CRYO AND ITS APPLICATION IN THE MEDICAL DOMAIN
The news on whole body cryotherapy is dominated by claims from the sports, vitality and beauty area. Whole body cryotherapy, however, originates from the medical domain; as it was dr. Yamauchi from Japan who used whole-body cryotherapy in the late 1970s to treat his Rheumatoid Arthritis patients. Is there a solid foundation for using whole body cryotherapy in the medical domain?
Whole-body cryotherapy (WBC) involves a short exposure to cold air, which is growing in popularity. Most protocols repeatedly expose individuals to extremely cold air (-110 to -140°C/ -166 to -220°F) in an environmentally controlled chamber for short periods (2-4 minutes). During exposure, individuals wear minimal clothing, gloves, a woolen headband covering the ears, a nose and mouth mask, and dry shoes and socks to reduce the risk of cold-related injury.
According to the consensus declaration on whole body cryotherapy, the main effect elements and indications for whole body cryotherapy are:
1. Pain relief
2. Anti-inflammatory effect
3. Effect on the skeletal musculature
4. Improvement in joint function
5. Regulation of the central activity level, psychophysical performance stimulation, and enhancement of well-being
6. Economization in the cardiovascular system and the energy balance
7. Optimization of thermoregulation
Moreover, whole body cryotherapy is indicated for:
1. Inflammatory/rheumatic disorders of the joints and the spine
2. Degenerative joint and spine disorders
3. Soft tissue rheumatic disorders
4. Chronic pain
5. Disturbed regulation of muscle tone in the case of infantile cerebral paralysis, multiple sclerosis, and muscular rigidity
6. Psoriasis with or without joint involvement
8. Contusions, sprains, status post-surgical procedures on joints and the spine, injuries to the musculoskeletal system
9. Performance optimization in sports and during medical rehabilitation
Which is Illustrating the potential of whole-body cryotherapy in the medical domain as well, but before being able to integrate whole body cryotherapy in the medical area in the USA, the FDA should clear and approve devices for medical treatment, an approval which is currently lacking.
Besides the proper and safe technology of the device, whole body cryotherapy should be acknowledged in the literature as being safe and effective, thereby being able to illustrate an appropriate foundation for its clinical effects. For this, we searched for scientific literature, included only full-text articles, which were available in English or German, described its impact on humans only and included different patient groups that were exposed to whole-body cryotherapy.
We were able to retrieve 48 studies that met the inclusion criteria and divided these over different patient groups, see table 1.
When looking into the available studies and by randomly summarizing a study within a specific patient group, we can conclude there is scientific foundation for applying whole body cryotherapy in the medical domain.
Example 1: Multiple Sclerosis
Multiple sclerosis (MS) is a chronic, heterogeneous disease with an unpredictable clinical course. Symptoms can include paralysis, ataxia, spasticity, incontinence, and fatigue syndrome. Fatigue is considered to be the most prevalent and disabling of the symptoms at all stages of the illness, and it occurs in 70–80% of patients. This characteristic of the disease directly impacts the quality of life of patients, affecting their social, physical and occupational well-being. The study from Miller and colleagues (2016) showed an improvement in the fatigue status and functional abilities of MS patients who had ten 3-min WBC exposures between 110 °C and 130 °C.
Example 2: Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory and destructive joint disease. Patient mobility is decreased due to chronic pain and morning stiffness, and functional disability affects the quality of life of the patient. WBC use has induced positive effects in patients with RA. A recent meta-analysis from Guillot and colleagues (2016) including six studies and 257 RA patients showed that consistent use of whole-body cryotherapy (14-20 applications) significantly decreased pain on the VAS and DAS. It appeared that the repetition of exposure was significant in treatment efficiency.
Example 3: Ankylosing spondylitis
Ankylosing spondylitis (AS) is a chronic, usually progressive inflammatory rheumatic disease affecting the axial skeleton and sacroiliac joints primarily. Chronic inflammation in the spine can develop into a complete fusion of the vertebrae. This phenomenon is called ankyloses, which causes a total loss of mobility of the spine. A study from Stanek and colleagues (2015) included 48 males and demonstrated that a cycle of whole body cryotherapy treatments has positive effects on AS patients regarding disease and functional score indexes, in the reduction of pain intensity and the improvement of some spinal mobility parameters.
Extracted from the literature above, for specific patient groups, different cycles of whole body cryotherapy should be recommended:
After considering the right safety precautions, different patient groups could benefit from exposure to cycles of whole body cryotherapy as we are getting to a reasonable amount of research for specific patient populations providing clinical value with no adverse events. However, before using whole body cryotherapy in the medical domain some additional steps needs to be considered and always with consultation of a medical supervisor.
1. Joch, W. et al. Consensus_Declaration_on_Whole_Body_Cryotherapy. (https://wholebody-cryotherapy.com/fileadmin/content/files/Downloads/Consensus_Declaration_on_Whole_Body_Cryotherapy.pdf)
2. Miller, E., Kostka, J., Włodarczyk, T. & Dugué, B. Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study. Acta Neurol. Scand. (2016). doi:10.1111/ane.12557
3. Guillot, X. et al. Cryotherapy in inflammatory rheumatic diseases: a systematic review. Expert Rev Clin Immunol 10, 281–294 (2014).
4. Stanek, A. et al. Can Whole-Body Cryotherapy with Subsequent Kinesiotherapy Procedures in Closed Type Cryogenic Chamber Improve BASDAI, BASFI, and Some Spine Mobility Parameters and Decrease Pain Intensity in Patients with Ankylosing Spondylitis? Biomed Res Int 2015, 404259 (2015).