developments in cryotherapy...the use of extremely low temperatures (below –100 c) applied for a...
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Ass. Prof. Agata Stanek MD, PhD
President of Polish Society of Cryotherapy
Department and Clinic of Internal Diseases, Angiology and
Physical Medicine in Bytom of Medical University of Silesia
in Katowice
DEVELOPMENTS
IN CRYOTHERAPY
EUROPEAN CRYOGENICS DAYS, GENEVA 9-10.06.2016
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COLD - HISTORY OF
THERAPEUTICAL APPLICATON
2500 B.C. – in Egypt- cold exerted
an anti-inflammatory effect and
alleviated injury pain;
in V B.C. Hippocrates used cold to
decrease swelling, bleeding and
pain;
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in 1883 a Polish physicists
Karol Olszewski and Zygmunt
Wróblewski executed the first
condensing of nitrogen and
oxygen;
COLD - HISTORY OF
THERAPEUTICAL APPLICATON
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in 1978 T. Yamauchi in Japan –
created whole-body
cryotherapy;
for the first time in the world
he applied whole-body
cryotherapy in the treatment
of patients with
rheumatoid arthritis
COLD - HISTORY OF
THERAPEUTICAL APPLICATON
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in 1982 R. Fricke
in Germany-
used whole-
body cryotherapy
for the first time in
Europe;
COLD -COLD - HISTORY OF
THERAPEUTICAL APPLICATON
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In 1983 – Z. Zagrobelny –
Department of Physiotherapy of
University School of Physical
Education in Wroclaw – local
cryotherapy was applied for
patients first time in Poland;
Cryotherapy in Poland:
COLD - HISTORY OF
THERAPEUTICAL APPLICATON
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1989 Polish cryochamber
(second in Europe, third in the world)
Zbigniew Raczkowski –Institute of Low
Temperatures and Structural
Investigations of the Polish Scientific
Academy in Wroclaw; the creator of the
first Polish cryochamber
Cryotherapy in Poland:
COLD - HISTORY OF
THERAPEUTICAL APPLICATON
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MODERN CRYOMEDICINE
Cryogenic temperatures in medicine
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CRYOTHERAPY
CRYOSURGERY
LOCAL
CRYOSTIMULATION
WHOLE-BODY
CRYOSTIMULATION
CRYOSTIMULATION
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CRYOSURGERY
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Cryosugery - interruption of
the continuity of tissues as
a result of freezing with a
view to their removal or
destruction.
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CRYO-S MINI
Cryoflex device for cryosurgery
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Cryosurgical treatment with usage of spray probe
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The use of extremely low temperatures
(below –100°C) applied for a short time
(2-3 minutes) to stimulate physiological
reactions in the human body, in order to
achieve more effective pharmacological
treatment and kinesiotherapy. Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice.
Balneol. Pol., 2007, 49, 1, 107, 37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical
Engineering. Indygo, Zahir Media, Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
CRYOTHERAPY- DEFINITION
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LOCAL CRYOTHERAPY
(CRYOSTIMULATION-
HYPERBARIC GASEOUS
LOCAL CRYOTHERAPY)
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application
of the cold
to a selected
part of the
human body.
LOCAL
CRYOTHERAPY
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ACCORDING TO THE KIND OF
COOLING MEDIUM LOCAL
CRYOTHERAPY IS DIVIDED
INTO:
1. Cryotherapy with liquid nitrogen.
2. Cryotherapy with carbon dioxide.
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CRYO -T ELEPHANT devices for local
cryotherapy-cooling medium liquid nitrogen
(METRUM CRYOFLEX)
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CRYO -T (METRUM CRYOFLEX)
device for local cryotherapy-cooling medium
liquid carbon dioxide
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KRIOPOL R60
CREATOR
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Application of cryogenic temperatures
for a short time (1-3 minutes) on the entire
body of the patient.
Whole-body cryotherapy is performed in
cryochambers
WHOLE-BODY
CRYOTHERAPY
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Antechamber: acclimatisation to cryogenic temperature,
exposure duration 60 seconds, temperature -60°C.
Proper chamber: exposure duration 2-3minutes,
temperature below -110°C.
The exposure duration depends on individual cryogenic
temperature tolerance.
Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol. Pol., 2007, 49, 1, 107,
37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering. Indygo, Zahir Media,
Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
WHOLE-BODY
CRYOTHERAPY
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CRYOTHERAPY CHAMBER –WROCŁAW TYPE
(CREATOR)
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TWO - CHAMBER SYSTEM
Antechamber
Temp.-60°C
Proper chamber
Temp. -110° C
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CRYOCHAMBER WITH COLD RETENTION
(CRYOFLEX METRUM)
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EXAMPLE OUTFITS FOR WHOLE - BODY
CRYOTHERAPY
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Endocrine system- increased beta-endorphins
secretion;
Neuronal system - functional exclusion of sensory
receptors and their junctions with proprioceptors;
decreased nerve transmission in sensory fibres,
reduction the activity of free nerve endings, raising
the pain threshold, over-ride the pain sensation -
known as the pain gate theory;
Wawrowska A.: Wpływ ogólnoustrojowej krioterapii organizm osób zdrowych i chorych reumatycznych ze
szczególnym uwzględnieniem stężeń wybranych hormonów, beta-endorfin, 6-ketoPGF1. Praca Dokorska
AWF, Wrocław 1992.
Bauer J., Skrzek A.: Fizjologiczne podstawy krioterapii. Acta Bio-Opt. Inform. Med.., 1997,3,(2-4), 115-120.
Sieroń A., Rykaczewska-Czerwińska M., Klimkiewicz T., Jakrzewska H., Jagodziński L., Birkner E., Wiśniowska
B., Plech A. Antinociceptive effect in rats induced by the cooling of their whole body. Acta Bio-
Opt.Inform.Med., 2002,8,153-155;
ANALGESIC EFFECT
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Metabolic action (among others
decreased concentrations of histamine
and lactate in inflammatory changed
tissues).
Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cholewka A., Cieślar G., Rosmus-Kuczia I., Drzazga Z., Sieroń A. Estimation of analgesic action of
whole-body cryotherapy in patients with ankylosing spondylitis..Fizjoter. Pol., 2011, 1, 4, 49-55.
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
ANALGESIC EFFECT
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reduction of nerve transmission
and reactivity of peripheral
sensomotor nerve endings
decreased muscle tone;
increased muscle power;
Bilińska M., Rudkowska-Brzecka A., Marytnów R., Brzecki A.: Badania elektromiograficzne w
ocenie siły mięśniowej po krioterapi u chorych z reumatoidalnym zapaleniem stawów.
Przegl. Lek., 1993, 50, (1-2), 12-13.
Schroder D., Anderson M.: Kryo-und-Theromtherapie: Grundlagen und praktische
Adwendung.Harausgegeben von Bernd Gaupel, Gustav Fischer verlag, Stuttgarrt-Jena-New
York 1995.
NEURO-MUSCULAR
EFFECT
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ANTIOEDEMATOUS
EFFECTarterial hyperemia of periarticular
oedemas,
increased capillary filtration,
improvement of lymphatic vessels
patency draining intercellular space.
Gregorowicz H., Zagrobelny Z. Krioterapia ogólnoustrojowa wskazania i przeciwwskazania,
przebieg zabiegu i jego skutki fizjologiczne i kliniczne. Acta Bio-Opt. Inform. Med., 1998, 4,119-
131.
Kalmus P., Włodarczyk K., Pinkowska I., Piotrowska E., Szulicka A. Wyniki leczenia
reumatoidalnego zapalenia stawow zabiegami krioterapeutycznymi i peloidowymi. Baln.
Pol.,1999, 41,83-91.
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ANTIOEDEMATOUS
EFFECTcryogenic temperatures accelerate
lymphatic flow but they do not
influence lymph formation
the lymphatic flow acceleration is
long lasting but it appears only at
the end of the exposure cycle (10
daily exposures)
Sieroń A., Pastuszka A., Marniok B., Wiśniowska B., Jagodziński L., Ślusarczyk K., Cieślar G.,
Stanek A. Influence of low temperatures on lymph formation and flow velocity in mice. Thermology
Int.,2004,14,127-130
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ANTIINFLAMMATORY
EFFECT
inflammatory parameters:
ESR (erythrocyte sedimentation rate),
CRP (C-reactive protein), seromucoid,
IL-2,IL-8,IL-10, sICAM;
Stanek A., Cieślar G., Strzelczyk K., Kasperczyk S., Wiczkowski A., Birkner E., Sieroń A.: Influence of
cold on inlammatory markers in patients with ankylosing spodylitis and healthy volunteers. Polish
Journal of Environmental Study, 2010,19,1, 167-175.
Banfi G., Melegati G., Barassi A., Dogliotti G., d’Eril G., Dugue B., Corsi M. Effects of whole-body
cryotherapy on serum mediators of inflammation and serum muscle enzyme in athtes. J.Thermal Biol.,
2008, 34,55-59.
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beneficial influence on the
prooxidant-antioxidant
balance
Stanek A. Influcence of whole-body cryotherpy on antioxidant status in patients with ankylosing
spondylitis. Thesis, Medical University of Silesia, 2004
Lubkowska A., Chudecka M., Klimek A., Szyguła Z., Frączek B.: Acute effect of a single whole-body
cryostimulation on prooxidant-antioxidant balance in blood of healthy, young men. J Thermal. Biol.,
2008, 33, 464-467
Mila-Kierzenkowska C., Wozniak A., Wozniak B., Drewa G., Rakowski A., Jurecka A., Rajewski R. Whole-
body cryostimulation in kayaker women: a study of the effect of cryogenic temperatures on oxidative
stress after the exercise. J. Sports Med. Phys. Fitness, 2009, 49, (2), 201-207.
ANTIINFLAMMATORY
EFFECT
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cellular and humoral immunity
prostaglandins and cytokins;
number and percentage of
lymphocytes: CD3, CD4, CD8, CD19,
CD56(NK);
Zagrobelny Z., Halawa B., Kuliczkowski K., Frydecka I., Grgorowicz H.: Wpływ ogólnoustrojowej
krioterapii w komorze niskotemperaturowej oraz leczenia ruchem na subpopulacje limfocytów we
krwi obwodowej u chorych na chorobę zwyrodnieniową stawów i reumatoidalne zapalenie
stawów. Reumatologia, 1996, 34,763-771.
IMMUNE SYSTEM
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HORMONAL SYSTEM
- adrenaline, noradrenaline, cortisol, B-
endorphine, testosterone (in males);
thyrothrophic hormone, thyroid hormones,
growth hormone, follicular hormone,
luteinizing hormone and 6-ketoPGF1
(prostaglandin metabolite causing
vasodilatation effect of blood vessels)
Wawroska A.: Wpływ ogólnoustrjowej krioterapii na organizm osób zdrowych i chorych reumatycznych ze
szczególnym uwzględniem stężeń wybranych hormonów, beta-endorfin, 6-ketoPGF1. Praca Dokorska AWF,
Wroclaw 1992.
Smolander J., Leppäluoto J., Westerlund T., Oksa J., Dugue B., Mikkelsson M., Ruokonen A. Effects of repeated
whole-body cold exposures on serum concentrations of growth hormone, thyrotropin, prolactin and thyroid
hormones in healthy women. Cryobiology, 2009, 58, (3), 275-278.
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CIRCULATORY
SYSTEM
MICROCIRCULATION MACROCIRCULATION
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MICROCIRCULATION
I phase: - contraction of
precapillary sphincters
skin precapillary
flow;
- opening of arteriovenous
anastomoses
oxygenated blood flow
back through veins to
the left atrium of the
heart;Bauer J., Skrzek A. Fizjologiczne podstawy krioterapii. Acta Bio-
Opt.Inform.Med., 1997,3,115-120.
Gregorowicz H.: Wpływ krioterapii ogólnoustrojowej na wybrane wskaźniki hemodynamiczne i wentylacji płuc w
schorzeniach reumatycznych. Praca Doktorska AM, Wrocław, 1992.
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MICROCIRCULATION
II phase: - vasodilatation of capillary vessels,
closure of arteriovenous anastomoses,
hiperperfusion of tissues oxygen
supply to tissues with inflammatory changes,
lactate and histamine concentrations pain
reduction
Bauer J., Skrzek A. Fizjologiczne podstawy krioterapii. Acta Bio-Opt.Inform.Med., 1997,3,115-120.
Gregorowicz H.: Wpływ krioterapii ogólnoustrojowej na wybrane wskaźniki hemodynamiczne i wentylacji płuc
w schorzeniach reumatycznych. Praca Doktorska AM, Wrocław, 1992.
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MACROCIRCULATION
blood pressure, heart rate,
left ventricular contractility;
in literature there are no
cases of arrhythmias,
electrocardiographic
symptoms of myocardial
ischemia;
Jagodziński L., Cieślar G., Stanek A., Puszer M., Bilska A., Wiśniowska B., Romuk E., Skrzep-Poloczek E., Birkner E., Sieroń A.: Ocena
frakcji wyrzutowej lewej komory serca u pacjentów z zesztywniającym zapaleniem stawów kręgosłupa poddanych krioterapii
ogólnoustrojowej. Balneol. Pol., 2003, 45, (3-4), 40-44.
Jonderko G., Końca A., Rosmus-Kuczia I., Nowicki L.: Wpływ krioterapii miejscowej gazem chłodzącym i lodem na elektrokardiogram i
ciśnienie tętnicze krwi u chorych na reumatoidalne zapalenie stawów. Ann.Acad. Med.Siles., 1991,24,131-138.
Zagrobelny Z., Halawa B., Negrusz-Kawecka M., Spring A., Gregorowicz H., Wawrowska A., Rozwadowski G.: Zmiany hormonalne i
hemodynamiczne wywołane schładzeniem całego ciała chorych na reumatoidalne zapalenie stawów. Pol. Arch. Med. Wewn., 1992,87,34-40.
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AND ALSO….
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WHOLE – BODY
CRYOTHERAPHY
beneficial influence on the
psyche (decreased level of
fear, anxiety, excitability;
increased perception).
Rymaszewska J., Biały D., Zagrobelny Z., Kiejna A. The influence of whole-body
cryotherapy on mental health. Psychiatr.Pol., 2000,34,64-653;
Rymaszewska J., Ramsey D., Chładzińska-Kiejna S. Whole-body cryotherapy as adjunct
treatment of depressive syndrome and anxiety disorders. Arch. Immunol. Ther.
Exp.,2008,56,63-68.
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WHAT MORE
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Cryotherapy prior to
kinesiotherapy facilitates
the intensification of
training and its duration
severalfold.Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol.
Pol., 2007, 49, 1, 107, 37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering.
Indygo, Zahir Media, Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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WHY ?
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Cryotherapy
Reduced stimulus threshold
Analgesia Reduced tendon reflexes
Reduced pain Reduced muscular tone
Prolonged relaxation
Improvement of motion range
Physical rehabilitation (kinesiotherapy)
Knight K.L. Cryotherapy in sport injury management, Human Kinetics: Champaingn, 1995.
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CRYOTHERAPY - clinical indications:
I. Disorders of motion system
II. Neurological system disorders
III. Wellness
IV. Depressive syndrome
V. Sports medicine
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DISORDERS OF MOTION SYSTEM:
inflammatory diseases of motor system
(f.e. reumatoid arthritis, ankylosing
spondylitis);
degenerative diseases of joints and the
spine;
inflammatory lesions of the joints of
metabolic origin (e.g. gouty diathesis);
Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010.
Stanek A., Cholewka A., Gaduła J., Drzazga Z., Sieroń A., Sieroń-Stołtny K.. Can whole-body cryotherapy with
subsequent kinesiotherapy procedures in closed type cryogenic chamber improve BASDAI, BASFI, some spine
mobility parameters and decrease pain intensity in patients with ankylosing spondylitis? BioMed Res Int 2015, Vol.
2015, Article ID 404259, 11 pages
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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DISORDERS OF THE MOTION SYSTEM:
posttraumatic and overloading
lesions,
discopathy,
osteoporosis,
fibromyalgia syndrome;
Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol. Pol.,
2007, 49, 1, 107, 37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering.
Indygo, Zahir Media, Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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diseases of the central nervous
system with muscle spasticity
multiple sclerosis
radicular syndromes
diseases of the peripheral nervous
system
NEUROLOGICAL SYSTEM DISORDERS:
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SPORTS MEDICINE :The benefits observed are:
reduction of pain
increase in muscle strength
inhibition of inflammatory
processes
reduction in the regeneration
phase
reduction of posttraumatic
treatment
enhancement of sports
performance
overall faster return to training
Biały D., Zimmer K., Zagrobelny Z. Krioterapia ogólnoustrojowa w sporcie. Med.Sport.,1999, 15,21-
24.
Swenson C., Sward L., Karlsson J. Cryotherapy in sport medicine. Scand. J. Med.Sci. Sport.,
1996,6,193-200.
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Future
development
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FUTURE CRYOTHERAPY -
health and well - being
More and more frequently
cryotherapy is used to improve
health, harden and revitalize the
body and prevent stress-related
diseases and their consequences
www.cryowellness.com,
www.criomed.com.
Stanek A., Sieroń A. Contemporary whole-body cryotherapy in biological
renewal. Ann. Acad. Med. Siles., 2012, 66, 4, 64-70
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FUTURE - SKIN
Whole-body
cryotherapy helps to
reduce the
appearance of
cellulite and loose
skin as a result of
aging, weight lost,
post liposuction as
well as prevents
wrinkles.
www.cryowellness.com
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CELLULITE - BEFORE AND AFTER WHOLE-BODY CRYOTHERAPY
www.onkocet.eu
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STRICT CONTRAINDICATIONS
TO CRYOTHERAPY:
cold intolerance,
cryoglobulinemia,
cryofibrinogenemia,
Raynaud’s phenomena,
cold urticaria, Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol. Pol., 2007, 49, 1,
107, 37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering. Indygo, Zahir Media,
Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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STRICT CONTRAINDICATIONS
TO CRYOTHERAPY:
venous thromboemolism,
hypothyreosis,
local disorders of blood supply,
Sieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol. Pol., 2007, 49, 1,
107, 37-45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering. Indygo, Zahir
Media, Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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STRICT CONTRAINDICATIONS TO
CRYOTHERAPY:
considerable anemia,
claustrophobia,
cachexia,
hypothermia,
cancer diseaseSieroń A., Cieślar G., Stanek A. (eds). Cryotherapy. alpha-medica press, Bielsko-Biała, 2010
Stanek A., Cieślar G., Sieroń A. Therapeutic aplication of cryotherapy in clinical practice. Balneol. Pol., 2007, 49, 1, 107, 37-
45.
Podbielska H., Stręk W., Biały D. (eds). Whole-body cryotherapy. Acta of Biomedical Engineering. Indygo, Zahir Media,
Wroclaw, 2007
Zagrobelny Z.(ed). Whole-body and local cryotherapy. Urban & Partner, Wroclaw, 2003
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