What have the British and Irish Lions Rugby Union squad, the 6-Nations championship winning side, Wales, the New York Knicks basketball club, Bayern Munich soccer players and several leading Olympic medallists from the London 2012 Olympics got in common? The answer may surprise many sport scientists and coaches and strength and conditioning coaches but they all have used what we call whole body cryotherapy (WBC) or partial body cryotherapy (PBC) in their recovery or recuperation programmes at critical phases in their training and competitive phases. The use of WBC as a recovery strategy following training and competition has been brought to the forefront as a result of the most recent and emphatic victory by the Irish and British Lions during the summer of 2013. In their early preparations during their UK and Ireland training camps the Lions used WBC to boost their recovery and aim to peak for the final series against Australia.
This short review will present a brief history of WBC and PBC and also review the growing number of studies that have been conducted in examining the purported benefits of using one form or the other of cryotherapy exposure.
Our focus, as normal, is not on general health and well-being but rather on sport performance and in particular on the potential benefits of both WBC and PBC to aid the athlete’s adaptation to training and recovery between training/competition bouts.
What is Whole Body or Partial Body Cryotherapy?
Whole body cryotherapy is where the body is completely exposed to extreme cold for a short duration. Temperatures of between -110O to -180 O Celsius (C) are used in an attempt to repair, recuperate and reinvigorate the systems of the body that have been stressed during intense, in our context, exercise (Papenfus 2006). An exposure period typically can vary from 1 to 3 minutes. Each exposure occurs in a chamber or sauna type compartment called a ‘cryosauna’ or a ‘cryochamber’ (see Figure 1 above). Partial body cryotherapy exposure is where the head is not exposed to the direct cold using stand-up cabins (Figure 2 below).
There has been much interest in recent years regarding WBC. For example, in one leading Irish Sunday newspaper claims were made regarding WBC stating that it was ‘a miracle cure’ (Ireland on Sunday August 13th 2006). From the outset we can confidently state that there are no miracle cures except through divine intervention!
Further, there has also been confusion between WBC and cold water baths and contrast cold water and warm water treatments. Regarding the latter (contrast of cold and warm baths) most team sport players at one stage or another have had cold baths and/or contrast baths following training or competing. Temperatures of about 12 degrees C are typical in cold water immersion recovery strategies. And when contrast techniques are used temperatures of warmer water typically range between 26 and 36 degrees C. While there are conflicting views in terms of the benefits when using cold water and or contrast baths, there is a reasonable body of research pointing to beneficial effects in terms of reducing what is known as the delayed onset of muscle soreness (DOMS) and for contrast bathing, in restoring and maintaining better strength compared to passive recovery especially in elite sport following intense and muscle damaging exercise (Bleakley et al 2012, Bieuzen et al 2013). Further cold water immersion seems to be the gold standard method for the treatment of exertional heatstroke (Casa et al 2007).
WBC on the other hand, it should be stressed, is nothing like the experience of applying cold or ice local to an injured body part or even taking a cold plunge into cold water. WBC involves exposure to temperatures below minus 110o C and colder. It is a totally different experience to taking a couple of minutes in a cold bath (which as you now know reaches somewhere between +6 and +15 degrees C depending on whether ice is used or not).
So let us start from the beginning and provide a brief history and background to this very interesting modern adjunct to sport training and performance. In 1979 Toshiro Yamauchi built the first WBC unit in Japan (Yamauchi 1986). The whole body form of cryotherapy as used by Yamauchi in Japan in the late 70’s and early 80’s was used to assist patients in the treatment of Rheumatoid Arthritis. Since then WBC has been used in the treatment and management of many different medical conditions and as an adjunct treatment for several diseases (Braun et al 2009, Papenfus 2006, Skrzek et al 2006).
Currently, there are hundreds of WBC centres worldwide but mainly in Eastern Europe with many being used for the management of a variety of medical conditions including fibromyalgia, multiple sclerosis and rheumatoid arthritis (Papenfus 2006).
The first cryotherapy chamber in the form of a PBC unit arrived to Ireland in 2003 and this was the first chamber in the UK and Ireland. Since then several WBC and PBC units or saunas are now present throughout Ireland and the UK.
In addition since the arrival of the first WBC in the USA, in 2009, there are now approximately over 30 centres offering this treatment to not only athletes and recreational enthusiast but also to a variety of patients under medical care (www.wholebodycryotherapy.org).
Further, the commissioning of the first prototype of a mobile unit has taken place in the UK (April 2013) and such developments will allow greater access to WBC and may also facilitate additional research into this unique exercise recovery modality as well as research into its effectiveness in ameliorating certain medical conditions.