CRYOTHERAPY 
+ ULTRASOUND THERAPY

Cold ultrasound therapy to help fight inflammation

Separately, Cryo and Ultrasound therapies have been used widely by athletes and patients for decades. By combining cryotherapy and ultrasound, Cryoultrasound is used effectively to target muscle injuries and penetrate deep into the connective tissue layers to promote healing.

WHAT IS COLD ULTRASOUND? 

The term "cold ultrasound" refers to the combination of therapeutic ultrasound and another treatment method known as cryotherapy, which is used in cryoultrasound (Cyro-US) therapy. Because of the anti-inflammatory properties that ultrasound offers and the analgesic effect that cryotherapy has, it is highly useful for treating inflammation. This is due to the combination of applying the two treatments at the same treatment session. The speedy recovery that cryoultrasound therapy provides for athletes was the primary factor that contributed to its early success in the sporting world. Cyro-US therapy has since made its way into traditional methods of treatment (Vulpiani et al., 2015).

WHAT IS CRYO-ULTRASOUND THERAPY?

Cryo-US therapy, also known as cryotherapy combined with therapeutic ultrasound, combines the beneficial effects of two distinct physical therapies: cryotherapy and therapeutic ultrasound. It has been demonstrated to be helpful in lowering edema and pain, cryotherapy is usually considered to be an essential component of the majority of injury care techniques (Ammendolia et al., 2023). The peak pressure of ultrasonic sound waves is 0.5 bar, which is approximately 1000 times lower than that of a shock wave. Ultrasound is made up of high-frequency oscillatory sound waves. 

 The effects of heat increases blood flow, relaxing the muscles as during injury muscles have a tendency  to spasm, and increase in the suppleness of collagen fibres, and a response that is pro-inflammatory. Cavitation and auditory microstreaming are examples of non-thermal effects, and they are responsible for inducing a boost of fibroblast activity, as well as increases in protein synthesis and blood flow, regeneration of tissue, and bone healing.

HOW DOES CRYO-ULTRASOUND THERAPY WORK?

As mentioned this therapy utilises the benefits of two proven treatment methods, namely cold and ultrasonic. As a result of its ability to suppress pain receptors and restrict blood flow, cold successfully controls the development of oedema in the affected area. On the other hand, ultrasound produces sound vibrations at extremely high frequencies that are invisible to the human ear. These sound vibrations, when they come into contact with the tissues, generate mechanical, thermal, chemical, and cavitation effects. Ultrasound is also used to diagnose and treat a variety of medical conditions. The benefits include relief from pain and inflammation, as well as preventing edema. It has also been shown that vascularization is improved as a direct result of the rise in temperature that is brought about by ultrasound, and the molecules that were responsible for the inflammation are removed. Meanwhile, the cold therapy has an analgesic effect, which helps ease the pain caused by contractures. Additionally, the ultrasound therapy causes the cells in the damaged tissue to vibrate, which results in a micromassage that is extremely deep and helps to assure a calming impact (Paoloni et al., 2015).

ADVANTAGES OF CRYO-ULTRASOUND THERAPY?

  • MUSCLE RECOVERY
     
  • IMPROVED SLEEPING
     
  • CHRONIC PAIN RELIEF

 

 

 

The first thing that happens when your body senses cooler temperatures is that it constricts your blood vessels, a process that's known as vasoconstriction, and in colder temperatures directs all of your blood towards your organs. When this takes place, the oxygen and nutrients in your blood become more concentrated. Then when your body heats up again, your blood vessels widen. This process is called vasodilation, and it sends blood that is rich in oxygen and nutrients back to your tissues. This increased blood flow helps kick-start the recovery process by flushing out the inflammation and toxins that have built up  (Qu et al., 2022).

 

There are multiple potential mechanisms through which cryo-US therapy might alleviate chronic pain. To begin, it's common knowledge that exposure to cold can temporarily alleviate pain. Consider applying an ice pack to a sprained ankle as an example. In pain cells, the transmission of nerve impulses (when a nerve sends a signal to the brain) is believed by scientists to be slowed down by cold temperatures (Garcia et al., 2021).

 

Researchers have suggested that cryotherapy may assist with sleep. For instance, the previously mentioned study on middle- and distance runners revealed that whole-body cryotherapy (WBC) not only reduced muscle inflammation and damage after exercise, but also that individuals reported greater quality of sleep . The sympathetic nervous system may be activated through the use of cryotherapy, which researchers believe may aid in the process of falling asleep. When a person is in a relaxed and secure environment, our autonomic nervous system, also known as the "automatic" nervous system, takes over the management of our body functions. This part of the autonomic nervous system is known as the "rest and digest" side (Douzi et al., 2019).

 

 

Cryotherapy is frequently utilised to speed up the healing process of muscles and tissues following physical activity or injury. To understand the rationale behind this, it requires an understanding of the physiological changes that take place in the human body as a result of exposure to cold and hot temperatures. 

 

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CRYO-ULTRASOUND THERAPY CLINICAL STUDIES?

 

Cryo-ultrasound therapy combines the benefits of therapeutic ultrasound with that of cryotherapy, which together can create enhanced benefits regarding recovery and reducing pain. Cryo therapy can help reduce the potential challenges related with the thermal heating impact of ultrasound therapy, allowing the patient to receive the combined advantages of both therapies together; mechanical and biological therapeutic benefits of ultrasound therapy. Cryo-ultrasound therapy . The ability to combine the advantages of therapeutic  ultrasound with the advantages of cryotherapy, could result in a boosting of both of these methods as a result of the combination of these therapies' respective strengths (Vulpiani et al., 2015).  In point of fact, a drop in temperature in deep tissues allows room for an increase in the density of waves within the tissue itself, which makes it possible for this enhancement to take place. (Vural et al., 2014). 

Experimental investigations on animal models (Chen et al., 2004), experiment investigations with in vitro cell line systems (Chao et al., 2008), and clinical trials on primary cultured human tenocytes (Leone et al., 2012) demonstrate that ESWT determines its stimulating impact on proliferation of cells, as well as the activation and improvement of the healing process. These findings suggest that ESWT may be useful in the treatment of a variety of musculoskeletal conditions. The morphological alterations, proliferation and motility of treatment cells, functional effects on neovascularization and production of collagen, as well as the expression of developmental clinical genes, all point to the possibility that ESWT may be able to improve tendon healing (Visco et al., 2014). Despite the fact that certain studies (Larsen et al., 2005) fail to establish this, there is substantial supporting data from research on animal models about the good influence that ultrasound has on the curing of tendon injuries(De Nardi et al., 2021). However, several research conducted in vitro on animal models demonstrate that ultrasonic can stimulate proliferation, migration, and collagen synthesis in tendon cells (Tsai et al., 2006). These effects can be seen in tendon cells. There are no studies that suggest that cryo-ultrasound has any effects that are stimulating on the healing process. However, it would appear that the efficiency of cryo-ultrasound relies on the synergistic relationship between cryotherapy and ultrasound therapy, increasing both the mechanical and physiological therapeutic effects of ultrasound therapy (Costantino et al., 2014).

There have only been a small number of studies conducted on cryo-ultrasound, and additional research is required to determine whether or not this treatment is indeed helpful (Costantino et al., 2014). One study (n=20) examines the effects of cryo-ultrasound, laser carbon dioxide, and tecar treatment on patients with severe insertional tendinitis of the Achilles tendon, the patellar tendon, and the epicondylar region. It demonstrates that Cryo-US is superior to laser CO2 treatment, and while it does not provide major variations with Tecar therapy, it does demonstrate a better mean variation in effectiveness. Cryoultrasound therapy has been shown in later studies to have the potential to provide patients suffering from persistent plantar fasciitis with a clinical improvement that is both effective and long-lasting. In the treatment of "chronic lateral epicondylitis, research has demonstrated that cryoultrasound therapy is inferior to extracorporeal shock wave therapy in terms of the number and severity of the benefits it provides (Costantino et al., 2005).

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REFERENCES

AMMENDOLIA, A., DE SIRE, A., LIPPI, L., AMMENDOLIA, V., SPANÒ, R., REGGIANI, A., INVERNIZZI, M. & MAROTTA, N. 2023. Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Proof-of-Concept Study. Sports, 11, 180.

BLEAKLEY, C., MCDONOUGH, S. & MACAULEY, D. 2004. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomised controlled trials. The American journal of sports medicine, 32, 251-261.

CHAO, Y.-H., TSUANG, Y.-H., SUN, J.-S., CHEN, L.-T., CHIANG, Y.-F., WANG, C.-C. & CHEN, M.-H. 2008. Effects of shock waves on tenocyte proliferation and extracellular matrix metabolism. Ultrasound in medicine & biology, 34, 841-852.

CHEN, Y. J., WANG, C. J., YANG, K. D., KUO, Y. R., HUANG, H. C., HUANG, Y. T., SUN, Y. C. & WANG, F. S. 2004. Extracorporeal shock waves promote healing of collagenase‐induced Achilles tendinitis and increase TGF‐β1 and IGF‐I expression. Journal of Orthopaedic Research, 22, 854-861.

COSTANTINO, C., POGLIACOMI, F. & VAIENTI, E. 2005. Cryoultrasound therapy and tendonitis in athletes: a comparative evaluation versus laser CO2 and te ca. r. therapy. Acta Biomed, 76, 37-41.

COSTANTINO, C., VULPIANI, M., ROMITI, D., VETRANO, M. & SARACENI, V. 2014. Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study. Eur J Phys Rehabil Med, 50, 39-47.

DE NARDI, M., BISIO, A., DELLA GUARDIA, L., FACHERIS, C., FAELLI, E., LA TORRE, A., LUZI, L., RUGGERI, P. & CODELLA, R. 2021. Partial-body cryostimulation increases resting energy expenditure in lean and obese women. International Journal of Environmental Research and Public Health, 18, 4127.

DOUZI, W., DUPUY, O., THEUROT, D., BOUCARD, G. & DUGUÉ, B. 2019. Partial-body cryostimulation after training improves sleep quality in professional soccer players. BMC Research Notes, 12, 1-5.

GARCIA, C., KARRI, J., ZACHARIAS, N. A. & ABD-ELSAYED, A. 2021. Use of cryotherapy for managing chronic pain: an evidence-based narrative. Pain and therapy, 10, 81-100.

KLIMENKO, T., AHVENAINEN, S. & KARVONEN, S.-L. 2008. Whole-body cryotherapy in atopic dermatitis. Archives of dermatology, 144, 806-808.

LARSEN, A., KRISTENSEN, G., THORLACIUS-USSING, O. & OXLUND, H. 2005. The influence of ultrasound on the mechanical properties of healing tendons in rabbits. Acta orthopaedica, 76, 225-230.

LEONE, L., VETRANO, M., RANIERI, D., RAFFA, S., VULPIANI, M. C., FERRETTI, A., TORRISI, M. R. & VISCO, V. 2012. Extracorporeal shock wave treatment (ESWT) improves in vitro functional activities of ruptured human tendon-derived tenocytes. PloS one, 7, e49759.

PAOLONI, M., TAVERNESE, E., CACCHIO, A., D’ORAZI, V., IOPPOLO, F., FINI, M., SANTILLI, V. & MANGONE, M. 2015. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med, 51, 521-8.

QU, C., WU, Z., XU, M., LORENZO, S., DONG, Y., WANG, Z., QIN, F. & ZHAO, J. 2022. Cryotherapy on Subjective Sleep Quality, Muscle, and Inflammatory Response in Chinese Middle-and Long-Distance Runners After Muscle Damage. Journal of Strength and Conditioning Research, 36, 2883-2890.

TSAI, W. C., PANG, J. H. S., HSU, C. C., CHU, N. K., LIN, M. S. & HU, C. F. 2006. Ultrasound stimulation of types I and III collagen expression of tendon cell and upregulation of transforming growth factor β. Journal of orthopaedic research, 24, 1310-1316.

VISCO, V., VULPIANI, M. C., TORRISI, M. R., FERRETTI, A., PAVAN, A. & VETRANO, M. 2014. Experimental studies on the biological effects of extracorporeal shock wave therapy on tendon models. A review of the literature. Muscles, ligaments and tendons journal, 4, 357.

VULPIANI, M. C., NUSCA, S. M., VETRANO, M., OVIDI, S., BALDINI, R., PIERMATTEI, C., FERRETTI, A. & SARACENI, V. M. 2015. Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study. Muscles, Ligaments and Tendons Journal, 5, 167.

VURAL, M., DIRACOGLU, D., ERHAN, B., GUNDUZ, B., OZHAN, G. & PEKEDIS, K. 2014. Efficacy of extracorporeal shock wave therapy and ultrasound treatment in lateral epicondylitis: A prospective, randomized, controlled trial. Annals of Physical and Rehabilitation Medicine, e190.

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