Research: “Cryotherapy doesn’t work”

Geschatte leestijd: 4 minuten “Cryotherapy? Perhaps you’d better save your money” The New York Times said yesterday about cryotherapy.

Cryotherapy

Cryotherapy or cold therapy has been around for centuries and is applied in various ways in different cultures. Nowadays, it’s particularly popular among professional athletes who believe it can enhance their performance and/or aid in faster recovery from injuries. You often see American football players diving into ice baths after a training session. I always find it somewhat unnatural to see a group of large black men going into an ice bath together. No, not meant in a homophobic way: I simply attribute my aversion to cold to my African roots. Besides ice baths, we’re seeing an increase in the use of cryotherapy pods. These are small chambers where you stand and the temperature is brought down well below zero. Numerous well-known athletes use them, from racers like Webber to basketball players like LeBron James. Aaron E. Carroll of The New York Times cited various studies in his article yesterday showing that there is little evidence to support the health claims made about cryotherapy [1].

“No Effect on Muscle Soreness”

For instance, there’s a 2015 review that compared multiple studies on the effects of cryotherapy on muscle soreness, fatigue, and overall sense of well-being [2]. Regarding muscle soreness, no positive effect was found except in studies where either the evidence or the study design itself wasn’t robust. In one of the reviewed studies, participants experienced less fatigue but no difference in well-being, while in another study, it was exactly the opposite. Ultimately, the researchers concluded that the current studies provide insufficient evidence for the claims about cryotherapy.

“No Effect on Rheumatism and Multiple Sclerosis”

Studies examining the effect on people with certain conditions such as rheumatism and M.S. provided even less evidence for effectiveness [3,4,5]. The demonstrated effect is small, which also applies to the size of the studies themselves, which were also of short duration. According to Carroll, publication bias heavily influences this. The desire to get published might lead researchers to view the results more positively than they should.

“No Effect on (Jump) Strength and Endurance”

More relevant for a fitness blog is the comparative study from 2013 on its effects on athletes’ performance [6]. There was no significant effect found on strength, endurance, and jump strength. Their comparison did show an increase in sprint speed, but that was due to a study with outlier results.

Cryotherapy and Injuries

So, is it good for anything? I’ve always considered it could have a positive effect on injuries involving inflammation. In an article about attachment problems from 2010 (reposted on Fitsociety in 2011), I mention the R.I.C.E. principle for inflammation. R.I.C.E. stands for Rest, Ice, Compression & Elevation. If this principle works locally with a cold compress, why not through whole-body cryotherapy where the entire body is cooled? In theory, this could prevent inflammations you’re not even aware of. However, Carroll points out a systematic review from 2012 that showed this principle wasn’t demonstrated. A systematic review conducted by researchers from the AMC where I was working at that time [7]. They compared 24 studies on the effect of R.I.C.E on recovering from a sprained ankle. Not only did they see no effect for R.I.C.E. in general, but even when cooling was replaced by heating or doing nothing, it had no effect.

“Can’t Hurt…”

I’ve always thought I benefited from an ice compress. For example, with a knee tendonitis from basketball or biceps attachment from weight training. Carroll also doesn’t discourage this; it’s cheap and safe. However, whole-body cryotherapy is more expensive and requires supervision. At Freezelab in Amsterdam, for example, you pay 28 euros to spend 3 minutes in a temperature of -110 degrees. The need for supervision is something 24-year-old Chelsea from Nevada found out. She worked for a spa that offers cryotherapy and decided to chill with a cryo session after work. She was found the next morning, frozen to death [8].

So: To Chill or Not?

As mentioned, resisting cold is not something I particularly want to showcase my masculinity in. But that’s me. If you’re a top athlete and want to utilize all possibilities to perform, then cryotherapy doesn’t seem to hurt at least. Even if it makes only a slight difference, it might be worth the cost. However, as a private individual lured in by attractive, unsubstantiated health claims, you might consider whether you’d rather spend half an hour sitting in a sauna.

References

1. nytimes.com/2017/01/02/upshot/cold-therapy-maybe-better-save-your-money
2. Costello JT, Baker PRA, Minett GM, Bieuzen F, Stewart IB, Bleakley C. Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD010789. DOI: 10.1002/14651858.CD010789.pub2.
3. 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 Dec;134(6):420-426. doi: 10.1111/ane.12557. PubMed PMID: 26778452.
4. Gizińska M, Rutkowski R, Romanowski W, Lewandowski J, Straburzyńska-Lupa A. Effects of Whole-Body Cryotherapy in Comparison with Other Physical Modalities Used with Kinesitherapy in Rheumatoid Arthritis. BioMed Research International. 2015;2015:409174. doi:10.1155/2015/409174.
5. Happe S, Evers S, Thiedemann C, Bunten S, Siegert R. Whole body and localcryotherapy in restless legs syndrome: A randomized, single-blind, controlled parallel group pilot study. J Neurol Sci. 2016 Nov 15;370:7-12. doi:10.1016/j.jns.2016.09.006. PubMed PMID: 27772790.
6. Poppendieck W, Faude O, Wegmann M, Meyer T. Cooling and performance recovery of trained athletes: a meta-analytical review. Int J Sports Physiol Perform. 2013 May;8(3):227-42. Review. PubMed PMID: 23434565.
7. Van den Bekerom MP., Struijs PA., Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GMM. What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? Journal of Athletic Training. 2012;47(4):435-443.
8. nytimes.com/2015/10/27/us/death-of-woman-in-tank-at-a-nevada-cryotherapy-center-raises-questions-about-safety.html?hp&action=click&pgtype=Homepage&module=mini-moth&region=top-stories-below&WT.nav=top-stories-below