Methods of using cryotherapy

Svetlana Kovaleva , cosmetologist (Russia)

There are many proverbs and sayings about the healing effects of cold, for example, “Everyone is young in the winter cold,” “Summer is for the soul, winter is for health.” Modern medicine agrees with popular wisdom: for many conditions, including quite severe ones, the best medicines are rigus, fames, quies - cold, hunger and rest. How do low temperatures affect human health?

Since ancient times, doctors have highly valued the therapeutic value of cold, but it was not used very widely before: local exposure to ice on individual parts of the body was mainly practiced for the purpose of pain relief and swelling. At the beginning of the twentieth century, the German hydrotherapist Sebastian Kneipp made an attempt to systematize the experience accumulated over the centuries, including that related to hardening. Kneipp’s interest in this issue was quite understandable: there is evidence that it was with the help of hardening that he was cured of tuberculosis.

Kneipp laid the foundations of the theoretical basis of hypothermia, began to use it as a full-fledged physiotherapeutic method and coined the term “cryotherapy”. Nevertheless, for a long time, low temperatures were included in the arsenal of medicine mainly as an element of self-medication and general health hardening. In the USSR, the most famous fans of the method were Porfiry Ivanov and his students, who walked barefoot all year round, wore a minimum of clothing - and practically did not get sick.

However, the physiological mechanisms of the therapeutic effect of cold were discovered only in the second half of the 20th century thanks to research in the field of medicine and biology. In 1979, at the Rheumatology Congress in Wiesbaden, Japanese scientist Toshiro Yamauchi first theoretically substantiated and practically proved the effectiveness of short-term local and general exposure to extremely low temperatures - from -100 to -180 ° C - in the treatment of rheumatic arthritis. However, Yamauchi's report did not attract much interest from the audience.

Only doctors in Germany, which historically had its own traditions of cold therapy, appreciated the promise of this idea. Already in 1984, at the clinic of the University of Münster, Professor Reinhard Fricke launched a physiotherapy module consisting of a cryochamber and a device for local aerocryotherapy. Thanks to competent marketing and advertising, interest in the technique was so great that the clinic performed up to 100 procedures a day. Gradually, the new direction gained more and more fans among both doctors and patients. Currently in Europe there are about a hundred cryomedicine clinics and thousands of specialized rooms at medical and cosmetology centers.

"CARRIERS" OF COLD

Traditional carriers of low temperatures used in cryotherapy are cold water, ice, chloroethyl, salt and gel cryopacks; To obtain ultra-low temperatures, liquefied gases (helium, nitrogen, argon, oxygen) are used. There are also devices whose operation is based on the thermoelectric Peltier effect, the Joule-Thompson effect, the galvanothermomagnetic Etingshausen effect, etc.

Liquid nitrogen as a therapeutic source of cold is slowly but surely falling into disuse. This is due primarily to the toxicity of its vapors, and also to the fact that when working with liquefied gas it is difficult to control the degree of exposure, and often areas of cryodestruction appear at the site of cryomassage, redness and peeling of the skin develops.

Currently, the best option for cryotherapy is considered to be devices that use a Peltier element as a source of low temperatures : a thermoelectric converter, the operating principle of which is the Peltier effect - the occurrence of a temperature difference when an electric current passes through the contact zone of semiconductors with different types of conductivity. The element is a chain of n- and p-semiconductors (electron donors and acceptors), covered with two metal plates. When current passes through semiconductors, one plate heats up and the other cools; The higher the current and the more semiconductors are assembled in the circuit, the greater the temperature difference. This thermoelectric effect was first described in 1834 by French researcher and mechanic Jean-Charles Peltier. In the English-language literature, Peltier elements are called thermoelectric cooler (TEC).

The Peltier element is sometimes called an "electronic ice cube". It allows you to accurately maintain the set temperature at the desired level and almost instantly cool tissue to the required depth. Devices based on it are compact, lightweight and easy to use. Due to conduction and convection, cold is carried out simultaneously in two directions - along the surface of the tissue and in depth.

Physiological aspects of the technique

The mechanism of action of cryotherapy is based on thermal shock: rapid cooling of tissues and subsequent maintenance of a stable low temperature.

The effect that appears most quickly is called controlled analgesia. The mechanism of the latter, studied relatively recently, is to reduce the speed of pain impulses and block sensitive skin receptors. This happens due to the activation of a physiological system that limits the conduction and perception of pain information. Its important component is the “gate control of pain”, carried out at the level of the spinal cord: in the gelatinous substance of the dorsal horns there are inhibitory neurons, which, through presynaptic inhibition, limit the transmission of pain impulses along the spinothalamic pathway. These neurons can be activated by various structures of the brain, as well as by periphery, in particular, when the skin is exposed to low temperatures. When the nociceptors (pain receptors) of the skin are excited, impulses along the thick myelin fibers of group A enter the central nervous system, to the multimodal neurons of the associative zones of the cortex, the excitation of the latter ensures the flow of pain impulses to the higher parts of the brain; At the same time, along the axonal collaterals, impulses arrive to the neurons of the gelatinous substance, which, according to the principle of presynaptic inhibition, reduce the activity of multimodal neurons, as a result of which pain sensitivity decreases.

At the next stage, a paradoxical vasomotor reaction appears. First, vasoconstriction of the microvasculature occurs, aimed at maintaining thermoregulation by reducing heat loss through the skin. Then, since the temperature remains stably low (this is the main condition of cryotherapy), various mediators and biologically active substances begin to be released in the tissues, and the initial vasoconstriction is quickly replaced by vasodilation. During the entire treatment session, there is a change in contraction and expansion of subdermal and dermal capillaries, which leads to increased microcirculation and easier lymph outflow.

One of the results of the paradoxical vasomotor response, which is caused by increased blood flow, is increased tissue oxygenation. By receiving a sufficient amount of oxygen, cells use their own energy resources in the most optimal way. Elimination of hypoxia is one of the main tasks in the treatment of most diseases and in procedures for correcting involutional changes in the skin.

In addition, with a paradoxical vasomotor reaction, the constant contraction and expansion of capillaries creates a pump effect, which facilitates the penetration of cosmetic components into the skin. By analogy with ion- and phonophoresis (the introduction of drugs into tissues through the use of electric current and ultrasound), the process of delivering substances using cold to the skin was called cryodermophoresis. Moreover, not only does a larger amount of active ingredients enter the tissues, but also their effectiveness is enhanced due to simultaneous oxygenation.

Indications and dosages

Cryotherapy is divided into general and local: to ensure an effect on the body as a whole, special cabins, swimming pools and cryosaunas (aerocryotherapy) are used; special mobile devices are used for local treatment

General cryotherapy improves the functioning of the immune system, increases blood and lymph flow, and relieves pain. The procedures accelerate regeneration processes, eliminate swelling, and normalize metabolism. Increased tissue trophism leads to an improvement in the condition and appearance of the skin and its appendages. During the session and for some time after it, increased energy consumption is observed, which helps to reduce excess body weight. The release of endorphins into the blood has a positive effect on overall well-being and mood.

For a pronounced result, a course of 10–12 sessions is required, the frequency and duration of which is determined by the doctor on an individual basis. If necessary, treatment is repeated after several months.

Local cryotherapy is used to obtain a local effect - hemostatic, anesthetic, regenerative, lymphatic drainage, etc.

The hemostatic effect is achieved due to spasm of peripheral vessels with slowing of blood flow. In the practical use of local hypothermia as a physical hemostatic agent (for example, at the time of injection of fillers into the area of the red border of the lips), one should remember the paradoxical vasomotor reaction and the fact that the effect of low temperatures is phasic in nature. The first phase - vasoconstriction - is accompanied by pale skin. The second - passive vasodilation - is manifested by hyperemia and increased blood flow in the area where cold is applied. Therefore, during the entire treatment time (from 2 to 7 minutes), it is necessary to constantly perform circular reciprocating movements with the nozzle with a small amplitude, without fixing the nozzle in one place for more than 5 seconds.

When used as a physical anesthetic, low temperature increases the comfort of peelings and injection procedures, making it possible to avoid applications using lidocaine, tetracaine, which can cause undesirable effects such as erythema, swelling, etc.

It takes an average of 2–5 minutes to treat the injection area. The exact time is set individually, taking into account the different sensitivity thresholds and psychosomatic characteristics of patients. The patient himself can hold the device’s handpiece while maintaining contact of the nozzle with the skin. Practice shows that patients who take at least a minimal part in the process feel much more relaxed and calm, which, combined with the correct execution of the manipulation, subject to all standards of preliminary diagnosis and general comfort, increases the effectiveness of the intervention and reduces the risk of adverse events in the post-procedure period.

A physiotherapeutic method based on a combination of cryotherapy and the use of professional cosmetics is called “cryoplasty”. This is a therapeutic and prophylactic technique that allows you to influence different layers of the skin and is used to correct a wide range of aesthetic imperfections. It makes it possible to improve the condition of stressed and aging skin, enhance the results of mesotherapy and even replace the latter (when using special preparations). The drainage, plastic and relaxing effects of cryoplasty can be enhanced through a special technique for performing movements with a cryoplasty. Experienced cosmetologists are able to correct even mild ptosis of the mammary glands by applying cold to the Cooper's ligaments and breast skin. During pregnancy, the procedure of local cryotherapy on the area of the lower extremities effectively relieves “fatigue” of the legs.

The frequency of sessions depends on specific problems and is usually 1–2 times a week. The minimum course lasts 1.5 months, but in the absence of contraindications, cryoplasty can be performed permanently.

Contraindications to local cryotherapy are the same restrictions as with conventional cosmetic massage: dermatitis in the acute stage, inflammatory and oncological skin diseases in the area of influence, fever of any origin. There are also specific contraindications: cold allergies and cryoglobulinemia.

Immediately before the session, the doctor must conduct a “Duncan test” - a test for intolerance to low temperatures. To do this, apply an ice cube to the inside of the forearm for 5–10 minutes and after 10 minutes the reaction is assessed. The appearance of redness, blisters, and itching at the site of contact indicates increased sensitivity to cold.

Particular attention should be paid to patients with Raynaud's syndrome (numbness of the distal phalanges of the fingers and toes): although it is not an absolute contraindication to the procedure, it can be combined with cold intolerance.

Cryoprocedures in the salon and at home

In a modern medical center that has the appropriate equipment, for general wellness you can, after consultation with a doctor, visit a cryosauna, conduct local hardware cryotherapy to restore the functionality of the joint, undergo cryoplasty of the entire face or exclusively the periorbital area to relieve swelling (including for the prevention of lymphostasis after blepharoplasty) , as well as to eliminate bags and dark circles. In the latter case, the cold exposure lasts from 1.5 to 10 minutes.

When working in the facial area, first cool the entire surface of the skin with stroking back-and-forth movements of the manipulator. Then a drainage massage is carried out from the neck to the forehead, and then, if necessary, they begin plastic effects on the muscle tissue. Before this, special gels are applied to the face , which are not destroyed by low temperatures and are intended to correct wrinkles, increase skin elasticity, moisturize, and improve complexion. Usually one gel is used, but several products can be mixed. It must be remembered that when working with a cryo-attachment, ultrasound guide gel or other foreign preparations should not be used, as this creates a serious risk for the patient of developing skin problems.

When correcting cellulite, the effectiveness of cryotherapy is due to the improvement of microcirculation and lymphatic drainage. Typically, cold exposure precedes the application of lipolytic creams and drainage serums. The procedure, which is carried out for 30 minutes, helps to reduce the volume by 0.5–1.5 cm in volume due to the outflow of fluid.

It is not possible to carry out such procedures at home, but there are simple ways to use cold to maintain the skin in good condition.

To do this you will need an ice cube and/or a gel mask. It is better to make cubes by freezing parsley decoction, but you can also use plain water. In the morning, after cleansing, apply a thick layer of rich cream to the face and massage along the cosmetic lines for 2-3 minutes, especially paying attention to the area around the eyes, but avoiding the feeling of freezing. The remaining cream is removed after the massage.

If you have a special hardening mask, you can put it in the refrigerator or freezer in advance, and then apply it to your face and fix it for 5-10 minutes. Before using it, it is recommended to apply a creamy nourishing or moisturizing mask to the skin.

Despite the skepticism of many professionals, such home cryoprocedures are quite good at removing morning swelling and maintaining skin tone.

For swelling of the legs at home, you can use cosmetic gels and sprays containing cooling agents - menthol and its analogues, carboxamides, sulfones, aliphatic alcohols, cyclic lactams, etc. Their action is associated with irritation of specific receptors of the TRP family (Transient Receptor Potential - transient receptor potential). potential). Recently, cilin has been included in the composition of drugs, which is many times superior to menthol in terms of the degree of cooling effect, although it has a similar mechanism of action.

COLD AND WEIGHT LOSS

Low temperatures are used in special devices for selective cryolipolysis (cryoliposuction). This technique appeared in Europe only 5-6 years ago; it is based on a combination of vacuum exposure and temperatures of about -8 ° C. The skin-fat fold is sucked into the nozzle by a vacuum, after which the fat layer is subjected to cooling, which triggers the death of adipocytes. The products of their biodegradation are eliminated from the body naturally. The best results are demonstrated by patients with normal weight who have problems with certain areas (waist, hips). In patients with significant excess body weight, the effect is insignificant.

However, there is an easier way to reduce body weight - to live in cool conditions. The body will be forced to spend more energy to maintain body temperature and, accordingly, “store less.”

At one time, a group of Japanese scientists observed an interesting effect of weight gain in excessively warm conditions. Dutch specialists from the Maastricht University Medical Center became interested in this work (Trends in Endocrinology & Metabolism, 2014), who conducted the following experiment: for 10 days, 6 hours daily, a group of volunteers was in light clothing at 17 °C.

All participants had increased levels of brown fat in their bodies, a specific tissue that is well developed in infants and hibernating animals. Unlike white fat, brown fat is a tissue that does not store, but releases energy: due to the large number of mitochondria, lipid oxidation occurs in it, which makes it possible to maintain body temperature for a long time even against the background of hypothermia and without the supply of nutrients from the outside.

In the second stage of the experiment, participants were placed in even lower temperature conditions; they quickly adapted to it and did not feel the cold. The authors of the study believe that a person can accustom his body to coolness in the same way as we accustom muscles to exercise, which will help avoid obesity.

First published: Les Nouvelles Esthetiques 2015/№1