Whole Body Cryotherapy for Less Researched Health Conditions: Application, Effects, and Suggested Treatment Regimens
Table of Contents
INTRODUCTION: MEDICAL USE REQUIRES SUPERVISION BY A DOCTOR Based on theoretical knowledge, clinical studies, and experience, we know that whole body cryotherapy has therapeutic and stimulating effects not only in the area where the cold penetrates but also in deeper-lying tissue that remains inaccessible to the 3-minute application of extreme cold.
The WBC impact on the body is systemic. While primarily pain-alleviating and anti-inflammatory, whole body cryotherapy also results in neuronal activation and improvement of blood circulation and metabolism in the skeletal muscles. It intervenes in a regulatory manner in disrupted central activity levels and plays a certain role in modulating the vascular system and numerous hormonal feedback loops. In addition, it has proven performance-optimizing benefits.
The “active components” of whole body cryotherapy can be summarized as follows: - Pain relief. or complete elimination. - Inflammation inhibition and immunomodulation. - Effect on skeletal musculature (regulation of tone, improvement in circulation and metabolism, neural activation). - Functional improvement of joints. - Regulation of the central activity level, psycho-physical performance enhancement and improvement of the overall well-being. - Economization of the cardiovascular system and the energy budget. The list of indications has been increasingly justified and expanded over the last years1 to include a variety of health disorders. The terminology has also been adjusted to distinguish between talking about healthy subjects (cryostimulation) versus patients (cryotherapy).
For some health conditions, the benefits of whole body cryotherapy have been proven to the point that recommendations to incorporate it in the treatment regimen are given by medical professionals with confidence.
These conditions include inflammatory rheumatic diseases (rheumatoid arthritis and ankylosing spondylitis), degenerative rheumatic diseases (osteoarthritis) and chronic pains of various causes. The most common expectations from incorporating cryotherapy in treating the named disorders are reduction in inflammatory activity and pain. We have already covered each of the most researched medical applications of whole body cryotherapy in detail. See the separate lessons for:
- Arthritis. - Ankylosing spondylitis. - Fibromyalgia. - Multiple sclerosis. - Affective (mood) and anxiety disorders. In addition to the above, there are diseases and health problems for which positive treatment results have been clinically obtained, yet different conclusions have been drawn. These conditions include, for example, bronchial asthma, skin disorders, central muscular spasms, and impaired central activity levels. More scientific studies will need to be performed to better justify or exclude the applications for which doubts still prevail.
The below listed indications shall be considered only as options where whole body cryotherapy may be beneficial but must be recommended (or not) in each individual case by a doctor. It shall always be remembered that one needs a medical license to give any medical advice or, moreover, to prescribe a treatment. Consequently, all cryocenters that do not have the credentials to practice medicine must stress the importance of consulting and seeking oversight by a medical professional.
POSSIBLE INDICATIONS FOR WHOLE BODY CRYOTHERAPY
CHRONIC PAINS
The spectrum of causes underlying chronic pain is large and ranges from severe organic diseases to inadequate pain treatment and psychosocial factors. Often several causes combine to bring about a chronic pain state.
Chronic pains cannot be understood only as a symptom of an underlying problem, for example, an inflammatory process. They can last from months to years, can become autonomous, can coincide with formation of pain memory, and can cause additional health problems, such as disrupted sleep or depression.
WBC may potentially help alleviate:
- Headaches and migraine.
- Back pains without an underlying diagnosis.
- Pains after operations.
- Phantom and stump pains.
- Osteoporosis.
Studies have shown that, inmost cases, an intense 4-week whole body cryotherapy course of 5 treatments per week results in noticeable relief.
SPINAL SYNDROMES (particularly of the cervical and lumbar vertebra) This is a relatively large group of indications for whole body cryotherapy. Often referred to as back pain, this category of conditions includes damaged or slipped discs and ischia syndrome (sciatica), caused mainly by degenerative modifications of the discs and the small vertebral joints. Strain injuries (pulled back muscle) also apply (2). Up to 20 once-daily exposures are generally recommended in case of spinal syndromes.
TENDINOPATHIES Tendinopathies are typically promoted by chronic overburdening of the connective tissue of the tendon attachments. Conditions include tennis and golfer’s elbow, inflammation of the Achilles tendon, heel pain, and more, and generally respond very well to whole body cryotherapy. Experience shows that the sometimes very severe pains upon movement already recede after 15 to 20 cryotherapy treatments. Intensity of the schedule should reflect severity of the pain. For more local pain relief, spot cryotherapy could be added to treat the inflamed, most painful areas.
SLEEP DISORDERS Sleep improvement is one of the most often reported outcomes of committing to whole body cryotherapy. WBC application acts directly, via the regulation of central activity levels, and indirectly, e.g. through elimination of pain, to improve sleep patterns. It shall be remembered that sleep behavior is primarily a logical result of wake behavior, and improvement is often achievable using relatively simple procedures – not every difficulty falling or staying asleep qualifies as a disorder.
Insomnia requiring therapy can only be considered to occur when sleep is disrupted continuously for longer than a month at least three times per week. A side effect of a sleep disorder is often tiredness. When it happens, whole body cryotherapy can help restore the disrupted homeostasis in central activity levels, so that sleep becomes more restful and daytime performance improves. Considerable results can be achieved already
after one week of cold therapy, while it is important NOT to rely just on the benefits. of cold. The causes of sleeplessness are too complex to do it. If pain is the underlying cause of not sleeping well, it often takes just a few cryotherapy treatments to experience relief. Experts also suggest using localized cryotherapy on the painful spots and planning for a WBC treatment in the evening hours. The freedom from pain then allows the individual to rapidly fall asleep and renounce on the intake of analgesic medications.
PSORIASIS Psoriasis, like rheumatoid arthritis, ankylosing spondylitis, or multiple sclerosis, is an immune mediated inflammatory disease. In this case, auto-aggression by the immune system leads to a chronic inflammation of the skin. Skin renews in approximately one month in healthy humans. People suffering from psoriasis experience it ever 5-6 days. As the normal wear process of the skin is disrupted, scale formation results. Psoriasis can also occur simultaneously with inflammation of joints. This condition is referred to as psoriatic arthritis. Like other autoimmune disorders, psoriasis can not yet be cured; so, the attention is focused on symptom management, using methods from medications and ointments to interventions in the immune system, light therapy, and now also whole body cryotherapy – 2 weeks of 25-30 treatments have produced the best results. Already after a few days of cryotherapy the scaling may become less intense and the itching recede, and the therapeutic effect post course of WBC may last for several months. The experiences have been INCONSISTENT, though. It appears that from the different forms of psoriasis, the typical or conventional psoriasis responds best to cold stimulus.
NEURODERMATITIS Neurodermatitis is hyper-reactivity of the organism towards environment that results in inflammation of the skin. The reaction can be purely extrinsic (allergic), but genetic factors may also play a determining role. Depending on the severity of the condition, up to 30 cold exposures may be necessary. The probability of an enduring therapeutic effect increases with an increasing number of treatments, while itching usually recedes already within the first few days of therapy and dermatitis regresses in about a week.
It is important to remember that whole body cryotherapy does NOT have a capability of its own to replace other established therapies, it must always be seen as an adjunct to other practices.
BRONCHIAL ASTHMA (high risk!) Asthma is a condition of hyper-reactivity of the bronchial system. Due to the involved risks, treatment of asthma patients shall be strictly administered or overseen by a doctor - although asthmatics often describe their WBC experience as highly recuperating, it can result in a slight narrowing of the bronchi3. Cryotreatment should ONLY be allowed if the previous asthma therapy has led to a stable state AND if the patient is capable of bearing both physical and psychological burdens. If used, the duration should be gradually increased from just one to three minutes over a period of several days. The potential positive effect of WBC on bronchial asthma is rooted in its broad spectrum of effects. A short-term dilation of the bronchial tubes occurs. The respiratory musculature relaxes, and the general physical capacity is improved. In addition, one can assume an inhibitory effect on chronic inflammatory processes in the bronchial mucosa.
INFANTILE CEREBRAL PALSY Infantile cerebral palsy is a chronic postural and locomotory disorder that results from damage of the central nervous system before, during, or immediately after birth. It is characterized by a permanently increased (spastic) tension in certain muscle groups leading to defective movement patterns. Treatment of spastic increases in muscular tone by cold is not new. Cold water baths before gymnastic exercises have been used prior to emerging of whole body cryotherapy equipment. WBC can be applied to spastic adults as well as children (5). WBC is recommended approximately 30 min before starting a mobilization therapy to help relax the spastic musculature. The results show that in about 70% of cases behavioral improvements can be achieved and sustained for several weeks. Improved mood and sleep patterns have also been observed. In about 10% of cases, on the contrary, increased irritability and difficulty falling asleep have been reported without the above positive effects.
Consequently, the treatments must be administered in close cooperation between the cryotherapist and the mobility therapist or doctor.
TINNITUS Isolated case studies have suggested that whole body cryotherapy may have positive effects on tinnitus symptoms (ringing in one or both ears). If left untreated, tinnitus can result in impaired hearing. In one clinical study a group of 80 tinnitus patients were treated with whole body cryotherapy in two series with a total of 10 3-minute exposures. As a result, 4 patients reported that their tinnitus symptoms had been eliminated. Another 47 reported reduced intensity. Only 13 patients (16%) in this group experienced no improvement. A reduction in hearing loss was also established (6).
DECIDING ON PROTOCOLS Even if one cold exposure can produce short-term improvement in mood, pain relief, or energy boost that may last for several hours, isolated or random treatments will not result in any significant change. The factors to consider when recommending a WBC protocol include the type of condition and severity of its symptoms, as well as individual characteristics of the patient. For the best outcome, a minimum of 10 consecutive treatments should be planned as often as possible – from once daily to not less than three times per week. Severe symptoms or flair ups are best taken care of by more significant skin temperature reductions twice daily, while many clients may find it difficult to commit to. Respecting the limitations, the rule of thumb remains - the more pronounced the symptoms, the more treatments should be suggested more often. In most studied health conditions, the cryotherapy protocol recommended to achieve a noticeable and lasting improvement is once daily (or as frequent as possible) treatments for AT LEAST 2 to 4 consecutive weeks. In spinal syndromes and tendinopathies, it typically is up to 20 exposures. In psoriasis, best results have been achieved from about two weeks of 25-30 cold exposures (twice daily).
Neurodermatitis, like psoriasis, also requires up to 30 treatments. In some cases, treatment TIMING is more important than frequency or the total number of exposures. It applies to cases when physical or mobilization therapy is recommended, yet the condition involves pain, muscle spasms, or other impairment that may effectively be reduced by cryotherapy. For example, in infantile cerebral palsy, cryotherapy session shall be planned 30 min (not more than 2 hours) before starting the mobilization therapy.
SOURCES 1. 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 2. Sliwinski Z et al. The assessment of pelvic statics in patients with spinal overload syndrome treated in whole body cryotherapy. Ortopedia, traumatologia, rehabilitacja 2005 https://pubmed.ncbi.nlm.nih.gov/17615517/ 3. Smolander J. et al. Lung function after acute and repeated exposure to extremely cold air (-110°C) during whole body cryotherapy. Clinical Physiology and Functional Imaging 2006 https://pubmed.ncbi.nlm.nih.gov/16836696/ 4. Donna-Ann Thomas, Benjamin Maslin, Aron Legler, Erin Springer, Abbas Asgerally, Nalini Vadivelu. Role of Alternative Therapies for Chronic PainSyndromes. Current pain and headache reports 2016 https://pubmed.ncbi.nlm.nih.gov/27038968/ 5. Podbielska H. et al. Whole body cryotherapy and infantile cerebral palsy. Kriotechnika Medyczna2006 6. Kaminska-Staruch A., Olszewski J. Evaluation of effectiveness of whole body cryotherapy in patients with tinnitus. Otolaryngologia Polska 2007. https://pubmed.ncbi.nlm.nih.gov/18552023/ 7. Morteza Dehghan and Farinaz Farahbod. The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study. Journal of Clinical & Diagnostic Research 2014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225921/
8. Czesław Giemza, Magdalena Matczak-Giemza, Bożena Ostrowska, Ewa Bieć, Mirosław Doliński. Effect of cryotherapy on the lumbar spine in elderly men with back pain. Randomized Controlled Trial. The Aging Male: The Official Journal of the International Society for the Study of the Aging Male 2014
9. Czesław Giemza, Magdalena Matczak-Giemza, Massimo De Nardi , Bożena Ostrowska, Piotr Czech. Effect of frequent WBC treatments on back pain therapy in elderly men. Randomized Controlled Trial. The Aging Male: The Official Journal of the International Society for the Study of the Aging Male 2015
10. K Ksiezopolska-Pietrzak. Cryotherapy in osteoporosis. Polski Merkuriusz Lekarski 1998 https://www.ncbi.nlm.nih.gov/pubmed/10101448
Disclaimer: This article is a summary of available publications and some well- known practices that have proven to be effective in managing symptoms of various disorders. By no means should this document serve as a success guarantee or as a replacement for medical advice.