A recent BBC article raised the question as to whether or not Cryotherapy Chambers work in helping Rugby players (The Welsh Rugby team in this case) recover from match soreness and injury. The research is lacking as to the benefit of this recovery method, so why do athletes still use it?
Ice baths are used by many top athletes and sports teams, below are Great British Olympic Champions Mo Farah and Jessica Ennis-Hill.
The obvious answer as to why cryotherapy (cold therapy) is used is that when we perform any activity which involves impact on the body, from Running to Rugby. There is going to be ‘soft tissue damage*’ and potentially damage to bones, joints and nerves. Ice baths are used with the intention that it helps athletes recover quicker, thus allowing them to compete or train sooner.
The 2015 Rugby world cup is on at the time of writing this and most of the teams if not all are using these methods to aid recovery in time to perform at the next brutal match.
If you have never watched Rugby, here is a video of some of the tackles that occur (not for the faint hearted):
Does damage really occur every time I do sport?
Pretty much yes, damage to the above structures can occur during most exercise – an example being with Running where your feet are impacting on the floor repeatedly (causing microdamage) and having your muscles contracting and lengthening rapidly (micro-tearing in the process). These motions can cause mainly mild soft tissue damage and joint soreness.
Have you ever felt sore after performing sport? Particularly if you haven't done it for a while? This is called Delayed Onset Muscle soreness ‘DOMS’ and is a perfect example of what is happening under your skin where mild tissue damage is occurring and inflammation is setting in to repair it (usually over 24-48 hours).
Taking Rugby as an example, you then start to look at potentially heavier soft tissue and bone damage all of which needs to be repaired as soon as possible so that the athlete is ready to participate again.
However, DOMS can occur with something as light as Yoga! After all, you are stretching, which is basically a nice way of ‘mildly tearing your muscles to a longer length’ – Sounds so brutal when you put it like that doesn’t it!?
So why Ice baths and Cryotherapy Chambers!?!?!
Players need to cover any areas particularly sensitive to extreme cold such as their mouth when in an extreme cryotherapy chamber.
Were you ever told, as a child, to run your finger under a cold tap if you had accidentally trapped it in a door? Or put an ice pack on a bruise to calm the swelling? This is the basic thinking for the use of cold. The idea is to try to minimise inflammation.
“why would I want to minimise the body’s natural healing process?” – good question, the answer is that inflammation is a ‘Jack of all trades, yet a master of none’.
Inflammation is an amazing process. However, it is designed to cater for all types of injury – cuts, bruises, burns, breaks, strains etc. Inflammation therefore has to account for all possibilities with these various forms of injury. It is therefore great at solving various injuries but none specifically.
Ultimately, it needs to avoid infection (can lead to your nasty things like amputation and death). Therefore, through a complicated cascade of cellular interactions you see the common signs of inflammation start to occur, in order to deal with these various possible scenarios.
Redness – due to increased blood flow to the area
Heat – raising the temperature of the area kills off certain causes of infection
Swelling – wards off an area of injury from potential infection
Pain – to let you know something is wrong in the area and avoid making it worse
Decreased function – your body is clever in that it can shut off use of a muscle or group of muscles if pain is present to avoid making the injury worse.
What this means with regard to sport is that the body can “do too much’ – imagine you have just finished a 10km run, your body is in pain, your muscles are sore and the inflammatory process has begun. On a very low-level, inflammation is at work, breaking down damaged tissue warding off any particularly sore areas.
The body sees an area that is damaged and essentially sprays it with inflammation, this leads to a whole bunch of inflammation – some components of which are not necessary. When you use an ice bath you are decreasing the availability of the inflammation to the area that is damaged. Achieved by constricting the arteries and decreasing the flow of blood to the area, essentially stepping on the hose pipe. This leads to just enough inflammation being applied to an area, rather than more than is required.
“Too much inflammation slows down the healing process”
When the body uses inflammation, it would prefer to use too much, rather than not enough (Obviously, it doesn’t go too crazy or you’d be one big red, hot, painful, swollen grape!).
Why is too much inflammation a problem? –
Redness – not a problem really, mainly just aesthetic
Heat – not too much of a problem but can be very itchy and uncomfortable for an athlete
Swelling – slows down the turnover of cells, by slowing the removal of dead tissues and arrival of new tissues
Pain – Can hinder performance and lead to decreased function
Decreased function – not great if you want to perform at your best as soon as possible
Ok, so why do you think this is the basic mechanism behind what is happening?
I’ll give an extreme example of this – mild disc bulges**, also known as slipped discs and disc herniations – all the same thing. They are THE BEST example of too much inflammation causing a slow down in healing. The biggest mistake made with these injuries is the use of heat packs rather than Ice packs, this causes an increase in inflammation in a very slow healing injury.
The record length of time I have had someone suffering with a mild disc bulge for this reason is 12 years. After treatment and using ice packs the patient was fine in a month, a perfect example of stagnated healing process due to too much inflammation. This is an extreme example and sports soreness is on a much lighter level but the same theory applies. Before you ask, no, I have never put anyone in an ice bath or a cryotherapy chamber as a form of treatment… Though it would be interesting!
With sports generally you see things used which generally do not have great evidence – Kinesio taping (I’ll cover this soon), Cool Downs and Ice baths are a few of the more common ones. However, if the Athletes feel that it is working for them and helps them, then until research catches up or something better comes along, athletes will continue to use them. Players will do anything to perform better and if they perform better, then the management will be happier. Placebo is a very strong thing.
Ice baths and cryotherapy chambers are not for everyone, they can be very dangerous if you have a history of cardiovascular issues or are hypersensitive to temperature changes. I would recommend speaking to a healthcare specialist such as your GP as to whether you would be ok to try these methods prior to using them. Cryotherapy chambers are super expensive to use by the way!
*Soft tissue – is a generic term that incorporates mainly your muscles, arteries, veins, lymph and fascia.
**Bear in mind that moderate and severe disc bulges can sometimes lead to surgery but mild ones are usually very succesful if treated correctly.