Cryotherapy Indications, Contraindications

Cryotherapy Indications

It is unclear if whole body cryotherapy (WBC) has any effect on muscle soreness, or improves recovery, after exercise.^[rx]

There is no evidence that whole body cooling effectively treats

• Pain? management – Cold packs increase pain thresholds and thereby reduce pain. Cryotherapy can be used in both acute? and chronic pain.
• Decrease muscle spasms – Cold therapy reduces the sensitivity of the muscle spindles and reduces pain. Thus, it helps to reduce muscle spasms.
• Reduce inflammation – Cold therapy slows the inflammatory response by reducing the release of inflammatory mediators.
• Edema? management – Cold therapy reduces capillary? permeability. As a result, cryotherapy helps to reduce edema as well as hemorrhage.
• Reduce spasticity – Muscle cooling has been found to reduce muscle stretch activity. Cryotherapy demyelinates nerves and reduces nerve conduction. This has been proven to reduce spasticity as well as fatigue? in MS? patients.
• Vasoconstriction – As cryotherapy lowers the tissue temperature, it acts as a vasoconstrictor. In the case of acute injury, this effect of cryotherapy along with elevation can stop bleeding along with easing pain.
• Relieve pregnancy back pain?, muscle spasms, and cramps – Common pregnancy symptoms can be relieved using cryotherapy and is a safe alternative to medications.
• Reduce fever? – Cryotherapy reduces fever by bringing the tissue temperature down. This has a significant impact on the physiological function of the body.
• Manage acute post-surgical conditions – In post-surgical conditions, ice packs can be used to manage pain, muscle spasm?, and edema.
• Improve muscle fatigue – Athletes use ice packs during training or competitions. Cryotherapy chambers can also be used to recover from exercise-induced muscle injury or delayed onset? of muscle soreness (DOMS).
• Induce temperature stress – Cryotherapy induces a short duration temperature stress to the body. The hormones released during stress — cortisol, adrenaline, and dopamine — increase the ability to withstand pain, fatigue, and hunger.
• Increase metabolism – After a session of cryotherapy, energy (calories) are used to reheat the body. It is hypothesized that during a three to the five-minute session, approximately 500 to 800 calories are burned.
• Cryotherapy can help with muscle pain?, as well as some joint and muscle disorders, such as arthritis?. It may also promote faster healing of athletic injuries.
• Cryotherapy is used in an effort to relieve muscle pain, sprains and swelling? after soft tissue damage or surgery.
• Reducing anxiety and depression
• Pain relief and muscle healing
• Reduced inflammation
• Preventing dementia?
• Alzheimer’s
• Preventing and treating cancer
• Improving symptoms of eczema?
• Treating Migraine? Headaches
• Fibromyalgia
• Migraines
• Rheumatoid arthritis
• Multiple sclerosis?
• Stress,
• Anxiety
• Chronic pain as its proponents claim.^[rx]
• Cancer
• Diabetes 
• Depression
• Dementia and arthritis.

Cold therapy, especially whole body cryotherapy, should be avoided in the following cases. Currently accepted contraindications for WBC include

• Any respiratory illness
• A history of heart attack? in the past six months
• High blood pressure
• Unstable angina pectoris?
• Cardiovascular disease or arrhythmias
• Circulatory disorders like peripheral arterial or venous disease (DVT?)
• Anemia? tumors
• History of stroke? or cerebral hemorrhage
• History of seizures
• Raynaud’s syndrome?
• Bleeding disorders
• Acute or chronic kidney disease
• Metal implants or pacemakers
• Pediatric patients (younger than 18)
• cryoglobulinemia
• cold intolerance
• Raynaud disease
• hypothyroidism,
• acute respiratory system disorders
• cardiovascular system diseases (unstable angina pectoris, cardiac failure in III and IV stage according to NYHA),
• purulent-gangrenous cutaneous lesions
• sympathetic nervous system neuropathies
• local blood flow disorders
• cachexia, and hypothermia, as well as claustrophobia and mental disorders hindering cooperation with patients during the treatment.

Cryotherapy Side Effects

There are a few side effects of cryotherapy treatments that therapists should note:

• While cryotherapy can reduce unwanted pain and nerve irritation, it sometimes can leave the tissue affected with unusual sensations, such as numbness or tingling.
• Cryotherapy can cause redness and irritation of the skin. But, these effects are generally temporary.
• If a localized cold pack or ice is left on the skin too long, it can cause integumentary damage (including frostbite in extreme cases). Therefore, localized cold therapy should never be applied longer than 30 minutes, and the skin integrity should be monitored during treatment.
• Whole body cryotherapy should not exceed five minutes (typical treatment sessions are two to three minutes). Whole body cryotherapy causes decreased heart rate, increased blood pressure, and lowered respiration. The patient’s vital signs and disposition should be monitored before, during, and after treatment. Oxygen levels inside the chamber should also be checked.
• The patient should ensure that all clothing and skin are completely dry when stepping into a cryotherapy chamber. Also, metal or jewelry should be removed. Last, sensitive body parts should be covered with a facemask, ear muffs, gloves, and socks or slippers. The burning of the skin or frostbite can occur when a patient does not follow proper protocol when entering a cryotherapy chamber.

Risks Factors

• Like any percutaneous procedure, bleeding may result—both from the puncture and the freezing of tissues such as the liver, kidney or lung.
• Damage to normal structures may occur. During liver cryotherapy, the bile ducts may be injured. During kidney cryotherapy, the ureter or collecting system may be damaged. The rectum may be damaged during prostate cryotherapy. Any treatment of the abdomen may result in damage to the bowel and cause a hole in the bowel, which may release bowel contents into the abdomen that can lead to potentially life-threatening infection.
• If freezing occurs near the diaphragm, fluid can accumulate in the space around the lungs.
• If the procedure is in or near the lung, the lung may collapse.
• Nerve damage may result. Completely frozen nerves can cause motor weakness or numbness in the area supplied by the nerves.
• Complications related to medications, including anesthesia, administered during the procedure may occur.
• Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
• This procedure may involve exposure to x-rays. However, radiation risk is not a major concern when compared to the benefits of the procedure.

Specific possible complications related to the cryotherapy of prostate cancer

• Permanent impotence since nerves controlling sexual potency is commonly involved in the freezing process. However, nerves can regenerate, resolving the problem in some patients.
• While the patient is under anesthesia, a bladder tube is positioned to drain urine until the swelling of the bladder neck—as a result of the procedure—resolves.
• May cause urethral sloughing; that is, blocking of the urine stream with dead tissue. Sloughing is reduced by keeping the urethra warm with sterile water circulating continuously through a catheter placed in the urethra during the procedure.

References