Therapeutic Benefits of Cryotherapy: Evidence Review
Cryotherapy has demonstrated therapeutic benefits primarily for pain relief in specific conditions, but lacks strong evidence for broader therapeutic claims beyond analgesia. 1, 2
Evidence for Cryotherapy in Different Clinical Contexts
Dermatological Conditions
- Cryotherapy is an established treatment for certain skin conditions, particularly Bowen's disease (squamous cell carcinoma in situ), with failure rates of 5-10% when adequate techniques are used 3
- High cure rates can be achieved in dermatological applications, with one study showing a recurrence rate of only 2% over 4 years for Bowen's disease 3
- Cryotherapy is considered a simple, inexpensive, and quick method of treating squamous cell carcinoma in situ, with the advantage of accessibility in outpatient settings 3
Musculoskeletal Injuries and Pain Management
- The primary benefit of cryotherapy in musculoskeletal injuries is reduced pain, with limited evidence supporting other claimed benefits such as reduced inflammation or enhanced tissue healing in humans 1
- Cryotherapy may be recommended in the first 6 hours following an injury to reduce pain, but should be used with caution beyond 12 hours as animal studies suggest it may interfere with tissue healing 1
- Both local and non-local cryotherapy applications show promise in reducing chronic pain associated with various chronic diseases, particularly those of rheumatic and degenerative origin 2
Post-Surgical Applications
- Moderate certainty evidence (GRADE III) supports cryotherapy after surgical procedures to reduce pain, improve range of motion, and increase patient satisfaction 4
- Cryotherapy in acute pain/injury or long-term pain/dysfunction shows positive effects but with lower certainty of evidence (GRADE II) 4
Limitations and Cautions
- Despite widespread use, there is no evidence from human studies that cryotherapy limits secondary injury or has positive effects on tissue regeneration beyond pain relief 1
- Animal studies suggest that cryotherapy may potentially delay or impair tissue healing, raising concerns about its use beyond the acute pain management phase 1, 5
- Complications of cryotherapy can include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing 6
Practical Applications and Recommendations
Optimal Use in Injury Management
- For acute injuries, cryotherapy is most effective when applied within the first few hours to limit secondary tissue damage 5
- Traditional cryotherapy application must often be repeated due to inadequate duration of cooling effect 5
- Novel applications like 15°C phase change material (PCM) have been administered for 3-6 hours with success following exercise 5
Rehabilitation Context
- In rehabilitation settings, cryotherapy is conditionally recommended for pain management, particularly as part of comprehensive physical therapy 3
- The American College of Rheumatology conditionally recommends thermal modalities (including cryotherapy) for rheumatoid arthritis management based on very low certainty evidence of improvement in pain and function 3
- For rotator cuff injuries, local cold therapy is considered beneficial to relieve pain after surgery, though this is based on expert consensus rather than high-quality evidence 3
Conclusion
While cryotherapy demonstrates clear benefits for pain reduction in various conditions and has established efficacy in specific dermatological applications, the evidence for its broader therapeutic claims regarding inflammation reduction, tissue healing, and recovery enhancement remains limited in human studies. The strongest evidence supports its use for pain management and in specific dermatological treatments rather than for accelerating healing or recovery.