Cryotherapy is a relatively new method that is actively used in dermatology and cosmetology. Recently, cold treatment has begun to be recommended for those who have been diagnosed with arthrosis, arthritis, osteochondrosis, intervertebral hernias and radiculitis. How effective is the treatment of arthrosis or osteoarthritis with this method?
Cryotherapy has been used in Russia since 1998
The essence of the procedure
To get a positive effect, you need to apply refrigerant to the damaged part of the body. But first you need to consult a doctor, because he is the one who decides how cool the nitrogen should be. Different parts of the body have different temperatures.
When the joint is very cold, standard reactions can be observed:
● blood vessels narrow, the speed of blood flow in the treated area decreases;
● the heart rate increases slightly;
● blood pressure increases;
● adrenaline and norepinephrine are released.
Thanks to all these processes, a large amount of blood, which is saturated with nutrients, flows to the damaged diseased joints. Tissues are saturated with oxygen, microcirculation is stimulated. When the second phase of nitrogen exposure begins, the body tries to compensate for temporary hypothermia. Body temperature rises slightly, the process of tissue and cell restoration accelerates. Over the entire cycle of the procedure, pain in the body is not simply reduced. He is tempered and mobilized to restore health.
Treatment of joints with nitrogen gives visible results that cannot be obtained with medications. However, therapy is often used in combination and supplemented with certain medications and special health-improving exercises.
Doctors recommend cryotherapy for joints for several diagnoses:
● arthritis;
● arthrosis;
● osteochondrosis;
● radiculitis;
● muscle spasms;
● myalgia.
However, there are also contraindications that prevent you from attending a cryotherapy session for knee or other joints. You will have to wait if you have one of these diseases:
● serious damage, wounds on the area of skin that will be treated;
● thrombophlebitis;
● blood diseases;
● diseases of the cardiovascular system;
● colds and ARVI.
results
The study was completed by 143 patients: 1 patient completed treatment ahead of schedule due to the development of phlebitis in the area of cryo-SMT, 2 patients each refused treatment in the AL group and in the VCT group, and 1 patient each in the GC and cryo-SMT groups due to poor tolerability of the procedure.
In the CT and cryo-SMT groups, during treatment, as pain decreased, patients gradually stopped taking NSAIDs. In the control group, patients continued taking NSAIDs throughout the observation period; due to adverse reactions from the gastrointestinal tract, 5 patients stopped taking NSAIDs.
All groups of patients were initially comparable in age, gender, BMI, duration of the disease, and severity of the pathological process (Table 1) .
Table 1. Characteristics of patients by treatment group
The majority of patients were women aged about 60 years and overweight. Among the patients, patients with stage II-III OA and with a pronounced degree of severity of the disease prevailed when calculating the Lequesne algo-functional index (on average 12 points).
During treatment (Table 2), a statistically significant decrease in the intensity of pain during movement compared to the state before treatment was observed in all patients of the CT, cryo-SMT and control groups: after the 3rd procedure - by 50-51% in groups of different types of CT and cryo-SMT, by 20% in the control group, after the 6th procedure - by 70-71 and 50%, respectively, after the 9th and 12th procedures - by 82-83 in the CT and cryo-SMT groups SMT, by 70% in the control group. There were no statistical differences between the groups of patients who received various types of CT and cryo-SMT, in contrast to the control group, in comparison with which a statistically significant difference was determined starting after the 6th procedure. The positive effect continued after completion of the CT course.
Table 2. Dynamics of pain, according to VAS (mm) during treatment with CT at different temperatures and cryo-SMT therapy and comparison group
Note. p* — statistical significance of the change in the indicator within the group compared to the initial value; p** - statistical significance of differences between groups 1, 2, 3, 4; p*** - statistical significance of differences between groups 1, 2, 3, 4, 5.
A significant decrease in pain at rest (see Table 2) was also noted in all groups at all stages of AC. Indicators in the CT and cryo-SMT groups decreased after the 3rd procedure also by 50-51% and in the control group - by 21%, after the 6th procedure - by 70-71 and 50%, respectively. The maximum analgesic effect was obtained after the 9th and 12th procedures: pain reduction by 81-83% in the CT and cryo-SMT groups and by 70% in the control group. At the same time, intergroup differences in patients receiving various types of LCT were not detected in relation to this indicator throughout the entire observation period, in contrast to the control group, in comparison with which statistical differences were obtained after the 3rd procedure.
Patients of all groups showed positive dynamics in the WOMAC index (Table 3) . A statistically significant decrease in the indicator was obtained when calculating the total score, as well as on the “pain” and “stiffness” scales, with no intergroup differences in the LCT groups and a statistically significant difference between the 1st and 4th treatment groups with the control group. On the “function” scale there was no statistically significant difference in values between all groups.
Table 3. Comparative dynamics of the WOMAC index during treatment with CT at different temperatures and cryo-SMT therapy and the comparison group
Note. * — statistical significance of the change in the indicator within the group compared to the initial value p<0.05; ** — statistical significance of the change in the indicator within the group compared to the initial value p<0.02; ***—statistical significance of the change in the indicator within the group compared to the initial value p<0.01; p* — statistical significance of differences between groups 1, 2, 3 and 4; p** - statistical significance of differences between groups 1, 2, 3, 4 and 5.
An assessment of the dynamics of NSAID intake showed a statistically significant decrease in diclofenac intake after the 3rd procedure in all CT and cryo-SMT groups; in the control group, an increase in the daily dose of NSAIDs was noted after the first questionnaire. In the main groups, by the end of treatment, only 10-12% of patients took NSAIDs on demand, in the control group - 25% of patients.
The assessment of the effectiveness of therapy by the patient and the doctor was satisfactory. In the main groups, the answers “significant improvement” and “improvement” were given by 36 and 47% of patients, respectively; treatment was considered ineffective by 11% of patients; 6% of patients refused treatment due to poor tolerance to cold.
In the control group, the answers “significant improvement” and “improvement” were given by 26 and 49% of patients, respectively; treatment was considered ineffective by 9% of patients; 16% of patients refused treatment with NSAIDs due to the development of gastrointestinal complications.
Analysis according to the OMERACT-OARSI criterion demonstrated a high percentage of response to therapy in all CT and cryo-SMT groups (81-83%) and in the control group (70%). Intergroup differences were not statistically significant (p>0.05) in the main group; a statistically significant difference was obtained between the main groups and the control group (p<0.01).
Treatment tolerability was good and practically did not differ in all main groups. Adverse events were noted only in the cryo-SMT group in the form of phlebitis. In total, 6% of patients refused treatment due to poor cold tolerance in the main group, 16% of patients in the control group due to side effects from the digestive system in the form of nausea, pain in the intestines of various locations, diarrhea, 1 patient - due to the development of gastric bleeding.
How is joint cryotherapy performed?
After consultation with a doctor, the patient is referred for general or local cryotherapy to treat joints. A refrigerant is applied to the skin (over the entire surface or just a certain area). It is customary to use either nitrogen (cooled to -190 degrees), helium (the coldest - up to -270 degrees), or carbon dioxide (maximum permissible temperature - -80 degrees) as a refrigerant.
Before the session begins, the patient is prepared: doctors measure his pulse and blood pressure. Gloves and socks are provided to protect his fingers and toes.
The whole procedure consists of several steps:
- The patient must be in a special cryochamber. Only the head is outside the processing area.
- The capsule is filled with cold gas.
- Body temperature drops. This causes natural physiological reactions, including activation of the immune system, as well as thermoregulation.
- The patient is in the chamber for about 3 minutes, then he is taken out of the capsule.
Already after the first procedure, the patient feels an improvement in health, but for a full recovery it is recommended to undergo a course of procedures, usually consisting of 10 sessions.
Sometimes it is not the entire body that is frozen, but a specific area. In this case, a camera is not required. The patient sits on the couch during the procedure. The doctor applies an antiseptic to the selected area. Then a special device is used that sprays the refrigerant in doses. Using a special hose, nitrogen is delivered to the desired area.
Prevention of spring exacerbation of joint diseases
Of all the existing problems with the musculoskeletal system, it is worth highlighting three main reasons why a seasonal exacerbation may occur, and these threats must be prevented:
- hypothermia;
- falls and sprains;
- passive lifestyle.
Let's consider all the reasons separately.
Threat #1 – cold
Even if a person has 100% health, this does not mean that joint inflammation such as arthrosis will pass by. Its occurrence is possible during freezing, ARVI. If the body is weakened, then someone will not need to get sick, it’s enough just to get hypothermic. Immune protection weakens precisely when exposed to cold. This creates ideal conditions for joint inflammatory processes.
With arthrosis itself, unlike arthritis, inflammatory processes in the joints are either absent or weak, but there is a violation of important functional processes. The destruction of substances that make cartilage stronger occurs much faster than their formation. You should be wary of cold precisely because it causes spasms in the muscles that surround the joint. The blood flow is significantly reduced, the cartilage will no longer receive the necessary nutrition, which is extremely important for the creation of cells, and the destructive processes are accelerated.
At first glance, it may seem that all sorts of problems with hypothermia remain in the winter, but this is not so. We have long been accustomed to the fact that it is cold in winter and we dress accordingly. As for springtime, the weather is deceptive, and warm days suddenly change into cold ones. That is why there is an increased risk of not guessing with outerwear.
Preventing Hypothermia
No matter how strange it may be, first of all, dress very warmly so that when the temperature rises you can take off some of your clothes, this is better than freezing. Or bring extra warm clothes with you. Be sure to keep your feet and problem joints warm. Hypothermia of the extremities negatively affects the immune system, even if the rest of the body is warm.
If you do get hypothermic, take a warm bath when you return home; it will warm you up and relax your muscles. For problem joints, use an ointment with a warming effect, which activates blood circulation.
Joint injuries
The main problem of all first frosts is slippery surfaces and the appearance of ice. For the development and treatment of arthrosis
in the future, dislocations, fractures in case of falls, ligament ruptures, etc. are greatly affected. If one of the above cases occurs, joint problems can develop in every person, including young people. If the person is elderly, then the possibility of injury and its consequences becomes more complicated, since healing will occur slowly.
Injury Prevention
If the road surface is slippery, try to wear stable shoes; it is advisable to leave smooth soles for the warm season. Elderly people should try not to walk on ice, or seek the help of relatives. If suddenly the weather was changeable and you were not prepared for ice, if it is impossible to avoid slippery areas, bend your knees and, leaning on your full foot, try to move very slowly. Try to avoid moving with a heavy load in your hands, otherwise your stability will fluctuate and it will become more difficult to maintain your balance.
Exercise stress
One of the biggest disadvantages for our body during the demi-season is the lack of physical activity. Our activity is reduced due to bad weather conditions and short days. With a sedentary lifestyle, we get weakened muscles, but they support our joints and take some of the load off them.
In some cases, even minimal activity can cause injury to the joint cartilage. When movement is limited, blood circulation slows down and the joints do not receive the necessary nutrition. But both a complete lack of exercise and physical inactivity are critical. The best option for everyone is no more than 40 minutes a day of aerobic exercise (walking, swimming, light jogging, cycling) up to 4-5 times a week.
Preventing microtrauma of joints
For people with diseases such as arthritis or arthrosis, special exercises are usually prescribed. After the removal of the most dangerous exacerbation, you should not forget about the exercises prescribed by specialists and return to your everyday lifestyle. A couple of weeks of exercise is not enough for complete recovery of the body and for prevention. By being conscientious about your exercises and exercising daily, over time you can expand the group of workouts or increase their duration.
Yoga or Pilates classes have a good effect on our body. Such sets of exercises can be done independently, even at home. As the weather warms up, you can gradually move your activities outdoors. In this case, you will maintain muscle tone, increase the rate of nutrition of your joints, and also charge the musculoskeletal system with the vitamin D it needs.
Prevent illness, treat joints
- a complex process, observing only a few important rules:
- do not get too cold;
- engage in physical activity - measured physical activity is simply necessary;
- be sure to eat right – it is better to consult a specialist when selecting a balanced diet;
- do not self-medicate, and if you use medications, make sure that they not only eliminate the symptoms, but actually treat the problem;
- dress according to the weather, not according to your wishes;
- Avoid drafts.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
General cryotherapy of joints
During the general cryotherapy procedure, the refrigerant enters the patient's entire body. For this purpose, a special chamber is used - a cryochamber. Inside it, either a nitrogen-air mixture or nitrogen liquid is directed at a person.
During general cryotherapy, the entire body is exposed to nitrogen. As a result, the functioning of the muscular system and nervous system improves. Due to cooling, the skin receptors are first briefly excited, and then an inhibition phase begins. Already after the first procedure, therapeutic effects can be noted:
● joint pain subsides;
● muscles relax;
● connective tissue joint structures are restored.
General cryotherapy is not always used. It is especially often recommended for compression or inflammation of the spinal cord roots. When the body cools down, the activity of the immune and endocrine system increases. Thermoregulation is activated. As pleasant side effects, patients note a decrease in anxiety, an increase in mood and a boost of vigor.
Cold treatment for throat
Often the first symptoms of a cold appear as a sore throat. Since cold exposure slightly “freezes” the inflamed mucous membrane, at the same time the activity of spreading viruses decreases. The inflammatory process is localized and the infection is destroyed. It is enough to put an ice cube in your mouth and begin to gradually dissolve it. You can use 2 to 4 cubes or just drink cold milk or eat a serving of ice cream.
By the way, if you prepare ice cubes with medicinal herbs, this will help destroy the infection in the first hours of its appearance. The following infusions are usually frozen:
- chamomile;
- sage;
- mint.
However, if a cold is accompanied by chills, severe weakness and high fever, it is no longer possible to treat a person with cold, since pathogenic microflora or viruses have already entered the bloodstream. In this case, home cryotherapy is useful and safe only in the initial stage of the disease, and if the symptoms progress, use classic remedies in the form of warm drinks and rinses.
Local cryotherapy
If it is necessary to cool a particular joint (for example, cryotherapy for arthrosis), solid, liquid or gaseous substances are used. When nitrogen comes into contact with an area of skin, heat is removed from that area. Local cooling of tissues leads to the following effects:
● pain in the joint is less pronounced;
● inflammatory processes are stopped;
● if there are muscle spasms, they disappear.
Patients also notice a slowdown in metabolic processes. While nitrogen is in effect, cells in the treated area require less oxygen.
Local therapy has several advantages:
● the first results appear faster - after 1-2 sessions;
● the procedure itself takes less time - about 1-5 minutes.
Can cryotherapy replace other methods of treating arthrosis?
Studies of patients with diseases of the musculoskeletal system have shown that cryotherapy only enhances the therapeutic effect in the treatment of arthrosis of the 2nd degree joints, but in itself does not cure degenerative diseases. With its help, you can improve your condition, reduce pain, and slow down the degradation of damaged tissue. Using this method, you can reduce the dose of other medications, but you cannot refuse to take chondroprotectors, intra-articular injections of Noltrex, a synovial fluid substitute, or other treatment.
Cryotherapy also has a number of contraindications. Thus, the method is prohibited for those who have been diagnosed with an allergy to cold or hypersensitivity to low temperatures. Infectious diseases are another reason to postpone the procedure until recovery.
One way or another, if you have been diagnosed with arthrosis and have been recommended intra-articular Noltrex injections or other complex treatment, do not rush to look for an alternative. Cold treatment, exercise therapy, massages and other physiotherapeutic methods are only auxiliary measures that never lead to a complete cure for this diagnosis.
When is it time to start rehabilitation?
Restorative procedures should begin when the exacerbation period subsides. A rehabilitation program is required:
- for arthrosis of the hip and knee joint;
- with degenerative-dystrophic changes in the spine;
- after endoprosthetics and arthroscopy.
The recovery period is divided into three main stages: immobilization is aimed at the fusion of the capsule and ligaments, as well as the formation of callus in fractures. As the functional stage passes, restoration of damaged joint functions is noted. Training is carried out to partially or completely restore the functions of the affected joint structures.