Cryotherapy

Cryotherapy (Greek krooq-ice) is a complex of physiotherapy related to exposure to the skin of low temperatures.

Local cryotherapy and general hypothermia are used.

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

[1], [2], [3], [4], [5]

Indications for cryotherapy

• chronic dermatoses (psoriasis, atopic dermatitis, eczema, hives, etc.);
• rosacea, couperose (in remission);
• seborrheic dermatitis;
• acne;
• hypertrophic, atrophic, pigmented scars, postacne;
• atrophic changes in the skin (including due to prolonged use of glucocorticosteroids);
• hyperpigmentation (post-traumatic, ephelids);
• alopecia,
• care for "mature", aging skin;
• care for dehydrated skin;
• preparation of the skin for cosmetic procedures (cryopilling);
• skin treatment after dermabrasion, thermo- and electrocoagulation, laser therapy and epilation (for removing excess heat, reducing redness and tension, preventing inflammation, reducing discomfort);
• treatment of cellulite, reduction of local fatty deposits;
• treatment of flabby, atopic skin of hands, hips, abdomen;
• restoration of the shape and elasticity of the breast;
• rehabilitation after plastic surgery, liposuction;
• application after injection techniques (mesotherapy, electrolysis);
• first aid for burns (allows to stop the action of high-temperature agent and thereby significantly reduces the necrosis zone);
• treatment of burn wounds at a later date (as an anesthetic, anti-inflammatory, kelloidoprotective agent, to stimulate reparative processes);
• chronic fatigue syndrome, depression

Historical reference

Improving and rejuvenating cold baths prescribed to their patients even Hippocrates, Galen and Avicenna. The ancients believed that, having got into extreme cold conditions, the body mobilizes all its hidden reserves. Therefore, "freezing" procedures were used to relieve pain and relieve inflammation. The fact that in the cold include the forces of self-healing, in the early XX century. Confirmed the German doctor Sebastian Kneipp. He jumped into the icy Danube to cure himself of a febrile pneumonia. Kneipp called hardening one of the main directions of physiotherapy. Since then, bathing in the ice hole has become a symbol of good health. Since the mid-70s of the last century, Japanese scientist Toshimo Yamauchi, observing patients with rheumatoid arthritis, found that the cold positively affects the joints. After exposure to cold, body temperature remains elevated for many hours, and favorable changes occur in the blood and joint fluid. Cold causes the body to produce "anti-rheumatic" hormones.

The Japanese suggested using air cooled to -100 ...- 180 ° С for the treatment of rheumatism. When the development of cryogenic technology allowed the use of such ultra-low and ultra-low temperatures in medicine, physiotherapeutic procedures using ice, dry cold air and liquid nitrogen were widely used in Japan, Germany and Poland. In Russia, cryotherapy became known only in the late 80's - early 90's of the last century. By now, the destructive (destructive pathological tissues), analgesic, anti-edematous, anti-inflammatory, healing and healing effects of ultra-low temperature influence have already been studied quite well. Overstepping the scope of medicine and enriched with the latest technology, cryotherapy came into aesthetic cosmetology.

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

The main mechanisms of cryotherapy

1. Influence on cellular and tissue structures.

Local cryotherapy:

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

General cryotherapy:

• improvement of the process of conjugation of phosphorylation in skeletal muscle;
• activation of tissue respiration in adipose tissue

2. Influence on the neuroendocrine system, metabolism.

General hypothermia.

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

3. Influence on the cardiovascular system.

In cryo-action, several protective reactions are distinguished:

• Narrowing of blood vessels (aimed at keeping heat),
• Expansion of the lumen of blood vessels within 1-3 hours after cryoexposure depending on the cooling dose (promotes enhanced heat formation).

The processes of constriction and expansion of the skin vessels have characteristic rhythmic fluctuations, which prevent ischemic tissue damage.

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

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

4. Influence on the neuromuscular apparatus.

When cryotherapy occurs excitation of skin receptors. With prolonged cooling, their inhibition and partial paralysis occur due to blocking the conductivity of nociceptive and tactile fibers of the underlying tissues. Thus, the patient first feels cold, then a feeling of burning and tingling, then pain that 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 endorphinic 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 brief but intensive cooling (up to -180 ° C), muscle relaxation occurs (reduction of muscle spasm). It should be taken 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 skin device and the vegetative system. The functional activity of the skin exteroreceptors becomes minimal when the skin is cooled to 13 ° C. Therefore, cooling the skin to 12-15 ° C is optimal for the removal of muscle spasm. With a general cryotherapy, there is more pronounced inhibition of the functions of the vegetative system than with local (for example, ice applications).

With the help of short-term exposure (less than 10 minutes), moderately low temperatures (about 0 ° C), due to an increase in the degree of conjugation of cellular respiration and oxidative phosphorylation in adipose tissue and skeletal muscles, an increase in muscle tone is achieved. At the same time there is an increase in strength and endurance of muscles

6. Influence on inflammation and immunological reactions.

Cooling of the inflammatory focus inhibits the activity of proteases released from lysosomes and prevents the multiplication of microorganisms in the wound. This reduces the alteration and edema of damaged tissues; regeneration of tissues in the field of trophic ulcers and long-term non-healing wounds is activated; acceleration of necrolysis and purification of purulent-necrotic wounds from necrotic tissues; The absorption of toxic products in burn wounds slows down. As a result, the differentiation of fibroblasts and the formation of granulation tissue are accelerated, and then the structural rearrangement of scars occurs. In persons with immune defects against the background of a decrease in the clinical signs of inflammation, the differentiation of T-lymphocytes slows down and the immunoglobulins G and M are destroyed.

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

Methods of cryotherapy

1. Methods using moderately low temperatures:
   • ice applications;
   • massage with ice cubes;
   • ice wraps;
   • local cold baths;
   • cryopacket applications (batch cryotherapy);
   • the imposition of cold bandages and bandages;
   • cold mud applications;
   • cryotherapy and cryoapplication with thermoelectric devices;
   • chloroethyl and alcohol blockades;
   • kromoterapiya ("carbonic snow").
2. Methods using extremely low temperatures:
   • cryomassage, cryopuncture effect with cryocatheters and cryozoids on devices in which the gas mixture is "blown out" at a pressure of 3.5-5 bar;
   • cryosauna (cryocamera).
3. Combined (combined) methods with the use of cryo
   • cryotherapy + physical exercises (cold bandages, vibrating massage + cold exposure);
   • cryotherapy + controlled compression of the affected area;
   • cryotherapy + hyperbaric oxygenation;
   • cryotherapy + UFO;
   • cryoelectric therapy (cryotherapy + pulsed currents of low frequency).

Procedure for the assignment of cryoprocedures

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

Before the procedure of cryotherapy, the reaction of the organism to the cold is usually examined. In this case, tests like "ice test", "cold pressure", etc. Are more often used. For example, testing is carried out by applying a piece of ice 2 or 3 cm ³ on 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.

Procedures for the execution of procedures

Cryomassage, aerocryomassage. Cryomassage is carried out with the help of liquid nitrogen (a colorless heavy liquid with a boiling point of -193 ... -220 ° C at a pressure of one atmosphere). Today we practice two parallel methods of cryotherapy. The first is an applicator, which is attached to a wooden rod. This structure descends into a balloon, the so-called "dewar", the long neck of which should not close tightly. There is liquid nitrogen. A cotton applicator moistened with liquid nitrogen is used to massage the face. Easy movements on massage lines with the applicator are very quickly carried out on the skin of the face. The feeling of slight burning and tingling soon disappears after the end of the procedure, and the skin acquires elasticity. The second method of carrying out cryomassage is more modern, in this case special equipment is used - a cryoprotector and a cryodestructor with various nozzles, including Teflon ones.

The equipment allows for dosed, even cooling of the skin. A composition (the same liquid nitrogen, called a "cryogen", which has a temperature of -180 ° C) is sprayed from the nozzle of the apparatus. The time of exposure to the skin is approximately 2-3 minutes per 1 dm ² with minimal intensity of the jet. The specialist can raise the temperature to -50 ...- 80 ° С depending on the individual features of the skin of the patient - its thickness, degree of wilting, color, age, etc. Cryo-massage can be applied for 15-20 minutes before the beginning of almost any cosmetic procedure . This will improve its effectiveness, because short-term exposure to cold activates capillary microcirculation and metabolic processes.

Cryopiling. During the cryopilipid procedure, gushirovanie liquid nitrogen until the appearance of peeling. This peeling is perfectly tolerated, has a pronounced bleaching, moisturizing and analgesic effect (often prescribed after plastic surgery, burns, bruises and scars post acne). The course of 5 to 15 procedures, 1-2 times a week, is recommended for patients with severe signs of skin dehydration.

Treatment of seborrhea and window. Good results are provided by cryotherapy with liquid nitrogen in cases of seborrhea and various forms of acne, in combination with general methods of treatment. Especially shown the use of liquid nitrogen in severe and common forms of acne (phlegmonous, conglobata, keloid acne). At the same time, liquid nitrogen is used in the form of extinguishing and deep freezing of inflammatory infiltrates. The stamping is carried out with a large diameter applicator, for which a cotton swab 7-10 cm long (in the form of "cane") is tightly fixed to the end of the wooden stick. The applicator is wetted with liquid nitrogen, placed parallel to the surface of the treated area and continuous rotational movements, under gentle pressure of the right hand, move along the affected surface until a rapidly disappearing whitening. The patient feels a feeling of cold and burning. After the burning sensation disappears, the procedure is repeated 2-3 times within 5-10 minutes. After 5-6 hours there is persistent hyperemia of the skin, which lasts 24-36 hours, the skin gradually darkens, on the third day there appears lamellar peeling, and after 5-6 days the darkened layers of the epidermis are completely rejected. Separate large inflammatory infiltrates of acne, festering atheromas and hypertrophic scars are additionally treated with liquid nitrogen to deeper freeze. On the foci, subjected to additional applications, bubbles often form with the subsequent formation of crusts, which are rejected after 8-10 days. In the future, treatment sessions are held twice a week with less exposure, causing weaker effects of reactive skin inflammation. The course is assigned 10-15 procedures.

Treatment of rosacea. In the treatment of rosacea, cryomassage with liquid nitrogen is carried out with lighter movements throughout the affected surface of the skin of the face. Separate nodular and pustular elements are frozen additionally with a short exposure - up to 10-15 seconds. Sessions are repeated 1-2 times a week, the course needs 10-15 procedures, depending on the prevalence of the process.

Treatment of some forms of alopecia. With seborrhea of the scalp with hair loss phenomena, as well as in cases of circular alopecia, liquid nitrogen has a beneficial effect under the condition of simultaneous application of general methods of action on the body as a whole (general restorative treatment, vitamin therapy, etc.). Liquid nitrogen in these cases is used as a massage of the scalp. In this case, the applicator is placed parallel to the surface of the skin and with light rotational movements massage the scalp down through the pro-parts. Duration of treatment of each site is 3-5 seconds, until a slight whitening of the skin, at the end of the cryomassage appears persistent erythema. The procedure takes 10-20 minutes on average (cryomassage of the entire scalp). With alopecia nest, treatment with liquid nitrogen only the focus of alopecia, intermittently for 1-2 minutes. The procedure is repeated after 2-3 days, the course needs 15-20 procedures. After a month's break, the course of treatment should be repeated. 2-3 courses are shown. It should be remembered that the low temperature of liquid nitrogen causes dryness and brittleness of the hair, so during the treatment should closely monitor the condition of the separation.

Combination with other methods : D'Arsonval, UFO, Bucci therapy, medication (immune preparations, vitamins, enzymes, sorbents, eubiotics), cosmetic procedures (facial cleansing, mesotherapy, contouring, cosmetic massage, etc.).

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