Applications, Effects, and Suggested Treatment Regimens
Table of Contents
INTRODUCTION TO CRYOTHERAPY APPLICATIONS AND INDICATIONS IN SPORTS
The clinical indications for whole body cryotherapy, including postoperative states, inflammatory processes, and blunt tissue damage, have led athletes to use whole body cryotherapy for therapeutic purposes.
Furthermore, it has been pondered how the regulation of central activity levels seen after whole body cryotherapy, the economization in the cardiovascular system and the muscular effects can be utilized to boost athletic performance.
Whole body cryotherapy applications in sports, for athletic performance and recovery, have been researched more than any other WBC indications, with publications dating back to early 1990s.
Already in 1997, findings were published that “Cold applications have become the most important form of passive physical therapy in sports medicine”. Importantly, it has also been concluded that whole body cryotherapy applications do NOT cause any alterations of the blood that might be considered in competitive sports as unethical.
The principle of stimuli – reaction – adaptation is used in whole body cryotherapy to achieve the dynamic equilibrium at a higher level of performance and state of well-being.
Two distinctively different applications of cryotherapy are possible – boosts of readiness and recovery, with or without injury.
The best timing, frequency, duration, and temperature is highly dependent on the sport and the purpose.
The sports in which clear benefits have been identified include:
- Track and field disciplines and particularly running events, from sprint to long- distance.
- Winter sports.
- Cycling, swimming, and rowing, as well as
- Team sports.
DURING THE ACTIVE SEASON of competition, cold applications could be used both before and after the event.
Cooling before will lead to improvement in muscular perfusion and coordination, and energy economization through lowering the core temperature and resting heart rate and reducing overheating of the core and sweating.
“The use of WBC prior to training may reduce the risk of oxidative stress and the extent of muscle fiber injuries provoked by intense exercise. The WBC seems to be an effective and safe method for limiting exercise-induced damage; thus, it may be used in biological regeneration of sportsmen” (Wozniak A. et al. Whole-body cryostimulation and oxidative stress in rowers: the preliminary results).
Cooling after physical activity contributes to faster removal of metabolic end products and increase in regeneration capacity, both physically and psychologically. Increase in parasympathetic activity promotes deeper, more restful sleep.
DURING OFF-SEASON PREPARATION when building of strength and muscle is preferred, whole body cryotherapy after training may be counterproductive, as the microtears and exercise-induced inflammation is the important part of the strength building process. Pre-training cryotherapy can help speed it up.
Topics of WBC for athletic performance and recovery include:
- Sport injuries and injury-conditioned surgical interventions. Injury prevention.
- Improvement of physical performance and acceleration of regeneration.
- Effect on physiological parameters.
- Incorporation in training and competition.
The severity and therapeutic influencing of the processes related to tissue damage largely determine the times for which athletes must refrain from training and competition as well as any lasting impairments on athletic performance.
Inflammatory reaction is always involved and must be managed.
Through cold applications, localized and whole body, immediate and forward-looking, the convalescence period can be considerably shortened and the tendency of the disorder to become chronic can be prevented.
Examples of injury-related indications of WBC in athletics:
- Bruises and effusions in the musculature with inhibition of muscular activity.
- Contusions near the joints, distortions with tendon over-stretching, and inflammatory joint processes.
- Painful tendon attachments with accompanying inflammatory processes
- States following injury-conditioned surgical interventions.
- Muscle strains and hardening resulting from inflammation and pain.
- Muscular imbalances and differences between the sides.
- Reactive psychological impairments and sleep disorders.
Effects of WBC with sports injuries may include:
Accelerated reduction of inflammation, pain elimination, and prevention of development of pain memory, resulting in:
- timely elimination of reflexive muscular inactivation
- prevention of longer pain- and inflammation-induced restriction in mobility of the afflicted joints
- improvement in muscular metabolism
- decrease in defects of kinesthesia
- prevention of atrophies in the muscle and collagenous connective tissue
- reduction in the risk of subsequent injuries
- reduction of periods away from training
- psychological equilibrium and regulation of sleep behavior.
Enhancement comes from:
- Boosted blood delivery to muscles.
- Economizing effect on the cardiovascular system.
- Alteration of central activity levels.
The skeletal muscle requires energy for its actions.
Energy generation in the musculature occurs via oxidation with participation of oxygen. Maximal usage of the energy is largely dependent on the amount of oxygen supplied to the organism per time unit.
If the demand for energy can no longer be sufficiently covered by aerobic means, it is also provided in parallel anaerobically – ATP generation can be increased greatly in a rapid manner for a short period of time. It is particularly important for short-term maximal sporting loads, like sprinting. The acquisition of energy can be trained through the process of therapeutic adaptation.
After whole body application, less lactate builds up upon athletic endurance training, meaning that the muscle must resort to anaerobic energy generation for maintaining performance later or to a lesser extent. The improved oxygen supply to the musculature supports aerobic energy generation.
Other findings suggest a mobilization of energy reserves with endurance athletes. Cold action leads to less energy required for cooling the body, and an energy surplus becomes available. Oxygen consumption and heart rate do not increase as much, and signs of fatigue occur later. Sweating is also reduced, which not only has effects on the energy balance, but also promotes perfusion of the musculature.
Whole body cryotherapy effects on psycho-physical performance:
EFFECT ON PHYSIOLOGICAL PARAMETERS
Oxidative stress has impacts on immune function, hormonal regulation, the oxygen transport function of blood and the regenerative capacity of the muscles.
Whole body cryotherapy leads to a significant reduction of the oxidative stress potential. “Damage to muscle fibers which occurs after high physical exertion and which is directly related to the oxidative stress potential is reduced after serialized whole body cold exposures accompanying the training program, also allowing a more rapid regeneration" (Wozniak A. et al. Whole-body cryostimulation and oxidative stress in rowers: the preliminary results).
Hormonal feedback loops (Cortisol and muscular enzymes).
“After repeated whole body cryo applications during the course of training the cortisol level is clearly reduced compared to a control group even three days after the cold exposure" (Wozniak A. et al. Whole-body cryostimulation and oxidative stress in rowers: the preliminary results).
“The findings appear to indicate a stress adaptation” (Banfi G, Lombardi G, Colombini A, Melegati G. Whole-Body Cryotherapy in Athletes).
The exertion related increases in the muscle enzymes that signal muscle damage become less evident under cryotherapy (Exercise-induced inflammatory parameters).
“If the high physical exertion is combined with cold exposure, the concentration of pro-inflammatory leukins decreases significantly while those of the anti-inflammatory leukins increase significantly. This means that inflammation can be effectively reduced in muscles after high physical exertion where whole body cold exposure is applied. The result is a protective effect against inflammation which can reduce injury of the muscle fibers and shorten recovery times” (Banfi G, Melegati G, Barassi A, Dogliotti G, Melzi d’Eril G, Dugué B, et al. Effects of whole-body cryotherapy on serum mediators of inflammation and serum muscle enzymes in athletes).
Exercise-induced haemolysis (breakdown of red blood cells due to mechanical impacts, particularly while running).
This phenomenon is a significant issue with long-distance and marathon runners.
Whole body cryotherapy has proven to counteract the adverse effects of exercise-induced haemolysis in competitive athletes (Banfi G. et al. Beneficial effects of the whole body cryotherapy on sport haemolysis).
Cardiovascular parameters and athletic performance:
Increase in the body’s core temperature and heat surplus is performance impairing. It results in unfavorable redistribution of the blood mass from the body core to the periphery, compromising cardiac economy and causing impaired oxygen supply to the muscles, earlier onset of lactate formation, and earlier fatigue.
AVOIDING the need to increase body temperature when warning up before athletic exertion has a positive effect on performance.
The optimal effect appears to be obtained when the exposure time before athletic performance is restricted to 2 – 2,5 min at -110° C, so that the core body temperature only falls slightly, by about 0.4° C. It has proven to reduce the resting heart rate and reduce increase in heart rate during the period of exertion, improving both performance and post-exertion recovery.
The observed increase in athletic performance brought about by WBC has been between 1% for acyclical rapidity and 18% for intensive endurance performance.
Based on the research results and experience gathered in working with high performance athletes at training facilities, sports clubs, and rehabilitation centers, we can say with confidence that cold applications could and should be an integral component of training both before and after, depending on the expected outcome.
Cryo before activity results in improvement in muscular perfusion and energy economization. What is referred to as “precooling” or cold application immediately before the athletic performance has already been applied often to induce a directly competitive reflexive increase in muscular perfusion, a reduction in sweat production with a reduction in the skin surface temperature and an immediate increase in performance within the cardiovascular system.
After physical exertion, it increases the capacity to regenerate and helps remove metabolic end products.
A CONTINUOUS application of whole body cold as a training component also produces good results in regulating the central activity level and psychological regeneration potential, helping to prevent conditions of excessive demand. Specialists suggest combining stationary and mobile forms of cold therapy, giving priority to a cryosauna or cryochamber, but also incorporating portable devices, especially in disciplines in which competition involves several events or multiple rounds.
To summarize, the main aspects of cold applications in training and competition include:
- Improvement in motor and coordination performance.
- Economization in the energy balance and in the cardiovascular system.
- Increase in motor and psychological regeneration potential.
- Regulation of the central activity level, as well as
- Immune stabilization.
Indeed, whole body cold can be used to achieve a dynamic equilibrium at a high level of performance and in a state of continuous well-being.
Prof. Dr. sc. Med. Winfried Papenfuß. Power from the Cold. Whole body cryotherapy at -110° C, a short-lasting physical therapy with a long-lasting effect. 5th, revised and expanded edition January 2016, ISBN 978-3-938912-08-9
Prof. Sandra Ückert. Temperature and athletic performance.
Banfi G, Lombardi G, Colombini A, Melegati G. Whole-Body Cryotherapy in Athletes. Sports Medicine 2010 https://pubmed.ncbi.nlm.nih.gov/20524715/
Banfi G. et al. Beneficial effects of the whole body cryotherapy on sport haemolysis. Journal of Human Sport and Exercise 2009 https://www.researchgate.net/publication/26630216_Beneficial_effects_of_the_whole-body_cryotherapy_on_sport_haemolysis
Banfi G, Melegati G, Barassi A, Dogliotti G, Melzi d’Eril G, Dugué B, et al. Effects of whole-body cryotherapy on serum mediators of inflammation and serum muscle enzymes in athletes. Journal of Thermal Biology 2009 https://www.researchgate.net/publication/222903178_Effects_of_whole-body_cryotherapy_on_serum_mediators_of_inflammation_and_serum_muscle_enzymes_in_athletes
Banfi G, Melegati G, Barassi A, d'Eril GM. Effects of the whole-body cryotherapy on NTproBNP, hsCRP and troponin I in athletes. Journal of Science and Medicine in Sport 2009. https://pubmed.ncbi.nlm.nih.gov/18835219/
Swenson C, Swärd L, Karlsson J. Cryotherapy in sports medicine. Scand J Med Sci Sports 1996.
Bleakley C. M., Bieuzen F., Davison G. W., Costello J. T. Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access Journal of Sports Medicine (2014). https://pubmed.ncbi.nlm.nih.gov/24648779/
Crystal NJ, Townson DH, Cook SB, LaRoche DP. Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise. Eur J Appl Physiol 2013.
Pournot H. et al. Time-Course of Changes in Inflammatory Responses afer Whole Body Cryotherapy Multi Exposures Following Severe Exercise.
Wozniak A. et al. Whole-body cryostimulation and oxidative stress in rowers: the preliminary results. Archives of Medical Science 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648812/
Wozniak A, Wozniak B, Drewa G, Mila-Kierzenkowska C, Rakowski A. The effect of whole-body cryostimulation on lysosomal enzyme activity in kayakers during training. European Journal of Applied Physiology 2007. https://pubmed.ncbi.nlm.nih.gov/17458576/
Wozniak A et. Al. The effect of whole-body cryostimulation on the prooxidant – antioxidant balance in blood of the elite kayakers after training. European Journal of Applied Physiology 2007 https://pubmed.ncbi.nlm.nih.gov/17668231/
Mila-Kierzenkowska C, Woźniak A, Woźniak B, et al. Whole-body cryostimulation in kayaker women: a study of the effect of cryogenic temperatures on oxidative stress after the exercise.Journal of Sports Medicine and Physical Fitness 2009 https://pubmed.ncbi.nlm.nih.gov/19528900/
Jaworska J, Micielska K, Kozłowska M, Wnorowski K, Skrobecki J, Radzimiński L, Babińska A, Rodziewicz E, Lombardi G, Ziemann E. A 2-Week Specific Volleyball Training Supported by the Whole Body Cryostimulation Protocol Induced an Increase of Growth Factors and Counteracted Deterioration of Physical Performance. Frontiers in Physiology 2018 https://pubmed.ncbi.nlm.nih.gov/30555349/
Joao B. Ferreira-Junior, Martim Bottaro, Jeremy P. Loenneke, Amilton Vieira, Carlos A. Vieira, and Michael G. Bemben. Could whole-body cryotherapy (below −100°C) improve muscle recovery from muscle damage? Frontiers in Physiology 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078193/
Westerlund T. et al. Neuromuscular adaptation after repeated exposure to whole body cryotherapy (-110° C). Journal of Thermal Biology 2009
Westerlund T. et. Al. Thermal, circulatory, and neuromuscular responses to whole body cryotherapy. Academic dissertation, University of Oulu, 2009
Dugué B, Smolander J, Westerlund T, et al. Acute and long-term effects of winter swimming and whole-body cryotherapy on plasma antioxidative capacity in healthy women. Scandinavian Journal of Clinical and Laboratory Investigation 2005. https://pubmed.ncbi.nlm.nih.gov/16081362/
Ewa Ziemann, Robert A Olek, Tomasz Grzywacz, Jan J Kaczor, Jędrzej Antosiewicz, Wojciech Skrobot, Sylwester Kujach, Radosław Laskowski.. Whole-body cryostimulation as an effective way of reducing exercise-induced inflammation and blood cholesterol in young men. European Cytokine Network 2014. https://www.ncbi.nlm.nih.gov/pubmed/24998353
Lubkowska A, Dolegowska B, Szygula Z, Klimek A. Activity of selected enzymes in erythrocytes and level of plasma antioxidants in response to single whole-body cryostimulation in humans. Scandinavian Journal of Clinical and Laboratory Investigation 2009. https://pubmed.ncbi.nlm.nih.gov/19330680/
Anna Lubkowska, Giuseppe Banfi, Barbara Dołegowska, Gian Vico Melzi d'Eril, Joanna Łuczak, Alessandra Barassi. Changes in lipid profile in response to three different protocols of whole-body cryostimulation treatments. Cryobiology 2010 https://www.ncbi.nlm.nih.gov/pubmed/20385115
Anna Lubkowska, Zbigniew Szyguła, Dariusz Chlubek, Giuseppe Banfi. The effect of prolonged whole-body cryostimulation treatment with different amounts of sessions on chosen pro- and anti-inflammatory cytokines levels. Scandinavian Journal of Clinical and Laboratory Investigation 2011. https://www.ncbi.nlm.nih.gov/pubmed/21574854
“WBC Protocols Sports” by Dr. Alan Christianson, NMD, for Millennium Ice 2013