5 Cryotherapy Side Effects Therapists Should Watch For

Cryotherapy side effects for therapists to be aware of

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. However, there are a few cryotherapy side effects that therapists should be aware of.

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, therapists should ask several questions 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?

Keep in mind that cryotherapy is most effective when used as a relatively continuous treatment, in conjunction with physical therapy, a home exercise program, or during physical activity (sports rehabilitation).

Generally, experts recommend 10 to 20 sessions of whole body cryotherapy to achieve optimum therapeutic benefits. The number of sessions depends on the severity of the condition (i.e. acute injury versus post-op versus chronic pain or sports recovery).

Related: Pain Assessment and Management: Role of the PT

Localized vs. whole body

Localized treatments are typically used for acute injury situations such as sprain/strain, tendonitis, edema, post-surgical pain, or fever. This can 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. Worth noting: Patients have no direct contact with liquid nitrogen while in 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, cold triggers fight-or-flight hormones, releasing a “feel good” endorphin boost to the patient.

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. Researchers have shown this treatment 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. They can also use cryotherapy chambers 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, the body burns up calories to bring tissues back to normal temperatures. Researchers estimate that a three to five minute session can burn up to 500 to 800 calories.

Related: Pain Assessment and Management: The Role of OT

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 patients or therapists leave a localized cold pack or ice on the skin too long, it can cause integumentary damage (including frostbite in extreme cases). Therefore, never apply localized cold therapy longer than 30 minutes, and monitor skin integrity 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. Monitor the patient’s vital signs and disposition before, during, and after treatment. Double check oxygen levels inside the chamber as well.
The patient should ensure that all clothing and skin are completely dry when stepping into a cryotherapy chamber. Make sure they also remove all metal or jewelry. Last, patients should cover sensitive body parts 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.