“From being on crutches and reliant on medication to walking freely again and pain free – in 2 weeks. That’s the power of the cold”
How Does Cryotherapy Support Rehabilitation from Injury?
Cryotherapy has long been used as an adjunct therapy to support rehabilitation from various types of injury – be it soft tissue damage from playing sports through to the more complex recovery needs following surgery.
This article looks at the varying mechanisms by which cold therapy helps with recovery from injury and then in more depth at the additional benefits from Cryotherapy that further support injury rehabilitation.
It then looks at a specific case study where cold therapies, and a Cryotherapy routine, helped Steve recover from a spinal injury which left him on crutches and reliant on medication, to getting active again with no need for painkillers.
Fig 1 highlights the broad ‘umbrella’ of techniques covered by Cryotherapy – including Cold Water Immersion (CWI) and Whole Body Cryotherapy (WBC). All cold therapies work in broadly the same way, but the their effects can be very different and it’s worth understanding the difference.
Acute injury – these happen suddenly, for example when playing physical sports, and are categorised by the sudden trauma and the type of injury (e.g. torn muscle or broken bone) that results
Chronic injury – these develop over time due to a variety of reasons such as overuse or incorrect form when moving. Common chronic injuries include the likes of shin splints and tendonitis.
Exercise Induced Muscle Damage (EIMD) – everyone will feel the effects of a strenuous exercise session from time to time – that’s how we improve. But if muscles are pushed too far in a session, then EIMD can be caused, characterised by more than the soreness one may expect post-workout (DOMS) combined with a loss of muscle effectiveness which can last for up to 14 days.
Post-surgery – the specific characteristics of post-surgery injury will depend on the individual and the type of surgery performed. When looking at any post-surgeryrehabilitation plan, please be sure to get advice from the surgeon or appropriately qualified professionals.
While cold therapy can support recovery for each category of injury, their specific characteristics mean that care should be taken in terms of when, and how, a cold therapy is used. If you’re unsure of what to do, speak to a qualified physiotherapist on how best to treat your injury.
Cold Therapy for Injury
Most people are aware of the protocol to use ice or some form of localised exposure for acute or chronic injury. The RICE (Rest, Ice, Compression, Elevation) technique is well known and for minor injuries, is generally effective to reduce inflammation and pain, and speed up recovery.
The ‘Ice’ involved in the RICE technique plays a key component as applying a cold medium to an injured area has a number of physiological effects.
Vasoconstriction of blood vessels in the local area which helps to decrease swelling and inflammation
Decreased tissue hypoxia
Decreased pain
Decreased muscle spasm
These effects are the key to how cold therapies help to reduce the severity of injury and speed up recovery over time:
Cold Induced Vasoconstriction
Vasoconstriction occurs when a cold medium (like ice) is applied to an injured area such as a sprained ankle. The body autonomically constricts surface blood vessels and in addition, cooled venous blood returning to general circulation in the body stimulates the hypothalamus to further increase vasoconstriction more generally.
This effect is key in acute injuries shortly after they occur, as the impact of the cold through vasoconstriction reduces the formation of hematoma (blood clots), reduces bleeding/bruising and lowers the level of exudate (fluid leaking from cells) in the local area.
Combined these effects can decrease the severity of the injury and promote more successful rehabilitation.
Decreased Tissue Hypoxia
Following an injury (especially acute injury) there is a disruption to the available local oxygen supply as a result of the tissue damage – which can mean that nearby uninjured tissue can also not get enough oxygen (hypoxia). If this is prolonged, then secondary damage can occur, aggravating the overall extent of the injury.
By applying cold to the injured area, the metabolic need for oxygen is significantly reduced in the injured and surrounding tissues. The cold induces a ‘temporary hibernation state of the tissue’ which in turn means the possibility of secondary damage from hypoxia is much reduced.
As such, the protective effect of the cold can be critical in the early management of injuries:
Cryotherapy, Review of physiological effects and clinical application, Ciolek, The Cleveland Clinic
Decreased Pain
A variety of studies have shown that the local application of ice to an injury reduces pain – and it’s thought that there is a direct and indirect mechanism for the effect.
The direct mechanism is that the cold may cause a temporary decrease in nerve conduction velocity, disrupting pain impulses back to the brain.
Indirectly the effect of the cold on nerve fibres and specifically pain signals is similar to Melzack’s Gate Control Theory – where an indirect decrease in pain occurs as a result of alternating signals from the injured area which ‘confuse’ the body’s pain response.
Decreased Muscle Spasm
This effect is most pertinent to those suffering with Exercise Induced Muscle Damage (EIMD) as the effect of the cold has a generalised effect on reducing muscle spasticity of damaged muscle fibres which in turn enables improved blood flow, oxygenation and repair, speeding recovery.
If you suffer from cramps and tight, sore muscles, this is an effect you’re probably familiar with.
Whole Body Cryotherapy for Injury Recovery – The Difference
Most people who have experienced any form of injury will be familiar with localised cold therapy – especially for acute injury – whether that is via an ice pack, a cold spray or the dreaded cold-sponge beloved of old school sports physios.
When it comes to more generalised recovery, Whole Body Cryotherapy offers something more – and it is these additional effects which can make it so powerful for speeding recovery and especially for mitigating/improving chronic pain conditions.
This review draws on two leading meta-studies which analyse the various mechanisms at play.
Whole Body Cryotherapy and Anti-Inflammatory Effects
As explored in this blog post, Whole Body Cryotherapy gently induces a thermal shock which stimulates the brain to react.
One of the reactions is the production of cytokines (proteins which enable cells to communicate with one another to produce specific actions) – specifically a group of cytokines known as interleukins.
Interleukins power the body’s anti-inflammatory response (as well as playing a significant role in our immune system response). WBC, after a single session increases levels of key proteins – Interleukin-6 (IL-6) and Interleukin-10 (IL-10) whilst reducing the actions of pro-inflammatory cytokines.
Why is this significant? The anti-inflammatory effects caused by the Whole Body Cryotherapy sessions significantly reduce inflammation across the entire body, and are especially effective for post exercise recovery and EIMD.
The body-wide anti-inflammatory impact is the start of a series of cumulative effects that WBC produces which can significantly accelerate injury recovery.
The next, and possible the most important effect, is enhanced sleep
Whole Body Cryotherapy and Enhanced Sleep
WBC leads to healthier sleeping patterns, augments quality of sleep, stimulates activation, creates a better physical condition in patients with psychological problems and reduces fatigue
Recent studies on sleep and circadian rhythms have shown the importance of sleep for overall health, reduced fatigue, physical condition and more. Sleep, or rather, good quality sleep is vital for our overall health and is especially important for injury recovery.
The mechanisms by which WBC promotes quality and effective sleep is thought to have to do with its impact on neurotransmitters – particularly serotonin. Serotonin plays a key role in our sleep cycles and overall mental health.
The ‘Cryo-high’ experienced following a Cryo-therapy session is a result of neurotransmitter levels being boosted by the brain in response to the thermal shock induced by a WBC session – and when that high gradually tapers off, the body is set for a deep and restful sleep.
For injury recovery, deep sleep is also when the body actively repairs itself. This is when the increase in anti-inflammatory proteins (and decrease in pro-inflammatory proteins) makes its impact felt – ensuring injured areas can be adequately accessed through reduced edema. By doing so, nutrient rich blood can reach the injured tissue and the process of repair begins.
Getting regular good quality sleep, combined with the anti-inflammatory boost from WBC, quickly adds up when it comes to reducing pain and hastening recovery.
Enhancing circulation is the last WBC effect which adds up to really accelerate injury recovery.
Whole Body Cryotherapy and Enhanced Circulation
In much the same way as the classic ice pack method discussed above, Whole Body Cryotherapy induces vasoconstriction across the entire exposed surface area of the body – not just the localised area an ice pack would be applied to.
This broad scale vasoconstriction, combined with the brain’s reaction to the thermal shock, results in the body’s tissues being flooded with fresh oxygenated blood when the body warms back up and the blood vessels vasodilate – with the blood now enriched with hormones, proteins and other building blocks.
This is particularly effective for those parts of the body where edema is present – as the cold reduces the swelling and inflammation quickly enabling enriched blood to flow into the affected tissue, reducing pain and kick-starting the healing process.
The key difference with WBC over a conventional ice/cold treatment is the whole body, not just the affected area is getting the benefit of the cold.
In addition, WBC sessions create the thermal shock response that means that the whole body is getting the benefit of the released hormones, proteins and nutrients needed for recovery at the same time – something an ice pack or even a cold dip in an ice bath can’t get close to replicating.
WBC for Injury Recovery Summary
In summary, Whole Body Cryotherapy turbo-charges injury recovery in 3 key ways, all of which work cumulatively and offer advantages over conventional ice-pack style treatment:
Anti-inflammation. WBC sessions create a thermal shock, stimulating the brain to respond with the production of hormones, neurotransmitters and proteins. Anti-inflammatory proteins are released and pro-inflammatory markers are suppressed, meaning the body as a whole, not just the injured area, becomes less stiff, sore and painful.
Improved sleep quality. The body needs sleep to repair. But sleep isn’t just about quantity – it’s about quality. WBC stimulates neurotransmitters which help the body’s clock to reset and results in high quality, deep sleep which is essential for the body to repair itself. Without good quality sleep, any physical program, weight loss or recovery regime won’t be effective.
Enhanced circulation. WBC causes vasoconstriction across the entire exposed surface area of the body – not just the impacted injured areas. When the body warms up and the circulatory system vasodilates, the body is flooded with enriched blood to help speed up the healing process.
How Fast Does WBC Work for Injury Recovery?
This will depend on the individual, their state of fitness and the nature of the injury itself.
What can be said is the effects can be felt after just one session – and tend to accelerate over time.
A good sense of just how effective cold therapy can be is in this case study – from one of our The Cryo Hub founders, Steve.
Recovering from Spinal Injury Through Cold Therapy | Case Study
Can you please describe the symptoms or condition you were feeling that led you to try Whole Body Cryotherapy? How were they impacting you?
I’d had back pain issues for many years, playing a variety of sports and from sitting too long at a desk. This eventually led to a disc prolapse which I put up with for far too long, somehow limping along getting intermittent relief from steroid injections and epidurals but over time, the symptoms got worse and worse – with sciatica so bad I couldn’t sleep or walk properly.
Eventually I had surgery – a discectomy and laminectomy. And the initial relief was amazing after putting up with so much pain for so long. I knew I had a long road to recovery (finding out after the surgery that I’d lost a huge amount of muscle mass – with one thigh now a full 15% smaller in circumference than the other) but was up for the challenge.
A few weeks later I was rushed back to hospital for surgery again – with a suspected infection. The surgical site was opened up again (I found out later the term for that, aptly enough, is a double insult) and this time I spent a month post-surgery in hospital.
This time round I couldn’t walk, and even the slightest movement such as a cough or a deep breath, could set off waves of back spasms.
Over the coming months I tried to get my strength back by walking (with crutches) a bit more each day but it was a miserable and painful experience. The back spasms in particular made life tough as they prevented any form of decent sleep and I needed handfuls of painkillers and tranquillisers to function day to day.
Why did you think Cryotherapy could help?
I’d tried ‘hot and cold’ therapies as recommended by the medical team, but had found the effect to be temporary and limited in terms of relief and improvement.
Whilst visiting family in Norway a relative recommended I go ‘into the ice’ – a prospect which didn’t sound fun. To get a sense of why this video shows how a US marine reacts to going into a freezing lake for the first time:
Royal Marines vs USMC – ice walk
It does show the Royal Marine rather enjoying himself – but there’s a reason they used to say 99% need not apply! Going into icy water that cold hurts. The vasoconstriction response is so strong it’s painful and very quickly you’ll find you can barely move. It’s not an environment you can be in for long.
But… after the first ‘dip’ I felt amazing. A first experience of the ‘cryo high.’ I didn’t feel in nearly as much pain for the rest of the day, and slept like a baby for the first time in a long time.
So the next day I did it again. And kept going each day.
After a week, I could walk without needing crutches anymore.
After 2 weeks I didn’t need any medication. No pain killers, no tranquilisers. And I’ve stayed that way since.
And so started my belief in the power of the cold.
Returning to the UK I started to research and tried various protocols such as the Wim Hof method, and got one of the popular ice baths at home. And that’s where progress stalled.
Picture of Lumi Home Ice Bath
Ice baths (such as the one pictured) are great if you enjoy the overall wellness benefits of cold therapy. Much like cold water swimming you get a mild ‘cryo-high’ and some of the benefits described above relating to injury recovery.
The snag is it’s difficult to get the temperature cold enough to really get the best impact and effects. There’s a big difference between a frozen lake with water temperature just above 0℃ and an ice bath somewhere between 10-15℃. The latter just didn’t quite hit the heights I’d experienced before.
The other problem with the ice bath method is it’s difficult just to get temperatures down to 10-15℃. It takes a colossal amount of ice to cool the ice bath down – Mark Wahlberg has the same problem as seen in the picture below. Not being a Hollywood star I didn’t have the time, patience or freezer space to keep doing that, let alone the stomach for the electricity bill needed to keep freezing that much water/ice each day.
Mark Wahlberg using buckets of ice to get his recovery ice bath to temperature
I looked at getting a commercial system with a chiller – but researching them showed that they’ve got their own set of challenges.
So it was either moving somewhere with a sub-zero climate or something else. So I started to try Whole Body Cryotherapy, finally finding the right balance of something that was cold enough to get the effects I was looking for, and was surprisingly quick and convenient.
From then on I was hooked.
How did you find the initial experience? Were there any changes to your symptoms?
The most surprising thing is how pleasant the experience is. Compared to going into freezing cold water there’s absolutely no initial shock at all, let alone pain. In fact my initial concern was whether it was going to be cold enough to get the effects I wanted.
By the end of the session my skin temperature had dropped by 14℃ and shortly afterwards I started to feel the familiar effects of what I now know to be the thermal shock induced by the rapid drop in skin temperature. I got the buzz, a good night’s sleep and continued to feel the improvement in my injury and overall health, without ever really feeling cold.
In terms of changes to symptoms, the most noticeable initially was a reduction in stiffness and less likelihood of cramping. This in turn enables me to push harder and harder physically, using cryo sessions to mitigate the impact of the exercise and continuing that pattern to improve, push harder, recover, improve…
Have you developed a routine which works for you?
If time and life permits, I’ll go in every day! More realistically, I’m at the point now where Cryotherapy is part of an overall wellness routine – as good for the mind as it is the body, and I try to get at least 2 or 3 sessions/week in. I do daily cold showers – but that’s as much a mental routine (‘do something each morning you’d really rather not do’) as opposed to something that creates a noticeable effect.
What are the outcomes you’ve seen as part of your routine? Not just for your initial goals but any other effects?
I went from being in agony – unable to walk properly, let alone exercise – to being able to run again and even do martial arts. I’ve hit personal records in terms of fitness that I couldn’t get close too when much younger. In fairness that’s a lot to do with better habits as part of an overall improved wellness routine, but the Cryotherapy is an integral part of that routine and I tend to perform/recover much better with Cryo-sessions tied closely into training.
I was sceptical about the claims made around the power of the cold but my experience, let alone the various Wim Hof style transformation stories highlights what many cold therapy advocates have been saying for years – that the cold can be truly transformational for a wide range of conditions. The explosion in credible research studies in the last decade adds further credence to what the technique can do.
All I’d say is if you’re in pain, try it. One session is usually enough to feel the difference and then go from there.
Want to Give Whole Body Cryotherapy a Go?
Cryotherapy is a daunting prospect for many. So at The Cryo Hub we take one barrier to experiencing the power of the cold away, and offer the first session free.
