Cryotherapy

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 lesions.[1] The most prominent use of the term refers to the surgical treatment, specifically known as cryosurgery or cryoablation. 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. It can be a range of treatments from the application of ice packs or immersion in ice baths (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 or shown in large controlled studies. Its long term side effects have also not been studied.[2][3]

Cryosurgery
Medical cryotherapy gun
Main article: 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.[4] Cryosurgery is used to treat a number of diseases and disorders, most especially skin conditions like warts, moles, skin tags and solar keratoses. Liquid nitrogen 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.[5]

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.[6][7][8][9]

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 with reflexive vasodilation, decreased local metabolism 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 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,[10] this occurs as a result of vasoconstriction, 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 immediately following ice pack therapy for 20 minutes.[11] 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.[12]

Cold spray anesthetics
Main article: Freeze spray

In addition to their use in cryosurgery, several types of cold aerosol sprays are used for short-term pain relief. Ordinary spray cans containing tetrafluoroethane, dimethyl ether, 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 are used to ease sports injuries, similar to ice pack therapy.

Whole body cryotherapy
Cryotherapy patients during preparation of treatment of c. 3 minutes

It is unclear if whole body cryotherapy (WBC) has any effect on muscle soreness, or improves recovery, after exercise.[13] There is no evidence that whole body cooling effectively treats Alzheimer’s, fibromyalgia, migraines, rheumatoid arthritis, multiple sclerosis, stress, anxiety, or chronic pain as its proponents claim.[14]

This 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.[13]

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.[13][15] If the cold temperatures are produced by evaporating liquid nitrogen, there is the risk of inert gas asphyxiation as well as frostbite.[16]

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.[16]

Society and culture

The football player Antonio Brown had foot burns as a result of inappropriate footwear while undergoing cryotherapy and was unable to report to training camp in August 2019.[17]

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See also

References
  1. Cryotherapy at eMedicine
  2. Novella, Steven (28 October 2015). "Whole Body Cryotherapy". Science-Based Medicine. Retrieved 29 July 2017.
  3. "Cryosurgery in Cancer Treatment". National Cancer Institute. 9 September 2005. Retrieved 29 July 2017.
  4. Andrews, Mark D. (15 May 2004). "Cryosurgery for Common Skin Conditions". American Family Physician. 69 (10). ISSN 0002-838X.
  5. "Information about Non-Melanoma Skin Cancers". Skcin – The Karen Clifford Skin Cancer Charity. Retrieved 29 July 2017.
  6. Bleakley, Chris; McDonough, Suzanne; MacAuley, Domhnall (2004). "The Use of Ice in the Treatment of Acute Soft-Tissue Injury. A Systematic Review of Randomized Controlled Trials". The American Journal of Sports Medicine. 32 (1): 251–61. doi:10.1177/0363546503260757. PMID 14754753.
  7. Mac Auley, D. C. (July 2001). "Ice therapy: how good is the evidence?". International Journal of Sports Medicine. 22 (5): 379–84. doi:10.1055/s-2001-15656. ISSN 0172-4622. PMID 11510876.
  8. Thorsson, O. (28 March 2001). "[Cold therapy of athletic injuries. Current literature review]". Lakartidningen. 98 (13): 1512–13. ISSN 0023-7205. PMID 11330146.
  9. Hohenauer Erich, Taeymans Jan, Baeyens Jean-Pierre, Clarys Peter, Clijsen Ron (2015). "The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis". PLOS ONE. 10 (9): e0139028. Bibcode:2015PLoSO..1039028H. doi:10.1371/journal.pone.0139028. PMC 4586380. PMID 26413718.CS1 maint: multiple names: authors list (link)
  10. Swenson, C; Sward, L; Karlsson, J (1996). "Cryotherapy in Sports Medicine". Scandinavain Journal of Medicine and Science in Sports. 6 (4): 193–200. doi:10.1111/j.1600-0838.1996.tb00090.x. PMID 8896090.
  11. Cross, K.M.; Wilson, R.W.; Perrin, D.H. (1996). "Functional Performance Following an Ice Immersion to the Lower Extremity". Journal of Athletic Training. 31 (2): 113–16. PMC 1318440. PMID 16558383.
  12. Saam, F.; Seidinger, B; Tibesku, C. O. (2008). "The Influence of Cryotherapy of the Ankle on Static Balance". Sportverletz Sportschaden. 22 (1): 45–51. doi:10.1055/s-2007-963601. PMID 18350484.
  13. Costello, Joseph T.; Baker, Philip Ra; Minett, Geoffrey M.; Bieuzen, Francois; Stewart, Ian B.; Bleakley, Chris (18 September 2015). "Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults" (PDF). The Cochrane Database of Systematic Reviews. 9 (9): CD010789. doi:10.1002/14651858.CD010789.pub2. PMID 26383887.
  14. "Whole Body Cryotherapy (WBC): A "Cool" Trend that Lacks Evidence, Poses Risks". www.fda.gov. U.S. Food and Drug Administration. 5 July 2016. Retrieved 6 January 2019.
  15. Bleakley, Chris; Bieuzen, Francois; Davison, Gareth; Costello, Joseph (March 2014). "Whole-body cryotherapy: empirical evidence and theoretical perspectives". Open Access Journal of Sports Medicine. 5: 25–36. doi:10.2147/OAJSM.S41655. PMC 3956737. PMID 24648779.
  16. Staff editors (23 March 2017). "The spread of cryotherapy". The Economist. Retrieved 27 March 2017.
  17. sport, Guardian (7 August 2019). "Oakland's Antonio Brown reportedly felled by frostbite in cryotherapy gaffe". The Guardian. Retrieved 8 August 2019.
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