Cryo/Cold Therapy - How Does It Really Work?
As an evidenced based practice, we want to take some time today to report on the new research behind those cryo/cold therapy techniques! You may have started to hear about cold water immersion or athletes that jump into ice baths after intense training; but how does it hold up in research?
Occupational Therapy practices in outpatient and acute settings (hospitals and clinics) may use these modalities to help with musculoskeletal injuries for decreasing inflammation and helping with pain. The cryotherapy body of evidence is large with moderate to weak evidence supporting most of the treatments. However, there are some studies that reported inconclusive results. Here are some recent (within the past 6 years) reviews of research regarding cryotherapy.
Note: The review of studies report information found in research, this is not a recommendation for treatment intervention without the guidance from a professional healthcare practitioner.
Cryotherapy
Q: Does cryotherapy alter tissue healing and repair?
A (+): Cryotherapy does not alter tissue healing and repair
Three research studies support that it does not alter tissue healing and repair. (2020- Peake et al. Frontier in Physiol, 2017- Singh et al. Frontier in Physiol, 2016- Vieira et al. Sci Rep)
A (-): Cryotherapy negatively alters tissue healing and repair
2020- Fuchs et al. J Physiol.
2020- Chaillou et al. J Physiol.
Q: Should athletes return to activity after cryotherapy?
A (-): Cryotherapy can adversely affect performance if athletes immediately return to activity. Progressive warmup is warranted.
2014- Prichard and Saliba. J Athl Train 60 09/10/20 Cryotherapy
Q: Does cryotherapy improve joint range of motion (ROM), strength, and neuromuscular control among healthy individuals?
A (+): Cryotherapy had positive results for all outcomes
2020- Kalli et al. J Bodw Mov Ther (review)
Q: Does cryotherapy decrease pain and increase function after musculoskeletal injury or pathology?
A (+): Cryotherapy had positive results for all outcomes
2019- Hsu et al. J Orthop Trauma (review)
2019- Sari et al. Pain Res Manag
2015- Malanga et al. Postgrad Me
A (-): Cryotherapy had inconclusive results
2019- Dantas et al. J Physiother
2019- Dantas et al. Clin Rehab (review) 61 09/10/20 Cryotherapy
Q: Does cryotherapy effect postural stability?
A (-): Cryotherapy adversely affects posture stability at the ankle.
2015- Fullan et al. J Athl Train
A (+): Cryotherapy does not effect posture stability at the knee.
2019- Fullan et al. J Sport Rehabil
Q: Does cryotherapy reduce pain and improve function after surgery?
A (+): Cryotherapy had positive results for all outcomes
2019- Larsen et al. J Oral Rehabil (review) (oral)
2019- Karaduman et al. Medicina (TKA) 62 09/10/20 Cryotherapy
Q: Does cryo-compression reduce pain and improve function after surgery?
A (+): Cryo-compression had positive results for all outcomes
2018- Nabiyev et al. Neurspine (spine)
2016- Secrist et al. AM J Sports Med (review) (ACL)
Cold Water Immersion
Q: Does cold water immersion (CWI) improve post-exercise muscle adaptation and muscle contractility?
A (-): CWI delays post-exercise adaptations
2020- Earp et al. Pharmaceutics
A (-): CWI delays muscle contractility after treatment
2020- Mur Gimeno et al. Sensors
Q: Does CWI enhance post-exercise recovery?
A (+): CWI enhances post-exercise recovery
2020- Gimeno et al. Sensors
2019- An et al. Int J Environ Res Public Health (review)
2018- Futado et al. Braz J Med Biol Res
2017- Higgins et al. J Strength Cond Res (review) 64 09/10/20 Cold Water Immersion
Q: Is CWI better than whole body cryotherapy (WBC) for post-exercise recovery?
A (+): CWI is better that WBS for recovery
2017- Abaidia et al. Int J Sports Physiol Perform
2017- Mawhinney et al. Med Sci Sports Exerc
Q: Is CWI better than contrast for post-exercise recovery?
A (+): CWI is better that contrast for post-exercise recovery
2017- Higgins et al. J Strength Cond Res (review)
Q: Is CWI better than ice cups for post-exercise recovery?
A (+): CWI is better that ice cup massage for post-exercise recovery
2016- Adamczyk et al. J Therm Biol
Other Cryotherapies
Q: Does WBC enhance post-exercise recovery?
A (+): WBC may have positive short-term recovery effects
2020- Louis et al. Eur J Appl Physiol
2020- Sliwicka et al. Sci Rep
2017- Mawhinney et al. Med Sci Sports Exerc
2017- Russel et al. J Strength Cond Res
A (-): WBC has no benefits for post-exercise recovery
2019- Broatch et al. Sci Rep
Q: Does Vapocoolent spray work?
A (+): Vapocoolent spray and stretch shows positive effects
2020- Koole et al. J Prosthet Dent
2008- Kostopoulos & Rizopoulos. J Bodw Mov Ther 66 09/10/20
Bottom Line
Occupational Therapist Considerations
Cryotherapy may:
Delay tissue healing and post-exercise recovery
Delay muscle contractility and impair postural stability
Improve pain, ROM, and function after strenuous exercise, injury, or surgery.
CWI seems to have the strongest evidence followed by the emerging WBC
Want to learn more about Cryo / Cold Therapy? Email Us!
References:
Abaïdia AE, Lamblin J, Delecroix B, et al. Recovery From Exercise-Induced Muscle Damage: Cold-Water Immersion Versus Whole-Body Cryotherapy. Int J Sports Physiol Perform. 2017;12(3):402-409.
Adamczyk JG, Krasowska I, Boguszewski D, et al. The use of thermal imaging to assess the effectiveness of ice massage and cold-water immersion as methods for supporting post-exercise recovery. J Therm Biol. 2016;60:20-25. An J, Lee I, Yi Y. The Thermal Effects of Water Immersion on Health Outcomes: An Integrative Review. Int J Environ Res Public Health. 2019;16(7).
Babaei-Ghazani A, Shahrami B, Fallah E, et al. Continuous shortwave diathermy with exercise reduces pain and improves function in Lateral Epicondylitis more than sham diathermy: A randomized controlled trial. J Bodyw Mov Ther. 2020;24(1):69-76.
Block JE. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open Access J Sports Med. 2010;1:105-113.
Broatch JR, Poignard M, Hausswirth C, et al. Whole-body cryotherapy does not augment adaptations to high-intensity interval training. Sci Rep. 2019;9(1):12013.
Cameron MH, Sutkus A. Physical Agents in Rehabilitation - E Book: An Evidence-Based Approach to Practice. Elsevier Health Sciences; 2017.
Chaillou T, Treigyte V. Cold water immersion puts the chill on muscle protein synthesis after resistance exercise. J Physiol. 2020;598(6):1123-1124.
Cho YS, Choi YH, Yoon C, et al. Factors affecting the depth of burns occurring in medical institutions. Burns. 2015;41(3):604-608.
Dantas LO, Breda CC, da Silva Serrao PRM, et al. Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial. J Physiother. 2019;65(4):215-221.
Dantas LO, Moreira RFC, Norde FM, et al. The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials. Clin Rehabil. 2019;33(8):1310-1319.
Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. Journal of clinical and diagnostic research : JCDR. 2014;8(9):LC01-LC04.
Devrimsel G, Turkyilmaz AK, Yildirim M, et al. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27(1):27-30.
Earp JE, Hatfield DL, Sherman A, et al. Cold-water immersion blunts and delays increases in circulating testosterone and cytokines post-resistance exercise. Eur J Appl Physiol. 2019;119(8):1901-1907.
Engelhard D, Hofer P, Annaheim S. Evaluation of the effect of cooling strategies on recovery after surgical intervention. BMJ Open Sport Exerc Med. 2019;5(1):e000527.
Fu T, Lineaweaver WC, Zhang F, et al. Role of shortwave and microwave diathermy in peripheral neuropathy. J Int Med Res. 2019;47(8):3569-3579.
Fuchs CJ, Kouw IWK, Churchward-Venne TA, et al. Postexercise cooling impairs muscle protein synthesis rates in recreational athletes. J Physiol. 2020;598(4):755-772. 102 09/10/20
Fullam K, Caulfield B, Coughlan GF, et al. Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint. J Athl Train. 2015;50(9):893-904.
Furtado ABV, Hartmann DD, Martins RP, et al. Cryotherapy: biochemical alterations involved in reduction of damage induced by exhaustive exercise. Braz J Med Biol Res. 2018;51(11):e7702.
Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010;17(5):484-489.
Harrison LE, Pate JW, Richardson PA, et al. Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain. J Clin Med. 2019;8(9).
Hawkins SW, Hawkins JR. CLINICAL APPLICATIONS OF CRYOTHERAPY AMONG SPORTS PHYSICAL THERAPISTS. Int J Sports Phys Ther. 2016;11(1):141-148.
Higgins TR, Greene DA, Baker MK. Effects of Cold Water Immersion and Contrast Water Therapy for Recovery From Team Sport: A Systematic Review and Meta-analysis. J Strength Cond Res. 2017;31(5):1443-1460.
Hsu JR, Mir H, Wally MK, et al. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. Journal of Orthopaedic Trauma. 2019;33(5):e158-e182.
Im SH, Han EY. Improvement in anxiety and pain after whole body whirlpool hydrotherapy among patients with myofascial pain syndrome. Ann Rehabil Med. 2013;37(4):534-540.
Kalli K, Fousekis K. The effects of cryotherapy on athletes' muscle strength, flexibility, and neuromuscular control: A systematic review of the literature. J Bodyw Mov Ther. 2020;24(2):175-188.
Karaduman ZO, Turhal O, Turhan Y, et al. Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study. Medicina (Kaunas). 2019;55(10).
Koole P, Zonnenberg AJJ, Koole R. Spray and stretch technique and its effects on mouth opening. J Prosthet Dent. 2020;123(3):455-460.
Kostopoulos D, Rizopoulos K. Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching. J Bodyw Mov Ther. 2008;12(2):96-104.
Kuyucu E, Bülbül M, Kara A, et al. Is cold therapy really efficient after knee arthroplasty? Ann Med Surg (Lond). 2015;4(4):475-478.
Kwiecien SY, O'Hara DJ, McHugh MP, et al. Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise. Eur J Appl Physiol. 2020;120(2):413-423. FLarsen MK, Kofod T, Starch-Jensen T. Therapeutic efficacy of cryotherapy on facial swelling, pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review. J Oral Rehabil. 2019;46(6):563-573.
