Whole Body Cryotherapy and Ice: Worth the Hype?

Whole Body Cryotherapy seems to be the latest rage, touting amazing benefits for all. But, is it really worth all the hype?

Key Points (for those of you who want the Coles Notes)WBC

  • Whole body cryotherapy is an inferior method to cooling subcutaneous and core body temperatures
  • Placebo is likely largely responsible for the positive effects of cryotherapy
  • Definitive evidence shows that cryotherapy (cold water immersion) does NOT enhance adaptations to exercise training
  • Not only this, but cryotherapy (cold water immersion) has been shown to negatively impact cell proliferation and muscle hypertrophy

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Whole Body Cryotherapy is a recent fad that purports to enhance your recovery after exercise, improve mobility, relieve arthritic pain and facilitate rehabilitation post injury.

What exactly is Whole Body Cryotherapy (WBC)? It is a large metal chamber that is filled with nitrogen gas at an ultra-low temperature of less than -100 degrees Celsius (often reaching as low as -150 degrees Celsius). Users walk in to this cold metal chamber and stay there for about 2.5 minutes.

Advocates of Whole Body Cryotherapy preach that this method of cooling is superior due to its extreme temperatures, and sell [decently expensive] sessions to paying clients to help them reap all of these aforementioned benefits.

So, is this really the miracle cure for delayed onset muscle soreness (DOMS – the soreness associated with working out), poor mobility, pain, and/or injury?

It’s time we take a closer look at the evidence, and to do so we are going to focus on TWO specific areas of research:

  1. The effectiveness of Whole Body Cryotherapy versus other simple forms of cryotherapy (such as Cold Water Immersion (a cold bath) and a simple Ice Pack)
  2. The Benefits of Cryotherapy (cold therapy), Period.

Lets jump in.

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The Effectiveness of Whole Body Cryotherapy versus other simple forms of cryotherapy (ie cold water immersion and ice pack application).

There is currently no strong evidence that Whole Body Cryotherapy offers any distinct advantage over traditional (read: easy, self-administered and cheap) methods of cryotherapy – such as cold water immersion or ice pack application.

Proponents of Whole Body Cryotherapy claim that because of the extremely low temperatures in the chamber it is a superior method of cooling the body.  However in truth, compared to water and ice, air has significantly lower thermal conductivity at 0.024 K vs 0.58 K (water) and 2.18 K (ice). (1,2)  (Note, K is a measure of thermal conductivity or a materials ability to transfer temperature.)

What this means is that air, as a material to transfer temperature, actually prevents significant subcutaneous and core body cooling compared to the other two methods. (2)

Delving further in to this, studies have found lower surface skin temperatures following a session of Whole Body Cryotherapy vs cold water immersion or a simple application of an ice pack.

One particular randomized controlled study looked at skin temperatures of the knee – a bony area highly susceptible to temperature change.

(Note the relevance of using the knee – Subcutaneous adipose tissue has a very low thermal conductivity, meaning it has an insulating effect on the body. What this means is that certain areas of the body will be more susceptible to a reduction in temperature with application of cryotherapy, with bony regions such as the patella (knee) generally experiencing the largest reduction in tissue temperatures (1,2,3).)

This study found that that 10-60 minutes post treatment surface knee temperatures were lower in the cold water immersion group versus the Whole Body Cryotherapy group.

What that means is that even in areas of the body that have very little adipose tissue and are mostly bony, Whole Body Cryotherapy was an inferior modality 10-60 minutes post treatment.

And these findings weren’t the only ones determining that these chambers were inferior to other methods of cryotherapy.

In a study looking at exercise induced muscle damage, soreness and function after strenuous exercise (4) results showed that greater reductions in blood flow and tissue temperature were observed after cold water immersion in comparison to Whole Body Cryotherapy.

Another study again compared cold water immersion and Whole Body Cryotherapy on recovery kinetics after exercise-induced muscle damage. This study found that again cold water immersion was more effective effective in accelerating recovery kinetics for performance at 72 hours post exercise and demonstrated lower soreness and higher perceived ratings of recovery (5).

 I don’t mean to get to science-y on you, but everything I just said above is a lot of research that shows that the expensive, gimmicky cold chamber is no better (and actually in some cases it is inferior) to other methods of cryotherapy which are mostly easy to self-administer and … well, free.

Key takeaways from this research?

  • Whole Body Cryotherapy is actually inferior to cold water immersion and simple ice pack application when it comes to thermal conductivity, preventing significant subcutaneous and core body cooling.
  • Cold water immersion was found to be superior to Whole Body Cryotherapy in accelerating recovery kinetics as well as levels of soreness and perceived ratings of recovery.

Okay, so cold water and ice packs work the same or better than those huge cold chambers. But, should we even be icing in the first place? This brings us to the second part of this article, or second focus of research:

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The Effect of Cryotherapy, Period

Okay, so we now have some evidence demonstrating that Whole Body Cryotherapy isn’t actually superior to other methods of cryotherapy including cold water immersion and ice pack application but that it is actually inferior.

But what about cryotherapy in general. What is the evidence backing its use?

A recent study just published this month looked at the effects of cryotherapy (like the above studies, cold water immersion and Whole Body Cryotherapy was used) vs placebo on markers of recovery following a marathon (6).

Results indicated that either form of cryotherapy was NO MORE EFFECTIVE than placebo at improving function, recovery or perceptions of training stress following a marathon. Not only this, results demonstrated that Whole Body Cryotherapy actually had harmful effects on muscle function compared to cold water immersion post marathon, including a negative impact on muscle function, perceptions of soreness and a number of blood parameters. (6).

Another randomized control study looked at the difference between a placebo and cryotherapy by looking at the recovery of the muscle strength 48 hours after an acute high intensity interval exercise session. Results showed that the recovery placebo was superior in the recovery as compared to cryotherapy (7).

These results lend strong evidence that shows that placebo may be largely responsible for the beneficial effects of cryotherapy.

Another recent paper (8) looked specifically at cold water immersion and the tenet that it enhances post-exercise recovery and resilience, thereby leading to greater adaptations to training. The author of this paper explained how evidence supporting this idea was very much lacking, and outlined two of his studies designed to find out more.

The first study measured muscle mass (using an MRI) and strength in two groups before and after a twice weekly exercise program for three months. One group performed active recovery for ten minutes after each exercise session (low intensity cycling) and the other performed cold water immersion for ten minutes. Results demonstrated that both groups gained muscle mass and strength, but that these gains were significantly smaller in the cold water immersion group compared to the active recovery group. Even more, the cross sectional area of type II (fast twitch) muscle fibres also only increased in the active recovery group.

This is definitive evidence against the idea that regular cold water immersion enhances adaptations to exercise training.

The second study performed looked at men who completed two separate session of resistance exercise on separate days and with separate legs. Researchers analysed blood samples and biopsies before exercise and 2, 24, and 48 hours after.

They found that exercise activated processes in the signalling pathway and stimulated cell proliferation and proteins that regulate muscle hypertrophy. In contrast, these processes were significantly attenuated following cold water immersion.

Inflammatory markers in the blood were also looked at and it was found that there were no significant different between the cold water immersion and active recovery treatments.

This is the first evidence in humans (there has been other evidence in animal studies) that is against the idea that cold water immersion provides anti-inflammatory benefits in muscle after exercise (8).

This shows that not only does cold water immersion not improve inflammation, but it seems to actually negatively effect our bodies ability to adapt to exercise training.

Key Takeaways from this research?

  • Cryotherapy is no better than placebo at improving function, recovery or perceptions of training stress
  • Cryotherapy reduced the amount of cell proliferation and proteins stimulating muscle hypertrophy leading to smaller muscle and strength gains
  • Cryotherapy did not show anti-inflammatory benefits in muscle after exercise

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In Conclusion:

When I started writing this article I truthfully did not intend for it to be so long. But when I got in to my research I saw SO many studies – many of them GOOD quality, randomized controlled studies – that simply needed to be discussed!

We have always believed that ice is the way to go for any sort of muscle damage, be it from an injury or from high intensity exercise. The fact that current research shows that it simply is not the best option anymore is one that is hard to swallow for many people, as they have spent their lives recommending or using ice. It is also these beliefs that we’ve held on for so long, that makes the idea of Whole Body Cryotherapy and all it touts to offer seem so appealing.

But, if you sit down and go through the evidence… I think you will see that there are many cheaper, easier, and most important better options out there.

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References:

  1. Costello J, McInerney CD, Bleakley CM, Selfe J, Donnelly A. (2012) The use of thermal imaging in assessing skin temperature following cryotherapy: a review. Journal of Thermal Biology, 37:103–110.
  2. Bleakley, C., Bieuzen, F., Davison, G., Costello, J. (2014). Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access Journal of Sports Medicine, 5:25-36.
  3. Costello, J., Donnelly, A., Karki, A., Selfie, J. (2014). Effects of whole body cryotherapy and cold water immersion on knee skin temperature. International Journal of Sports Medicine, 35(1): 35-40.
  4. Mawhinney, C., Low, D., Jones, H., Green, D., Costello, J., Gregson, W. (2017). Cold water mediates greater reductions in limb blood flow than Whole Body Cryotherapy. Medicine and Science in Sports and Exercise, 49(6): 1252-1260.
  5. Abaidia, A et al. 2017. Recovery from exercise induced muscle damage: cold-water immersion versus Whole Body Cryotherapy. International Journal of Sports Physiology and Performance, 12(3): 402-409.
  6. Wilson, L et al. 2018. Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control. European Journal of Applied Physiology, 118(1): 153-163.
  7. Broatch, J., Petersen, A., Bishop, D. 2014. Postexercise cold water immersion benefits are not greater than placebo effect. Medicine and Science in Sports and Exercise, 46(11): 2139-2147.
  8. Peake, J. Cryotherapy: Are we freezing the benefits of exercise? Temperature, 4: 211-213.

 

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