Cryotherapy is being touted as a “cure-all” to enhance health and well-being. It may be helpful in treating some acute injuries, but will not “fix” all health concerns.
Lifelong Learning in Clinical Excellence | January 30, 2023 | 2 min read
By Alexis Coslick, DO, MS, Johns Hopkins Medicine
Cryotherapy is a trending and popular treatment with celebrities, including household names like Alicia Keys, Mandy Moore, Demi Moore, Jennifer Aniston, Jessica Alba, and Lindsey Lohan. Because of this, patients may ask about it. Here’s what you need to know:
Cyotherapy dates back many centuries and is a common treatment for an acute injury as one of the components of the well-known acronym RICE (Rest, Ice, Compression, Elevation). However, its utility is broader including chronic pain, muscle spasm, inflammation, and delayed onset muscle soreness after exercising.
Cryotherapy works by removing heat from the body. Lower temperatures cause vasoconstriction and decrease inflammation, metabolic demand of tissues and nerve conduction velocity, therefore providing an analgesic effect. However, more important is the prolonged decrease in the muscle temperature as tolerated to prevent secondary damage. The most substantial effects of immediate post-exercise cryotherapy occur in the 24-96 hours after exercising.
There are multiple modalities of cryotherapy that exist. These include traditional ice, cold water immersion (CWI), whole body cryotherapy with cold air (WBC), cryocompression therapy, and phase change material cooling (PCM). Icing likely has increased efficacy if it is applied repetitively for short durations. CWI in water < 15 °C for 15 minutes and WBC may help with improvement in soreness after exercise. Cryocompression is often used post-operatively. PCM cooling allows better absorption of heat from the body due to the change in phase without increasing its temperature. The temperature of phase change can be manipulated by substrates to allow for a warmer temperature and longer duration of utilization in the form of wearable materials, such as vests and lower extremity garments. PCM may help with soreness as well as counteract strength loss following exercise.
While rare, frostbite injuries with cryotherapy exist. This occurs when the skin cools more rapidly than the deeper muscle structures. Cryotherapy may need to be avoided in people with impaired sensation or other conditions of cold intolerance.
There is no universal consensus on the optimal cryotherapy modality, duration, and frequency. Research studies are inconsistent surrounding post-injury and post-exercise cooling. There are some arguments against cooling, as this disrupts the natural inflammatory and healing process. Cryotherapy also has the potential to interfere with strength gains following resistance training. However, these negative outcomes have been shown in animal models.
The research is inconsistent on the efficacy of cryotherapy and thermotherapy. Therefore, we rely on expert opinion:
1. Heat prior to exercise or rehabilitation can help warm up the stiff tissues and cryotherapy can be utilized post-exercise to help with soreness although it may not help with functional recovery.
2. Cryotherapy can help treat acute injuries, whereas heat can be utilized for joint and muscle pain.
Most importantly, the patient should use the modality that feels the best for them and the method that they are likely to use.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.