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Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy may be used to treat a variety of tissue
lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...
s. The most prominent use of the term refers to the surgical treatment, specifically known as cryosurgery or
cryoablation Cryoablation is a process that uses extreme cold to destroy tissue. Cryoablation is performed using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are positioned adjacent to the target in ...
. Cryosurgery is the application of extremely low temperatures to destroy abnormal or diseased tissue and is used most commonly to treat skin conditions. Cryotherapy is used in an effort to relieve muscle pain, sprains and swelling after soft tissue damage or surgery. For decades, it has been commonly used to accelerate recovery in athletes after exercise. Cryotherapy decreases the temperature of tissue surface to minimize hypoxic cell death, edema accumulation, and muscle spasms, all of which ultimately alleviate discomfort and inflammation. It can be a range of treatments from the application of ice packs or immersion in
ice bath In sports therapy, an ice bath, or sometimes cold-water immersion or cold therapy, is a training regimen usually following a period of intense exercise in which a substantial part of a human body is immersed in a bath of ice or ice-water for a l ...
s (generally known as cold therapy), to the use of cold chambers. While cryotherapy is widely used, there is little evidence as to its efficacy that has been replicated by or shown in large controlled studies. Its long-term side effects have also not been studied. However, there is a study that concludes that cryotherapy has a positive impact on the short-term recovery of athletes. Cryotherapy helped manage muscle soreness and facilitate recovery within the first 24 hours following a sport-related activity. Athletes who use cryotherapy within the first 24 hours to alleviate pain recovered at a faster rate than athletes who did not use cryotherapy after their sport-related activity.


Cryotherapy chamber

There are different types of cryochambers, each with different mechanisms of action and uses. The Partial-Body Cryotherapy (PBC) makes use of nitrogen to decrease the temperature. This cryochamber is an individual, tube-shaped enclosure that covers a person's body with an open-top to keep the head at room temperature. The second cryochamber is called the whole body cryotherapy (WBC) and makes use of electricity to reduce the temperature inside the chamber. In contrast to the first, the user fully enters the electrically operated chamber. This is a specific type of low-temperature treatment used to reduce
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
and painful effects. Cryotherapy was developed in the 1970s by Japanese rheumatologist Toshima Yamaguchi and introduced to Europe, US and Australia in the 1980s and 1990s. Both cryochambers decrease the skin temperature, but WBC reaches lower temperatures than PBC and might be considered more effective.


Mechanism of action

When the body is vulnerable to extreme cooling, the blood vessels are narrowed and make less blood flow to the areas of swelling. Once outside the cryogenic chamber, the vessels expand, and an increased presence of anti-inflammatory proteins (IL-10) is established in the blood. Cryotherapy chamber involves exposing individuals to freezing dry air (below −100 °C) for 2 to 4 minutes.


Main uses

Proponents say that cryotherapy may reduce
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
and
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
, help with mental disorders, support exercise recovery performance and improves joint function. Cryotherapy chambers belong to the group of equipment associated with sports rehabilitation and wellness. *
Weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat ( adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other co ...
* Reducing anxiety and depression * Reducing the symptoms of
eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved c ...


Cryosurgery

Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The application of ultra-cold liquid causes damage to the treated tissue due to intracellular ice formation. The degree of damage depends upon the minimum temperature achieved and the rate of cooling. Cryosurgery is used to treat a number of diseases and disorders, most especially skin conditions like warts,
moles Moles can refer to: * Moles de Xert, a mountain range in the Baix Maestrat comarca, Valencian Community, Spain *The Moles (Australian band) *The Moles, alter ego of Scottish band Simon Dupree and the Big Sound People * Abraham Moles, French engin ...
, skin tags and solar keratoses.
Liquid nitrogen Liquid nitrogen—LN2—is nitrogen in a liquid state at low temperature. Liquid nitrogen has a boiling point of about . It is produced industrially by fractional distillation of liquid air. It is a colorless, low viscosity liquid that is wid ...
is usually used to freeze the tissues at the cellular level. The procedure is used often as it is relatively easy and quick, can be done in the doctors surgery, and is deemed quite low risk. If a cancerous lesion is suspected then excision rather than cryosurgery may be deemed more appropriate.


Ice pack therapy

Ice pack therapy is a treatment of cold temperatures to an injured area of the body. Though the therapy is extensively used, and it is agreed that it alleviates symptoms, testing has produced conflicting results about its efficacy and possibility of producing undesirable results() . An ice pack is placed over an injured area and is intended to absorb heat of a closed traumatic or Edematous injury by using conduction to transfer thermal energy. The physiologic effects of cold application include immediate
vasoconstriction Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vess ...
with reflexive
vasodilation Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstrictio ...
, decreased local
metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run ...
and enzymatic activity, and decreased oxygen demand. Cold decreases muscle spindle fiber activity and slows nerve conduction velocity; therefore, it is often used to decrease
spasticity Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles ...
and muscle guarding. It is commonly used to alleviate the pain of minor injuries, as well as decrease muscle soreness. The use of ice packs in treatment decreases the blood flow most rapidly at the beginning of the cooling period, this occurs as a result of
vasoconstriction Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vess ...
, the initial reflex sympathetic activity. Ice is not commonly used prior to rehabilitation or performance because of its known adverse effects to performance such as decreased myotatic reflex and force production, as well as a decrease in
balance Balance or balancing may refer to: Common meanings * Balance (ability) in biomechanics * Balance (accounting) * Balance or weighing scale * Balance as in equality or equilibrium Arts and entertainment Film * ''Balance'' (1983 film), a Bulgaria ...
immediately following ice pack therapy for 20 minutes. However, if ice pack therapy is applied for less than 10 minutes, performance can occur without detrimental effects. If the ice pack is removed at this time, athletes are sent back to training or competition directly with no decrease in performance. Ice has also been shown to possibly slow and impair muscle protein synthesis and repair in recreational athletes. This is especially true for cold water immersion, but equivalent controlled studies have not been done to see if the same effects hold true for ice packs. Regardless, ice has been shown in studies to inhibit the uptake of dietary protein post-muscle conditioning exercise.


Cryotherapy following total knee replacement

Total knee arthroplasty (TKA) is a common intervention for patients with end-stage osteoarthritis of the knee. Post-surgical management includes cryotherapy. Cryotherapy may slightly reduce the amount of blood loss and pain. It was generally safe and not associated with any serious adverse events. It may improve the range of movement at the knee in the first one to two weeks after surgery. Potential benefits of cryotherapy on blood loss, postoperative pain, and range of motion may be too small to justify its use, and the quality of the evidence was very low or low for all main outcomes. Well designed randomized trials are required to improve the quality of the evidence. In conclusion, the effectiveness of cryotherapy is unclear.


Cold spray anesthetics

In addition to their use in cryosurgery, several types of cold
aerosol spray Aerosol spray is a type of dispensing system which creates an aerosol mist of liquid particles. It comprises a can or bottle that contains a payload, and a propellant under pressure. When the container's valve is opened, the payload is forced out ...
s are used for short-term pain relief. Unlike other cold modalities, it doesn’t produce similar physiological effects due to the fact it decreases skin temperature, not muscle temperature. It reflexively inhibits underling muscle by using evaporation to cool the area. Ordinary spray cans containing
tetrafluoroethane 1,1,1,2-Tetrafluoroethane (also known as norflurane (INN), R-134a, Freon 134a, Forane 134a, Genetron 134a, Green Gas, Florasol 134a, Suva 134a, or HFC-134a) is a hydrofluorocarbon (HFC) and haloalkane refrigerant with thermodynamic properties si ...
,
dimethyl ether Dimethyl ether (DME; also known as methoxymethane) is the organic compound with the formula CH3OCH3, (sometimes ambiguously simplified to C2H6O as it is an isomer of ethanol). The simplest ether, it is a colorless gas that is a useful precursor ...
, or similar substances, are used to numb the skin prior to or possibly in place of local anesthetic injections, and prior to other needles, small incisions, sutures, and so on. Other products containing
chloroethane Chloroethane, commonly known as ethyl chloride, is a chemical compound with chemical formula CH3CH2Cl, once widely used in producing tetraethyllead, a gasoline additive. It is a colorless, flammable gas or refrigerated liquid with a faintly sweet ...
are used to ease sports injuries, similar to ice pack therapy.


Whole body cryotherapy

An increasing amount of research is done on the effects of whole-body cryotherapy (WBC) on exercise, beauty, and health. Research is often inconsistent because the usage of the different types of cryo-chambers, and different treatment periods. However, it becomes increasingly clear that WBC has a positive effect on muscle soreness and decreases the recovery time after exercise. Some older papers show inconsistencies in the effects. Cryotherapy is also increasingly used as a non-drug treatment against
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...
,
stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...
,
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, or
chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continue ...
,
multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This ...
and
fibromyalgia Fibromyalgia (FM) is a medical condition defined by the presence of chronic widespread pain, fatigue, waking unrefreshed, cognitive symptoms, lower abdominal pain or cramps, and depression. Other symptoms include insomnia and a general hyp ...
. Studies for these, and other diseases (
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,
migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
s), are ongoing although more evidence becomes available on the positive effects of Whole Body Cryotherapy. The FDA points out that the effects of Whole Body Cryotherapy lacks evidence and should be researched more. Cryotherapy treatment involves exposing individuals to extremely cold dry air (below −100 °C) for two to four minutes. To achieve the subzero temperatures required for WBC, two methods are typically used: liquid nitrogen and refrigerated cold air. During these exposures, individuals wear minimal clothing, which usually consists of shorts for males, and shorts and a crop top for females. Gloves, a woollen headband covering the ears, and a nose and mouth mask, in addition to dry shoes and socks, are commonly worn to reduce the risk of cold-related injury. The first WBC chamber was built in Japan in the late 1970s, introduced to Europe in the 1980s, and has been used in the US and Australia in the past decade.


Adverse effects

Reviews of whole body cryotherapy have called for research studies to implement active surveillance of adverse events, which are suspected of being underreported. If the cold temperatures are produced by evaporating liquid nitrogen, there is the risk of inert gas asphyxiation as well as
frostbite Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in t ...
. However, these risks are irrelevant in the electronically operated chambers.


Partial body

Partial body cryotherapy (PBC) devices also exist. If the cold temperatures are produced by evaporating liquid nitrogen, there is the risk of inert gas asphyxiation as well as
frostbite Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in t ...
.


See also

*
Cryonics Cryonics (from el, κρύος ''kryos'' meaning 'cold') is the low-temperature freezing (usually at ) and storage of human remains, with the speculative hope that resurrection may be possible in the future. Cryonics is regarded with skeptic ...
*
Cold shock response Cold shock response is a series of neurogenic cardio-respiratory responses caused by sudden immersion in cold water. In cold water immersions, such as by falling through thin ice, cold shock response is perhaps the most common cause of death. Als ...
*
Cold compression therapy Cold compression therapy, also known as hilotherapy, combines two of the principles of rest, ice, compression, elevation to reduce pain and swelling from a sports or activity injury to soft tissues and is recommended by orthopedic surgeons follow ...
*
Freeze spray Freeze spray (cold spray or vapocoolant) is a type of aerosol spray product containing a liquified gas used for rapidly cooling surfaces, in medical and industrial applications. It is usually sold in hand-held spray cans. It may consist of vario ...


References


External links

* {{Authority control Alternative medical treatments