Transcript Cryotherapy?

The Deep Freeze:
Whole body Cryotherapy
Erik Zarandy, D.O.
AnMed Health PCSM Fellow
Fred Hoover Sports Medicine Symposium
Disclosures
• I have no relevant financial
relationship(s) to disclose.
Objectives
• Understand what whole body
cryotherapy is, and how it works
• Become familiar with some of its uses
• Review the literature regarding whole
body cryotherapy and its uses
• Review consensus statements
regarding whole body cryotherapy and
its uses
Phases of exercise
Ohhh! That hurts!!!
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Structural alterations to
muscles accompanied by
physiologic and subjective
perception of muscle
damage.
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exercise induced muscle
damage (EIMD)
delayed onset muscle
soreness (DOMS)
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within 24-72 hours
DOMS
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Muscle soreness that develops within 24-72 hours following strenuous
activity.
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Eccentric contractions accentuates DOMS more than
concentric/isometric contractions.
Sore muscles often described as stiff, aching, or tender.
Multiple theories as to mechanism of DOMS
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Currently thought to be multifactorial
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Mechanical stress --> biochemical response --> inflammatory
response
SO WHAT?!
• Reductions in strength and power
parameters noted.
• Loss of muscle function.
• Long-lasting fatigue.
• All this leads to reduction in
performance and/or a less than optimal
training intensity.
DOMS
• Good news!
• DOMS self
limited with
return to 5-7
days.
Help me, help you!
• Recovery is an important, but often
neglected, part of training plans.
• Recovery has become a priority for
athletes.
• Number of post-exercise recovery
strategies are used.
We can rebuild them
• Post-exercise recovery strategies
include:
• nutritional strategies
• stretching/massage
• NSAIDs
• hydrotherapy
• far-infrared therapy
• cryotherapy
We can rebuild them
• Post-exercise recovery strategies
include:
• nutritional strategies
• stretching/massage
• NSAIDs
• hydrotherapy
• far-infrared therapy
• cryotherapy
Cold as ice
Cold as ice
• Cold-water immersion (CWI)
• one of the most popular interventions
to prevent DOMS and promote
recovery.
• beginning to gain traction with
amateur athletes.
• involves immersion in water temp of
< 15 C for 15-20 minutes.
Why are you doing
this
to
me?
• Thought to reduce pain, swelling,
metabolism/inflammation associated
with secondary injury through:
• cold-related vasoconstriction
• limit vessel permeability and thus
inflammatory process
• decreased nerve transmission speed
• psychological benefits
If some is good more
is better, right?
Whole body cryotherapy
(WBC)
• Exposure to extremely cold dry air
• below 100 C
• typical exposure time usually 2-4
minutes
• achieved by using liquid nitrogen or
refrigerated cold air.
Whole body
cryotherapy
• Dr. Yamaguchi (1978)
• used cryotherapy to treat his RA
patients.
• rapid short-term freezing was more
beneficial than gradual cooling while
immersed in ice bath.
So, how does it
work?
• Hypothesized to affect the body on
three different levels...
• Hold on to your horses, this may get
weird...
First up...the
biochemical
level
• Strong cold signals body to shunt blood
from the periphery to the core.
• blood begins to circulate in an
“internal cycle.”
• blood is enriched with O2 and
necessary nutrients and enzymes.
• after session, body perceives change in
temp. and enriched blood is then
shunted back to periphery.
Next to the plate...the
energy
level
• Energy level in the body is made up of a
network of energy meridians.
• Rapid drop in peripheral temp. while
maintaining core temp. leads to strong
flow of energy in the meridians.
• restoring energy flow where
disruptions may have been present.
• correcting this energy flow allows
people to stay healthier, longer.
Finally...the
information
level
• The brain sends signals to all parts of the body
through the nervous system to determine the
extent of compromise.
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done to allocate adequate resources where
needed.
rapid cooling causes the brain to survey all body
parts, creating an up-to-date picture of the bodies
health
•
brain then able to properly allocate its
resources.
What’s really going
on
• Effects are probably linked to
modifications of immunological markers.
• increase in anti-inflammatory markers
• decrease in pro-inflammatory markers
• stabilizing lysosomal membranes
• positive effects on CK and LDH.
•
To treat, or not to
treat
Some treated disorders include:
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RA
Fibromyalgia
OA
Osteoporosis
Phantom pain
Ankylosing spondylitis
MS
Chronic pain
But wait...there’s
more!
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Also thought to be useful for:
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cellulite reduction
tighter and healthier skin
stronger and fuller hair and nails
fewer skin blemishes
increased metabolism and caloric burn
increased libido
increased collagen production
The real reason we’re
all here
• Athletes have been a driving force
behind growth of WBC.
• Game-time and race success
dependent upon their body’s ability to
train, recover, and perform.
So I ask you,
again...why are we
doing this?
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WBC in athletics thought to:
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decrease muscle soreness
reduce DOMS
increase energy and peak performance
allow more intense and higher volume training
improves muscle strength and joint function
overall faster return to sports training
decrease fatigue
Tell me something
good
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Ziemann et al...
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Hausswirth et al...
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decrease in cytokines and inflammatory markers after 5 day, twice
daily cryotherapy protocol in professional tennis players.
improvement in maximal voluntary contraction and subjective
sensation of pain v. other recovery modalities (FIR, PAS) in
runners.
Schaal et al...
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single WBC exposure enhanced subjective and metabolic
recovery after intense bouts of swimming.
All good things must
come to an end!
• With all that
being said...
• Most studies
showing
benefits of
WBC were of
poor quality.
All good things must
come to an end!
•
Costello et al...
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3 minute exposure at -110 C had little effect on joint positional
sense and muscle function compare to control.
follow-up study showed few differences between control group v.
WBC in terms of strength, power, and muscle soreness.
Fonda and Sarabon...
•
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functional recovery at more intense cooling dose (-195 C)
few significant differences in strength and power.
All good things must
come to an end!
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Recent Cochrane review showed:
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there is insufficient evidence to determine
whether WBC reduces self-reported muscle
soreness, or improves subjective recovery.
Also...
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the lack of evidence on adverse events is
important given that the exposure to extreme
temperature presents potential hazard.
Now here comes the
bad news...
• Nov. 2011- woman suffers third degree
burns on her arm leading to permanent
disfigurement.
• In 2011, Justin Gatlin, suffered frostbite
to the feet.
• Oct. 2015- 24 year old female dies in
cryotherapy sauna.
Show me the money!
• One clinic pricing:
• $250 per month
• $65 for 1 session
• $300 for 5
sessions
• $1800 for 45
sessions for
maximized
wellness
What does big
brother have to say
about
this?
• FDA found very little evidence about its
safety or effectiveness in treating the
conditions for which it is being
promoted.
• No FDA approval for ANY cryotherapy
saunas.
• Recommend consulting physician
before trying WBC.
Where do we go from
here?
• Very few high-quality studies showing
effectiveness of WBC...
• No FDA approval...
• Possible adverse outcomes...
Take home message
• No strong evidence that WBC offers any
distinct advantage over other forms of
cryotherapy (CWI, ice packs).
• Significantly more expensive!
• and much less accessible.
• There is risk involved if proper care is
not taken!
Any questions?
References
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Kruger M, et al. “Whole body cryotherapy’s enhancement of acute recovery of running performance in well-trained
athletes.” International Journal of Sports Physiology and Performance. 2015, 10; 605-612.
Hausswirth C, et al. “Effects of whold body cryotherapy vs. far-infrared vs. passive modalities on recovery in highlytrained runners.” Plos ONE 6 (12).
Ziemann E, et al. “Five-day whole body cryostimulation, blood inflammatory markers, and performance in high ranking
professional tennis players.” Jounal of Athletic training. Dec. 2012; 6 (47).
Costello JT, et al. “Cochrane review: whole body cryotherapy for preventing and treating muscle soreness after exercise
in adults.” Jourmal of Evidence-based medicine. Jan. 2016.
Whole body cryotherapy: a”cool” trend that lacks evidence, poses risk. www.fda.gov/consumer. July 2016.
Vieira A, et al. “Dose whole body cryotherapy improve vertical jump recovery following a high-intensity exercise bout?”
Open access Journal of Sports Medicine. 2015; 6, 49-54.
Bleakley C, et al. “Whole body cryotherapy: empirical evidence and theoretical perspectives.” Open access Journal of
Sports Medicine. 2014; 5, 25-36.