Sports Injuries

Updated 04 July 2016

Cryotherapy for improved healing and sports performance

In cryotherapy your body is exposed to temperatures ranging between -120 °C and -160 °C with liquid nitrogen vapour for 30 seconds up to three minutes. Cryogenics has become very popular for sports performance and recovery.

Q: Who invented Cryotherapy, how did it come about and how old is it?

A: Cryotherapy was invented in 1978 by a Japanese doctor, Toshima Yamauchi for the treatment of pain and inflammation in patients suffering from rheumatoid arthritis. Cryogenics has become very popular for sports performance and recovery. Cristiano Ronaldo reportedly chills out at home in his own CryoSauna.

Q: How does it work?

Your body is exposed to temperatures ranging between -120 °C and -160 °C with liquid nitrogen vapour for 30 seconds up to three minutes. The hypothalamus, which is responsible for the extremely complex process of thermoregulation, responds to the extreme cold in an effort to protect the body and especially its core temperature. It does so by activating a long list of physiological responses. A few of these are:

1. The body constricts all the blood vessels and capillaries in the skin to reduce cold transfer. By doing so, all this blood rushes to the body’s core.

2. With such an extreme change in the body, the body always seeks to create balance (homeostasis) again. In this case after the session, the body expands the capillaries and vessels by up to 4 times their normal diameter through a process called vasodilation. This increases blood flow to such regions by up to 4 times. This in itself offers host of benefits, such as:

   a. Improved circulation in regions suffering from poor blood flow, like cartilage and tendons

   b. Increased oxygenation and enzyme activity

   c. Creating an improved healing environment

3. As the skin is cooled at such a rapid rate and to such an intense degree, the body works very hard to compensate by creating heat from within. This is achieved by revving up the metabolism on a cellular level. It therefore creates a very powerful stimulatory effect which again allows for an improved healing environment.

Read: Fitness: pain vs. gain

4. The body’s white blood cells secrete small proteins (cytokines), which are used in cell signalling and ultimately affect the behaviour of other cells. These proteins can be either pro-inflammatory or anti-inflammatory. During Whole Body Cryotherapy, pro-inflammatory cytokines are decreased and anti-inflammatory cytokines are increased. This causes a powerful anti-inflammatory response throughout the whole body.

Unknown to most, inflammation is a major issue amongst even relatively healthy people; often high levels of inflammation can lead to chronic diseases.

5. The cold exposure drastically reduces the body’s ability to communicate pain signals. After multiple sessions, the body adapts its perception to pain stimuli. It’s for this reason that patients suffering from chronic pain, such as with Fibromyalgia, have reported astounding improvements.

6. The body’s total anti-oxidative status is increased. The body achieves an improved ability to eliminate free radicals, naturalise toxins and repair cellular damage. This process can lead to a powerful anti-ageing effect.

7. Another mechanism the body employs to protect itself is to release an array of hormones. One of them is Beta endorphin which causes people to experience a sense of euphoria and deep relaxation. There is also adrenaline and cortisol which makes individuals alert. In men, studies have suggested an increase in testosterone is achieved. It’s partly due to the hormonal responses that athletes have achieved significant benefits from the treatment.

Q: Which conditions/ailments/injuries is it most suited for?

Because Cryotherapy is a powerful natural anti-inflammatory, there is quite a long list of inflammatory conditions it has been shown to benefit. As mentioned above, there are other responses as well making it suitable to treat specific ailments. Here is the list of the most common applications Cryotherapy has been used for worldwide:

Medical benefits

  • Reduces chronic pain
  • Reduced chronic inflammation
  • Reduces oedema
  • Improves postoperative recovery
  • Improves muscular fatigue
  • Decreases muscle spasticity and spastic paresis

Mental health and stress management

  • Improves mood and experience of wellbeing
  • Reduces stress levels
  • Decreases anxiety
  • Decreases depression
  • Benefits seen in sleeping disorders
  • Proposed treatment for Alzheimer’s prevention

Cosmetic benefits

  • Reduces signs of ageing
  • Increases collagen production
  • Improves skin condition
  • Improves condition of hair and nails
  • Increases metabolism (studies suggest between 500-800 calories can be burnt as a response from one WBCT session).
  • Reduces cellulite

Q: Why is WBC better than simply jumping into icy water or placing a block of ice on an injured part of the body?

Eugene Pienaar of  CryoLiving says it is different from normal icing of an injury or an ice bath, which slows down the blood flow, enzyme activity and cellular metabolism.

Read: Speed up your metabolism

Cryostimulation has the opposite effect, as it speeds up processes. Cellular metabolism is drastically increased. One can feel that your skin temperature increases significantly beyond the norm shortly after a treatment. It is therefore not an appropriate treatment for a brand new injury as it will stimulate it. However, the stimulatory effect is probably the most effective way of speeding up recovery once the injury has settled.

Q: Do muscle and fat composition of a person have an influence on how well it works?

This has no apparent influence on the treatment success. A very muscular limb, however, seems to need more exposure time before the tissue responds.

Q: Why are extremities protected?

Achilles tendons, hands and to a lesser degree the elbows, offer very poor blood flow. Thus those areas struggle to compete with the cold through internal reheating. If protective clothing is not worn there is a risk of getting cold burns.

Q: What’s the longest one can stay in the sauna and why?

Three minutes is the maximum stay in the Cryosauna. Firstly no more than 3 minutes is needed to get the full benefit of Cryotherapy. Even in a shorter period people come out of the CryoSauna with their skin flushed. As the skin turns pink, it indicates that Vasodilation was achieved.

Read: Facial flushing

Q: How often can you do it?

The impact of WBCT is cumulative, so it is important to do multiple sessions in a relatively short period of time before assessing how your body responds. The number of sessions and frequency depends on your goals.


For general wellbeing and health optimisation:

5–10 initial sessions, then 1-2 sessions per week as maintenance

For athletes:

10–15 sessions initially, then after each intense training session. Professional athletes also use WBCT before competitions due to the natural hormonal benefits.

For patients suffering from indicated diseases:

It is suggested that you work closely with your doctor to establish an optimal programme. In severe cases where a disease involves highly active processes, treatments can be done 2–3 times a day for 2–3 weeks before reducing the frequency.

Q: Can children or the elderly also do the treatment? 

Anyone can use local Cryotherapy.  However, we do not treat children prescribed by a doctor. Elderly can definitely do the treatment as long as they do not suffer from any of the listed contra-indications.

The following is a case study for the treatment of fibromyalgia with local cryotherapy:

This 50 year old female presented with a 5 year history of Fibromyalgia which coincided with rotator cuff surgery to her left shoulder.

She described pain in the neck, mid back, lower back and anterior arms that ranged from 5-8 out of 10 on the visual analogue scale.

She reports that gentle stretching can help temporarily but that cardiovascular exercise had the potential to aggravate her symptoms if done for more than 15 minutes at a time.

She has described the inability to sleep through the night for approximately 5 years, often waking with pain. She is currently on Arcoxia which provides temporary relief.

Otherwise she reports to be in good general health.

All blood tests and MRI scans to the cervical spine were NAD.

Following five sessions of local cryotherapy, which were done daily, the patient had noticed that she was sleeping through the night. By session ten the patient had described pain relief in all of the affected areas by up to 85%. 

She is currently having local cryotherapy treatment twice weekly as a maintenance and describes feeling more energised, improved mood, reduced pain and has described her response to treatment as “having her life back”.

This case demonstrates the efficacy of local cryotherapy in the treatment of fibromyalgia, we must however stress that the treatment does have an accumulative effect and so a course of treatment as in the case of the above patient usually brings the most favourable results.  

Read more: 

Cryotherapy for pain and injuries now available in SA

Cryotherapy investigated after Vegas spa worker found dead

Meditation can improve sports performance


Ask the Expert

Sports Injuries Expert

Adrian Rotunno is a medical doctor in the Sports & Exercise Medicine fellowship at the Sports Science Institute of South Africa, and qualified physiotherapist. Team physician for Dimension Data pro-cycling, and Boland Rugby. Special interests include endurance sport, in particular cycling, as well as contact sports.

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