Although the details of Ake-Salvacion's death last week are not clear yet
, advocates of cryotherapy — which involves short exposure to very cold temperatures — say the treatment is safe when used correctly. For example, cryotherapy centers generally do not allow people, even employees such as Ake-Salvacion, to go into the machines without supervision.
Ake-Salvacion's death may highlight the real risks of cryotherapy and also raise questions about whether it has real benefits. In a statement released by Ake-Salvacion's employer, Rejuvenice, the company said, "We firmly believe in whole-body cryotherapy treatments for pain management, athletic recovery, detoxification and a variety of other ailments. Millions of treatments have been given safely all over the world for more than 20 years."
Advocates say it is no more painful, and is more effective, than the standard ice bath that many athletes dip themselves into after a workout. However, researchers say it is too soon to say whether cryotherapy is harmful, and whether it is any better at alleviating muscle and joint pain than ice.
Cryotherapy generally involves stepping into a cylindrical tank (the head stays out of the tank) or a sauna-like chamber that pumps air at least as cold as anything you would find in Antarctica (between -166 and -319 degrees Fahreinheit). The treatment only lasts two to three minutes, just enough time to chill the skin without changing internal body temperature. Centers require customers to wear gloves and booties to protect from frostbite.
"It is like an accelerated air conditioner blowing on your body," said Sal Buscema, managing partner at Elite Total Body Cryotherapy in Wayne, New Jersey. "It's not unbearable but I could tell you that for anybody that has been an athlete and has been in an ice bath, it is (comfortable) compared to submerging your body in a water bath," added Buscema, who experienced the ice bath treatment when he played college football and is now a regular practitioner of cryotherapy.
The chilling sensation of cryotherapy does not last, Buscema said. By the time most customers are out of the cryotherapy tank and put their clothes back on, they feel normal, and many even feel more limber than before the treatment, he said.
Although there is no doubt that an ice bath can be a "potent analgesic," or pain killer, there have not been any studies directly comparing cryotherapy with ice water, said Joseph Costello, senior research associate in the department of sport and exercise science at University of Portsmouth in the United Kingdom.
"There is not enough evidence to say whether cryotherapy is effective or is not effective for athletic recovery and muscle soreness," said Costello, who recently co-wrote a review article
on the topic. He basically concluded that more research needs to be done.
There are inklings that cryotherapy could offer benefits. Studies have found lower levels of inflammatory molecules
, indicators of muscle soreness, in people after cryotherapy, and lower levels of creatine kinase
, which is linked to muscle injury.
However, the pain relief that ice baths (and possibly cryotherapy), offer could come at the cost of muscle mass. "To increase muscle size, you need muscle damage and repair; that's just the body's natural regeneration process. However, if cold water or (cryotherapy) blunt the inflammatory response, you may not get (muscle building)," Costello said.
That possibility, as well as the uncertainties around cryotherapy, have not stopped numerous elite athletes, from pro golfers
to professional soccer players and track and field stars
from subscribing to the therapy.
Although ice bath therapy has been practiced for millennia — ancient Greeks used cold dips to ease muscle pain — the practice of cryotherapy has only come about in the last few decades, Costello said. It was first a treatment for rheumatoid arthritis and cancers and precancerous skin lesions
. In the last decade it has taken off among both professional and recreational athletes around the world, and has become part of the health and wellness "salon culture," especially in the United States, Costello said.
Indeed, people seek out cryotherapy at centers around the United States for a number of reasons, including relief for muscle and joint pain, recovery from illness and fatigue, and to boost beauty. Cryotherapy is purported to reduce wrinkles. Customers at the KryoLife NYC centers in New York are interested in all three areas, said Joanna Fryben, CEO and co-founder of KryoLife.
Customers "walk out with a smile on their face," Fryben said, adding that they feel invigorated and very happy.
As for the tragic story of Ake-Salvacion, Fryben said that could not happen at KryoLife because all therapy sessions are supervised, and customers are not allowed to stay in the machines for more than three minutes even if they want to. The temperature is also carefully determined based on customers' health conditions, including body fat and stress levels, Fryben said.
Despite the precautions of cryotherapy centers, there are still concerns because very little research has looked into the potential adverse effects of the treatment, Costello said. Several studies have reported frostbite, but most have not addressed the potential for other harm, he said.