Whole Body Cryotherapy for Arthritis: Application, Effects, and Suggested Treatment Regimens
Table of Contents
INTRODUCTION: MEDICAL USE REQUIRES SUPERVISION BY A DOCTOR
Based on theoretical knowledge, clinical studies and experience the indication list for whole body cryotherapy has been increasingly justified and expanded over the last years to include a variety of health disorders. The terminology has also been adjusted to distinguish between talking about healthy subjects (cryostimulation) versus patients (cryotherapy). Some of the medical conditions for which whole body cryotherapy has been adequately proven include inflammatory rheumatic diseases(rheumatoid arthritis), degenerative rheumatic diseases (osteoarthritis) and chronic pains of various causes.Based on the available evidence, German Statutory Pension Insurance, for example, has listed whole body cryotherapy in its “Classification of therapies used for medical rehabilitation” with the indications of “Inflammatory joint diseases and pain syndromes” for functional improvement and to reduce inflammatory activity and pain. Nevertheless, regardless of the available proof of benefits, it must be noted that one needs a medical license to give any medical advice or, moreover, to prescribe a treatment. For this reason, all cryocenters that do not have the credentials to practice medicine must stress that whole body cryotherapy is an option that must be considered in every individual case by a doctor.
WHAT IS ARTHRITIS Arthritis is not a single disease, but an informal way of referring to joint pain or joint disease. In fact, there are more than 100 different types of arthritis and related conditions. In one way or another, arthritis affects 1 in every 3 to 4 adults, the most widespread diagnosis being osteoarthritis (degenerative) and rheumatoid arthritis (autoimmune inflammatory). Osteoarthritis occurs when the cartilage – the slick, cushioning surface on the ends of bones – deteriorates. Osteoarthritis is referred to as “wear and tear” arthritis, as it commonly develops with age. It can also be a result of joint injury or obesity. Osteoarthritis seldomly affects only one joint - wearing away is systemic. Initially, microscopically small tears in the cartilage appear. As they grow little by little, the cartilage roughens, and small pieces start easily breaking off, making cells of the damaged tissue release inflammatory substances. In more advanced stages, bone starts rubbing against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic.
Rheumatoid arthritis is caused by the immune system, mistakenly attacking its own tissue. It is an autoimmune chronic inflammatory disease that can be genetically inherited or acquired. The central role in the progression of rheumatoid arthritis (RA) is played by one specific cytokine*(tumor necrosis factor alfa or TNF-α). Its overproduction by cells of the immune system causes a whole chain reaction of inflammatory processes in which auto-aggressive function of immune cells gets promoted and more pro-inflammatory cytokines get released or activated. Systemic in nature and affecting the entire body, rheumatoid arthritis manifests primarily in joints where it causes uncontrolled inflammation and can result in joint erosion. In addition, people with RA present a cardiovascular mortality rate that is 50% higher than in healthy persons and not related to the traditional cardiovascular risk factors (e.g., hypertension, tobacco use, physical inactivity). Several studies have shown evidence that INFLAMMATION is directly and indirectly the major risk of cardiovascular problems in people with rheumatoid arthritis.
* Cytokines are a category of small proteins- cell signaling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection, and trauma. The term "cytokine" is derived from a combination of two Greek words - "cyto" (cell) and "kinos" (movement).
Common arthritis symptoms regardless of the type include warming and swelling, joint pain, morning stiffness, decreased range of motion of joints and limited physical function, as well as fatigue.
THE SIZE OF THE PROBLEM People of all ages, sexes and races can and do have arthritis, while it is more common among women and occurs more frequently as people get older. - Arthritis is the leading cause of disability among adults in the US. - By conservative estimates, at least 54 million Americans have doctor-diagnosed arthritis. It includes about 31 million cases of osteoarthritis. - The number of affected people is growing and is projected to reach 78 million by 2040. - Arthritis can also develop early in life - almost 300,000 babies and children in the US have arthritis or a rheumatic condition. - The problem is much more common among people who have other chronic conditions. It affects 49% of adults with heart disease, 47 % of adults with diabetes and 31% of adults who are obese.
THE RISK FACTORS AND THEIR MANAGEMENT Predisposition to arthritis can be genetic, but numerous. factors usually contribute to developing and worsening the condition, including weight, lifestyle (diet, physical activity, smoking), environmental factors, certain professions that require repetitive movement, as well as injuries.
The risk, as well as the symptoms, while mild, can be managed by: - Maintaining healthy weight and excluding inflammatory foods from the diet. - Regular physical activity. - Strengthening the muscles around joints for added support. - Avoiding excessive repetitive movements. - Balancing activity with rest. - Using hot and cold therapies.
THE IMPORTANCE OF TREATMENT Arthritis symptoms can be mild or moderate and remain unchanged for a long period of time, but they are likely to intensify with age. Arthritis is a progressing illness which is not yet possible to cure despite all the advances made in its therapy to date. The goal of treatment is therefore to achieve a decrease in disease intensity to halt or delay its progression, in line with managing the symptoms. Unlike local therapies, whole body cryotherapy has the advantage of simultaneously influencing all arthritic disease foci and suppress several disease factors (pains and inflammation) for extended periods of time.
Common arthritis symptoms include warming and swelling, joint pain, stiffness, decreased range of motion, and fatigue. Severe arthritis can result in chronic pain and inability to do daily activities. The joint damage can become permanent, and other organs can be affected over time, while slowing the disease activity can help minimize or even prevent it. "I am a strong believer in the window of opportunity, which probably spans two years after symptom onset," says Dr. S. Kazi, MD, associate professor of internal medicine and chief of rheumatology at the Dallas VA Medical Center. "If rheumatoid arthritis goes untreated for two years, the majority of people will develop joint erosion, indicating disease progression." As arthritis is a systemic disorder that impacts the entire organism, its treatment must also be complex, from medication and, in case of rheumatoid arthritis, antibody therapies to physical therapies, including warm and cold applications, exercise, and psychological treatment. For best results, treatment must begin as early in the disease progression as possible. Whole body cryotherapy can be understood in this context as an adjuvant physical therapy. It is not a substitute for other proven therapies, even if it has reportedly resulted in reduction in drug consumption in some cases.
THE ROLE OF CRYOTHERAPY It was the German Prof. Reinhard Fricke back in the 1980-s who first pointed out that whole body cold application may be instrumental in offsetting the inflammatory processes involved with arthritis. It has since been demonstrated by multiple studies that whole body cryotherapy at -110° C does indeed result in decrease of pro-inflammatory cytokines and other inflammatory immune cells and increase in anti-inflammatory cytokines and immune cells, thus having a positive effect on inflammation. Due to its analgesic and anti-inflammatory effects whole body cryotherapy is now used to ease symptoms of many diseases. In arthritis patients, regardless of the small number of studies, there is now enough evidence in the literature that demonstrates the benefits of cryotherapy on pain relief and arthritic disease activity, even if the mechanisms are not completely clear (3,4).
Cryotherapy -> reduced inflammation. Another benefit of cryotherapy is improving the exercise capacity of arthritis patients by lessening pain and, consequently, improving range of motion.
Physical activity has been identified as an important strategy to maintain joint function and to control inflammation. In RA patients, it also helps prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by arthritis challenges its regular practice. Moreover, persons with arthritis tend to avoid physical activity due to the fear of exacerbating the inflammatory potential and pain. Cold application before exercise reduces pain sensitivity and makes it easier and more effective.
Cryotherapy -> reduced pain and improved range of motion-> -> better exercise-> reduced cardiovascular risks. Clinical observations suggest that, with the right treatment protocol, whole body cryotherapy may help achieve effects that can still show 3 to 6 months after completion of therapy (7), including: - Improvement in general well-being. - Pain reduction. - Reduction of inflammatory signs such as swelling and warming. - Improvement in general mobility and joint function (reported by up to 60% of patients). - Reduction in intake of glucocorticoids and non-steroidal antirheumatics (observed in 35-40% of cases).
The pain relief becomes more sustainable with increasing duration of serial treatment. CRYOTHERAPY PROTOCOLS FOR ARTHRITIS Cryotherapy was initially developed to ease arthritis pain, and it has been used for this purpose. ever since, although many other applications have emerged. With the different types of arthritis, pain can be experienced along a large continuum. Some people experience minor, episodic pain to a small number of joints or even a single joint, while others can have debilitating, crippling and lasting pain effecting many areas. Unfortunately, most medical treatments for pain are not adequately effective or carry substantial long-term side effects. Whole body cryotherapy has proven to be one of the best adjuncts for those with chronic arthritis due to its lack of harmful side effects and quick time frame for relief.
To predict duration and response to treatments, subjective pain scales like this one are useful:
Treatment protocol will depend on the severity of the symptoms, the person’s response to cold and access to treatment. It should also ALWAYS be coordinated with the doctor for recommendation and professional oversight of the patient’s reaction and progress. The following treatment protocols have been recommended by Dr. Alan Christianson, NMD, one of the first adopters of whole-body cryotherapy in the United States:
Arthritis treatment protocol A for those with long-standing chronic arthritis involving multiple joints and with higher average pain scores: - Pain scores of 6 or over. - Those with pain over multiple joints. - Duration of symptoms greater than 2 years. Minimum number of treatments: 20. Recommended frequency of treatments: five days per week (weekdays). Duration of treatments: 4-5 weeks.
Arthritis treatment protocol B for those with more recent onset arthritis involving fewer joints and with lower average pain scores: - Pain scores of 5 or under. - Pain over single joints. - Duration of symptoms less than 2 years. Minimum number of treatments: 10. Best frequency of treatments: five days per week (weekdays). Duration of treatments: 2-3 weeks.
Treatments twice a day have also been tried on people with a high initial activity of the disease. For example, Dr. Bianka Benkenstein in her 2001 doctoral thesis reports giving rheumatoid arthritis patients whole body cryotherapy twice a day for 2-3 consecutive weeks and relief of symptoms after, on average, 10 to 15 cold exposures. This was done in a hospital setting and under tight medical supervision, though. Having people to commit to 2 treatments per day would have been difficult in any other circumstances.
OTHER CONSIDERATIONS FOR MORE NOTICEABLE RESULTS All inflammatory conditions are tightly linked to insufficient exercise and poor nutrition. For best results, approach to controlling and reducing symptoms of arthritis must be complex and include medication, physical therapy and adjunct treatments like whole body cryotherapy, movement, diet, and other lifestyle adjustments. Leaving any particular nutrition- or other health-related advice to professionals, a cryotherapy center may at least raise awareness of the importance of proper nutrition with the clients. For example, there is a consensus that anyone suffering from arthritis should try to COMPLETELY EXCLUDE the 5 foods that have proven to increase the risk and worsen the symptoms of arthritis by as much as 300%. Numerous studies have demonstrated that eating any of these in ANY amounts can completely offset the effects of treatments and medications that lessen inflammation and pain (sources: NaturalHealthReports.Net, Mayo Clinic and Arthritis Foundation): #1 Artificial trans fats (common in butter replacement products like margarine, frozen biscuits, microwaveable popcorn, etc.). #2 Refined carbohydrates (the starches and sugars that do not exist in nature). #3 Sugary sodas (proven to be DIRECTLY associated with arthritis and increasing the risk of developing the disorder by 63%). #4 Blackened (grilled) foods that are rich in unhealthy and highly inflammatory advanced glycation end products (or AGE-s). #5 High fructose corn syrup (extremely widespread in salad dressings, relishes, ketchup, apple sauce, canned foods, etc.).
Other proven strategies include: - ADDING collagen to the diet, from home-made bone broth to bone broth protein shakes and collagen supplements, available in many different forms and natural flavors. - EMBRACING herbs and spices, especially ginger, turmeric (both available fresh, in teas, and as supplements), cayenne pepper, and wasabi. - SEEKING natural remedies, such as pain-fighting essential oils. - Gently MOVING the achy joints to improve blood circulation to them. Although it might seem like the last thing to do when in pain, even mild physical activity can strengthen the muscles that support the painful joints and preserve and increase joint range of motion. It also improves sleep quality that is extremely important in managing inflammation.
SOURCES 1. Daniele PERES, Yoshimasa SAGAWAJr, Benoit DUGUÉ,Susana C. DOMENECH, Nicolas TORDI, ClementPRATI. The practice of physical activity and cryotherapy in rheumatoid arthritis: systematic review. EuropeanJournal of Physical and Rehabilitation Medicine 2017 https://www.ncbi.nlm.nih.gov/pubmed/27996221 2. Guillot X, Tordi N, Mourot L, Demougeot C, Dugué B, Prati C, et al. Cryotherapy in inflammatory rheumatic diseases: a systematic review. Expert Review of Clinical Immunology 2014 https://pubmed.ncbi.nlm.nih.gov/24345205 3. Hirvonen HE, Mikkelsson MK, Kautiainen H, Pohjolainen TH, Leirisalo-Repo M. Effectiveness of different cryotherapies on pain and disease activity in active rheumatoid arthritis. A randomized single blinded controlled trial. Clinical and Experimental Rheumatology 2006 https://www.ncbi.nlm.nih.gov/pubmed/16870097 4. Wojtecka-Lukasik E, Ksiezopolska-Orlowska K, Gaszewska E, Krasowicz- TowalskaO, Rzodkiewicz P, Maslinska D, et al. Cryotherapy decreases histamine levels in the blood of patients with rheumatoid arthritis. Inflammation Research: OfficialJournal of the European HistamineResearch Society, 2010 https://www.ncbi.nlm.nih.gov/pubmed/20020313 5. Bouzigon R, Grappe F, Ravier G, Dugue B. Whole- and partial-body cryostimulation/cryotherapy: Current technologies and practical applications. Journal of Thermal Biology 2016 https://pubmed.ncbi.nlm.nih.gov/27712663
6. Gizinska M, Rutkowski R, Romanowski, Lewandowski J, Straburzyńska-Lupa A. Effects of Whole-Body Cryotherapy in Comparison with Other Physical Modalities Used with Kinesitherapy in Rheumatoid Arthritis. BioMed Research International 2015 https://pubmed.ncbi.nlm.nih.gov/26576422 7. Prof. Dr. sc. Med. Winfried Papenfuß. Power from the Cold. Whole body cryotherapy at -110° C, a short-lasting physical therapy with a long-lasting effect. 5th, revised and expanded edition January 2016, ISBN 978-3-938912- 08-9 8. Kay-P Braun, Sabine Brookman-Amissah, Katrin Geissler, Doris Ast, Matthias May, Helmut Ernst. Whole-body cryotherapy in patients with inflammatory rheumatic disease. A prospective study. Medizinische Klinik, 2009 https://www.ncbi.nlm.nih.gov/pubmed/19337708 9. D Metzger, C Zwingmann, W Protz, W H Jäckel. Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases- pilot study. Die Rehabilitation 2000 https://www.ncbi.nlm.nih.gov/pubmed/10832164
10. Ewa Ziemann, Robert A Olek, Tomasz Grzywacz, Jan J Kaczor, Jędrzej Antosiewicz, Wojciech Skrobot, Sylwester Kujach, Radosław Laskowski.. Whole-body cryostimulation as an effective way of reducing exercise-induced inflammation and blood cholesterol in young men. European Cytokine Network2014 https://www.ncbi.nlm.nih.gov/pubmed/24998353 11. Anna Lubkowska, Zbigniew Szyguła,Dariusz Chlubek, GiuseppeBanfi. The effect of prolonged whole-body cryostimulation treatment with different amounts of sessions on chosen pro- and anti-inflammatory cytokines levels. Scandinavian Journal of Clinical and Laboratory Investigation 2011 https://www.ncbi.nlm.nih.gov/pubmed/21574854 12. Anna Lubkowska, Giuseppe Banfi, Barbara Dołegowska, Gian Vico Melzi d'Eril,Joanna Łuczak, Alessandra Barassi. Changes in lipid profile in response to three different protocols of whole-body cryostimulation treatments. Cryobiology 2010 https://www.ncbi.nlm.nih.gov/pubmed/20385115 13. “WBC Protocols Pain” by Dr. Alan Christianson, NMD, for MillenniumIce 2013
Disclaimer: This article is a summary of available publications and some well-known practices that have proven to be effective in reducing inflammation and managing arthritis pain. At the same time, every condition is different, and the result depends on many factors. By no means should this document serve as a success guarantee or as a replacement for medical advice.