Commentary

Is cold therapy for you? Assessing the risks and benefits of different types of cryotherapy

There’s been quite a bit of interest in cryotherapy (various forms of using cold temperatures for recovery and health benefits), and in this article I’ll briefly describe the types of cryotherapy available. We’ll also touch on an interesting emerging concept: is applying ice immediately after an injury really the best thing to do for healing and recovery?
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What is cryotherapy?

Cryotherapy (cold therapy) includes:

Cold Water Immersion (CWI) – ice baths.
Whole Body Cryotherapy – ice chambers.
Local Icing – ice packs.

Research suggests cold can be used for therapeutic purposes as a means of accelerating recovery after strenuous exercise. Many top-level athletes, coaches, and practitioners have adopted cryotherapy as a potentially beneficial supplement to training. While cold water immersion (CWI) requires little equipment or specialist instruction (you can use your bathtub), whole body cryotherapy (WBC) has been marketed as an alternative.

What are the differences?

CWI – Cold water immersion is the process of immersing the body in a cold water (≤59F) bath or plunge pool for up to 10 minutes immediately after exercise. It attempts to enhance the recovery process for muscles and provides camaraderie (team building) if done in a group.
WBC – Whole body cryotherapy is an enclosed chamber that surrounds the body with the head exposed. It drops to below -200°F for up to 4 minutes.
Local Icing utilizes the placement of ice packs to reduce swelling in specific areas of the body.

What are the benefits of cold therapy?

Cold may be useful in limiting swelling and decreasing pain in the short term. Its benefits may also include deeper sleep, increased metabolism, and stress reduction. Although cold treatments may make you feel better, it doesn’t necessarily mean your muscles adapt or heal quicker.

What are the risks of cold therapy?

Here’s where it gets interesting. We’ve known for a very long time that the initial inflammation after an acute injury is important because the inflammatory cells contain growth factors, cytokines, and other substances helpful in healing the injury.

Chronic inflammation -- inflammation that takes place over months or years -- can on the other hand be harmful. For example, a growing body of evidence suggests that chronic inflammation in the arteries of the heart leads to narrowing of the arteries and risk for a heart attack.

General risks of cryotherapy may also include:

Poor circulation.
Skin burns and irritation.
Hypothermia.
Exacerbating pre-existing risk factors (High blood pressure, cardiovascular issues).

Rethinking RICE (Rest, Ice, Compression, Elevation)

I’ve long been a proponent of RICE for acute sports related injuries, and RICE remains the standard of care for these types of injuries.

Early application of RICE after, for instance, a significant ankle sprain appears to speed up the time to return to play compared to those who don’t apply RICE. But is it coming at the expense of the actual healing of the injured tissue?

In other words, is the athlete getting back to play faster because she/he is feeling better and has more mobility due to less swelling, but underneath is the injured tissue not fully healed?

This is a very interesting question causing us to rethink whether everyone should in fact apply ice after an acute injury. We’ll follow the research on this closely.

Is cold therapy for you?

As long as you recognize that the research proving cryotherapy recovery claims are lacking and you don’t experience any adverse effects, then cold treatment may be for you. For now, RICE after an acute sports injury is still the accepted standard.

If you find cold therapy reduces your soreness after an intense workout and increases recovery time towards the gym, then it may be a practice you can utilize.

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Key Points
Cryotherapy (cold therapy) is reported to enhance recovery from intense workouts and may have other health benefits.
Cryotherapy may be applied to the whole body or locally to an injured area.
There is some controversy emerging about the real benefits of local ice application after a sports injury. Ice may speed return to play but actually might slow down tissue healing.

(Dr. Dev Mishra is in private practice at the Institute for Joint Restoration in Menlo Park, California, and Medical Director of Apeiron Life. He is the creator of the SidelineSportsDoc.com online injury management course and the Good to Go injury assessment App for coaches, managers, parents and players. Mishra writes about injury recognition and management at SidelineSportsDoc.com).

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