Cryotherapy

Cryotherapy (Greek krooq-ice) is a complex of physiotherapeutic procedures associated with the effect of low temperatures on the skin.

Local cryotherapy and general hypothermia are used.

• Local cryotherapy (cryomassage) is a therapeutic effect on the organs and tissues of the body of cold factors that reduce the temperature of tissues to no less than the limits of their cryostorage (5-10° C) and do not lead to a significant change in the body's thermoregulation
• General hypothermia (extreme cryotherapy, aerocryotherapy) is a short-term exposure of the patient’s skin to a gas environment with a temperature ranging from -20 to -170° C.

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Indications for cryotherapy

• chronic dermatoses (psoriasis, atopic dermatitis, eczema, urticaria, etc.);
• rosacea, couperose (in remission);
• seborrheic dermatitis;
• acne;
• hypertrophic, atrophic, pigmented scars, post-acne;
• atrophic changes in the skin (including those due to long-term use of glucocorticosteroids);
• hyperpigmentation (post-traumatic, ephelides);
• alopecia,
• care for mature, aging skin;
• care for dehydrated skin;
• preparing skin for cosmetic procedures (cryopeeling);
• skin treatment after dermabrasion, thermal and electrocoagulation, laser therapy and epilation (to remove excess heat, reduce redness and tension, prevent inflammation, reduce discomfort);
• cellulite treatment, reduction of local fat deposits;
• treatment of flabby, atopic skin of the arms, thighs, abdomen;
• restoration of breast shape and elasticity;
• rehabilitation after plastic surgery, liposuction;
• use after injection techniques (mesotherapy, electrolipolysis);
• providing first aid for burns (allows to stop the action of the high-temperature agent and thereby significantly reduces the area of necrosis);
• treatment of burn wounds at a later stage (as an analgesic, anti-inflammatory, keloid-protective agent, to stimulate reparative processes);
• chronic fatigue syndrome, depression

Historical background

Hippocrates, Galen and Avicenna prescribed cold baths to their patients for their healing and rejuvenating properties. The ancients believed that when exposed to extreme cold conditions, the body mobilizes all its hidden reserves. Therefore, "freezing" procedures were used to relieve pain and stop inflammation. The fact that self-healing powers are activated in the cold was confirmed at the beginning of the 20th century by the German doctor Sebastian Kneipp. He jumped into the icy Danube to cure himself of febrile pneumonia. Kneipp called hardening one of the main areas of physiotherapy. Since then, bathing in an ice hole has become a symbol of heroic health. In the mid-70s of the last century, the Japanese scientist Toshimo Yamauchi, observing patients with rheumatoid arthritis, discovered that cold has a positive effect on joints. After exposure to cold, body temperature remains elevated for many hours, and at the same time, favorable changes occur in the blood and synovial fluid. Cold stimulates the body to produce “anti-rheumatic” hormones.

The Japanese suggested using air cooled to -100...-180° C to treat rheumatism. When the development of cryogenic technology made it possible to use such ultra-low and ultra-low temperatures in medicine, physiotherapy procedures using ice, dry cold air and liquid nitrogen became widespread in Japan, Germany and Poland. Cryotherapy became known in Russia only in the late 80s - early 90s of the last century. By now, the destructive (destroying pathological tissues), analgesic, anti-edematous, anti-inflammatory, healing and healing effects of ultra-low temperatures have been studied quite well. Having stepped beyond the boundaries of medicine and enriched with the latest technologies, cryotherapy has also come to aesthetic cosmetology.

Today, scientists believe that the future of cryotherapy lies in temperatures reaching -196° C.

The main mechanisms of action of cryotherapy

1. Effect on cellular and tissue structures.

Local cryotherapy:

• local slowdown of the level of metabolic processes in cooled tissues;
• reducing their consumption of oxygen (and need for it) and nutrients;
• decreased activity of muscle spindles and muscle contractility;
• increase in the viscosity of synovial fluid.

General cryotherapy:

• improving the process of phosphorylation coupling in skeletal muscle;
• activation of tissue respiration in adipose tissue

2. Impact on the neuroendocrine system, metabolism.

General hypothermia.

Activation of central thermosensors leads to the release of pituitary hormones and catecholamines, which stimulate catabolic processes in tissues, and the accumulating corticosteroids activate reparative regeneration in the inflammatory focus.

3. Effect on the cardiovascular system.

During cryotherapy, several protective reactions are distinguished:

• Vasoconstriction (aimed at retaining heat),
• Expansion of the lumen of blood vessels for 1-3 hours after cryotherapy, depending on the cooling dose (promotes increased heat generation).

The processes of narrowing and dilating the blood vessels of the skin have characteristic rhythmic fluctuations that prevent ischemic tissue damage.

• After local cryotherapy, cold (reactive) hyperemia is observed, the mechanism of formation of which is based on reflex excitation of adrenergic sympathetic fibers. In the underlying tissues, the content of norepinephrine increases, which causes a pronounced and prolonged narrowing of the microcirculatory bed vessels and an increase in blood viscosity. These changes contribute to a decrease in hematocrit and blood fluidity.

Reactive hyperemia is characterized by individual differences that depend on local signs (skin thickness) and constitutional features (age, general thermal balance before the procedure, etc.).

4. Effect on the neuromuscular system.

During cryotherapy, excitation of skin receptors occurs. With prolonged cooling, their inhibition and partial paralysis occurs due to blocking the conductivity of nociceptive and tactile fibers of the underlying tissues. Thus, the patient first feels cold, then a burning and tingling sensation, then pain, which is replaced by anesthesia and analgesia. The analgesic effect is realized due to a sharp decrease in the conductivity of the nervous tissue, activation of endorphin inhibition systems, neutralization of chemical reactions to acetylcholine, histamine, prostaglandins, etc.

5. Regulation of muscle tone.

With prolonged (more than 10 min) cooling in the temperature range of about 0° C or with short-term but intensive cooling (to -180° C), muscle relaxation occurs (reduction of muscle spasm). It is necessary to take into account that the effect of various types of cryotherapy almost does not change the temperature of muscles and nerve trunks, and the spasmolytic effect is realized through the exteroceptor apparatus of the skin and the vegetative system. The functional activity of the exteroceptors of the skin becomes minimal when the skin is cooled to 13° C. Therefore, cooling the skin to 12-15° C is optimal for relieving muscle spasm. With general cryotherapy, there is a more pronounced inhibition of the functions of the vegetative system than with local cryotherapy (for example, ice application).

By means of short-term exposure (less than 10 min) to moderately low temperatures (around 0° C), due to an increase in the degree of coupling of cellular respiration and oxidative phosphorylation in adipose tissue and skeletal muscles, an increase in muscle tone is achieved. At the same time, an increase in muscle strength and endurance is noted.

6. Effect on inflammation and immunological responses.

Cooling of the inflammatory focus inhibits the activity of proteases released from lysosomes and prevents the proliferation of microorganisms in the wound. This reduces alteration and swelling of damaged tissues; activates tissue regeneration in the area of trophic ulcers and long-term non-healing wounds; accelerates necrolysis and cleansing of purulent-necrotic wounds from dead tissue; slows down the absorption of toxic products in burn wounds. As a result, the differentiation of fibroblasts and the formation of granulation tissue are accelerated, and then the structural reorganization of scars occurs. In individuals with immune defects, against the background of a decrease in clinical signs of inflammation, the differentiation of T-lymphocytes slows down and immunoglobulins G and M are destroyed.

The main therapeutic effects of cryotherapy are: analgesic, anesthetic, hemostatic, anti-inflammatory (anti-edematous), reparative-regenerative, vasoconstrictive, desensitizing, relaxing, sedative.

Cryotherapy methods

1. Methods using moderately low temperatures:
   • ice applications;
   • ice cube massage;
   • ice wraps;
   • local cold baths;
   • cryopackage applications (package cryotherapy);
   • application of cold dressings and bandages;
   • cold mud applications;
   • cryotherapy and cryoapplication using thermoelectric devices;
   • ethyl chloride and alcohol blockades;
   • cryotherapy ("carbon dioxide snow").
2. Methods using extremely low temperatures:
   • cryomassage, cryopuncture treatment using cryocatheters and cryozoids on devices in which the gas mixture is “blown out” under a pressure of 3.5-5 bar;
   • cryosauna (cryochambers).
3. Combined (combined) methods using cryotherapy
   • cryotherapy + physical exercises (cold bandages; vibration massage + cold exposure);
   • cryotherapy + controlled compression of the affected area;
   • cryotherapy + hyperbaric oxygenation;
   • cryotherapy + ultraviolet irradiation;
   • cryoelectric therapy (cryotherapy + low-frequency pulsed currents).

Procedure for prescribing cryoprocedures

Local cryotherapy can be prescribed without a medical examination. General cryotherapy is prescribed only after a medical examination: examination by a therapist or physiotherapist (electrocardiological examination, general clinical blood and urine tests).

Before the cryotherapy procedure, the body's reaction to cold is usually examined. In this case, tests such as "ice test", "cold-pressure", etc. are most often used. For example, testing is carried out by applying a piece of ice 2 or 3 cm ³ to the forearm. In this case, a pronounced reaction is considered a contraindication for cryotherapy. A more reliable method is a temperature test using special computer systems.

Procedure execution schemes

Cryomassage, aero cryomassage. Cryomassage is performed using liquid nitrogen (a colorless heavy liquid with a boiling point of -193...-210° C at a pressure of one atmosphere). Today, we widely practice two parallel methods of cryotherapy. The first is an applicator that is attached to a wooden rod. This structure is lowered into a cylinder, the so-called "dewar", the long neck of which should not be tightly closed. There is liquid nitrogen there. A cotton applicator soaked in liquid nitrogen is used to massage the face. With light movements along the massage lines, the applicator very quickly moves over the skin of the face. The feeling of slight burning and tingling disappears soon after the procedure, and the skin becomes elastic. The second method of cryomassage is more modern, in this case, special equipment is used - a cryo-sprayer and a cryodestructor with various attachments, including Teflon ones.

The equipment allows for dosed, uniform cooling of the skin. A composition is sprayed from the nozzle of the device (the same liquid nitrogen, called "cryogen", which has a temperature of up to -180 ° C). The exposure time on the skin is approximately 2-3 minutes per 1 dm ² at minimum jet intensity. The specialist can increase the temperature to -50... -80 ° C depending on the individual characteristics of the patient's skin - its thickness, degree of aging, color, age, etc. Cryomassage can be used 15-20 minutes before the start of almost any cosmetic procedure. This will improve its effectiveness, since short-term exposure to cold activates capillary microcirculation and metabolic processes.

Cryopeeling. During the cryopeeling procedure, gushering with liquid nitrogen is performed until peeling occurs. This peeling is well tolerated, has a pronounced whitening, moisturizing and pain-relieving effect (often prescribed after plastic surgery, burns, bruises and post-acne scars). A course of 5 to 15 procedures, 1-2 times a week, is recommended for patients with pronounced signs of skin dehydration.

Treatment of seborrhea and acne. Cryotherapy with liquid nitrogen gives good results in cases of seborrhea and various forms of acne in combination with general methods of treatment. The use of liquid nitrogen is especially indicated for severe and widespread forms of acne (phlegmonous, conglobate, keloid acne). In this case, liquid nitrogen is used in the form of shading and deep freezing of inflammatory infiltrates. Shading is carried out with a large-diameter applicator, for which a cotton swab 7-10 cm long (in the form of a "reed") is tightly fixed to the end of a wooden stick. The applicator is moistened with liquid nitrogen, placed parallel to the surface of the treated area and, with continuous rotational movements, under light pressure of the right hand, moved along the affected surface until a quickly disappearing whitening appears. The patient feels a feeling of cold and burning. After the burning sensation disappears, the procedure is repeated 2-3 times for 5-10 minutes. After 5-6 hours, persistent hyperemia of the skin appears, which lasts for 24-36 hours, the skin gradually darkens, on the 3rd day, lamellar peeling appears, and after 5-6 days, the darkened layers of the epidermis are completely rejected. Individual large inflammatory infiltrates of acne, suppurating atheromas and hypertrophic scars are additionally treated with liquid nitrogen for the purpose of their deeper freezing. On the foci subjected to additional application, blisters often form with subsequent formation of crusts, which are rejected after 8-10 days. Subsequently, treatment sessions are carried out 2 times a week with a shorter exposure, causing weaker phenomena of reactive inflammation of the skin. The course consists of 10-15 procedures.

Rosacea treatment. When treating rosacea, cryomassage with liquid nitrogen is performed with lighter movements over the entire affected surface of the facial skin. Individual nodular and pustular elements are additionally frozen with a short exposure - up to 10-15 sec. Sessions are repeated 1-2 times a week, a course of 10-15 procedures is required depending on the prevalence of the process.

Treatment of some forms of alopecia. In cases of seborrhea of the scalp with hair loss, as well as in cases of circular alopecia, liquid nitrogen has a beneficial effect, provided that general methods of influencing the body as a whole are used simultaneously (general strengthening treatment, vitamin therapy, etc.). In these cases, liquid nitrogen is used in the form of a scalp massage. In this case, the applicator is placed parallel to the skin surface and the scalp is massaged downwards along the partings with light rotational movements. The duration of treatment of each area is 3-5 seconds, until the skin turns slightly white; at the end of the cryomassage, persistent erythema appears. The procedure takes an average of 10-20 minutes (cryomassage of the entire scalp). In cases of alopecia areata, only the bald spot is treated with liquid nitrogen, intermittently for 1-2 minutes. The procedure is repeated after 2-3 days, the course requires 15-20 procedures. After a month's break, the course of treatment must be repeated. 2-3 courses are indicated. It should be remembered that the low temperature of liquid nitrogen causes dryness and brittleness of hair, so during the treatment it is necessary to carefully monitor the state of sebum secretion.

Combination with other methods: D'Arsonval, UFO, Bucky therapy, medicinal effects (immune drugs, vitamins, enzymes, sorbents, eubiotics), cosmetic procedures (facial cleansing, mesotherapy, contour plastic surgery, cosmetic massage, etc.).

Alternative methods: mesotherapy, phonophoresis, electrophoresis, microcurrent therapy, cosmechanics.