Whole Body Cryotherapy (WBC) is starting to trend in the health and wellness arena. As a big proponent of non-medical self-care methods to achieve and maintain health, it piqued my interest when I first encountered it. No, it’s not a place that uses crying as a form of emotional therapy, as the name could suggest. Cryotherapy is the application of cold to the body for therapeutic effect. It is one of the two, basic modalities that have been used for centuries to reduce pain; the other, of course, being heat. Ice packs, ice baths, ice massages and frozen hand-held metal applicators are common ways to apply cryotherapy. Ice is 0⁰ Celsius (32⁰ F) so when it contacts your skin, which is about 91⁰ F plus or minus a couple of degrees depending on the outside temperature, heat flows out of your body since energy flows from high concentration to low (diffuses). It is the movement of heat out of your body that the brain perceives as cold (it is not “cold” moving into your skin).
But what happens if instead of 0⁰ C, you exposed your skin to -100⁰ C (-148⁰ F)? That is what a cryotherapy center offers, and will be the focus of this article.
Does Cryotherapy Work for Pain?
We already have a good understanding of what happens when human tissue is exposed to such extreme cold temperature, since cryotherapy has been around for decades. Cryosurgery, a form of cryotherapy, is highly focused cold using liquid nitrogen or argon gas to treat dermatological conditions such as warts and benign tumors, as well as cancerous tumors of the liver, kidneys, bones, lungs and breasts. It is also used for anesthetic purposes to deaden irritated nerves. Since human cells are about 75% water, when you apply sub-zero temperature to them the water crystallizes and denatures the cells, effectively killing them. The body then replaces the dead tissue with new cells. Cryotherapy centers, however, do not offer cryosurgery. They apply extreme cold to the whole body not to kill cells, but to “shock” the body’s central nervous system, causing it to initiate physiological processes that benefit pain reduction and tissue healing (explained later).
There are many studies in the medical literature that support the use of cryotherapy for inflammation and pain. In one study, patients suffering from adhesive capsulitis of the shoulder were randomly divided into two groups. One group had whole body cryotherapy along with physical therhapy (PT), and the other only PT. The results showed that while both groups improved, the group receiving WBC plus PT experienced significantly greater improvement in shoulder range of motion, subjective pain, and functionality.1
Another study examined the effects of WBC on fibromyalgia, a systemic condition that involves heightened sensitivity to pain throughout the body. In the 100 person study, fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life compared to the non-treated subjects, as indicated by their scores on qualitative indexes (questionnaireson functionality/ quality of life). The researchers speculate that the positive result was due to cryotherapy’s effect on reducing pro-inflammatory mediators involved in the modulation of pain.2
My Experience at a Cryotherapy Center
I am fortunate to live in a city where cryotherapy is offered. Last week, I visited one called U.S. Cryotherapy to find out for myself what this new pain relief trend is all about. It’s a franchised business with locations in ten states including here in California, Arizona, Texas, and Florida. Upon meeting the owner, I discovered that you do not need to have a professional license (M.D., R.N.) in order to own or operate a center. Apparently, the corporate attorneys made sure that the services offered do not violate any laws regulating the practice of medicine in the state. This also suggests that the services are relatively safe to do without direct supervision of a doctor or nurse, which is reassuring.
I filled out a general medical history form on a wall tablet (touch screen). This lets the technicians know if you have any condition that might make cryotherapy risky, such as heart problems. After that, I got a tour of the facility and was shown the main cryotherapy services: whole body cryotherapy (WBC) and localized treatment cryotherapy. I decided to try WBC first. They have you remove your clothes and provide shorts (yes, you go in a freezing room bare skinned!). You put on a terry cloth head band that goes over the ears to protect them from the cold, a towel face mask to cover your nose and mouth, a pair of large wool mittens to protect your hands, and wool loafers. At this point, I am wondering what I have gotten myself into, as I have never experienced being in sub-zero temperature in bare skin!
Whole body cryotherapy chamber, -150 degrees F.
The WBC room resembles a meat locker,with a warmer holding room that you stand in prior to entering and a reefer-style heavy stainless steel door. The technician stands at the control console outside the room, which hasa large window so that you can be monitored constantly. H e sets the time and temperature, and when the temperature reaches 100 degrees below zero Celsius, he then gives the sign to enter.
I enter, and at first it doesn’t feel as cold as I thought—a crisp, dry cold enveloping my whole body. Later, I found out why. According to their website:
“Cold air therapy in the whole body chamber is a dry fresh, oxygenated air so you won’t experience shivering, goosebumps or other reactions that you might associate with being cold. Because of this technology, unlike an ice bath or immersion, cryotherapy is not painful. During the treatment, your skin temperature will decrease between 30-45 degrees over 2.5 to 3.5 minutes inside the chamber.”
Now this is interesting. With dry air (much of the water vapor removed) you can handle lower temperatures than if you were to soak in an ice bath. You see, heat travels faster through a liquid than it does through gas (air—CO2, O2, N, and H) which is why most people can’t handle more than a few seconds of being submerged in a bathtub full of ice water. The dry, sub-zero temperature air of WBC enables you to stay exposed for 2-3 minutes enabling more therapeutic effect.
At the one minute mark, I was getting really cold, and started to walk around and move my arms to generate some heat. But even then, it was a different kind of cold I haven’t experienced before. I wasn’t shivering. My teeth weren’t rattling, and I did not get goosebumps. It was just a sensation of homogeneous, intense cold. I noticed some small ice crystals forming on my arm, because as heat leaves the surface of the body it interacts with the air causing any remaining water vapor in the air to crystallize into frost. Was I going to make it?
At the two minute mark, I noticed my heart was beating faster. This is a sympathetic nervous system response to extreme cold and is a desired response as it stimulates the release of endorphins and norepinephrine by the brain. Endorphins are the “feel good” hormone that reduce pain and stress, and creates the sense of euphoria. Norephinephrine, also called noradrenaline, is a neurotransmitter released during times of stress that boosts focus, attention and mood. Scientists also found out that it suppresses the production of tumor necrosis factor (TNF), one of several inflammation-promoting biochemicals. This sequence of events occurs in response to what is called “cold shock,” and is the therapeutic goal of WBC. Cold shock is caused by a hypothermic event (a big, sudden temperature drop at skin, such as that caused by WBC) causing heat to leave the body much faster than usual, which vasoconstricts (tightens) the blood vessels of the extremities (another sympathetic nervous system response) and diverts blood from the arms and legs to the core to keep the vital organs warm.
As the effects of cold shock continue, any musculoskeletal pain present (strain, acute or chronic injury, or arthritis) is lessened. Blood vessels constrict, blood flow slows down, inflammation drops, and pain signals traveling from pain site to brain slow down significantly because action potentials (electrochemical charges) move slower in colder environments.
At 2:15 into the treatment, I sensed my cold tolerance quickly being reached and was ready to get out the chamber ASAP (but, this could partly be due to apprehension as it was my first experience). I reached 2:30, and eagerly exited the chamber. The technician used a laser thermometer on my skin and reported that my skin temperature dropped about 50 degrees.
Upon exiting the waiting room of the WBC chamber, I felt invigorated. Although I am in pretty good shape musculoskeletal-wise, I have minor aches in my feet and shoulders, mostly due to my age and years spent as a chiropractor. But after the cryotherapy session, these aches were significantly reduced, almost down to zero.
When you exit the chamber and return to room temperature, the heat from the warmer air moves into your colder skin, which is sensed by your central nervous system. This shuts off the cold shock response, and the body returns to homeostasis: the constricted blood vessels dilate back to normal and oxygen-rich blood moves into the extremities again. So if you have, let’s say, knee swelling and inflammation, the constriction and then dilation of blood vessels effectively “wrings out” inflammation and then draws in oxygenated blood and nutrients to the knee, much like squeezing out dirty water from a sponge and then releasing it, letting it soak up clean water.
Here is a short video provided by U.S. Cryotherapy that explains how cryotherapy works:
Is a Simple Ice Pack Just as Good as Whole Body Cryotherapy?
WBC produces a much different effect than using localized ice, which also reduces pain by localized vasoconstriction and slowing down pain signals. The big difference between the two is that ice application does not initiate the systemic (body-wide) cold shock response like WBC does, so you don’t get the additional anti-inflammatory benefits previously described, or the endorphin and norepinephrine release. Local cryotherapy application is also superior to an ice pack because it is able to apply lower temperature to your skin. Most physical therapists will tell you to ice for 20 minutes max, but that is not possible with localized cryotherapy because of the much lower temperature it provides. Two to three minutes is the longest time human skin can take with cryotherapy.
How Often Should You Get Cryotherapy?
Whole body cryotherapy treatment guidelines for pain reduction depend on the goal. If you are post-surgery or have an acute (recent) injury, daily to multiple per day exposures for a week are appropriate. If you have chronic joint pain, a wellness routine is more appropriate, which can be once to twice a week treatments. Lastly, you can do it for general wellness on an as-needed basis. You’ll get a jolt to your circulatory system; increased heart rate (strengthens heart muscle like exercise), endorphin release, and according to the folks at U.S. Cryotherapy, improved sleep and mood.
Now with WBC under my belt, I decided to try localized cryotherapy on my chronic elbow strain and hand. For this procedure, I sat in a recliner while the technician used a machine to blow cold, dry air around my elbow. While he did this, he used a laser thermometer to monitor skin temperature. He directed the cold stream of air back and forth in quick, short strokes over the painful areas. The air is so cold that you cannot leave it in one spot for more than a few seconds; otherwise you can get tissue damage. Overall it felt as intense as the chamber, except localized. After the 3 minute treatment, the pain was reduced about 70%.
Localized cryotherapy treatmentAfter You Do Cryotherapy
After your cryotherapy session, you can engage in 20 minutes of exercise on a treadmill or stationary bike. This enhances circulation and flushes out of waste products. They also have a red light therapy chamber you can use immediately after doing WBC, as well as Pulsed EMF (uses pulsed magnetic waves) which can further reduce pain and even accelerate healing of tissues. I previously wrote about the benefits of both of these modalities as I have used them myself, with success. They make excellent home therapy devices.
What Health Experts Say About Cryotherapy
You may have heard of Wim Hoff, known as the “Iceman.” He is a Dutch athlete famous for being able to withstand extremely cold temperatures. He does this regularly because he believes exposure to cold is good for your health. According to Hoff:
“Proper exposure to the cold starts a cascade of health benefits, including the buildup of brown adipose tissue and resultant fat loss, reduced inflammation that facilitates a fortified immune system, balanced hormone levels, improved sleep quality, and the production of endorphins— the feel-good chemicals in the brain that naturally elevate your mood.”
Wim Hoff opines that modern living, where man is always wearing layers of clothes and living in temperature controlled environments dulls the body’s innate responsiveness and adaptability to its natural environment, which makes modern man more susceptible/ less resistant to disease. You don’t need to emulate Wim Hoff (the physical feats he does in cold would kill most people), but realize there are health benefits to exposing your body to cold.
Mark Sisson, a popular health blogger noted for his “primal” philosophy of mimicking prehistoric man’s lifestyle to strengthen your health (which I follow loosely), states that occasional, intentional exposure to cold will “improve your focus, confidence, and mental resilience…and that these benefits will carry over into all other areas of life.” He adds, “Anecdotal evidence from [extreme cold] enthusiasts also suggests that toughing out a cold shower or committing to a focused cold therapy regimen has profound mood elevating effects.” Those who endure the unpleasantness of being subject to extreme cold do so because they know that feeling good is just around the corner.
According to Dr. Rhonda Patrick, PhD., an expert in longevity science, just a 20-second immersion into freezing water a couple times a week can increase norepinephrine levels 200-300 percent. Imagine what 2-3 minutes would do. This will increase your heart rate, constrict blood vessels, and release glucose into the blood for your skeletal muscles. As previously mentioned, norepinephrine also acts as an anti-inflammatory by reducing tumor necrosis factor, a substance associated with practically all inflammatory-related diseases.
When you do whole body cryotherapy or other extreme cold practice, it basically conditions your body’s innate, adaptive mechanisms. Your body’s ability to handle large temperature swings is actually a health metric, like cardiovascular fitness and mobility. We tend to lose this as we age, which is why the elderly are more vulnerable to heat waves and are usually the first casualties when one strikes. Exposing yourself to very cold temperatures for short periods to increase your tolerance to cold is intuitively a good, health-promoting activity.
One thing that I should point out about cryotherapy is that it is not recommended post exercise. When you do an intense workout such as a marathon, the post-workout inflammation in the muscles should be allowed to run its course. This builds muscle adaptation to exercise by conditioning its restorative/recuperative mechanisms. Doing cryotherapy immediately after exercise, while it feels soothing, interrupts the process. It inhibits the “adaptation conditioning” of your muscles and you will not increase your endurance.
The Final Verdict
If you have any form of musculoskeletal pain and are fortunate to have a cryotherapy center nearby, give it a try. It’s one of those things that, while not a magic bullet for pain, has enough anecdotal evidence to validate its claim, as well as science. 100 degrees below zero Celsius while in your shorts can understandably intimidate some people, but it’s not that bad—you are in there for less than three minutes, and it’s dry cold, which your body is able to tolerate better. Whole body cryotherapy’s value is its ability to “comfortably” produce cold shock, reducing inflammation and pain and stimulating endorphin and norepinephrine release which improves mood, mental clarity and sleep. Do not use it post-exercise; rather, consider using it a couple of days after orthopedic surgery; after any recent soft tissue trauma (sprain/strain, whiplash from car accident, sports injury); if you have a chronic musculoskeletal condition such as knee osteoarthritis or shoulder problem; or, for general wellness.
If you don’t have a cryotherapy center in your town, there’s another way to get the benefits of extreme cold therapy: get a freezer chest and fill it with water and ice so that the temperature is near freezing. Then, you’ll need to brave the initial shock of submerging yourself, and see how long you can tolerate it. Since it’s cold water and not cold air that you are using, it won’t be as comfortable as using a cryotherapy chamber; you will likely shiver due to the faster heat transfer properties of water vs. air. Here is a video of Brad Kearns, co-author (with Mark Sisson) of the Keto Reset Diet and cold therapy enthusiast, on how to set up your personal cold therapy center:
Lastly, if this isn’t an option for you, try turning your shower water to cold for a minute or two. It’s best to just go for it and not try to ease yourself into it—turn that knob and tough it out. Do it in the middle of your shower and finish with a couple of minutes of warm water, or finish your shower with two minutes of cold water. You will feel invigorated; trust me. Do it every time you take a shower, or every other time– the more you do it, the better you’ll adapt. Keep in mind all the health benefits of cold exposure you’ve learned here; hopefully this will motivate you to take some action.
1 Sang-Yeol Ma et. al, Archives of Physical
Medicine and Rehabilitation. Volume 94,
Issue 1, January 2013, Pages 9-16.
2 Lorenzo Bettoni et. al, Clinical Rheumatology. September 2013, Volume 32, Issue 9, pp
1337–1345.
