In this episode of the No Plateau podcast, host Henry Hoffman sits down with physiatrist and researcher Dr. Paul Winston to talk about cryoneurolysis, an emerging treatment that is gaining attention in neurorehabilitation.

Dr. Winston breaks down how this minimally invasive technique works and why it is generating excitement among clinicians treating spasticity. Using a probe that delivers extremely cold temperatures, around −88°C, through gases like nitrous oxide, clinicians create a small “ice ball” around targeted peripheral nerves. This controlled freezing temporarily interrupts the nerve signals that drive muscle overactivity. The key advantage is that the nerve’s structure stays intact, allowing it to regenerate over time and creating a valuable window for rehabilitation and functional recovery.

Henry and Dr. Winston also explore how cryoneurolysis compares with more familiar treatments like botulinum toxin injections, nerve blocks, and surgical approaches. While some treatments chemically block or damage nerve signaling, cryoneurolysis uses a physical process that allows nerves to recover gradually.

Dr. Winston shares stories that will stick with you, the husband grasping his wife's hand for the first time in years, the 12-year-old boy applying his own deodorant, the patient who threw away his AFO and now runs through the neighborhood. These aren't just clinical successes; they're reminders of why we do this work. The conversation also highlights how collaboration between physicians, occupational therapists, and physical therapists can help patients make the most of this recovery window.

Listen to the full episode to learn how cryoneurolysis may reshape the future of spasticity treatment and what it could mean for your clinical practice or rehabilitation journey.

In This Episode

Podcast disclaimer (00:09)

Introduction to Dr. Paul Winston (01:21)

From dance to rehab (02:44)

How cryoneurolysis differs from cryotherapy (05:35)

How cryoneurolysis became part of Dr. Winston’s practice (09:11)

The first cryoneurolysis patient: eureka moment that changed everything (13:13)

Anatomy of a nerve: what actually happens during cryo (16:28)

Using ultrasound and electrical stimulation to target nerves (23:30)

Sensory vs motor nerves in cryoneurolysis treatment (25:58)

What spasticity really is beyond textbook definitions (30:02)

Comparing common spasticity interventions: Botox, phenol, and cryoneurolysis (33:44)

Choosing cryo vs Botox (38:35)

Toxin vs cryo: comparing mechanisms and applications (39:26)

How Botox works (41:33)

Contraindications and potential side effects of cryoneurolysis (43:21)

How therapists should use cryoneurolysis in rehab (50:01)

Real patient outcomes and functional improvements (56:01)

The future of cryoneurolysis in rehabilitation (01:00:53)

Understanding reducible deformity vs contracture (01:05:38)

Where clinicians can learn more about cryoneurolysis (01:07:56)

Our Guest

Dr. Paul Winston, MD

Dr. Paul Winston is a Canadian physiatrist and Clinical Associate Professor at the University of British Columbia specializing in neurological rehabilitation and spasticity management. Originally trained as a dancer at Canada’s National Ballet School, he brings a unique perspective on movement to rehabilitation medicine. He is widely recognized for advancing cryoneurolysis and is a co-founder of the Canadian Advances in Neuro Orthopedics for Spasticity Consortium. His work focuses on improving movement and quality of life for people living with neurological disabilities.

Resources & Links

Dr. Paul Winston on LinkedIn

Henry Hoffman on LinkedIn

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