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Does local cryotherapy improve thermal diagnosis similar to whole-body cryotherapy in spinal diseases?

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Thermal imaging has been used for patients with spinal diseases who were qualified by their physicians for whole-body treatment or local cryotherapy. The experimental groups of patients consisted of 20 males aged 51.6 ± 9.0 (12 treated by whole-body cryotherapy and 8 by local cryotherapy). The distribution of the skin surface temperature was monitored by using a Thermovision Camera E60 before and immediately after body cooling. The chosen spinal region (Th5/Th6–L5/S1) was taken into consideration for all of the research groups. An essential drop in skin temperature and a better differentiation of the body surface temperatures (leading to an increase in the diagnostic value of thermography) was observed after both methods of cold impact. In order to estimate the usefulness of thermovision used after body cooling, the quantitative parameters including temperature contrast—the difference between the maximum and minimum temperatures before and after cold impact and relative contrast ratio (related to the average temperature of the selected area of interest, before and after cooling, respectively)—were compared for both kinds of medical treatment. The statistical analysis proved that significant differences between the parameters obtained before and after body cooling in the case that patients treated by local and whole-body cryotherapy are similar. However, local therapy is cheaper and easy for application while whole-body therapy can give more information about the state of soft tissues for the whole back.
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Does local cryotherapy improve thermal diagnosis similar
to whole-body cryotherapy in spinal diseases?
Armand Cholewka
1
Agata Stanek
2
Magdalena Wo
´
jcik
1
Karolina Sieron
´
-Stołtny
3
Zofia Drzazga
1
Received: 4 October 2015 / Accepted: 7 April 2016
The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract Thermal imaging has been used for patients
with spinal diseases who were qualified by their physicians
for whole-body treatment or local cryotherapy. The
experimental groups of patients consisted of 20 males aged
51.6 ± 9.0 (12 treated by whole-body cryotherapy and 8
by local cryotherapy). The distribution of the skin surface
temperature was monitored by using a Thermovision
Camera E60 before and immediately after body cooling.
The chosen spinal region (Th5/Th6–L5/S1) was taken into
consideration for all of the research groups. An essential
drop in skin temperature and a better differentiation of the
body surface temperatures (leading to an increase in the
diagnostic value of thermography) was observed after both
methods of cold impact. In order to estimate the usefulness
of thermovision used after body cooling, the quantitative
parameters including temperature contrast—the difference
between the maximum and minimum temperatures before
and after cold impact and relative contrast ratio (related to
the average temperature of the selected area of interest,
before and after cooling, respectively)—were compared for
both kinds of medical treatment. The statistical analysis
proved that significant differences between the parameters
obtained before and after body cooling in the case that
patients treated by local and whole-body cryotherapy are
similar. However, local therapy is cheaper and easy for
application while whole-body therapy can give more
information about the state of soft tissues for the whole
back.
Keywords Thermovision diagnostics Local
cryotherapy Whole-body cryotherapy Physical medicine
Introduction
Internal body temperature gives us information about the
condition of each part of the body. It is usually measured
by contact thermometers which must be stuck to the skin
for even few minutes (i.e., mercury thermometers), or put
inside the organism’s cavities, i.e., mouth, ear or rectum
what can be problematic during children’s examinations or
when we are interested in studying a large body area
temperature gradient [14].
A very simple way to avoid these problems is using non-
contact thermometry thermovision. It is a well-known skin
temperature gradient and its changes are also very good
disease indicators and their associations with local blood
flow and changing metabolism, mostly in the superficial
skin layer, can bring some information about metabolism.
This is why thermovision can be widely and easily used in
medical diagnosis [516].
& Armand Cholewka
armand.cholewka@gmail.com
Agata Stanek
agata.stanek@gmail.com
Karolina Sieron
´
-Stołtny
kstoltny@hot.pl
Zofia Drzazga
zofia.drzazga@us.edu.pl
1
Department of Medical Physics, A. Chełkowski Institute of
Physics, University of Silesia, Uniwersytecka 4,
40-007 Katowice, Poland
2
Department and Clinic of Internal Diseases, Angiology and
Physical Medicine in Bytom, School of Medicine with the
Division of Dentistry in Zabrze, Medical University of
Silesia, Batorego Street 15, 41-902 Bytom, Poland
3
Chair of Physiotherapy, Department of Physical Medicine,
School of Health Sciences in Katowice, Medical University
of Silesia, Medyko
´
w Street 12, 40-752 Katowice, Poland
123
J Therm Anal Calorim
DOI 10.1007/s10973-016-5453-3
There are many different diseases in which the symptoms
are manifested as an increase or decrease in internal tem-
perature as well as skin temperature. On the other hand, there
are many different physical factors used in medicine, mostly
in physical medicine, that can have influence on changes in
the temperature response of the human body [516].
This is the reason why in this work the authors tried to
find out whether local body cooling, as a faster and cheaper
alternative to whole-body cryotherapy, can also give
additional information in thermovision diagnostics.
What are the differences between whole-body and local
cryotherapy? First, whole-body cryotherapy uses a tem-
perature lower than -100 C (the temperature can range
from -120 to -160 C) on human body, but in the case of
local cryotherapy the temperature applied to the surface of
the patient’s body is a little higher (it depends on the dis-
tance between the cryoprobe and the body surface as well as
the speed of shifting a cryoprobe over the cooled surface).
Second, in whole-body cryotherapy the cryogenic temper-
ature is applied on the patient’s whole body, but in local
cryotherapy it is only applied on the patient’s selected part
of the body. During the whole-body cryotherapy procedure,
more cold receptors on the skin are stimulated, and there-
fore, we observed a better therapeutic effect. Third, another
difference causes several favorable, physiological reactions
such as: an analgesic effect, a neuromuscular effect, an anti-
inflammatory and anti-edematous effect, as well as a cir-
culatory effect. However, cryogenic temperatures applied
through whole body apart from the aforementioned effects
also have a significant influence on the psyche, as well as the
endocrine and immune systems [17, 18].
Cryotherapy is widely used, especially in the treatment
of locomotor system diseases such as: the degeneration and
inflammatory states of joints, osteoporosis, post-traumatic
and overloading lesions and fibromyalgia [14, 1922].
Both kinds of cold treatment trigger important and
varied changes in the body and in the skin surface tem-
perature gradient which causes an increase in thermal
imaging’s diagnostic value [716]. The question is if local
cryotherapy’s positively influential effects are comparable
to whole-body ones in the case of spinal diseases.
Materials and methods
The study involved 20 non-smoking male patients (mean
age 51.6 ± 9.0 years) with patients suffering from lower
back pain who were divided by a physician into two
groups: 12 patients exposed to whole-body cryotherapy
procedures and 8 men exposed to local cryotherapy pro-
cedures, with no significant difference in mean age and
body mass index between them.
Before the study, each patient was examined by a
physician to exclude any coexisting diseases as well as any
contraindications for cryotherapy procedures.
All patients included in the trial had no commonly
accepted contraindications for cryotherapy as: intolerance
of cold, cryoglobulinemia, Raynaud’s phenomena,
hypothyroidism (an increased risk of hypothermia), acute
diseases of the respiratory tract, neoplastic disease (due to
an adaptive intensification of local blood supply), insta-
ble angina pectoris, severe heart valve defects (in a stage of
insufficient circulation), cardiac failure, severe arrhythmias,
purulent–gangrenous skin lesions, vegetative neuropathies
(due to predisposition to hyperhidrosis), local blood flow
disturbances, cachexia and hypothermia, as well as claus-
trophobia and mental diseases (due to an inability to comply
with the safety rules in the cryogenic chamber) [1, 2].
In all patients, prior to the study, a resting electrocar-
diogram was performed, and before each session of
cryotherapy, blood pressure was measured.
The research was carried out during routine rehabilita-
tion sessions at the following centers: the Health Resort in
Goczałkowice Zdro
´
j, the Department and Clinic of Internal
Diseases, Angiology and Physical Medicine, Medical
University of Silesia in Bytom. In Goczałkowice Zdro
´
j,
whole-body cryotherapy procedures were performed in a
cryochamber with cold retention (Metrum Cryoflex). The
temperature inside the cryochamber was -110 ± 10 C.
Liquid air was used to get very low temperatures in the
cryogenic chamber. At the Department and Clinic of
Internal Diseases, Angiology and Physical Medicine, the
local cryotherapy procedures were performed. In local
cryotherapy, a Froozer device was used, a nitrogen system
manufactured by Technomex. The temperature at the outlet
of the nozzle was -160 C. During the WBC procedure,
all patients were dressed in swimsuits, cotton socks and
gloves, and wooden shoes, and their mouths and noses
were protected by surgical masks and their ears by ear
protectors. All jewelry, glasses and contact lenses were
removed before entry into the chamber. During the WBC
procedure, the subjects were walking around the chamber
without touching each other. During the LC procedure, all
patients were dressed only in swimsuits. The local
cryotherapy procedure was applied for the Th5/Th6–L5/S1
spinal region.
All patients of both groups were exposed for 10 con-
secutive days to a cycle of whole-body cryotherapy or local
cryotherapy procedures lasting 3 min a day, with a subse-
quent 60-min routine of kinesiotherapy. The cryotherapy
study protocol has been reviewed and approved by the
Bioethical Committee of the Medical University of Silesia
in Katowice (permission no. NN-6501-93/I/07), and all
analyzed patients were informed about the trial and gave
A. Cholewka et al.
123
written consent for inclusion in the study. All clinical
research has been conducted according to the principles
expressed in the Declaration of Helsinki (1964).
The patients were requested to not drink alcohol or hot
drinks for 3–4 h before the trial. The distribution of the
skin surface temperature was monitored by using a Ther-
movision Camera E60 calibrated by black body. The
emissivity was set at the range of 0.97–0.98. The chosen
spinal region (Th5/Th6–L5/S1) was taken into considera-
tion for all patients. The thermal images of the chosen
regions of interests were performed before and immedi-
ately after completion of the cryotherapy procedure in a
special room where the temperature was stabilized
23 ± 1 C. The distance between the camera and the body
was about 0.5–1.5 m (depending on the size of the patient
and inspected area). It was necessary to follow the standard
protocol of infrared imaging in medicine [2325]. Thermal
images were analyzed by using a ThermaCAM TM
Researcher Pro 2.8 SR-3. Statistical analysis was done in
Statistica 9.1 using t-tests, Wilcoxon’s and ANOVA tests.
Differences with a p \ 0.05 were regarded as significant.
Results and discussion
Thermal images of the two representative patients treated
by whole-body cryotherapy (WBC—Fig. 1) and local
cryotherapy (LC—Fig. 2) suffering from low back pain
performed before (a) and immediately after (b) cold
treatment are presented. As expected, an essential drop of
skin temperature was observed due to cold impact causing
a bigger differentiation of the body surface temperature and
therefore an increase in the diagnostic value of thermog-
raphy in contrast to what was reported in earlier papers
[2, 7, 1113, 15]. The effects of the differentiation of the
temperature body map inside the regions of interest (cho-
sen lines along the spine) seen on the thermal images
performed after cryotherapy seem to be similar for both
ΔΔ
TC
1.50 °C 3.90 °C 2.60 °C 0.05 0.18 3.83
15.0 °C
36.0 °C
LI01
15.0 °C
36.0 °C
LI01
Th5/Th6 L5/S1
Δ = 1.5 °C
Δ = 3.9 °C
ΔT/°C
before
34
32
30
28
26
24
°C
T
T
after
before
after
T
T
CR
CR
before
after
RCR
(a)
(b)
(c)
(d)
Fig. 1 Thermal images of the back of patient four, suffering from
lower back pain performed before (a) and after (b) 3 min of whole-
body cryotherapy with the temperature inside the cryochamber set at
-110 C. In addition, we included temperature plots performed
before (I) and after (II) cryotherapy obtained from the line along the
spinal column in the range of Th5/Th6–L5/S1 (c), as well as the
calculated temperature parameters collected in the table (d)
Does local cryotherapy improve thermal diagnosis similar to whole-body cryotherapy in spinal
123
therapies; however, one can see that whole-body
cryotherapy cools the entire body but local cryotherapy
only chosen parts of the body. In a comparison between the
thermal images obtained after whole and local body cool-
ing, it should be noted that after local cryotherapy the
additional details observed on the thermal images are
connected with tissues located only in the vicinity of the
spinal cord because that was the area of cold air effect. On
the other, when we consider the thermal image performed
after whole-body cryotherapy, it is clearly seen that a
decrease in temperature can be observed for all soft tissues
on the entire back, not only in the vicinity of the spinal
cord. Such an effect can give important additional diag-
nostic information not only about the spinal cord but also
about a soft tissue metabolism state which is essential to
determine in some back diseases. Hot spots observed in
both thermal images presented in Fig. 1 suggest inflam-
matory states connected strictly with vertebrae.
However, the advantages of thermal imaging after
whole-body cooling are possible to see. Some temperature
changes occurred on both sides of the spinal cord may
suggest the inflammatory states of soft tissues character-
ized, for example, in sciatica. It was also reported that the
character of temperature variations depends on the degree
of advancement as well as the kind of illness [2, 7, 11, 15].
These are the main differences between the qualities of
effects that are visible on the thermal images.
In light of the goal of this work, to compare the influ-
ence of cold impact on temperature parameters, thermal
imaging was performed in both kinds of plots along the
chosen lines for all representative patients. Figures 1c and
2c show the plots of the temperature along the vertical line
17.0 °C
38.0 °C
17.0 °C
38.0 °C
Δ = 2.0 °C
before
T
Δ = 3.6 °C
T
after
Th5/Th6
L5/S1
ΔT/° C
34
32
30
28
26
Δ
Δ
TC
2.00 °C 3.60 °C
1.80 °C 0.06
0.13
2.15
before
after
T
T
CR
CR
before after
RCR
(a)
(b)
(c)
(d)
Fig. 2 Thermal images of patient one’s back suffering from lower
back pain performed before (a) and after (b) 3 min of local
cryotherapy. There are temperature plots performed before (I) and
after (II) cryotherapy, obtained from the line along the spinal column
in the range of Th5/Th6–L5/S1 (c), as well as the calculated
temperature parameters collected in the table (d)
A. Cholewka et al.
123
characterizing spinal vertebrae in the range of Th5/Th6–
L5/S1.
All statistical analysis was performed for the parameters
derived from the marked range of the spinal column in the
full group of patients. The marked temperature changes
observed along the spine for patients after cryotherapy can
be correlated with some disease processes underlying the
skin, especially with spinal diseases. Hot and cold spots are
visible in different ranges of the spine on thermal images
which indicate inflammatory states of different vertebrae.
Some quantitative parameters were needed to evaluate the
usefulness of local cryotherapy in thermovision diagnostics
of spinal diseases. This is the reason the lines selected
along the spine in the range of vertebrates were counted;
Th5/Th6–L5/S1 temperature parameters: mean T
mean
,
maximum T
max
, minimum T
min
. The values we discovered
made it possible to calculate more specific parameters that
the authors introduced in previous papers. These parame-
ters were: difference between maximum and minimum
temperature before cryotherapy DT
before
¼ T
max; before
T
min:before
, difference between maximum and minimum
temperature after cryotherapy DT
after
¼ T
max; after
T
min:after
, temperature contrast TC defined as difference
between a maximum temperature and minimum tempera-
ture read from thermal images performed before and after
cold impact TC ¼ DT
after
=DT
before
, contrast ratio before
cryotherapy CR
before
¼ DT
before
=T
mean;before
, contrast ratio
before cryotherapy CR
after
¼ DT
after
=T
mean;after
and finally
relative contrast ratio RCR ¼ CR
after
=CR
before
. The results
of the statistical analysis of the temperature contrast TC
and the relative contrast ratio RCR for all groups are shown
in Fig. 3a–d. The statistical outlines proved that there are
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.26
0.24
0.20
0.22
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.24
0.20
0.22
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
Temperature contrast before WBC
Temperature contrast after WBC
Temperature contrast before LC
Temperature contrast after LC
WBC RCR Before WBC RCR After
LC RCR Before LC RCR After
Mean
SE
SD
Mean
SE
SD
Mean
SE
SD
Mean
SE
SD
p = 0.002
p = 0.01
p = 0.002
p = 0.01
(a) (b)
(c) (d)
Fig. 3 These graphs show the results of a statistical analysis of the temperature contrast TC and relative contrast ratio RCR changes for patients
treated by local cryotherapy (a, d) and whole-body cryotherapy (b, c)
Does local cryotherapy improve thermal diagnosis similar to whole-body cryotherapy in spinal
123
statistically significant differences in the temperature con-
trast (p \ 0.05) as well as the relative contrast ratio
(p \ 0.05) between the parameters obtained for patients
before and after body cooling in the cases of patients
treated by local or whole-body cryotherapy. It means that
using thermovision in combination with body cooling
(whole or local cryotherapy) for patients with lower back
pain diseases indicated noticeable changes on the thermal
map of the body surface in the chosen body region. Such
situational influences on a bigger differentiation between
temperature parameters derived from the researched body
areas (DT is increasing) in what led to an increase in
the thermal imaging diagnostic value due to cold impact
[2, 7, 11, 15].
For a better interpretation of our results and an overall
easier analysis, in Table 1 all of the values for the tem-
perature contrast and relative contrast ratio TC (charac-
terizing the spinal column) were collected in the range
from Th5/Th6 to L5/S1 for patients suffering from lower
back pain treated by whole-body and local cryotherapy.
However, the question is that if local body cooling is
faster and cheaper than whole-body cryotherapy, can it also
give additional information in thermovision diagnostics?
That is why it was necessary to find out if there are sig-
nificant differences between the quantitative parameters
(temperature contrast TC and relative contrast ratio RCR)
obtained from patients treated with whole and local
cryotherapy (Fig. 4a, b).
The results of our statistics showed that there are no
significant differences in the temperature contrast
(p = 0.48) as well as relative contrast ratio (p = 0.18)
between patients treated by local or whole-body cryother-
apy. It may be pointed out that all kinds of body cooling
can give additional diagnostic information on thermal
images. Such knowledge may be useful because local
cryotherapy is cheaper and easier to perform than whole-
Table 1 Values of the temperature contrast and relative contrast ratio
characterizing the spinal column in the range from Th5/Th6 to L5/S1
for patients suffering from lower back pain treated by whole-body and
local cryotherapy, where: temperature contrast TC ¼ DT
after
=DT
before
,
and relative contrast ratio RCR is defined as CR
after
=CR
before
DT
before
DT
after
TC CR
before
CR
after
RCR
Whole-body cryotherapy (WBC)
P1 1.40 3.10 2.21 0.04 0.15 3.48
P2 2.70 7.60 2.81 0.08 0.34 4.22
P3 1.50 3.90 2.60 0.05 0.18 3.83
P4 1.20 6.10 5.08 0.04 0.23 6.62
P5 1.10 3.40 3.09 0.03 0.14 4.28
P6 1.20 2.20 1.83 0.04 0.10 2.57
P7 1.40 3.50 2.50 0.04 0.16 4.03
P8 1.90 4.80 2.53 0.06 0.23 3.62
P9 1.50 2.50 1.67 0.05 0.08 1.86
P10 2.10 3.30 1.57 0.07 0.15 2.30
P11 2.00 4.05 2.03 0.06 0.18 2.88
P12 2.30 4.00 1.74 0.07 0.17 2.41
Local cryotherapy (LC)
P1 2.00 3.60 1.80 0.06 0.13 2.15
P2 1.40 4.80 3.43 0.04 0.18 4.53
P3 1.50 4.20 2.80 0.04 0.15 3.38
P4 1.40 6.40 4.57 0.04 0.25 5.66
P5 2.60 4.50 1.73 0.08 0.19 2.19
P6 1.70 5.40 3.18 0.05 0.21 3.31
P7 2.08 5.32 2.55 0.06 0.21 3.31
P8 3.30 5.00 2.17 0.07 0.19 2.75
5.0
4.8
4.6
4.4
4.2
4.0
3.8
3.6
3.4
3.2
3.0
2.8
2.6
2.4
2.2
2.0
4.0
3.8
3.6
3.4
3.2
3.0
2.8
2.6
2.4
2.2
2.0
1.8
1.6
1.4
TC WBC TC LC
RCR WBC RCR LC
Mean
SE
SD
Mean
SE
SD
p = 0.48
p = 0.16
(a) (b)
Fig. 4 These graphs show the differences between the calculated values of the temperature contrast TC (a) and relative contrast ratio RCR
(b) for patients treated by local cryotherapy and whole-body cryotherapy
A. Cholewka et al.
123
body one but can find similar diagnostic effects in some
health problems such as lower back pain.
It was also interesting to see the representative tem-
perature plots from the lines along the spine in the marked
range from the patients after whole-body and local
cryotherapy in Fig. 5.
The temperature plots resulting from the thermal images
performed after cold impact indicated that the inflamma-
tory states in almost the whole range for the patient treated
with whole-body cryotherapy as well as for the patient
treated by local cryotherapy. The temperature peaks testify
about it in both cases. Moreover, the high values of tem-
perature contrast and relative contrast ratio were evident in
both of them, shown in Fig. 5.
The results of the studies point out an increase in ther-
mal imaging diagnostic value due to cold impact—whole-
body cryotherapy as well as local cryotherapy. However, it
seems that thermovision diagnostics performed after
whole-body cryotherapy can give more information about
the metabolism state of soft tissues on the whole back
unlike the local one. On the other hand, the relative con-
trast ratio should be more proper in the thermal charac-
teristics of back pain in health problems and diseases as a
result of using the mean temperature in our calculation
which makes such a parameter more objective.
Conclusions
Thermal imaging performed after body cooling brings
additional diagnostic information that can be read from
thermal images.
It seems that such quantitative temperature parameters
such as temperature contrast and relative contrast ratio may
have potential diagnostic value also.
However, after local cryotherapy the additional details
observed on curves are only connected with soft tissues
located in the vicinity of the spine where the cold air
affected, but when considering the thermal images
performed after whole-body cryotherapy, additional diag-
nostic information is connected with the entire body sur-
face and thus can be connected with metabolism and
changes in states of health.
Open Access This article is distributed under the terms of the
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tivecommons.org/licenses/by/4.0/), which permits unrestricted use,
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appropriate credit to the original author(s) and the source, provide a
link to the Creative Commons license, and indicate if changes were
made.
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... Most studies used local cryotherapy (LC) (n = 12) [44,45,47,50,53,54,[59][60][61][62][63][64]; less often, whole body cryotherapy was used (n = 7) [46,48,49,51,52,55,58]. One study used both WBC and LC (using liquid nitrogen vapor) [56], and one used WBC and PBC [57]. ...
... Polidori et al. [57] used thermography to compare whole-body temperature distribution between WBC and PBC, while Cholewka et al. [56], focusing on the spinal region of Th5/Th6-L5/S1, verified whether PBC improves thermal diagnostics in spinal diseases in a manner comparable to WBC. Cryotherapy (cryostimulation) is a physical procedure that exposes the body to low or extremely low temperatures. ...
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In recent years, the usefulness of infrared thermography (IRT) as a valuable supplementary imaging method in medical diagnostics, as well as for assessing the effects of the treatment of musculoskeletal injuries, has been increasingly confirmed. At the same time, great importance is attached to the standards of thermographic research, the fulfillment of which determines the correct methodology and interpretation of the results. This article discusses the medical applications of infrared thermography in musculoskeletal system diseases, with particular emphasis on its usefulness in assessing the therapeutic effects of physical treatments used in rehabilitation. The literature from the last decade that is available in the Medline and Web of Science databases has been reviewed. Among the physiotherapeutic methods used, the following were selected that directly affect the musculoskeletal system: cryotherapy, laser therapy, electrotherapy, diathermy, and massage. The article summarizes all the guidelines and recommendations for IR imaging in medicine and rehabilitation.
... The application of cryotherapy is quite diverse. Local cryotherapy can be used to destroy pathological tissues [2] whereas the same method can also be used for cryostimulation [3] with certain changes in the operating parameters. Whole body cryostimulation is another aspect of cryotherapy which is used in the treatment of rheumatic and inflammatory diseases such as rheumatoid arthritis, fibromyalgia, and ankylosing spondylitis as well as multiple sclerosis [4,5]. ...
... Quantity of agarose powder and water is selected in such a way that 0.6 w/v concentration can be ensured in gel because it resembles the property of dermis [11]. The cuboid container has a dimension of 100 100 70 mm 3 . Continuous spray technique is used to spray liquid nitrogen on the gel for 120 s followed by a thawing duration of 130 s. ...
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Cryospray is a process of destructing cancerous lesions occurring on the skin. Cryogen is sprayed on the affected area and ablation is achieved through rapid freezing of the cell. Metabolic heat generation, blood perfusion and thermal properties of tissue affect the heat sink in the skin. However, these terms are neglected in in-vitro experiments because they are performed on the tissue phantom. So, the outcomes of such studies will only provide direction to dermatologist but cannot be used in clinical applications. Hence, in-vivo thermal analysis must be conducted in order to obtain precise values before proceeding for clinical application. Present study is an attempt to explore the difference between in-vivo and in-vitro experiments. An in-vivo experiment is performed on healthy male rats (Charles Foster rats) weighing about 150-200 g while the in-vitro experiment is performed on tissue phantom. Single freeze-thaw cycle (freezing 120 s and thawing 130 s) with a spraying distance of 18 mm is selected for both the experiments. Non-invasive thermal imaging technique is used to record the temperature profile on the surface. Cryoablation beneath the surface is estimated through thermocouples. A comparative study between customised multihole nozzle (MHN) and commercial single hole nozzle (SHN) is also conducted to analyze the impact of number of holes on cryoablation in in-vivo conditions. Data extracted through thermocouples advocates that biological factors have negligible impact on cryoablation. However, histopathological results suggest that in-vivo necrotic zone is larger than the in-vitro necrotic zone. Natural thawing is responsible for such behavior. The area of cryoablation on the surface of rat skin is 50 % larger when cryogen is sprayed through MHN as compared to SHN.
... Thermotherapy is a field of physical medicine in which we introduce thermal energy into the body during physical therapy treatments [1][2][3][4][5][6][7][8]. The body's responses are systemic and organ reactions are of an adaptive nature, i.e. the occurrence of a thermoregulatory reaction connected with the regulation of blood supply, resulting in the tension of the vegetative system [9]. ...
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The aim of this study is to provide the thermal imaging assessment of local and general surface temperature changes after short-wave diathermy treatment. The study group consisted of 26 women aged 19–24. The correct functioning of the thermoregulation system was determined by means of cold pressor and orthostatic tests. The subjects underwent short-wave diathermy treatment in the area of the right knee joint, and the body’s response was determined by thermovision using a ThermaCAM P640 thermal imaging camera manufactured by FLIR. Curves were recorded in a digital form (images with a resolution of 640 × 480 pixels) and analyzed with ThermaCAM ReporterTM software. In people with a properly functioning thermoregulation system, the short-wave diathermy treatment statistically significantly increased the body surface temperature on the posterior surface of the knee joint. On the front side, the surface temperature decreased. There were no changes in surface temperature in the other areas of the body studied. The results of thermal imaging studies confirmed the local nature of the action of short-wave diathermy. The recommendation to use a physical procedure should be preceded by an assessment of the body’s thermoregulation system level of function. Reactions to the prescribed physical treatment may be different in people with a disturbed autonomic system.
... WBC-whole body cryotherapy (WBC) use the stimulating effect of extremely low temperatures (below − 100 • C) applied to the body for a period of about 3 min [2,3,6,12]. So far, WBC procedures have been commonly used in the treatment of rheumatic and inflammatory diseases such as rheumatoid arthritis [7], fibromyalgia [9,19], and ankylosing spondylitis [21,22] as well as multiple sclerosis [15], and sport medicine [18] Currently WBC is used more and more frequently as a wellness method in healthy subjects, to help maintain good health [23,24]. ...
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Introduction The aim of the paper was to evaluate changes in selected skin parameters (hydration, sebum level and pH of the skin) after whole-body cryotherapy (WBC). Material and Methods The study encompassed of 16 individuals (8 men and 8 women), who participated in 15 WBC sessions. There were 4 measurements of skin parameters performed in the following way: prior to the first cryotherapy session, directly after the first session, after the 15th session, and after 3 weeks from the moment when the therapy was discontinued. Results No significant differences were observed for hydration and skin pH. Sebum level significantly decreased after 2nd cryotherapy session. Conclusion Whole-body cryotherapy seems to be safe for skin.
... Cryotherapy used in medicine and cryostimulation used in biological regeneration is a short-time (2-3 min) treatment using temperatures below − 100 • C. Depending on the indications, local therapy is performed on a selected part of the body, and systemic therapy (WBC -Whole Body Cryotherapy), when the patient is in the cryogenic chamber [1,2]. The body's response to the effects of low ambient temperature is initiating a series of thermoregulatory reactions preventing the reduction of the temperature of the organism. ...
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Introduction Systemic cryotherapy is a popular treatment involving a short stay in a cryogenic chamber at a temperature below -100 ° C. This leads to a number of physiological reactions, some of them also observed in the skin. The aim of the study was to analyze the effect of a single cryogenic treatment on selected skin characteristics (skin pH, level of hydration and TEWL – Transepidermal Water Loss) in young, healthy people. Materials and methods Skin characteristics in 77 young people (23.63 ± 1.36 years) were assessed. In the study, 43 women and 33 men who took part in a one-time treatment (-120°C) lasting 3 minutes. Measurements were made on the forearm skin and (in men) on the face twice: before and immediately after the procedure. Results: Initial differences in hydration of the stratum corneum and TEWL were observed between the group of women and men. After one treatment, the examined characteristics of the forearm skin did not change, and an unfavorable increase in TEWL in men was indicated in the facial area. Conclusions A single stay in the cryogenic chamber, while maintaining the correct methodology of the treatment, is safe for the skin. The changes taking place depend on the body surface area tested, which indicates that the skin on the limbs and on the face reacts differently to the cryogenic stimulus.
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Background: Local cryotherapy (LC) is one of the physiotherapeutic methods used in the conservative treatment of lateral epicondylitis (LE). The aim of the study was to verify the direct effect of a single LC procedure on the clinical symptoms of lateral epicondylitis enthesopathy (pain, pain free grip, PFG) and its effect on the bioelectrical properties of the wrist extensor muscles at rest, on maximal contraction and isometric contraction during fatigue. Methods: The study group was 28 men (35.4 ± 6.13 years) with confirmed unilateral epicondylitis. The performed procedures included the assessment of pain (visual analogue scale, VAS), PFG and ARMS (root-mean-square amplitude) and mean frequencies (MNF) of the sEMG signal before (T0) and after (T1) LC on the side with enthesopathy (ECRE) and without enthesopathy (ECRN/E). Results: There was an increase in the ARMS values of the signals recorded during rest and MVC from the ECR muscles both with and without enthesopathy (p = 0.0001, p = 0.006), an increased PFG after LC only on the side with LE (p < 0.0001) and decreased pain (p < 0.0001). During isometric fatigue contraction, a higher ARMS on both the ECRE side (p < 0.0001) and the ECRN/E side (p < 0.0001) was observed after LC treatment, and a lower MNF was observed on both the ECRN/E side (p < 0.0001) and the ECRE side (p < 0.0001) after LC. Conclusions: LC reduces the pain and increases PFG and muscle excitation expressed by ARMS and seems to delay muscle fatigue.
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Aging causes oxidative stress, endothelial dysfunction and a reduction in the bioavailability of nitric oxide. The study aim was to determine whether, as a result of repeated whole-body exposure to cryogenic temperature (3 min −130 °C), there is an increase of inducible nitric oxide synthase (iNOS) concentration in senior subjects (59 ± 6 years), and if this effect is stronger in athletes. In 10 long-distance runners (RUN) and 10 untraining (UTR) men, 24 whole-body cryotherapy (WBC) procedures were performed. Prior to WBC, after 12th and 24th treatments and 7 days later, the concentration of iNOS, asymmetric dimethylarginine (ADMA), 3-nitrotyrosine (3-NTR), homocysteine (HCY), C-reactive protein (CRP) and interleukins such as: IL-6, IL-1β, IL-10 were measured. In the RUN and UTR groups, after 24 WBC, iNOS concentration was found to be comparable and significantly higher (F = 5.95, p < 0.01) (large clinical effect size) compared to before 1st WBC and after 12th WBC sessions. There were no changes in the concentration of the remaining markers as a result of WBC (p > 0.05). As a result of applying 24 WBC treatments, using the every-other-day model, iNOS concentration increased in the group of older men, regardless of their physical activity level. Along with this increase, there were no changes in nitro-oxidative stress or inflammation marker levels.
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Introduction. Whole body cryotherapy is becoming a more and more popular form of therapy used by people of all ages. Understanding the organism’s response to short exposure to extremely low temperatures can contribute to the safety of treatments. The aim of the study was to assess the influence of a series of whole body cryotherapy with kinesiotherapy on the reaction of cardiorespiratory system of patients at different ages and the analysis of the occurrence of adverse reactions under the influence of cryotherapy. Materials and Methods. The study included 36 patients aged 32-70 divided into two age groups. Before and after the first and after the tenth treatments, blood pressure, heart rate, respiratory rate per minute and a match test were made. A questionnaire regarding adverse effects related to the stay in the cryochamber was also conducted. Results. After the first cryotherapy with kinesitherapy in the younger group (p = 0.005) and the older one (p = 0.03) the diastolic pressure was decreased, and after a series of treatments in the older group, also the systolic blood pressure decreased (p = 0.004). There were no changes in other parameters of the circulatory and respiratory systems. After the stay in the cryochamber, the patients most frequently reported discomfort associated with staying in a small room (7 people) and during breathing (5 people). Conclusions. Systemic cryotherapy with kinesitherapy can cause adaptive changes associated with lowering blood pressure and do not significantly affect the respiratory system. Responses of the cardiorespiratory system to the above treatments are similar in the elderly and younger. Whole body cryotherapy can cause adverse effects, but they are not very serious and do not eliminate patients from participating in the therapy. Older age is not associated with a higher incidence of adverse changes.
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Introduction: Whole body cryotherapy with kinesitherapy can potentially improve the everyday functioning of patients. The aim of the study was to assess the influence of whole body cryotherapy on the pain perception and functional efficiency of patients with pain syndromes in a different age and to assess the occurrence of adverse effects during treatment. Material and Methods: The study involved 40 patients with pain syndromes aged between 24 and 73 divided into 2 groups: group I (younger) up to 55 years old and group II (older) over 55 years old. The subjects underwent a series of 10 treatments of cryotherapy. The following tests were used to assess functional performance and pain: FTSST (Five Times Sit- to- Stand Test), TUG (Timed Up and Go Test), VAS (Visual Analogue Scale) Modified Pain Questionnaire according to Laitinen. Results: In the group I: the intensity of pain on the VAS scale was reduced after the first treatment (p=0.003); after a series of 10 treatments improvement in pain scales (VAS: p = 0.001, Laitinen Questionnaire: p = 0.002) and functional tests (TUG: p = 0.002, FTSST: p <0.001) was obtained. In the group II: improvement in pain perception at VAS scale after first treatment (p = 0.01) was achieved and after a series of 10 treatments, functional improvement (TUG: p = 0.006, FTSST: p <0.001) and in results in pain scales (VAS: p = 0.04, Laitinen questionnaire: p = 0.05) was obtained. Conclusions: Whole body cryotherapy with kinesitherapy contribute to the reduction of pain after only a single exposure, and after a series of 10 treatments occur to improve performance of functional tests. Cryotherapy may be associated with adverse effects, which are relatively rare, disappear quickly and do not endanger the life or health of patients. The age of patients has no significant effect on the final outcomes of therapy and on the occurrence of adverse effects.
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The present study investigated whether whole-body cryotherapy (WBC) procedures could potentially have more beneficial effects on index of BASDAI and BASFI, pain intensity, and spine mobility parameters: Ott test, modified Schober test, chest expansion in ankylosing spondylitis (AS) patients, than kinesiotherapy procedures used separately. AS patients were exposed to a cycle of WBC procedures lasting 3 minutes a day, with a subsequent 60 minutes of kinesiotherapy or 60 minutes of kinesiotherapy only, for 10 consecutive days excluding weekend. After the completion of the cycle of WBC procedures with subsequent kinesiotherapy in the AS patients, BASDAI index decreased about 40% in comparison with the input value, whereas in the group of patients who received only kinesiotherapy it decreased only about 15% in comparison with the input value. After the completion of the treatment in theWBC group, BASFI index decreased about 30% in comparison with the input value, whereas in the kinesiotherapy group it only decreased about 16% in comparison with the input value.The important conclusion was that, inWBC group with subsequent kinesiotherapy, we observed on average about twice better results than in the group treated only by kinesiotherapy.
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Most physical treatments have thermal effects. Effect of heat on the body is not always uniform and depends on the treated body surface, the intensity of the stimulus, the stimulus duration, changes in the intensity of the stimulus and the physical environment. Thermovision is a method that allows for precise determination of the temperature distribution of the tested body surface. The aim of the study was to evaluate the effect of sequence of execution of infrared irradiation combined with visible light, for simplicity called further IR and diadynamic currents (called further DD) on the distribution of skin surface temperature. We also evaluated whether the order of execution of physical treatments affects the consensual reaction and temperature variations depending on sex and body mass index. The study involved 28 volunteers—16 women and 12 men aged 19–28 years. The treatments were performed on the front of right thigh in two sequences—IR–DD and DD–IR. For measuring the temperature distribution, there was thermovision used. In each sequence, there were five images captured with the use of FLIR T335 camera. The significance of changes in skin temperature was rated with Student’s t test for dependent samples, whereas the dependence on the treatments sequence and sexual differentiation was analyzed with the use of test for independent samples, and the correlations were evaluated by determining the Pearson’s r linear correlation coefficient. In the assessment of statistical significance, the critical threshold α = 0.05 was used. Regardless of the treatments sequence, the average surface temperature of the right thigh after IR radiation increased by more than 4 °C. However, there were no significant temperature changes observed after the treatment with diadynamic currents. More dynamic changes in the average temperature values were stated in the sequence DD–IR, as 30 min after the second treatment, the temperature was higher as compared to the initial value by 1 °C. Statistically significant sex-dependent differences occurred only after infrared radiation.
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In physiotherapy, various physical agents are applied in order to combat pain, inflammation and to maximize the movement possibility of the treated person. Many physical modalities influence the body temperature; therefore, the therapy results may be directly visualized in terms of thermovision. The therapeutic doses and duration of treatment should be personalized according to the patient needs, feelings during the therapy, and the observed therapeutic results. Thermal imaging allows to visualize the skin temperature, as well as the temperature changes due to the physiotherapeutic procedures, and it is a helpful tool for therapy outcomes monitoring. In this paper, we analyzed the body response to therapeutic cooling (local cryotherapy) and heating (red and near infrared irradiation with special lamp) in two groups of volunteers: students (mean age 20.4) and older people (mean age 68.7). The physical agents were applied on the right thigh area. The mean temperatures in this areas were determined from thermal images before treatment, just after, and then 15 and 30 min after the therapy. The new MATLAB-based software was developed for image processing and analysis in selected regions of interests (ROI). The analysis revealed that in the case of heating the mean temperature returns to the initial one after 30 min in younger persons, whereas in elderly persons after 30 min it was still higher than that before the treatment. In the case of cooling, in older people the decrease of the mean temperature was smaller than in juniors. The analysis of temperature distribution in ROI in the untreated left leg revealed also that there is a systemic response to the physical agents, which was more visible after the application of cryotherapy. The thermovision allowed to find out the different responses to the physiotherapy in younger and older persons, what should be taken into account by therapy planning.
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The aim of the document is inform those either using or considering using infrared thermal imaging mass screening systems for fever detection of recent developments surrounding this concept. The recent publicity surrounding the Swine influenza outbreak ( H1N1 strain of influenza type A) has spurred interest in the use of this technology. However, the publicity has also sparked a debate concerning the effectiveness of using infrared thermal imaging for this purpose. It is important to note that this document is not intended to answer the question as to the reliability of infrared thermal imaging for fever screening. Clearly opinions will vary depending on the interests and experience of the reader. Nevertheless, the European Association of Thermology (EAT) feel that there are some basic facts that need to be taken into account when either using and/or designing specialized infrared thermal imaging installations for mass screening of human subjects.
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Exposure to the extreme low temperatures, ranging between −60 and −140 °C, has many beneficial effects on the human body what is exploited for example in sport medicine, for treatment of locomotory system diseases or even some psychiatric disorders. To insure the safe treatment in a cryochamber, careful planning of the procedure and proper qualification of patients, is required. Cardiovascular system, especially skin vasculature plays the major role of the body response to the extreme cold. The changes in skin blood flow are reflected in changes of the temperature distribution. Therefore, the thermal imaging, which allows to analyze the temperature distribution on the human body, may be successfully exploited to examine the influence of extremely low temperatures on the skin vascular system. The aim of this work was to examine the temperature, blood pressure, and heart rate changes after the whole body cryotherapy in healthy subjects to determine the safety conditions of the treatment. 480 healthy students of the Wrocław University School of Physical Education were divided into two groups (each 240 persons). All subjects were exposed for 1–3 min to the extremely low temperatures: −60, −100, −120, and −140 °C. In one group, the thermograms were recorded before and 5 and 30 min after the cryotherapy by means of ThermoVision A20 M thermal camera. In the other one, heart rate and blood pressure were measured before and 5 min after the cryotherapy. It was demonstrated that 3-min exposure in the cryochamber and the temperature −120 °C are the optimal and safe cryotherapy parameters.
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Background. The aim of the study was to evaluate the effectiveness of cryotherapy and physiotherapy regimens in patients with indications for use of these procedures in the knee joint region or knee joints. Material and methods. The study was performed in the Cracow Rehabilitation Centre in 2008. The study involved a group of 38 patients who underwent cryotherapy of the knee joint region. The patients were divided into two groups. Group 1 included patients who performed lower limb exercises immediately after the cryotherapy procedure, and patients in group 2 performed exercises 30 minutes following the cryotherapy procedure. Changes in thermograms were recorded in all patients. Results. Mean temperature in the affected knee joint before treatment was x=30.19°C in group 1 and 31.46°C in group 2. The differences between the study groups revealed in examination 2 were also not statistically significant. Examination 3 showed significant differences. The mean value of the temperature range was x=28.54°C in Group 1 and 23.38°C in Group 2. The last examination, performed 30 minutes after the completion of the cryogenic therapy procedure, showed a mean temperature of the treated knee joint of x=28.99°C in Group 1 and x=29.43°C in Group 2. Conclusions. Tissue temperature in the knee joint region increased at a slower rate in patients who did not undergo kinesitherapy immediately after cryotherapy of that region.
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The skin temperature response to whole body cryotherapy for a group of volunteers (6 female and 24 male) age 41.2 ± 13.3 has been studied by quantitative infrared thermography. The group consisted of 22 patients suffered from low back pain (5 female and 17 male in age 47.1 ± 10.1) and 8 health young people (1 female and 7 male in age 25 ± 4.1). Lower lumbar regions (selected areas and temperature profiles) were taken into consideration. A marked decrease of skin temperature after whole body cryotherapy was observed. These studies showed that cold impact doubles the range of temperature inside the region of interest. For this reason the slight changes of skin temperature before cryotherapy became more visible after whole body cryotherapy. The statistical analysis of temperature parameters (mean, maximum and minimum temperature) derived from thermal imaging after cryotherapy confirmed the significant differences between healthy men and patients with low back pain. Thermal evaluation showed that whole body cryotherapy induced significant changes of local blood flow dependent on tissue, degenerative processes and inflammatory states. An enhancement of the skin temperature profile could therefore increase the diagnostic sensitivity of infrared imaging in patients suffering from back pain.
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Photodynamic diagnosis (PDD) as well as thermovision belong to the category of non-invasive optical diagnosis techniques. Among many different skin cancer diseases, basal cell carcinoma (BCC) is the most frequently occurring one (almost 95% of all skin tumours). In contrast, seborrhoeic keratosis represents almost 70% of benign skin tumours. In this paper we present infrared thermography as an additional method, combined with PDD, to show the differentiation between these two skin mutations. The photodynamic diagnosis studies were performed by using the autofluorescence diagnosis system Xillix Onco. As an additional non-invasive diagnosis technique, thermovision studies were performed. Thermal imaging was done by using a Thermovision Camera A40M with a sensitivity of 0.07K. The thermograms of the chosen areas were performed in a special room with a temperature of 22.5±1°C. All patients were treated in the Chair and Clinic of Internal Diseases, Angiology and Physical Medicine in Bytom. Thirteen skin lesions were studied: 9 diagnosed as basal cell carcinoma and 4 as seborrhoeic keratosis. All skin lesions were confirmed in histopathological examinations. The results of the studies revealed significant differences in skin thermal mapping between patients suffering from basal cell carcinoma and seborrhoeic keratosis. It appears that benign skin lesions are characterised by a lower mean temperature than the surrounding healthy skin. To the contrary, cancerous skin mutations appeared on the thermal map at a higher mean temperature. Thermal images for the chosen skin lesions and temperature parameters derived from the thermograms are contiguous with the photodynamic diagnosis results and may give some additional diagnostic information.