Cold for centuries: a brief history of cryotherapies to improve health, injury and post-exercise recovery

Influence of contrast compression therapy and water immersion contrast therapy on biomechanical parameters of the forearm muscles in martial arts athletes

Objective

This study compared the immediate effects of game-ready contrast therapy (GRT) and contrast water immersion therapy (CWT) on stiffness, muscle tone, flexibility, pressure pain threshold, and isometric muscle strength.

Design

Experimental, single-blind, randomized controlled trial. Thirty volunteers training MMA (age: 28.20 ± 7.57 years, BMI: 26.35 ± 4.06, training experience: 10.37 ± 7.34) were randomized to two groups: experimental (n = 15) and control (n = 15). In the first phase, the experimental group underwent GRT and the control-game-ready sham therapy (GRS). After a 2-week break, the experimental group underwent CWT and the control-contrast water sham therapy (CWS). The main outcome measures were muscle tone (T) stiffness (S) elasticity (E), pressure pain threshold (PPT), and maximum isometric strength (Fmax) assessed before therapy (Rest) and 5-min and 1-h after treatment (PostTh5min and PostTh1h).

Results

Analysis of variance results for T, S, E, PPT, and Fmax showed statistically significant differences (p < 0.0001) for main effects and interactions. For both therapies GRT and CWT: T, S, and E were lower 5 min after therapy and 1 h after therapy compared to Rest (interaction effect, p < 0.00001). For both therapies GRT and CWT the PPT and Fmax were higher 5min and 1 h after therapy compared to Rest (interaction effect, p < 0.0001). The post hoc test showed statistically significant differences (p < 0.0001) for T, S, E, PPT, and Fmax in the experimental groups (GRT and CWT) for Rest-PostTh5min and Rest-Post1h. No statistically significant differences were found for Post5mi-Post1h. The effect size of Cohen's d for S, E, PPT, and Fmax showed similar values, with only T being significantly more pronounced in the GRT group (large, d > 0.8). There were no statistically significant differences (p > 0.05) in the control groups (GRT for GRS and CWT for CWS) in the Rest-PostTh5min-PostTh1h range.

Conclusion

The positive impact of both contrast therapy strategies as a stimulus influencing important aspects of biomechanics was confirmed. The results showed similar effects of CWT and GRT (both similarly lowering S and E and increasing Fmax and PPT) except for the analysis of muscle tone, where the lowering effect of GRT had larger effect. These findings can be directly applied by researchers, sports medicine specialists, and martial arts trainers interested in the biomechanical effects of therapy on athletes, improving their understanding and practice.

Autonomic Responses to Cold Pain: Effect of Type, Duration, and Habituation in Cryotherapy

PURPOSE

Cold limb immersion, a form of cryotherapy, can cause cardiovascular changes due to cold-pain induced autonomic reflexes. This cryotherapy treatment side effect has received less attention but could have direct implications for physical rehabilitation of individuals with cardiovascular comorbidities.

METHODS

To test hypotheses related to the pressor effects of varied limb sites and surface areas of cryotherapy, two common lower limb injury sites (ankle and knee) were immersed into cold water (15 min, 1-3°C) and then referenced to a standard cold pressor test (CPT). Beat-by-beat arterial blood pressure (finger photoplethysmography), heart rate (ECG), systemic vascular conductance (SVC; Modelflow), and calf vascular conductance (VC) (venous occlusion plethysmography) were measured in 14 healthy participants.

RESULTS

At 2 min, CPT increased mean arterial pressure (21 ± 4 mm Hg) more than either ankle or leg immersion (15 ± 4 and 15 ± 5 mm Hg, respectively; P = 0.015). Systemic vascular conductance and calf VC decreased but were not different across treatments ( P = 0.417 and P = 0.086). Mean arterial pressure and SVC were not different from 2 to 15 min of immersion ( P = 0.164 and P = 0.522), but calf VC decreased further by the end of immersion (3.1 ± 0.5 to 2.8 ± 0.4 and 2.7 ± 3 to 1.7 ± 0.2 units; P = 0.028). Mean arterial pressure increases with CPT were similar with solely CPT and when CPT followed ankle or leg immersion (27 ± 5 and 23 ± 4 mm Hg, respectively; P = 0.199).

CONCLUSIONS

These data indicate robust pressor responses without autonomic reflex habituation and that cryotherapy immersion location but not surface area appears to mediate cardiovascular responses. This cryotherapy side effect may be an important consideration for patients with cardiovascular-related comorbidities.

Complementary Approaches to Postoperative Pain Management: A Review of Non-pharmacological Interventions

Postoperative pain significantly affects many surgical patients. While opioids are crucial for pain management, they come with unwanted side effects. Alternatives like nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate (NMDA) receptor antagonists, and regional anesthesia techniques such as nerve blocks are utilized, but these also have limitations. This underscores the need for complementary non-pharmacological interventions to enhance postoperative pain control and reduce opioid dependence. This study aimed to synthesize evidence on the efficacy of nondrug approaches for managing postoperative pain. The study examined the effects of non-pharmacological interventions such as preoperative patient education, mind-body modalities, and physical therapies. Findings suggest that these approaches can reduce pain intensity, decrease opioid consumption, and enhance recovery outcomes. The study also highlighted the pivotal role of healthcare professionals in implementing these strategies. However, it identified workload constraints and insufficient training as barriers to effective utilization in clinical practice. Integrating non-pharmacological interventions into multimodal pain management regimens can improve postoperative pain control and reduce reliance on opioids. Further research is crucial to definitively establish the efficacy of individual interventions and optimize their combined use in clinical practice. Additionally, enhanced training programs for nurses and initiatives to facilitate the implementation of these strategies are necessary for their successful adoption.

Influence of acute and chronic therapeutic cooling on cognitive performance and well-being

PURPOSE

Research regarding the effect cold-water immersion (CWI) has on cognitive performance often uses excessive cooling protocols (>1-hour) to measure the detrimental impact prolonged cold exposure has on cognition. Previous studies have not considered shorter CWI protocols, similar to that used in recovery and wellness practices (∼10 min).

AIMS

To investigate a more ecologically valid CWI protocol on cognition, well-being and sleep in an acute and chronic manner. It was hypothesised that a therapeutic CWI protocol would improve well-being, and sleep and have no detrimental effect on cognition.

METHODS

Thirteen healthy participants (20.85±2.15 years), (169.96±7.77 cm), (72.03±14.92 kg), (27.67±9.55 BF%) volunteered to complete a 4-week CWI protocol. Participants were immersed in cold water (10.42±0.59 °C) 3-times a week for 4-weeks. Cognitive performance (Stroop & TMT), well-being (WEMWBS, PSWQ, GAD-7, SHS) and sleep (PSQI) were measured acutely and chronically over the 4-week protocol along with thermoregulatory measures (Tsk, Tco, thermal comfort).

RESULTS

Results show that CWI had no detrimental impact on cognitive performance, with Stroop performance & well-being seeing no differences acutely or chronically. Alternatively, the trail making test showed significant improvement from baseline (TMT-A 15.17±4.81-seconds, TMT-B 39.68±15.12-seconds) to week-3 (TMT-A 11.06±3.29-seconds, TMT-B 26.18±10.23-seconds). A reduction in sleep disturbances was seen from baseline scores of 7.85±3.44 AU to the end of week-3 measures 5.75±3.77 AU.

CONCLUSION

Therapeutic cooling can improve sleep quality when utilised in short frequent doses (3 times per week, for 4-weeks) and is not detrimental to cognitive performance, improving certain aspects of executive function.

Whole-Body Cold Stimulation Improves Cardiac Autonomic Control Independently of the Employed Temperature

Background/Objectives: The autonomic nervous system (ANS) is considered one of the mechanisms mediating the benefits of whole-body cold stimulation (WBC). Nevertheless, different treatment protocols, different methodologies employed to assess the ANS, and, in particular, difficulties in interpreting the numerous variables obtained represent important barriers to understanding the effects of WBC on the ANS. The present study aimed to explore the effects of WBC on cardiac autonomic control (CAR) as assessed using a single composite percentile-ranked proxy of autonomic balance (ANSI), considering two different WBC temperatures and the same WBC protocol. Methods: Heart rate variability (HRV) was employed to assess the ANS in 23 subjects with obesity who underwent 10 WBC sessions, studied before and after 2 min WBC at -55 °C (15 subjects) or 2 min WBC at -110 °C (8 subjects) both at the first session (T1) and the last one (T10). To overcome some important barriers in data interpretation and age/sex bias, we considered the Autonomic Nervous System Index (ANSI), a single composite percentile-ranked proxy of autonomic control. Results: We observed an improvement in CAR independently of the employed temperature. Both treatments, without distinction, caused a significant increase in the ANSI post-WBC treatment both at T1 and T10 and a significant betterment of the total power of the RR interval variability from pre- to post-treatment at T1 and overall from T1 to T10. Conclusions: WBC was capable of inducing an immediate change in the ANS control (pre- vs. post-treatment both at T1 and T10) and a long-term modulation in cardiac autonomic control (T1-pre vs. T10-pre).

Immediate Effect of Compression Contrast Therapy on Quadriceps Femoris Muscles' Regeneration in MMA Fighters

Objectives: This study aimed to evaluate the immediate effect of Game Ready (GR) heat-cold compression contrast therapy (HCCT) on changes in the biomechanical parameters of the quadriceps femoris muscles and tissue perfusion. Methods: Fifteen male MMA fighters were subjected to HCCT on the dominant leg's thigh and control sham therapy on the other. The experimental intervention used a pressure cuff with the following parameters: time-20 min; pressure-25-75 mmHg; and temp.-3-45°C, changing every 2 min. For the control group, the temp. of sham therapy was 15-36 °C, and pressure was 15-25 mmHg, changing every 2 min. Measurements were taken on the head of the rectus femoris muscle (RF) 5 min before therapy, 5 min after, and 1 h after therapy in the same order in all participants: microcirculatory response (PU), muscle tension (MT), stiffness (S), flexibility (E), tissue temperature (°C), and pressure pain threshold (PPT). Results: The analysis revealed significant differences between the HCCT and sham therapy groups and the measurement time (rest vs. post 5 min and post 1 h) for PU, MT, E, and °C (p < 0.00001) (a significant effect of time was found) in response to GR therapy. No significant differences were found for the PPT. Conclusions: The results of this study prove that GR HCCT evokes changes in the biomechanical parameters of the RF muscles and perfusion in professional MMA fighters.

Whole-Body Cryotherapy Reduces Systemic Inflammation in Healthy Adults: Pilot Cohort Study

BACKGROUND

Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease-related inflammation. In addition, the long-term durability of W-BC effect is unknown.

OBJECTIVE

This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides.

METHODS

Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at -110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw.

RESULTS

The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (-0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (-0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and <5.7%) and was not clinically significant. There was no association between W-BC and LDL cholesterol, HDL cholesterol, or triglycerides (P>.10), although LDL trended lower over the time period examined (P=.07).

CONCLUSIONS

These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose.

Observational Study with a New Portable Cryosurgery Device, HYDROZID®, in Superficial Epidermal Lesions: An Indian Experience

Background

Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India.

Aims

This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions.

Methods

The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit.

Results

Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients.

Conclusion

The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device.

The Effects of Combined Contrast Heat Cold Pressure Therapy on Post-Exercise Muscle Recovery in MMA Fighters: A Randomized Controlled Trial

The purpose of this study was to evaluate the effects of contrast heat and cold pressure therapy (CHCP) on muscle tone, elasticity, stiffness, perfusion unit, and muscle fatigue indices after plyometric training consisting of five sets of jumping on a 50-cm high box until exhaustion. A prospective, randomized, controlled single-blind study design was used. Twenty professional MMA fighters were included in the study. The experimental group (n = 10) was subjected to the CHCP protocol (eGR), while the control group (cGR) (n = 10) was subjected to sham therapy. Both protocols consisted of three CHCP sessions performed immediately after plyometric exercise, 24 and 48 h afterwards. Measurements were taken at the following time points: 1) at rest; 2) 1 min post-exercise; 3) 1 min post-CHCP therapy; 4) 24 h post-CHCP therapy; 5) 48 h post-CHCP therapy. The results of the eGR compared to the cGR showed significantly higher perfusion at time point 5 (p < 0.001), higher muscle tone at time points 1, and 3-5 (p < 0.001 for all), higher stiffness at time points 1, 3-5 (p < 0.001 for all) and a higher pain threshold at time points 1 and 5 (p < 0.001 for all). This study suggests a positive effect of CHCP therapy on muscle biomechanics, the pain threshold, and tissue perfusion, which may contribute to increasing the effectiveness of post-exercise muscle recovery in MMA athletes.

Effectiveness of cryotherapy in preventing oral mucositis in pediatric cancer patients in Jordan: a randomized controlled trial

PURPOSE

The study aimed to evaluate the effectiveness of cryotherapy in preventing oral mucositis in pediatric patients receiving chemotherapy.

METHODS

An evidence-based practice project utilized a randomized control trial design with two groups (experimental and control groups). Fifty-nine pediatric patients with cancer in Jordan, aged 8-18 years, were randomly assigned to the experimental group (n=29) or the control group (n=30). The intervention was conducted from June 2022 to December 2022. The severity of oral mucositis among pediatric cancer patients was assessed using the World Health Organization oral mucositis grade.

RESULTS

There were no significant differences in sex or disease type among the groups. On days 7, 14, and 21, we observed notable between-group differences in treatment responses and the intensity of oral mucositis, highlighting the efficacy of cryotherapy in diminishing the severity of oral mucositis.

CONCLUSION

This study supports the use of cryotherapy as a preventive measure for oral mucositis among pediatric oncology patients in Jordan. The findings suggest that cryotherapy effectively reduces the severity of oral mucositis. Further research is necessary to investigate the broader impacts of cryotherapy.

Association between temperatures and type 2 diabetes: A prospective study in UK Biobank

OBJECTIVE

This study aims to prospectively examine the association between temperatures and the occurrence of type 2 diabetes (T2D).

METHODS

We used the CPH models to analyze 103,215 non-diabetic participants in the UK Biobank cohort who answered questions about workplace temperature, to evaluate the survival relationship, and the interaction effects of working environmental temperature and T2D-related genetic risk scores (GRS) on the occurrence of T2D. The occurrence of T2D was assessed by hospital inpatient records. The weighted T2D-related GRS were calculated.

RESULTS

During 1,355,200.6 person-years follow-up, a total of 2436 participants were documented as having diagnosed T2D. After adjustment, compared to the comfortable group, the participants working in non-comfortable environmental temperature had greater risk of T2D (HR: 1.27, 95 %CI: 1.04 to 1.55, for cold; HR: 1.32, 95 %CI: 1.17 to 1.48 for hot; HR: 1.51, 95 %CI: 1.38 to 1.65 for alternate). Similarly, individuals exposed to different levels of genetic risk scores in alternating hot and cold work environments had a higher risk of developing type 2 diabetes.

CONCLUSIONS

This study found working in single non-comfortable environmental temperatures was associated with greater risk of T2D occurrence, and exposure to alternating environmental temperatures had the highest risk of range and severity.

Evaluation of thermal shock therapy for reducing pain during intense pulsed light therapy: An intrapatient randomized controlled study

BACKGROUND

Intense pulsed light (IPL) is used for the treatment and improvement of various skin issues. However, patients often experience local skin burning and pain after IPL treatment. Cooling and analgesic measures are indispensable.

AIMS

To investigate the clinical effect of thermal shock therapy on pain relief and reduction of adverse reactions during IPL therapy.

PATIENTS/METHODS

A total of 60 female patients with facial photoaging who received IPL therapy were enrolled in the study. As a comparative split-face study, one side of the face was randomly selected as the control side. The other side was given thermal shock therapy before and after the IPL treatment immediately as analgesic side. The visual analog scale (VAS) was used to evaluate the pain degree of the patients. The telephone follow-ups regarding the occurrence of adverse reactions were conducted respectively on the 2nd day, 7th day, and 1 month after treatment.

RESULTS

The VAS score and skin temperature of analgesia side was lower than that of control side at different stages of treatment. In terms of adverse reactions, the incidence of transient facial redness on the analgesic side was lower than that on the control side. Two patients showed slight secondary pigmentation on the control side, and the other patients showed no other adverse reactions on both sides.

CONCLUSIONS

Thermal shock therapy assisted IPL therapy can reduce skin temperature during treatment, effectively relieve patients' pain, reduce the occurrence of adverse reactions caused by heat injury, and improve patients' comfort level.

Cold exposure increases circulating fibroblast growth factor 21 in the evening in males and females

Objectives

Cold exposure is linked to cardiometabolic benefits. Cold activates brown adipose tissue (BAT), increases energy expenditure, and induces secretion of the hormones fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15). The cold-induced increase in energy expenditure exhibits a diurnal rhythm in men. Therefore, we aimed to investigate the effect of cold exposure on serum FGF21 and GDF15 levels in humans and whether cold-induced changes in FGF21 and GDF15 levels differ between morning and evening in males and females.

Method

In this randomized cross-over study, serum FGF21 and GDF15 levels were measured in healthy lean males (n = 12) and females (n = 12) before, during, and after 90 min of stable cold exposure in the morning (07:45 h) and evening (19:45 h) with a 1-day washout period in between.

Results

Cold exposure increased FGF21 levels in the evening compared to the morning both in males (+61% vs -13%; P < 0.001) and in females (+58% vs +8%; P < 0.001). In contrast, cold exposure did not significantly modify serum GDF15 levels, and no diurnal variation was found. Changes in FGF21 and GDF15 levels did not correlate with changes in cold-induced energy expenditure in the morning and evening.

Conclusion

Cold exposure increased serum FGF21 levels in the evening, but not in the morning, in both males and females. GDF15 levels were not affected by cold exposure. Thus, this study suggests that the timing of cold exposure may influence cold-induced changes in FGF21 levels but not GDF15 levels and seems to be independent of changes in energy expenditure.

Optimal Duration of Cold and Heat Compression for Forearm Muscle Biomechanics in Mixed Martial Arts Athletes: A Comparative Study

BACKGROUND Cold and heat therapies for recovery in sports are commonly used, including in the mixed martial arts (MMA). The Game Ready (GR) device can be used for local monotherapy with either heat or cold and for contrast therapy. This study aimed to compare the effects of duration of cold and heat compression on biomechanical changes in the forearm muscles of 20 healthy mixed martial arts athletes. MATERIAL AND METHODS Twenty MMA volunteers (26.5±4.5 years old) underwent 3 different phases of the GR: (1) stimulation time 10 min (eGR-10, GR experimental group), (2) 10 min (cGR-10, sham control group) and (3) 20 min (eGR-20, GR experimental group). The following outcomes were assessed: muscle tone (T), stiffness (S), flexibility (E), pressure pain threshold (PPT), microvascular response (PU), and maximum isometric strength (Fmax). All measurements were performed before GR (rest) and after GR stimulation (post). RESULTS Both eGR-10 and eGR-20 significantly improved outcomes T (p<0.001), S (p<0.001), E (p=0.001, and p<0.001, respectively), PPT (p<0.001), PU (p<0.001), and Fmax (p<0.001). Notably, eGR-20 exhibited superior improvements in PU, Fmax, and PPT, with larger effect sizes (p<0.001). While eGR-10 demonstrated more pronounced reductions in T and S (p<0.001), these results underscore the potential for tailored GR therapy durations to optimize specific recovery goals for MMA athletes. CONCLUSIONS GR stimulation affects muscle biomechanical changes, pain threshold, muscle strength, and tissue perfusion. The study results suggest that 10 min of GR stimulation is sufficient to achieve changes that can be used to optimize recovery for MMA athletes.

Whole Body Cryostimulation: A New Adjuvant Treatment in Central Sensitization Syndromes? An Expert Opinion

Central sensitisation is defined as a multifactorial etiopathogenetic condition involving an increase in the reactivity of nociceptive neurons and alterations in pain transmission and perception in the central nervous system. Patients may present with widespread chronic pain, fatigue, sleep disturbance, dizziness, psychological (e.g., depression, anxiety, and anger) and social impairment. Pain can be spontaneous in onset and persistence, characterised by an exaggerated response and spread beyond the site of origin, and sometimes triggered by a non-painful stimulus. Whole-body cryostimulation (WBC) could be an adjuvant therapy in the management of this type of pain because of its global anti-inflammatory effect, changes in cytokines and hormone secretion, reduction in nerve conduction velocity, autonomic modulation, and release of neurotransmitters involved in the pain pathway. In several conditions (e.g., fibromyalgia, rheumatoid arthritis, and chronic musculoskeletal pain), WBC affects physical performance, pain perception, and psychological aspects. Given its multiple targets and effects at different organs and levels, WBC appears to be a versatile adjuvant treatment for a wide range of conditions of rehabilitation interest. Further research is needed to fully understand the mechanisms of analgesic effect and potential actions on pain pathways, as well as to study long-term effects and potential uses in other chronic pain conditions.

Immediate Effect of Cryo-Compression Therapy on Biomechanical Properties and Perfusion of Forearm Muscles in Mixed Martial Arts Fighters

Mixed martial arts (MMA) fighters use their arms and hands for striking with the fists, grappling, and defensive techniques, which puts a high load on the forearms and hand muscles. New methods are needed to decrease the risk of injury and increase the effectiveness of regeneration. This study aimed to assess the effectiveness of cryo-compression (CC) therapy of different times (3 and 6 min) on forearm muscles in MMA fighters by investigating muscle pain, stiffness, tension, elasticity strength, and perfusion. Twenty professional male MMA fighters aged 26.5 ± 4.5 years, with training experience of 10.3 ± 5.0 years, were enrolled on an experimental within-group study design. The participants underwent CC therapy at a temperature of 3 °C and compression of 75 mmHg for 3 min and, in the second session, for 6 min. The investigated parameters were in the following order: (1) perfusion in non-reference units (PU), (2) muscle tone (T-[Hz]), (3) stiffness (S-[N/m]), (4) elasticity (E-[arb]), (5) pressure pain threshold (PPT-[N/cm]), and (6) maximum isometric force (Fmax [kgf]) at two time points: (1) at rest-2 min before CC therapy (pre) and (2) 2 min after CC therapy (post). There were significant differences between 3 and 6 min of CC therapy for PU and T. Meanwhile, F, E, PPT, and S were significantly different when comparing pre- to post-conditions. These results provide evidence that CC therapy is a stimulus that significantly affects parameters characterizing muscle biomechanical properties, pain threshold, strength, and tissue perfusion.

Impact of cold exposure on life satisfaction and physical composition of soldiers

This article has been retracted.

A randomised crossover trial of five cryocompression devices' ability to reduce skin temperature of the knee

BACKGROUND

The application of cold and pressure to the knee is a common part of post-operative rehabilitation. Skin temperature should be reduced to within 10-15 °C to optimise the therapeutic benefits of cryocompression. The purpose of this study was to investigate the ability of five different cryocompression devices to reduce skin temperature to within this therapeutic range.

MATERIALS AND METHODS

32 healthy adult participants (mean (SD): age 26.3 (7.9) years; BMI 24.8 (2.7) kg/m2; 20 males) were recruited for this randomised crossover study. Skin temperature was measured 20 mm distal to the patella using a k-type thermocouple every five minutes during a 30-minute treatment with one of five different cryocompression devices (Physiolab S1, GameReady, Cryo/Cuff, VPulse, and a Gel Wrap). Changes in skin temperature over time were compared to baseline within and between conditions. A subjective rating of comfort was also recorded for each device.

RESULTS

The Physiolab S1 and GameReady devices caused significantly lower skin temperatures compared to the VPulse, Gel Wrap, and Cryo/Cuff after 30 minutes (p<0.05). 87-96% reported a positive comfort rating for the Physiolab S1, VPulse, Cryo/Cuff and Gel Wrap, whereas 53% of participants reported a positive comfort rating for the GameReady.

CONCLUSIONS

Only the Physiolab S1 and GameReady devices reduced skin temperature of the knee to within the target range of 10-15 °C. The Physiolab S1 was reportedly more comfortable than the GameReady. Clinicians should be aware of the performance differences of different cryocompression devices to understand which is most likely to provide an effective dose of cold therapy to a joint.

The Effect of the Timing of Cold Application on Pain and Satisfaction in Patients With Fractures

This experimental study used a repeated-measures design to examine the effect of the timing of cold application on pain and satisfaction in a sample of 60 patients who had fracture surgery. Cold was applied for 20 minutes each hour for four hours to patients assigned to the experimental group. Whereas cold was applied once to those in the control group: for 20 minutes during the first hour after surgery. Results following data analysis from repeated measurements of pain before and after cold application in both groups showed a significant difference between the groups (p < .05). Patients' levels of satisfaction with nursing care practice were higher in the experimental group than in the control group, although not significantly (p > .05). The pain score in the experimental group decreased significantly with each cold application. In the control group, the pretreatment pain score decreased significantly after one cold application, increasing again in 3 hours without cold application. These findings are important for nurses caring for postoperative patients and giving discharge instructions. Our findings suggest repeated cold applications for 20 minutes at hourly intervals may result in better overall pain reduction than a single cold application.

Split-face study to evaluate efficacy of global cryomodulation for reduction of pain and inflammation after nonablative fractional resurfacing

OBJECTIVES

Cryomodulation, or the delivery of controlled cooling to downregulate inflammatory processes in the skin, has been proposed to mitigate acute side effects following various dermatologic treatments. A new controlled cooling device has been developed to deliver cryomodulation for a range of different indications. In this clinical study, we evaluate the device for the reduction of pain, erythema, and edema following nonablative fractional resurfacing (NAFR).

METHODS

A single-blind, prospective, randomized, split-face study was conducted to assess the efficacy of the controlled dermal cooling device for the reduction of pain, edema, and erythema following nonablative fractional resurfacing with the dual 1550 nm erbium-doped fiber and 1927 nm thulium fiber laser. Subjects were randomized to receive a 10-min controlled cooling treatment to either the left or right side of the face immediately following full face NAFR. Pain ratings were recorded immediately postlaser treatment and immediately postcryomodulation treatment. At follow-up, subjects were surveyed for reduction of side effects and treatment satisfaction. Blinded review of photographs by two physicians was conducted to assess efficacy.

RESULTS

The average pain score for subjects immediately post-NAFR was 5.15. Following cryomodulation, the average pain score on the treatment side was reduced by 69%, to an average of 1.6. The untreated side of the face was reduced by 19%, to an average of 4.2. Overall, 90% of subjects endorsed reduced discomfort. At follow-up, 70% of subjects reported a noticeable improvement in edema and 50% reported a noticeable improvement in erythema between the treatment and control sides. The average subject satisfaction score for the cryomodulation treatment was 4.2. All subjects (100%) indicated that they would elect to undergo the cryomodulation treatment again. Both blinded physician reviewers were successful in identifying the cryomodulation-treated side of the face in 70% of subjects' posttreatment photographs.

CONCLUSIONS

The results of this split-face study support the efficacy of a global cryomodulation device for the reduction of pain, edema, and erythema following NAFR treatment. Cryomodulation was delivered in a simple 10 min procedure and yielded high patient satisfaction.

Cryogenic Media in Biomedical Applications: Current Advances, Challenges, and Future Perspectives

This paper explores the crucial role of cryogenic mediums in driving breakthroughs within the biomedical sector. The objective was to investigate, critically discuss, and present the current knowledge and state-of-the-art practices, along with the challenges and perspectives of the most common applications. Through an extensive literature review, this work aims to supplement existing research, offering a comprehensive and up-to-date understanding of the subject. Biomedical research involving cryogenic mediums is advancing on multiple fronts, including the development of advanced medical technologies, clinical treatments for life-threatening conditions, high-quality biospecimen preservation, and antimicrobial interventions in industrial food processing. These advances open new horizons and present cutting-edge opportunities for research and the medical community. While the current body of evidence showcases the impressive impact of cryogenic mediums, such as nitrogen, helium, argon, and oxygen, on revolutionary developments, reaching definitive conclusions on their efficiency and safety remains challenging due to process complexity and research scarcity with a moderate certainty of evidence. Knowledge gaps further underline the need for additional studies to facilitate cryogenic research in developing innovative technological processes in biomedicine. These advancements have the potential to reshape the modern world and significantly enhance the quality of life for people worldwide.

Cardiovascular and mood responses to an acute bout of cold water immersion

Cold water immersion (CWI) may provide benefits for physical and mental health. Our purpose was to investigate the effects of an acute bout of CWI on vascular shear stress and affect (positive and negative). Sixteen healthy adults (age: 23 ± 4 y; (9 self-reported men and 7 self-reported women) completed one 15-min bout of CWI (10 °C). Self-reported affect (positive and negative) was assessed at pre-CWI (Pre), 30-min post-immersion, and 180-min post-immersion in all participants. Brachial artery diameter and blood velocity were measured (Doppler ultrasound) at Pre, after 1-min and 15-min of CWI, and 30-min post-immersion (n = 8). Total, antegrade, and retrograde shear stress, oscillatory shear index (OSI), and forearm vascular conductance (FVC) were calculated. Venous blood samples were collected at Pre, after 1-min and 15-min of CWI, 30-min post-immersion, and 180-min post-immersion (n = 8) to quantify serum β-endorphins and cortisol. Data were analyzed using a one-way ANOVA with Fisher's least significance difference and compared to Pre. Positive affect did not change (ANOVA p = 0.450) but negative affect was lower at 180-min post-immersion (p < 0.001). FVC was reduced at 15-min of CWI and 30-min post-immersion (p < 0.020). Total and antegrade shear and OSI were reduced at 30-min post-immersion (p < 0.040) but there were no differences in retrograde shear (ANOVA p = 0.134). β-endorphins did not change throughout the trial (ANOVA p = 0.321). Cortisol was lower at 180-min post-immersion (p = 0.014). An acute bout of CWI minimally affects shear stress patterns but may benefit mental health by reducing negative feelings and cortisol levels.

Comparative Techniques of Acupuncture and Dry Needling Intersecting with Trigger Point Physiology and Diagnostics: A Cross-Discipline Narrative Review

Background

Pain management is a great burden on society; therefore, cost-effective and nonaddictive treatments for pain are urgently required. Needling of painful spots has been applied in acupuncture along with dry needling

Methods

A narrative review of the literature on TrP physiology, its associated diagnostics, and the techniques of DN and acupuncture was performed.

Results

Diagnostic imagery may benefit the study and treatment of TrPs using needling. Acupuncture and DN techniques are similar in their applications. However, the warm needling technique is established in acupuncture but not in dry needling. Additionally, translational difficulties have inhibited crossdiscipline learning.

Conclusions

Historical evidence suggests a need to examine the use of heat in needling further. Additional research should be conducted on TrP categories to determine if a relationship with the needling technique can be established. Furthermore, interdisciplinary communication would benefit both modalities.

Collapse

Key Words

• acupuncture
• dry needling
• myofascial trigger points
• trigger point physiology

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Jordan Barber AOMA Graduate School of Integrative Medicine, Austin, TX, USA
Fabio Lodo So Wen School of Acupuncture, Milan, Italy
Andrew Nugent-Head Association for Traditional Studies, Ashville, NC, USA
Xia Zeng AOMA Graduate School of Integrative Medicine, Austin, TX, USA

Collapse

The isolated effects of local cold application on proteolytic and myogenic signaling

Post-exercise cooling studies reveal inhibitory effects on markers of skeletal muscle growth. However, the isolated effect of local cold application has not been adequately addressed. It is unclear if the local cold or the combination of local cold and exercise is driving negatively altered skeletal muscle gene expression. The purpose was to determine the effects of a 4 h local cold application to the vastus lateralis on the myogenic and proteolytic response. Participants (n = 12, 27 ± 6 years, 179 ± 9 cm, 82.8 ± 13.0 kg, 18.4 ± 7.1 %BF) rested with a thermal wrap placed on each leg with either circulating cold fluid (10 °C, COLD) or no fluid circulation (room temperature, RT). Muscle samples were collected to quantify mRNA (RT-qPCR) and proteins (Western Blot) associated with myogenesis and proteolysis. Temperatures in COLD were lower than RT at the skin (13.2 ± 1.0 °C vs. 34.8 ± 0.9 °C; p < 0.001) and intramuscularly (20.5 ± 1.3 °C vs. 35.6 ± 0.8 °C, p < 0.001). Myogenic-related mRNA, MYO-G and MYO-D1, were lower in COLD (p = 0.001, p < 0.001, respectively) whereas myogenic-mRNA, MYF6, was greater in COLD (p = 0.002). No other myogenic associated genes were different between COLD and RT (MSTN, p = 0.643; MEF2a, p = 0.424; MYF5, p = 0.523; RPS3, p = 0.589; RPL3-L, p = 0.688). Proteolytic-related mRNA was higher in COLD (FOXO3a, p < 0.001; Atrogin-1, p = 0.049; MURF-1, p < 0.001). The phosphorylation:total protein ratio for the translational repressor of muscle mass, 4E-BP1Thr37/46, was lower in COLD (p = 0.043), with no differences in mTORser2448 (p = 0.509) or p70S6K1Thr389 (p = 0.579). Isolated local cooling over 4 h exhibits inhibited myogenic and higher proteolytic skeletal muscle molecular response.

Comparative Efficacy of Vibration foam Rolling and Cold Water Immersion in Amateur Basketball Players after a Simulated Load of Basketball Game

To compare the efficacy of different recovery strategies (sitting; cold water immersion, CWI; vibration foam rolling, VFR) on the lower extremities of amateur basketball players after the simulated load of a basketball game, we assessed the power, agility, and dynamic balance before and after interventions. Ten amateur basketball players alternately underwent 12 min of sitting, 12 min of CWI at 5 °C, and 12 min of VFR. The power, agility, and dynamic balance were measured immediately post-warm-up, immediately post-game, immediately post-intervention, 1 h after interventions, and 24 h after interventions. To simulate the load of a basketball game, specific movements were designed and implemented. Jump height was measured using a Kistler force plate. Reaction time and dynamic balance score were assessed using the Pavigym agility response system and the Y balance test, respectively. The data were analyzed with a two-way repeated measures analysis of variance (ANOVA). The results showed that the vertical jump height significantly decreased after the CWI intervention compared to the CON and VFR groups (p < 0.001). At 1 h after the intervention, the vertical jump height in the CON group showed delayed recovery compared to the CWI and VFR groups (p = 0.007; p < 0.001). At 24 h after the intervention, the vertical jump height in the CWI group further increased and was significantly different from the CON and VFR groups (p < 0.001; p = 0.005). Additionally, reaction times significantly increased immediately after the CWI intervention (p = 0.004) but showed further recovery at 24 h compared to the CON group (p < 0.001). The dynamic balance score significantly rebounded after the CWI intervention compared to the CON group (p = 0.021), with further improvement at 24 h (p < 0.001). CWI initially showed negative effects, but over time, its recovery effect was superior and more long-lasting. VFR had the best immediate effect on lower limb recovery after the game.

The forgotten art of cold therapeutic properties in cancer: A comprehensive historical guide

Cold therapy has been used for centuries, from Julius Caesar to Mohandas Gandhi, as a potent therapeutic approach. However, it has been largely forgotten in modern medicine. This review explores the history of cold therapy and its potential application as a therapeutic strategy against various diseases, including cancer. We examine the different techniques of cold exposure and the use of other therapeutical approaches, such as cryoablation, cryotherapy, cryoimmunotherapy, cryothalectomy, and delivery of cryogen agents. While clinical trials using cold therapy for cancer treatment are still limited, recent research shows promising results in experimental animal cancer models. This area of research is becoming increasingly significant and warrants further investigation.

Direct Effect of Local Cryotherapy on Muscle Stimulation, Pain and Strength in Male Office Workers with Lateral Epicondylitis, Non-Randomized Clinical Trial Study

Background: Local cryotherapy (LC) is one of the physiotherapeutic methods used in the conservative treatment of lateral epicondylitis (LE). The aim of the study was to verify the direct effect of a single LC procedure on the clinical symptoms of lateral epicondylitis enthesopathy (pain, pain free grip, PFG) and its effect on the bioelectrical properties of the wrist extensor muscles at rest, on maximal contraction and isometric contraction during fatigue. Methods: The study group was 28 men (35.4 ± 6.13 years) with confirmed unilateral epicondylitis. The performed procedures included the assessment of pain (visual analogue scale, VAS), PFG and ARMS (root-mean-square amplitude) and mean frequencies (MNF) of the sEMG signal before (T0) and after (T1) LC on the side with enthesopathy (ECRE) and without enthesopathy (ECRN/E). Results: There was an increase in the ARMS values of the signals recorded during rest and MVC from the ECR muscles both with and without enthesopathy (p = 0.0001, p = 0.006), an increased PFG after LC only on the side with LE (p < 0.0001) and decreased pain (p < 0.0001). During isometric fatigue contraction, a higher ARMS on both the ECRE side (p < 0.0001) and the ECRN/E side (p < 0.0001) was observed after LC treatment, and a lower MNF was observed on both the ECRN/E side (p < 0.0001) and the ECRE side (p < 0.0001) after LC. Conclusions: LC reduces the pain and increases PFG and muscle excitation expressed by ARMS and seems to delay muscle fatigue.