the temperature of thigh muscles. Materials and Methods: The subjects included 15 men and 15 women with an average age (±SD) of 21.6±1.2 years. To evaluate the level of anaerobic power, the Wingate test was applied. The subjects were submitted to 6 WBC treatments at –130°C once a day. After each session they performed a single Wingate test in the 15, 30, 45, 60, 75 and 90th min after leaving the cryogenic chamber. The order of the test was randomized. All Wingate tests were preceded by an evaluation of thigh surface temperature with the use of a thermovisual camera. Results: The average thigh surface temperature (Tav) in both men and women dropped significantly after the whole body cryostimulation treatment, and next increased gradually. In women Tav remained decreased for 75 min, whereas in men it did not return to the basal level until 90th min. A statistically insignificant decrease in MAP was observed in women after WBC. On the contrary, a non-significant increase in MAP was observed in men. The course of changes in MAP following the treatment was similar in both sexes to the changes in thigh surface temperature, with the exception of the period between 15th and 30th min. The shorter time to obtain MAP was observed in women till 90th min and in men till 45 min after WBC compared to the initial level. Conclusions: A single whole body cryostimulation may have a minor influence on short-term physical performance of supra maximal intensity, but it leads to improvement of velocity during the start as evidenced by shorter time required to obtain MAP.
Improvement of Motor Skills
Motor activities and physical efficiency Research by Łuczak, carried out on a large group of athletes (300 people), was meant to find an optimal operating temperature during the whole-body cryostimulation for the improvement of motor skills. The effects of exposure were compared between two 10 minute whole-body cryostimulations (at -100°C, -130°C and -160°C) and physical efficiency, based on an assessment of agility, balance, speed and dynamic strength of abdominal muscles.The analysis of the results showed no effect of cryostimulation on the level of agility. Balance improved significantly in groups exposed to temperatures below -100°C, while no significant effects were observed for -100°C. Parameters evaluating speed and dynamic strength of abdominal muscles improved most after the application of -100°C. It was proposed that whole body cryotherapy exerts positive effects on human motor characteristics, although the lowest cryogenic temperatures should be used in only specific cases [Łuczak et al. 2006]. Subsequent studies showed that a series of 20 stimulations with an average temperature -130°C performed on martial arts competitors, resulted in an extended duration of exercise and lower subjective feeling of fatigue at increasing mean speed and angle of treadmill inclination during an exercise according to the Bruce protocol [Hagner et al. 2009]. A recent study on the effects of whole-body cryostimulation on aerobic and anaerobic capacities showed that three 10 minute sessions (average temperature -130°C) increased maximal anaerobic power in males but not in females, and did not influence aerobic capacity in either gender [Klimek et al. 2011]. There are also reports of improved exercise tolerance, expressed by a lower level of lactates, heart rate and increased threshold capacity during a rowing ergometer test by Olympic team athletes (rowers) after 23 cryostimulation sessions (3-minutes at a temperature of -150°C, 2 x day) [Chwalbińska- Moneta 2003].
Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders.
Introduction: Rheumatism has been treated using whole-body cryotherapy (WBCT) since the 1970s. The aim of this study was to assess the efficacy of WBCT as an experimental, adjunctive method of treating depressive and anxiety disorders. Materials and Methods: A control (n=34) and a study group (n=26), both consisting of outpatients 18–65 years old with depressive and anxiety disorders (ICD-10), received standard psychopharmacotherapy. The study group was additionally treated with a series of 15 daily visits to a cryogenic chamber (2–3 min, from –160°C to –110°C). The Hamilton’s depression rating scale (HDRS) and Hamilton’s anxiety rating scale (HARS) were used as the outcome measures. Results: After three weeks, a decrease of at least 50% from the baseline HDRS-17 scores in 34.6% of the study group and 2.9% of the control group and a decrease of at least 50% from the baseline HARS score in 46.2% of the study group and in none of the control group were noted. Conclusions: These findings, despite such limitations as a small sample size, suggest a possible role for WBCT as a short-term adjuvant treatment for mood and anxiety disorders.
Translating whole-body cryotherapy into geriatric psychiatry – A proposed strategy for the prevention of Alzheimer’s disease
Alzheimer’s disease (AD), which is the most common form of dementia, constitutes one of the leading causes of disability and mortality in aging societies. Currently recommended medications used in treating AD include cholinesterase inhibitors and the NMDA antagonist – memantine, but poorly counteract progression of the disease. According to current knowledge, the neuropathological process underlying the etiology of AD begins many years, if not decades, before the development of overt symptoms of dementia. Mild cognitive impairment (MCI) is regarded as the first detectable manifestation of cognitive decline. Nowadays, there is a general consensus that vascular alterations, oxidative stress and inflammatory response contribute to the development of AD. Following these mechanisms and tracing the anti-inflammatory and anti-oxidative effects of cryostimulation, we postulate that whole-body cryotherapy (WBCT) might be utilized as a means of preventing AD. WBCT is a relatively safe and cost-effective procedure, which is widely applied in various medical specialties. Thus, there is an urgent necessity to evaluate the long-term effectiveness of WBCT in the prevention of AD in patients with MCI and healthy individuals.
Effects of whole-body cryotherapy on a total antioxidative status and activities of antioxidative enzymes in blood of depressive multiple sclerosis patients.
Objectives. Oxidative stress (OS) plays an important role in the pathogenesis of multiple sclerosis (MS). In MS patients depression is often observed. Cryotherapy might have an effect on OS. The aim of this study was to compare the effects of whole body cryotherapy (WBCT) on changes in total antioxidative status (TAS) of plasma and activities of antioxidative enzymes in erythrocytes from depressive and non-depressive MS patients. Methods. Twenty-two MS patients with secondary progressive disease course (12 depressive and 10 non-depressive) were treated with 10 exposures in a cryochamber. Before and after WBCT the plasma TAS and the activities of superoxide dismutase (SOD) and catalase (CAT) in the erythrocytes were measured. Results. The level of TAS in depressive MS group was significantly lower than in non-depressive MS (P < 0.0003). WBCT increased the level of TAS in depressive (P< 0.002) more than in non-depressive MS patients (P <0.01). WBCT treatment of MS patients resulted in the significant increase of TAS level in plasma but had no effects on activities of SOD and CAT. Conclusions. Our results indicate that WBCT suppresses OS in MS patients, especially in depressive patients.
Complementary and Alternative Medical Therapies in Fibromyalgia
This article describes the studies that have been performed evaluating complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM). There is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. CAM has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications). Another CAM therapy such as chiropractic care has neither well-designed studies nor positive results and is not currently recommended for FM treatment. Once CAM therapies have been better evaluated for safety and long-term efficacy in randomised, placebo-controlled trials, they may prove to be beneficial in treatments for FM. It would then be important to assess studies assessing cost-benefit analyses comparing conventional therapies and CAM.
Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females
OBJECTIVE: Cold therapy is used to relieve pain and inflammatory symptoms. The present study was designed to determine the influence of long-term regular exposure to acute cold temperature. Two types of exposure were studied: winter swimming in ice-cold water and whole-body cryotherapy. The outcome was investigated on humoral factors that may account for pain alleviation related to the exposures.
MATERIAL AND METHODS: During the course of 12 weeks, 3 times a week, a group of healthy females (n = 10) was exposed to winter swimming (water 0-2 degrees C) for 20 s and another group (n = 10) to whole-body cryotherapy (air -110 degrees C) for 2 min in a special chamber. Blood specimens were drawn in weeks 1, 2, 4, 8 and 12, on a day when no cold exposure occurred (control specimens) and on a day of cold exposures (cold specimens) before the exposures (0 min), and thereafter at 5 and 35 min.
RESULTS: Plasma ACTH and cortisol in weeks 4-12 on time-points 35 min were significantly lower than in week 1, probably due to habituation, suggesting that neither winter swimming nor whole-body cryotherapy stimulated the pituitary-adrenal cortex axis. Plasma epinephrine was unchanged during both experiments, but norepinephrine showed significant 2-fold to 3-fold increases each time for 12 weeks after both cold exposures. Plasma IL-1-beta, IL-6 or TNF alpha did not show any changes after cold exposure.
CONCLUSIONS: The main finding was the sustained cold-induced stimulation of norepinephrine, which was remarkably similar between exposures. The frequent increase in norepinephrine might have a role in pain alleviation in whole-body cryotherapy and winter swimming.
J Leppäluoto, T Westerlund, P Huttunen, J Oksa, J Smolander, B Dugué, M Mikkelsson
Scandinavian journal of clinical and laboratory investigation. 01/02/2008; 68(2):145-53. ISSN: 0036-5513 DOI: 10.1080/00365510701516350
Cryotherapy in osteoporosis
Cryotherapy is use of temperature lower than -100 degrees C onto body surface, for 2-3 minutes, in aim to cause physiological reactions for cold and to use such adapting reactions. Organism’s positive response to cryotherapy supports treatment of basic disease and facilitates kinesitherapy. Low temperature may be obtained by use of air flow cooled with liquid nitrogen; this could be applied either locally, over chosen part of the body, or generally, over the whole body, in cryosauna or in cryochamber. The most efficiently is applying cryotherapy twice a day, with at least 3 hours interval. Kinesitherapy is necessarily used after each cryotherapy session. Whole treatment takes 2 to 6 weeks, depending on patient’s needs. Cryotherapy reduces pain and swellings, causes skeletal muscles relaxation and increase of their force, also, motion range in treated joints increases. Thus, cryotherapy seems to fulfill all necessary conditions for rehabilitation in osteoporosis. Cryotherapy represents numerous advantages: it takes short time for applying, being well tolerated by patient, also patient’s status improves quickly. In addition, contraindications against cryotherapy are rare. All this makes cryotherapy a method for a broad use in prophylactics and treatment of osteoporosis.
Authors: K Ksiezopolska-Pietrzak
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/11/1998; 5(28):222-4. ISSN: 1426-9686
Beneficial effects of the whole-body cryotherapy on sport haemolysis
Background. Sport’s anemia is a common risk for athletes. The principal source of an accelerated turnover of the erythrocytes in sportsmen is the intravascular hemolysis. This phenomenon is induced by mechanical breakage for impact of feet and muscular contractions, but also by osmotic changes causing membrane fragility, typically evident after exercise, when free radicals are increased. Whole-body cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking.
Design and Methods. We recruited ten rugby players of the Italian National Team. In these athletes we measured hematological parameters, before including mean sphered cell volume (MSCV) by means of Coulter LH750, besides of haptoglobin, and after WBC. The subjects underwent five sessions on alternate days once daily for one week. During the study period, the training workload was the same as that of the previous weeks.
Results. We observed in the athletes increase of haptoglobin and an increase of MSCV after the treatment period. Conclusions. WBC reduces sports haemolysis, as judged from MSCV and haptoglobin data, supported from other haematological values, as well as the absence of mean corpuscolar volume and reticulocytes increase. The treatment is useful to prevent the physiological impairments derived from sport haemolysis.
Authors: Banfi Giuseppe, Melegati Gianluca, Barassi Alessandra, Gianvico Melzi d’Eril
Journal of Human Sport and Exercise. 01/01/2009;