The Cold Hard Facts About Cryotherapy

CryotherapyPeople are paying top dollar to expose their bodies to temperatures not found on Earth for one to three bone-chilling minutes while stripped down to their swimwear or birthday suits and sporting gloves, socks, and sometimes other protective accoutrements. In Antarctica, the coldest temperature ever recorded was measured by a satellite at -135.8 degrees F, while liquid-nitrogen-cooled cryochambers range between 150 to 300 degrees below zero. When exposed to such frigid temperatures, we’re thrust into survival mode: the brain sends the majority of the body’s blood to its core in an attempt to keep it warm, and receptors prompt the nervous system to release endorphins—those feel-good chemicals that help diminish pain while triggering positive feelings. After exiting the chamber, the ensuing rush of blood ostensibly rids the body of toxins and rejuvenates it at the cellular level.

Whole-body cryotherapy (WBC), which has not been approved for medical use by the U.S. Food and Drug Administration (FDA), claims to reduce inflammation, cellulite, anxiety, headaches, and even depression. Early adopters include professional athletes, who traded ice baths for cryotherapy to help ease their aches and pains. Now, celebrities are hopping on the bandwagon: A single cryotherapy session is reputed to burn up to 800 calories and help with anti-aging and weight loss. Cryotherapy is also popping up in spas across the country, from cryotherapy facials to whole-body cryotherapy treatments.

Despite its recent popularity, cryotherapy is far from new. According to “History of Cryotherapy” in Dermatology Online Journal (2005) by Anatoli Freiman, M.D., and Nathaniel Bouganim, M.D., of the McGill University Health Centre Division of Dermatology (Montreal), the Egyptians used cold to treat injuries and inflammation as early as 2500 BCE. Following World War II, liquid nitrogen became commercially available, and over the years, cryotherapy has become a well-established treatment for a wide variety of benign and malignant skin lesions. Today’s whole-body cryotherapy, developed in 1978 in Japan to treat rheumatoid arthritis, involves entering a chamber of liquid nitrogen, which tricks the body into hypothermia. Scientists in Germany and Poland further developed cryo (cold) procedures, and in 1989, the third cryochamber in the world was created in Poland. The treatment quickly became commercialized and popularized among athletes in Europe.Cryotherapy

Cold Hard Facts

There is a dearth of cryotherapy studies in the U.S., because the majority of research has been done in Europe and Japan, with studies focusing on the benefits for patients with rheumatoid arthritis, a chronic inflammatory and destructive joint disease. The first randomized controlled trial of whole-body cryotherapy was conducted in Finland in 2006: 60 patients with active seropositive rheumatoid arthritis were recruited and received localized and whole-body cryotherapy treatments and conventional physiotherapy. Pain decreased in all treatment groups, but most markedly in the whole-body cryotherapy group, where patients had two to three daily cryotherapy sessions at -110 degrees C (-166 degrees F) for one week.

In addition to treating inflammation and pain, cryotherapy may play a positive role in treating patients with depression and anxiety disorders. A 2008 study in Poland found that the decrease of anxiety and depressive symptoms were significantly higher in a group of patients who were exposed to daily cryotherapy. The study group was treated using a series of 15 daily visits to a cryogenic chamber (-110 to -160 degrees C, -166 to -256 degrees F), which lasted two to three minutes each, in addition to standard outpatient psychopharmacotherapy. A control group with similar symptoms also received psychopharmacotherapy, without cryotherapy treatments. These findings suggest a possible role for whole-body cryotherapy as a short-term adjuvant therapy for depressive and anxious patients.

Frozen Future

While cryotherapy was slow to come to the U.S., body-conscious consumers have quickly adopted it. KryoLife (New York City), which opened in 2012, offers whole-body cryotherapy sessions (single session, $90; package of 3, $240; package of 10, $700). The sessions use protocols that have been developed over 25 years of using the modality in Europe and include a treatment in a cryosauna or cryochamber, as well as a 10- to 15-minute warm-up on cardio equipment. While every session is beneficial and provides immediate results, cofounder and CEO Joanna Fryben recommends a minimum of 10 sessions to see cumulative benefits. “My friends—athletes—were using the therapy back in my native country of Poland,” says Fryben. “I became more familiar with it when my mom had a knee-replacement surgery and used the therapy for pain relief and as a part of her physical therapy. She absolutely loved the results and the way she looked and felt after. I did a lot of research and interviewed many doctors and people who used the therapy in Poland and in Europe before I decided to introduce the modality on the East Coast.” KryoLife is a distributor of Juka Cryosaunas and an exclusive distributor of KrioSystem Life. “The reason we use and sell their equipment is because unlike other devices available on the market, they have European medical and quality certifications,” she says.

Athletes swear by cryotherapy because of its healing benefits and lack of recovery time. Fryben explains that unlike an ice bath, which does not affect the nervous and endocrine systems, cryotherapy positively impacts our nervous, endocrine, and immune systems. “Whole-body cryotherapy is much more potent, of much shorter duration, and much more comfortable for the user,” she says. “After an ice bath, an athlete should take a rest for the remainder of the day, but after whole-body cryotherapy, one is encouraged to exercise. The therapy increases neuromuscular connection, so the movement is more efficient. After an ice bath, muscle loses its capacity for some time.” Plus, with cryotherapy, guests don’t get wet.

Golfers are getting in the game, too. In April 2015,The Spa at Sea Island (GA) started using Impact Cryotherapy equipment. “We were exposed to the Impact unit because one of our members is a cofounder of the company,” says spa director Ella Stimpson. “We did a test with the professional golf community in our area, and it was a big hit. So when crafting a program that was primarily focused on golfers and other athletes, it made perfect sense to include a groundbreaking new technology to tackle pain, flexibility, and inflammation.” Stimpson explains that obtaining a full understanding of the guest’s medical history is important, because there are a few conditions that are contraindicated and some that require less extreme temperatures and time. “We want to understand their full training and therapeutic concerns so we can craft not only a great cryotherapy session for them but also build a recurring program around their lifestyle that will impact their game and quality of life,” she says.

Spas and wellness clinics across the globe are striving to provide guests with the most effective programs, and incorporating cryotherapy as a part of the treatment plan is becoming increasingly popular. Thermes Marins Monte-Carlo (Monaco), a wellness and preventative health center, started offering cryotherapy to its guests following a massive restoration at the end of November 2014. Guests enter the cryotherapy chamber from Zimmer MedizinSystems wearing swimwear (without any metal pieces) and are given socks, gloves, a face mask, and a headband to cover sensitive areas. They first enter a pre-chamber of -76 degrees F to acclimatize to the temperature for 10 seconds before entering the second chamber, which is set to -166 degrees F. “Cryotherapy is truly an amazing treatment with so many benefits,” says general manager Christine Zoliec. She explains that the cryotherapy treatment ($62) triggers a series of reactions in the body. “At the end of the session the body will take 20 to 30 minutes to recover the skin temperature, then the guest will start to feel effects. Within three minutes, a session helps to treat muscle and inflammatory diseases but can also help recovery from jet lag, help fight against sleep disorders, and has an anti-stress and anti-aging effect,” says Zoliec. SHA Wellness Clinic (Alicante, Spain) has also offered cryotherapy since 2014. “We are constantly trying to innovate and offer both scholastic (conventional) and alternative therapies,” says head of internal medicine and anti-aging Vicente Mera, M.D. “Whichever ancient or novel therapy might improve our patients’ wellbeing, if it is safe, then we try to implement it into the context of a general or more specific therapeutic program.”

Face Freeze

As more technology is developed to localize cryotherapy treatments for the face and neck, spas are expanding their cryotherapy offerings. Additionally, with smaller, less expensive devices, more spas can afford to offer the therapy to spa-goers. At Skintology Skin and Laser Center (New York City), guests can experience the CryoCure Facial ($155, 60 minutes). “A controlled beam of vaporized liquid nitrogen is used to freeze the skin of the face, scalp, and neck area,” says owner Yevgenya Freylikhman. “The cold nitrogen produces an instantaneous tightness in the skin, filling in fine lines and wrinkles. Collagen is activated to produce more cells, causing skin to become more elastic over repeated use.” Additionally, pore size is reduced, keeping toxins, dirt, and grime out. The treatment flushes away built-up toxins in the skin and soothes inflammation, eliminating puffiness. Using Skintology products, the therapist first cleanses skin with Chamomile Facial Cleanser, then exfoliates with Rescue Face Cream, a natural botanical formula. Following extractions, Drying Lotion banishes bacteria without stripping skin, and a skin-appropriate mask is selected. After the cryotherapy, which uses a CryoWand from Cryohealthcare, an oil-free moisturizer is applied.

Cryohealthcare was among the first companies to bring cryotherapy to the U.S. in 2009 after discovering it in Germany, and they have sold approximately 200 cryotherapy units nationwide. Medical director Jonas Kuehne, M.D., developed the Cryofacial ($45 suggested, 10 to 12 minutes), a treatment where gaseous nitrogen is applied to the skin with different levels of pressure. “Cryofacials have been done in the past by soaking gauze in liquid nitrogen and placing it directly onto the skin of the face,” says managing director Emilia Kuehne. “However, this treatment brings with it the risk of overexposure and possible burns, as it is difficult to apply the soaked gauze evenly to the skin. Our method allows very even cold exposure to the face in a controlled manner.” In addition to full-body cryotherapy and local cryotherapy, Chicago CryoSpa offers the Cryofacial ($65, 10 to 12 minutes). “When we had the opportunity to be the first destination outside of Los Angeles to offer the Cryofacial, we jumped on it right away,” says founder Jim Karas. Chicago CryoSpa was conceptualized by Karas and opened in July 2013 after a revelatory personal experience. “More than three years ago, I woke up with a partially torn Achilles,” he says. “I tried every conceivable treatment but with no luck. I was giving a speech and taping numerous television segments in Los Angeles, and a friend recommended cryo. After five days of the cryosauna, followed by five days of the local treatment directly on the injured area, I could run across the street. This was after eight months of limping. I came home, rented the space, and bought the equipment. It was the fastest business decision I have ever made.”

Primary Precautions

Cryotherapy should always be administered by trained professionals who screen for current and past medical conditions, including heart attack or stroke, high-blood pressure, pregnancy, seizures, blood-clotting issues, infections or fever, a pacemaker or other implanted medical devices, and Raynaud’s disease, which causes some areas of the body to feel numb and cold in response to cold temperatures or stress. Even with proper screening and precautions, more high-quality research is needed.

While proponents claim the treatment isn’t dangerous, safety precautions have become a concern. The accidental death of 24-year-old Chelsea Ake-Salvacion, a cryotherapy operator at Rejuvenice (Las Vegas), who was found frozen in the spa’s cryotherapy chamber in 2015, might prompt new regulations in the industry. Ake-Salvacion apparently entered the chamber after-hours when she was alone . She had allegedly texted a friend about a possible nitrogen leak in the machine, noting that the nitrogen appeared to be used quickly. The tragic incident rocked the cryotherapy world and drew attention to the treatment’s safety standards.

Safety is a priority for cryotherapy companies. KryoLife selects and trains technicians to the medical-grade safety standards by prescribing physicians in Europe. “There have not been reported cases of any negative impact of whole-body cryotherapy,” says Fryben. “It is much safer than a hot sauna. However, the protocols, some precautions, and common sense should always be applied, and we are very strict about them at KryoLife. The treatment should always be supervised.” At Cryohealthcare, clients wear socks, gloves, shoes, underwear (for men), earmuffs, and a face mask in order to prevent irritation or injury to areas of compromised blood circulation during cold exposure. “We adhere to all European standards and added some of our own,” says Kuehne. “A first-time treatment may not exceed two minutes, and maximum treatment time for whole-body cryotherapy is three minutes.”

It is imperative to have trained therapists who never operate machines alone and nitrogen monitors that ensure levels are within safe parameters—breathing too much nitrogen can deplete the oxygen supply in the blood, which can be fatal. Facilities should also have a defibrillator and emergency kit onsite and provide CPR training to employees. Even with precautions, side effects can occur: moisture on the skin or clothing could freeze and cause frostbite, and cold intolerance and temporary nausea are possible reactions to the treatment. However, the many benefits of cryotherapy provide yet another reason for spa-goers to chill out.