Cold Therapy: Ice Bath vs Cryotherapy Compared

man in a Cryotherapy chamber

When you put an ice pack against a sprained ankle or a swollen knee, you are using a contemporary method of ice therapy to relieve your discomfort. Other examples of cold therapy comprise ice baths, coolant mists, ice massages, and whirlpools.

These methods, to this day, remain among the most basic and tried-and-true approaches to reducing inflammation and discomfort. For centuries, cold therapy has been under practice in various civilizations.

It is known to enhance the body’s healing abilities, which aids in easing the symptoms of various medical ailments while also instilling the senses of vitality and well-being.

If practised daily, ice bathing also brings about long-lasting benefits for your circulatory, immune, digestive, and lymphatic systems.

R.I.C.E.

Cold therapy defines the ‘I’ component of the R.I.C.E. protocol of physiotherapy. R.I.C.E. abbreviates for rest, ice, compression and, elevation. It is generally advised for self-treating numerous injuries, especially those that are sports-related. In addition, cold treatment for pain reduction can be utilized for a variety of reasons, including:

  • Arthritis pain
  • Runner’s knee
  • Tendonitis
  • Sprains
  • Low back pain
  • Inflammation and pain that follows a hip or knee replacement surgery
  • Inflammation and pain underneath a cast

Applying an icepack helps reducing pain and oedema by lowering skin temperature and vasoconstriction. In addition, cold therapy, according to experts, helps reduce inflammation, which is linked to discomfort.

It could also lessen pain perception. Cold therapy could be highly beneficial when dealing with inflammation and discomfort, notably surrounding joints or tendons.

The Lewis Hunting Response

Lewis hunting reaction or the hunting response is a mechanism involving recurrent vasoconstriction and vasodilation in cold-exposed regions. The Lewis reaction, a term named after Thomas Lewis, who identified it first in 1930, is also employed.

Vasoconstriction initially occurs to prevent heat loss. It also causes severe cooling of the body parts. The blood arteries of that area will instantly vasodilate within five to ten minutes of cold exposure.

Vasoconstriction is most likely due to a reduction in neurotransmission from the sympathetic nervous system to the muscular layer of the arteriovenous aneurysms due to local cold. Hence, the vasodilation induced by the cold would subsequently increase blood circulation and the affected area temperature.

Following vasodilation, a new period of vasoconstriction occurs, and the cycle continues. When the cold is sustained for more than fifteen minutes or the temperature is dropped to ten degrees Celsius, Cold can elicit vasodilation after an initial phase of vasoconstriction.

How to Use an Ice Pack and other Cold Therapy Techniques?

Applying ice packs or frozen substances straight on the skin might provide instant relief but irritate it. The advisable method is to wrap your gel or ice pack with a thin towel before applying it to your skin. The towel would act as a shield to the skin from direct cooling.

Treat the affected area several times a day by applying the ice pack for almost ten to twenty minutes. While administering ice therapy, observe the skin sensations keenly.

You need to ensure that the tissues do not acquire any damage. Then, combine the ice therapy with the other components of the R.I.C.E. protocol as instructed below.

  • Rest: pause all activities that might aggravate the pain.
  • Compression: applying firm and moderate pressure to the affected area would help with pain and edema. It will also help the affected area in staying stable, so it does not acquire more damage.
  • Elevate: try elevating the affected body part.

Rehabilitation exercises should be performed depending on the injury acquired. You might want to try the strengthening and stretching exercises prescribed by your physician to help to heal and support the area. Over-the-counter pain medicines would also help with the discomfort due to pain.

Cease the application of you feel like losing the sensations of the area where you applied the ice pack. Consider contacting your healthcare professional if the therapy is not beneficial individuals with certain medical conditions should also avoid cold treatment. For example, there will be an impaired ability to detect tissue damage for a diabetic patient.

Other methods to employ cold therapy involve ice massages, chemical cold packs, cooling tubs, sprays, and cold compression. Each technique differs in its application but produces the same effects.

  • Cold compress involves soaking a washcloth in ice water and applying it to the affected area.
  • Coolant sprays usually comprise methanol which induces a soothing effect. They are convenient to use and are also capable of providing lasting relief.
  • Cooling tubs employ complete submergence in ice water. However, if this seems uncomfortable, you can only immerse the affected region in the tub.
  • Chemical cold packs are also among the convenient methods of cold therapy. With one squeeze, the pack is activated. However, it will only last for thirty minutes.
  • Massaging the affected area with ice for seven to ten minutes could help reap the benefits of ice massage and reduce pain and inflammation.

How is Cold Therapy Beneficial?

A few benefits of cold therapy have been mentioned earlier in the article. However, here are some details of those essential advantages. Let’s analyze them.

Improves Immunity and Lymphatic System

The lymphatic system, in essence, purifies your body. It is a system that extends across your body, assisting in toxin, bacteria, and pathogen removal from the body cells. The lymphatic fluid propels through the vessels via muscle contractions used by the lymphatic system.

Lymphatic flow implies that not exercising would cause the lymphatic system to grow slow and inefficient. A cumbersome lymphatic system would lead to the lymphatic fluid stagnating and causing toxin build-up in the body, resulting in common cold, joint discomfort, infections, and illnesses.

Immersing yourself in cold water would constrict the lymphatic vessels, pushing the lymphatic system to propel the fluid throughout your body. This pumping of the lymphatic fluid would flush away the toxins from your body. 

Our white blood cells would subsequently be activated and would attack and destroy any unwelcomed substances. So to put it short, cold therapy would activate your lymphatic system, which will activate the immune system. The two would work to keep you healthy and content.

Enhanced Circulation

Among the most important aspects of general health is good cardiovascular circulation. Not only does poor circulation hamper blood flow, but it also strains the heart. This could ultimately result in fatigue, headaches, muscular cramps and, raised blood pressure. The worst-case scenario would be a heart attack or stroke.

An improved circulation, on the contrary, would help improve our metabolism and cardiovascular, cognitive, and immune functioning. Thus, besides exercising and dieting, ice bathing is also a method for increasing circulation.

Immersing yourself in cold water would cause a sudden drop in body temperature. So as a protective mechanism, the circulation will turn central. This implies that the blood will rush to the vital organs of your body.

The central circulation would force the heart to function rapidly and pump blood to all your veins, providing your body parts with oxygen and nutrients. Practising this regularly would therefore lead to healthier circulation and body.

Reduced Muscle Inflammation

Many individuals find themselves extremely sire after an intense workout. This condition is termed DOMS, abbreviated for delayed-onset muscle soreness. It can be highly unpleasant for some individuals, necessitating the use of anti-inflammatory medications.

Activities that push your muscles beyond their natural tendencies end up causing microscopic tears in muscle fibres hence initiating tissue inflammation. Ice bathing has been clinically demonstrated to help alleviate these symptoms.

As mentioned earlier, cold water reduces the tissue temperature and constricts blood vessels. In addition, the drop in the temperature numbs the nerve endings hence alleviating the pain.

Enhances Weight Loss

Cold therapy has been demonstrated to increase the body’s metabolic rate by roughly sixteen per cent if done regularly. This intentional divergence from the body’s optimum temperature will cause the body to react to it to maintain the temperature.

Among these reactions, one is an increase in the metabolic rate. An increased metabolic rate would hence promote weight loss.

The advantages are adaptive; therefore, a few isolated ice baths are unlikely to provide them. They are correlated explicitly to an individual’s preferred degree and the actual temperature. It is crucial to note that cold therapy is not a wonder drug for weight loss, but it can aid when combined with adequate nutrition and increased daily exercise.

Read more about freezing fat off your body.

Resets your Thermoregulation

If you are always cold, taking a cold shower can help you recalibrate your body’s temperature management. Unfortunately, most of us ended up losing our tendencies to stay warm in the changing society.

Central heating and warm garments keep us at a consistent temperature. However, over time, your body may grow reliant on external heating systems instead of its heat-generating capabilities.

Showering in cold water might help your body re-heat. Among the many advantages of taking regular cold therapy is that you will always be warm. For somebody who suffers from chronic cold, this could be really beneficial.

Analyzing Cold Water Immersion and Whole-body Cryotherapy

Cold Water Immersion has been in practice for over decades now and has an ancient legacy. The earliest known experiments related to the implications of cold water immersion were first conducted in 1970 by Dr James Currie.

Dr Yamauchi first documented trials employing whole body cryotherapy in 1979. These trials were conducted on a group of rheumatoid patients.

Both are considered modalities in that they apply a sort of stress to physiological systems to induce an involuntary reaction. For the respected modalities, if either one of the treatment periods or the intensity is inadequate, little to no improvements are gained. Let’s analyze both in detail.

Cold Water Immersion (CWI)

Cold Water Immersion (CWI) is a rehabilitation technique that involves submerging the body in ice water (≤15˚C/59˚F) soon after training to speed up recovery. CWI is a successful strategy for improving recovery. Recovery is an essential element of training because it helps to reduce the danger of overuse injuries while also improving physical and mental readiness.

This is especially necessary during intervals of rigorous practise or competition to maintain a high level of performance. Many rehabilitation procedures, such as massages, foam rolling, electrotherapy, whole-body vibrations, compression gear, hyperbaric oxygen therapy, and aquatic immersion therapy, have been developed due to this understanding.

The cold water immersion technique has become a more prevalent rehabilitation protocol. It has been shown to increase subjective assessments of recovery, although its implications on objective criteria are less clear.

Despite its propensity to increase recovery, psycho-physiological processes that support this form of healing are yet unknown. While more research is required, reducing inflammatory markers and the osmotic implications of water immersion simultaneously present intriguing possibilities for the beneficial effects of cold water therapy.

Essential Guide to practicing CWI

When applying CWI, it is crucial to remember some dos and don’ts. When it comes to the water temperature, cautiousness is the better option. Recognize that everyone has a different cold threshold, and flowing water is colder than still water.

Similarly, overexposing and re-warming right after the treatment are not suggested. Also, bear in mind that the colder the water, the better is not an advisable strategy. Shallow temperatures could end up damaging the tissues.

Does it Enhance Recovery?

Exercise can exhaust the musculoskeletal, neurological, and metabolic components to varying degrees proportional to the intensity. Exercise causes minute tears in muscle fibres, termed exercise-induced muscle damage (EIMD) and can lead to DOMS.

Several criteria have been measured to determine the success of CWI. The two major categories are subjective and objective measures.

The subjective measure comprises perceived exertion (RPE) ratings and delayed-onset muscle soreness (DOMS). At the same time, the objective measures consist of interleukins, creatine-kinase, blood lactate levels, and C-reactive protein.

How Does it Improve Recovery?

The following theories have been proposed for the effective mechanisms of its capacity to promote recovery:

  1. Vasoconstriction: According to one idea, submerging oneself in cold water produces vasoconstriction, resulting in reduced localized blood circulation. The chilly temperature is hypothesized to trigger the temperature nerve endings (nociceptors), resulting in a changed sympathetic stimulation and therefore causing the lowered blood flow. Edemas and inflammation response is reduced by the temperature-induced decrease in blood circulation surrounding injured tissues generated by vigorous exercise.
  2. Analgesia: the Analgesic impact of the iced water, according to the one study, is responsible for the lessened sense of pain. Soaking in cold water causes nerve conduction velocities and irritability to slow down, limiting nociceptor transmission with sympathetic stimulation. In the end, this will cause a decrease in pain sensitivity.
  3. Reduction in Inflammatory Pathways: Others have proposed that reducing pain sensitivity is due to reduced inflammatory markers, such as nociceptor hypersensitivity, exercise-induced swelling, and leukocyte access. As a result, this notion is a composite of outcomes, and it is repeatedly alluded to as the fundamental physiological cause for improved outcomes in the study.
  4. Placebo Effect: Psychiatric evaluation of CWI’s efficacy in preventing post-exercise discomfort and weariness is crucial. This shows that the person feels more ‘alert’ throughout and after the CWI, resulting in a reduction in pain perception.
  5. Hydrostatic Pressure: When someone is submerged in water, they are exposed to the implications of hydrostatic pressure. With every meter of dipping, the pressure gradient increases by 74mm Hg.

This is nearly comparable to our normal diastolic blood pressure. However, with the growth in depth and pressure gradient, this hydrostatic pressure will generate an inward and upward pressing motion on the body. This mechanism, therefore, leads to the impacts of buoyancy. Since buoyancy lowers the gravitational pressure, human bodies also weigh less in water.

The hydrostatic pressure enables fluid displacement from the lower extremities to the thoracic area during hip-level submergence. According to some professionals, this liquid migration to the thoracic area might be essential in improving health.

This activity can minimize exercise-induced edemas, boost interstitial fluid transfer into the circulation, and enhance cardiac output. An increase in heart rate indicates more blood flow and faster elimination of waste materials during exertion. The buoyancy impact of immersion also relieves tiredness by enhancing energy efficiency and reducing neuromuscular activation.

Whole Body Cryotherapy (WBC)

Whole Body Cryotherapy, WBC entails a brief exposure to cold air in an ecologically controlled chamber. The durations last for two to four minutes and lie between -166°F/-110°C to -220°F/-140°C.

Cryotherapy is a catch-all word for a therapy that works by decreasing the tissue temperature. As mentioned earlier, whole-body cryotherapy has a long history that originated in Japan, evolved in Europe, and lastly made its way to the United States.

Numerous clinical trials have been conducted to alleviate pain and swelling caused by fibromyalgia, multiple sclerosis, sports injuries, rheumatoid arthritis, skin disorders like dermatitis and psoriasis. Physical therapists, wellness specialists, chiropractors, athletic trainers, and holistic medicine practitioners are among the most important providers of WBC treatment.

Cryotherapy activates the body’s innate healing processes. Extreme cold is used in WBC to trigger responses on three levels: the circulatory system, energy pathways, and neurological system.

Procedure for WBC

Even though provided at extremely low temperatures, this treatment is deemed to be relatively safe. The Nitrogen utilized to cool the cryotherapy chamber is the same one found in the atmosphere. For their protection, the patients must cover the susceptible tissues of the hand and feet.

The walk-in chambers require the patients to cover their faces as well to avoid cold air inhalation. The ears are to be protected as well. During the treatment, the body produces endorphins that make a person feel happy and energized.

At least five to ten sessions in close succession are recommended to maximize the benefits. This, however, may change depending on the condition of the patient. Following this, the patient may have spaced sessions to maintain the effects on their own.

The initial cold effect from the treatment will raise the body’s core temperature for a brief period. This is enough for stimulating the immune system to help reduce the intensity and frequency of the common cold. Since the procedure is completely dry, showers are not required before or after the sessions.

Types of WBC Chambers

Cryogenic Chambers

Cryogenic chambers are preferred for WBC since they ensure the right temperature and humidity levels. The patients must maintain constant communication with the physiotherapist through speakers and glass doors instilled in the chamber.

Alarm systems have also been placed within the chambers to enable the patient to summon assistance in an emergency. This is also why the doors have been structured so that the person inside the chamber could also open them.

The chamber’s interiors are coated with water-resistant material. The walls are designed with particular attention not to have any pointy projecting piece that would generate any discomfort when they come into contact with the patient’s skin. There exist numerous types of chambers in the marketplace. The selection is usually based on the design, coolant type, and the number of rooms and patients to be treated.

Two-stage Cryogenic Compartments

This chamber consists of one to two antechambers possessing a temperature of about -60°C. The other chamber is the main chamber, comprising a temperature of -110°C to -160°C. This is usually determined by the coolant type being utilized.

For sustaining temperatures as slow as these, liquid nitrogen is directly integrated through heat exchangers that include air pretreatment, cooling, and controlling. The method of breathing air processing consists of compressing, filtration, and drying.

This configuration allows filtered dry air to enter the chamber, reducing the sense of cold and enhancing the transparency. In addition, heat exchangers fitted in the antechambers and the main chambers keep the temperature stable.

An electricity supply and a controlling panel provide the appropriate data variables for the monitoring system. A glass door that opens through body pressure and an emergency mechanism provides additional security. Chambers of this nature are capable of holding five patients simultaneously.

Cryosaunas

Cryosauna’s are one-person chambers where the patients are enveloped in cold vapours to the arm level. They breathe from the chamber with their heads kept away from the extremely low temperatures.

The body pressure opens its swinging door hence enabling and excellent communication with the client. The coolants, as mentioned earlier, are mainly made of liquid nitrogen.

Cryochambers

These use air as their coolant with compressing cooling systems. Cryochambers are also divided into two antechambers and the main chamber.

The antechambers lie at the temperatures of -10°C and -60°C, respectively, and the main chamber has around -100°C. Since this chamber is insulated from the floor, it could be readily built both indoors and outdoors.

Powered by three compressors, the cooling system employs solely non-flammable and non-toxic gasses. This chamber includes all features required for safe cryostimulation, including an emergency escape, visual and audible communication with the administrator, and computer monitoring. It is also suitable for group treatment.

Cryochambers with Cool-hold Effect

This chamber is kept cold by mixing liquid nitrogen and oxygen in ratios similar to ambient air. External tanks are used to pump the air, and sprinklers are used for spraying it. Both are designed carefully.

The basis for the idea lies in the phenomena of cold retention. This benefits by minimizing the need for thermal insulation and eliminating the antechambers hence lowering the material expenses. It can hold three to four people at once, with wheelchair users having limited access.

Ice Bath and Cryotherapy Compared Through Studies

Cold Water Immersion, CWI or ice baths and Whole Body Cryotherapy, WBC or just Cryo have been compared through studies. Here are some of them.

  • Abadia and coworkers investigated the impacts of CWI and WBC on recuperation kinetics after exercise-induced muscle injury in 2016. They found that CWI was better than WBC at improving muscle strength regeneration 72 hours later.
  • CWI is proven to reliably minimize the impact of DOMS and RPE in a broad stream of work. CWI is an efficacious regimen for preventing the occurrence of DOMS twenty-four hours, forty-eight hours, and ninety-six hours after exercise, according to a study conducted.

Furthermore, it was demonstrated to lessen RPE symptoms twenty-four hours after exercise. Bleakley and coworkers presented a comprehensive review in 2012 that backed up these findings.

  • One study looked into the effects of long-term, repeated exposure to extremely cold temperatures. Winter bathing in ice water and WBC were also investigated. The conclusion was looked at in terms of humoral elements that could explain pain relief as a consequence of the exposures.

A team of healthy participants was regularly subjected to ice water swimming for twenty seconds three times per week for twelve weeks. Another team was treated to whole-body cryotherapy for two minutes in special chambers. Blood samples were taken during weeks one, two, four, eight and, twelve.

At five and thirty-five minutes, these samples were drawn on a day of no exposure and a day of cold exposure before the treatment. According to the results, the cortisol and plasma ACTH levels were considerably lower during weeks four to twelve than in week one. This was taken at the thirty-five-minute time point.

This, therefore, indicated that both WBC and ice water swimming did not activate the pituitary-adrenal cortical axis. In addition, plasma epinephrine remained stable during both tests, whereas norepinephrine increased by two to three times for twelve weeks following both cold treatments. After the sessions, there were no changes in plasma IL1beta, IL6, or TNF.

The most important observation was the persistent cold-induced activation of norepinephrine. It was strikingly consistent across the exposures.

This concludes that the average elevation in norepinephrine may contribute to pain relief in whole-body cryotherapy and ice water swimming. Hence, indicating that twenty seconds of cold water immersion could be equal to two minutes of whole-body cryotherapy.

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References

  1. https://pubmed.ncbi.nlm.nih.gov/27396361/
  2. https://www.tandfonline.com/doi/full/10.1080/00365510701516350
  3. https://pubmed.ncbi.nlm.nih.gov/22336838/

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