5 Cryotherapy Side Effects Therapists Should Watch For

While there are many benefits of cryotherapy for use in PT or OT practice, there are a few risks associated with this treatment. Discover 5 cryotherapy side effects every therapist should know.

Cryotherapy, also known as cold therapy or ice treatment, is an application utilized to bring the body temperature down at the tissue and cellular level in order to achieve therapeutic benefits, but there are a few cryotherapy side effects that therapists should be aware of. 

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But, First… How to Provide Cryotherapy

Cryotherapy treatment options range from cold packs and ice or gel packs to cryotherapy machines or full-body cryotherapy chambers.

When planning cryotherapy treatment, there are several questions to ask before deciding on the type of cryotherapy and the treatment schedule:

• What are the goals of treatment? What expected benefits will this provide to the patient?
• What type of cryotherapy is financially realistic for the patient?
• How many treatment sessions can the patient attend? What is the patient’s schedule for current physical therapy treatment (three times per week, two times per week, etc.)? Can cryotherapy treatment coincide with the current PT or OT treatment schedule?
• Can the treatment be provided as part of a home exercise protocol?
• Does the patient have any contraindications to using cryotherapy (see below)?

Keep in mind that cryotherapy is most effective when it is used as a relatively continuous treatment, in conjunction with physical therapy, a home exercise program, or during physical activity (sports rehabilitation). Generally, 10 to 20 sessions of whole body cryotherapy are recommended to achieve optimum therapeutic benefits. But, the number of sessions depends on the severity of the condition (i.e. acute injury versus post-op versus chronic pain or sports recovery).

Localized Versus Whole Body Cold Therapy Treatments

Localized treatments are typically used for acute injury situations such as sprain/strain, tendonitis, edema, post-surgical pain, or fever. Localized treatments include the application of ice or gel packs, ice massage, or cryotherapy machines (for post-op) for 20 to 30 minutes at a time, several times per day, especially after physical therapy or exercise. Localized cold therapy affects the superficial tissues as soon as 5 minutes after application. However, it takes around 20 to 25 minutes of localized application in order to reach deeper tissues.

Whole body cryotherapy treatments are used in chronic conditions or to reduce muscle pain and fatigue in athletes. (Whole body cryotherapy is contraindicated in pregnancy. See further contraindications below.)

How Do Cryotherapy Chambers Work?

Whole body cryotherapy treatments involve exposing the entire body to an extremely code environment for five (or less) minutes. Most cryotherapy chambers (also called “cryosaunas” or “freeze labs”) use liquid nitrogen or an electrical system to achieve the -100 to -150 degrees F temperature, which lowers the patient’s skin temperature within a few minutes. (Of course, patients do not come in direct contact with liquid nitrogen when it is used to cool the chamber.) The intense cooling induces a number of physiological changes such as vasoconstriction of blood from the limbs, which is pooled to the vital organs. Additionally, inflammatory mediators are reduced, inducing a powerful immune system response. Last, fight-or-flight hormones are released causing a “feel good” endorphin boost to the patient.

What are the Benefits of Cryotherapy?

Cryotherapy provides the following therapeutic benefits:

• 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 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 five minute session, approximately 500 to 800 calories are burned.

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. Burning of the skin or frostbite can occur when a patient does not follow proper protocol when entering a cryotherapy chamber.

Cryotherapy Contraindications

Cold therapy, especially whole body cryotherapy, should be avoided in the following cases:

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• 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)

If your patient has any history of chronic illness, confer with the prescribing physician before beginning cryotherapy treatment.

How does cryotherapy work?

During cryotherapy, the healthcare provider applies extreme cold to abnormal tissue. Cells can’t survive this severe cold and die after treatment.

Your healthcare provider can use a few different substances to create the intense cold used in cryotherapy. These substances can include:

• Liquid nitrogen.
• Liquid nitrous oxide.
• Argon gas.

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What cryotherapy method will my healthcare provider use?

There are different cryotherapy methods to freeze tissue. The way your healthcare provider applies the cold depends on the location of the abnormal tissue.

• External: If the tissue is located on your skin, your provider will typically use a spraying device or a cotton swab to apply the freezing agent.
• Internal: To treat conditions inside the body, like precancerous cells or a tumor, your provider will use an instrument called a cryoprobe. This probe is inserted through a small incision (cut) in your skin.

External cryotherapy causes frozen skin to blister and peel off so that healthy new skin can grow. When abnormal cells freeze and die during internal cryotherapy, your immune system helps clear the tissue out of the body.

How should I prepare for cryotherapy?

Most people don’t need to do anything special to prepare for cryotherapy on the skin. Your healthcare provider will give you instructions before internal cryotherapy to help you prepare.

You may have to stop taking certain medications, such as aspirin or blood thinners, a few days before internal cryosurgery. Other special instructions may include:

• Limiting how much you eat or drink before the procedure.
• Planning for someone to drive you home after the procedure.

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What should I expect during cryotherapy?

If you have external cryotherapy, your healthcare provider will apply the cold with a spraying device or cotton swab. Providers usually use liquid nitrogen for this type of treatment.

For internal cryotherapy, the cryoprobe is inserted through a small incision in your skin. Your healthcare provider may use ultrasound imaging to guide the cryoprobe to the tissue to be frozen.

Depending on the location of the abnormal cells, you may be given either local anesthesia or general anesthesia. Local anesthesia works to numb a specific spot, while a general anesthesia is used during surgeries to put you to sleep.

What should I expect after cryotherapy?

If you have cryotherapy for an external skin condition, the treated area will turn red and possibly blister after treatment. Any mild pain should be gone after about three days. The treated area will form a scab, which usually heals in one to three weeks.

After internal cryotherapy, you may have mild pain or soreness in the affected area for up to three days. Women who have cryotherapy on the cervix may have a watery discharge for a few days to a few weeks.

5 Cryotherapy Side Effects Therapists Should Watch For

Cryotherapy: Uses, Procedure, Risks & Benefits