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Whole body cryotherapy in cryo-chamber for treating ostheoarthritis

Alongside inflammatory-rheumatic joint diseases, arthroses (osteoarthritis, i.e. degenerative rheumatic diseases of the joints) have also become a major field of indication for whole body cryotherapy. This can be attributed to a number of reasons. Osteoarthritis is a very common disease, particularly in advanced age. A treatment at the root cause of the disease is still not possible so that also here symptomatic therapies are sought for. Ultimately, whole body cryotherapy has in any case proven itself to be effective through its systemic activity. This is important in many respects: osteoarthritis seldom afflicts only one joint. As a rule several (large and small) joints are afflicted. Unlike local therapies, whole body cryotherapy has the advantage that it can simultaneously influence all arthritic disease foci. In addition it can also suppress several disease factors of the osteoarthritis through its multi-component spectrum of activity. Another aspect is its long lasting therapeutic effect that often endures for several months (regarding pains and inflammation).

Unlike rheumatoid arthritis, where the synovial membrane of the articular capsule primarily participates in the origin of the disease and the joint cartilage only becomes affected secondarily, osteoarthritis is a disease that plays out mainly within the joint cartilage. It starts with microscopically small tears in the cartilage that grow little by little. The cartilage -roughens, and attrition fragments then appear that move freely within the joint. -Smaller cartilage pieces can also become released or torn out from the tissue dressing. Cells of cartilage tissue damaged this way release inflammatory substances. This results in inflammation of the inner capsule skin through which cartilage tissue can continue to be damaged.

The occurrence of such wear phenomena is promoted by various factors including the decrease in water content of the cartilage, the reduction in elasticity, layer thinning and the reduced nutrient supply and waste product disposal with age. The ability to absorb impacts decreases. A special role is also played by permanent that occurs overweight acting as a burden to joints such as the hip and the knees. Raised pressures occur in the cartilage upon burdening of these joints so that nutritional problems arise. The cartilage tissue does not possess its own blood supply so that the nutrients and oxygen must be provided via the synovial fluid which is formed from the synovial membrane of the articular capsule. For this process optimal pressure conditions must be present within the cartilage tissue, but if this is damaged lastingly a chronic nutritional emergency can arise in the cartilage tissue.

However, hormonal influences have also been attributed an important role in promoting the disease (finger joint osteoarthritis amongst women after their menopause), just as have chronic, partially impaired joint functions due to poor posture, unilateral burdening and inadequate joint movements.

In its advanced stage, particularly if osteoarthritis becomes active due to inflammatory processes, the joint swells up and becomes markedly warmed.

The course of the osteoarthritis is sometimes accompanied by intense pains caused by

–   the raised pressure on the joint surfaces of the participating bones,

–   the inflammation of the synovial membrane of the articular capsule,

–   the stretching of the articular capsule due to joint effusion and

–   a chronic irritated state of the tissue structures near the joint (ligaments and tendons, but also the musculature).

The pains usually occur with and after physical load and abate upon rest and at night. As the disease progresses, however, pain can also occur at rest that results in restriction of mobility.

Osteoarthritis only tends to heal itself poorly. In the final stage of the disease a “connective tissue repair” can be induced, however, due to the chronic inflammation process and the bone-damage that sets in. This can in turn lead to a partial replacement of the lost cartilage and as such a relief of symptoms and a functional improvement.

Whole body cryotherapy can in principle be applied at all stages of disease development. As far as possible, however, it should already be begun in the early phase in which the cartilage, albeit impaired, is still functional.

The therapeutic targets for whole body cold can be recognized from the briefly described pathogenetic mechanism for osteoarthritis. These are:

–   the pain event,

–   the inflammatory process and

–   the disrupted functioning of muscle groups near the joint.

Although arthritic pain is determined by several injurious factors, it is possible to combat it effectively with the help of whole body cold applications and to reactivate the mainly pain-induced blocking of joint function. As such the conditions for a subsequent passive and active mobilization therapy can be improved, whereby the sometimes rapid pain freedom achieved without medication should not however lead to any excess (pressure) burdening. It is important that the therapist and patient find a reasonable “moderate” level of burdening so that the nutrient supply of the cartilage can be improved through the normalization of pressure within the joint. Increased mobility also stimulates the supply of nutrients to the cartilage cells.

Just as with the pressure conditions, a certain viscosity of the synovial fluid is also important for maintaining the metabolic balance within the articular cartilage. Whole body cold application has an advantage concerning this compared to traditional local cold application. As a short-term therapy that does not or only briefly affects deeper tissue layers and as such also the joint interior, it does not impair the flow properties of the synovial fluid.

Like pain, signs of inflammation such as warming and swelling are also suppressed effectively by whole body cold. That suggests that the inflammatory event can be influenced therapeutically in its entire complexity.

A major proportion of osteoarthritis complaints can be attributed to the involvement of connective tissue and musculature in the disease event. As such, due to pain-conditioned misloading of the afflicted joint, changes in proprioception occur not only in the joint itself, but also in the tendons and muscle groups near the joints. Normal neural information from these areas, however, is vital for organized muscle contractions and maintaining a sense of balance. Coordination disorders combined with an unsure gait can occur as a result of defective afferent impulses.

The destructive joint processes cause an increased release of inflammation and pain promoting substances, i.e. mediators such as prostaglandins, bradykinin and serotonin, as well as an activation and sensitization of nociceptors. In addition a sympathicotonic reflex like state arises via the autonomic nervous system that must be regarded as a cause for perfusion defects in the affected muscle and connective tissue. Defensive muscular tension as well as shortening of muscles and connective tissue result.

In chapter 3 of the book we already discussed the ways in which whole body cryotherapy can intervene in such disease processes through the influencing of peripheral and central control and protection mechanisms. It is not therefore necessary to repeat this description as it relates to the arthritic event. Figure 4.6 serves adequately to summarize the therapeutic targets of whole body cold.

Fig. 4.6 Components of osteoarthritis and effects of whole body cryotherapy

whole body cryotherapy, cold chamber, cryo-chamber, cryo-sauna, chronic inflammation, pain relief, pain memory, chronic pains, mobility restrictions, chronic inflammatory processes, oxygen supply, regulation of muscle tone, coordination defects, diseased joints, inflammation

Clinical experience and studies have shown that 12 to 15 exposures in the cold chamber can already achieve a good therapeutic outcome. However, in the interests of establishing a long-term effect a serial cold therapy should include about 20 to 25 applications. According to the severity of the disease, repetitions of therapy are recommended at half to one year intervals. It also makes sense to apply whole body cold both pre- and postoperatively, e.g. upon prosthetic treatment of the arthritic joints.

Whole body cryotherapy does not represent a (complete) substitute for other proven osteoarthritis therapies. It should always represent just one component of an overall therapeutic concept (pharmaceutical treatment, mobilization therapy that must immediately follow cold application, techniques for muscular relaxation, surgical treatment).

As with inflammatory-rheumatic joint diseases, a (temporary) reduction/interruption of pharmaceutical therapy can be considered also with osteoarthritis if cryotherapy is effective, but only after medical consultation.

For further useful information about whole-body cryotherapy at -110 ° C, and the mechanisms of action, we recommend the book "The Power of the Cold" by Prof. Dr. sc med Winfried Papenfuss, published by Edition K Wolfsegg. Large parts of the content of this website were taken from this book. 

The catchy standard work is suitable for both professionals and interested readers. With pleasure we forward your order of "The Power of the Cold" directly to the publisher.