Welcome to the PT Rebels Podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible.
I’m your host, Dr. Gina Fick.

When it comes to cryotherapy and the proper use of cryotherapy, we rely on evidence-based guidelines for our patients, and it’s really important that you have a physical therapist who understands the evidence and who can properly prescribe cryotherapy or any treatment for that matter for your. Recovery from exercise or in the treatment of injury. When it comes to the use of cryotherapy, we traditionally use cryotherapy for the treatment of pain. We use it for reducing pain, following an acute injury or for. A really hard exercise bout, but the timing of that cryotherapy is really important. So understanding the evidence and how it ties into the proper use of cryotherapy is critical and essential so that you aren’t actually getting detrimental effects from cryotherapy. Um, the evidence suggests that the chronic use of cryotherapy. After resistance training can actually harm the anabolic training effect or muscle building effects from that anabolic training exercise. So it’s really important that you don’t actually get negative benefits from the cryotherapy. That you have a physical therapist who has the understanding of how to properly prescribe cryotherapy in your recovery routine. And it’s also critical that you have someone guiding you that understands your specific sport and your specific event. So for instance, if you’re a distance runner versus a sprinter or a hurdler or a jumper who was more of a power athlete. It’s essential to plan your recovery and plan your cryotherapy if you are going to use it so that you do have beneficial effects from that, and it doesn’t harm your body’s ability to respond well if you are trying to obtain a muscle hypertrophy effect, for instance. So if you have a really hard lift. Or if you have a hill workout or hill repeats, or a max velocity workout, it’s probably not going to be as beneficial for you to immediately do cryo or to do cryotherapy on a regular basis. Right after those types of exercise because that could actually potentially harm the muscle hypertrophy effect that your coach and that you are going for in your training. Manet and Costello in 2015 highlighted in their research the need for specificity in the prescription of recovery interventions. As I mentioned earlier, long duration exercise such as with cross country training or more distance-based training results in predominantly metabolic damage. Resistance exercise or anaerobic workouts such as hill repeats or max velocity can result in the breakdown of actual structural elements of the muscle tissue and potentially have greater functional effects or perturbation effects with that trainee. So the effectiveness of any recovery routine or modality, whether it’s. Cryotherapy or electrical stimulation or red light therapy really needs to be examined and prescribed by a physical therapist who understands specific recovery effects with those modalities. And in relation to the different modes of exercise and the block or type of training that you’re doing at that time. If you’re going into a sports recovery training center, for instance. You have the option to get in a big hot tub or get in a big cold tub, or to use electrical stem, or to use red light therapy or to use laser therapy. It’s really nice to have all of those options available, but it’s critical to understand when and why you should use it. So if you don’t have someone guiding you in that, and you just have a monthly membership or a membership to go into a center like this without. Considering your specific needs, it could potentially be detrimental or actually not very helpful, and you may be throwing money down the drain and wasting time and energy on something that may not be of max benefit to you. So there is evidence as well broach it all in 2014 and Wilson it all in 2018. Highlight that many therapeutic effects attributed to cryotherapy treatment. May actually be due to a placebo effect. So it may be due to the athlete or the active individual’s belief that cryotherapy is going to help in their recovery, and we know that that can be the case oftentimes with many forms of modalities and actually physical therapy as well. So we want you to understand that there’s a scientific basis to what we’re doing as physical therapists, and we aren’t just prescribing fad treatments that we think could be helpful for you because we truly want to honor your time and your money, and we want you to be receiving the treatments that are gonna be of max benefit to you. And they’re gonna help most in your performance enhancement, and they’re gonna allow you to run your fastest and jump your highest and be at your best. So there’s a few studies that I also wanted to highlight just because again, we aren’t trying to just talk about these fad treatments and the potential benefits from them based on generic effects, but we really want to give you the evidence and the nitty gritty of what could potentially be the most beneficial treatments for you. So with that. I looked at a few studies that I thought you might find helpful. Hoen, hower, et all in 2020 looked at 28 female athletes and they looked at the effect of cold water immersion. Versus partial body, cryo versus a control. And with partial body, cryo would be like a cryo gun or just where you have cryotherapy treatment just to a portion of your body. And so they applied that partial body cryo for 30 seconds at about 60 degrees Celsius, and then for two minutes at about 1 35 degrees Celsius. Now the cold water immersion, like a cold plunge that was applied for 10 minutes at 10 degrees Celsius, and then in the control group, they just let them rest for 10 minutes. They had no treatment intervention. So what these authors found is that cold water immersion had greater physiological effects than the partial body cryo. In terms of decreasing delayed onset muscle soreness. Now when compared to the control group, cold water immersion and partial body cryo were both more effective at decreasing delayed onset muscle soreness than the control group that just sat there and rested. However, there was no effect on maximum voluntary intramuscular contraction, and there was no effect in vertical gem performance up to 72 hours after the treatment. How we apply this is if you’re going into a cryotherapy chamber or you’re using cold plunge to enhance your performance from exercise, there may not be a significant performance enhancement effect after that cryotherapy, however. The athlete may have a decrease in the delayed onset muscle soreness after a hard valve of exercise, and when timed correctly, that could be very beneficial. So we go back to the point where I was talking about how important it is to consider where you are at in your training and what you’re trying to accomplish. So sometimes after a hard workout or a hard bout of exercise, it’s extremely important to give your body time and adequate time to rest and recover and give your body time to adapt to that training load so that you can have a muscle hypertrophy effect. You don’t want that dampen by cryotherapy. However, if you’re at. State track meet, for instance, and you have three days of hard, physical, intense activity and you’re, um, going to be running the a hundred meter dash and the 200 meter dash and prelims, and the next day you’re going, going to be running a 400 meter dash and maybe a four by four. The evidence does show that if you do cryotherapy, like a cold water immersion full body, um, soon after you finish that. Hundred meter dash or the 200 meter dash, it probably is going to have an effect in decreasing your delayed onset muscle soreness, and you are probably going to feel better the next day before those other events. So it’s extremely essential to, again, have a good understanding of what you’re trying to accomplish through cryotherapy and to have someone who can adequately guide you in that. In terms of further research, we. As healthcare professionals really need to look at and understand how cryotherapy is going to benefit our patients in terms of recovery and in terms of enhancing performance effects to apply suggestions to the athlete and recommendations based on science and not based on fads and not based on. Revenue generating capabilities and not put our interest as a healthcare profession in terms of revenue generation ahead of the athlete’s needs.