Contrast Bath in Physical Therapy

June 10, 2020
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The contrast bath can help improve circulation around your injured tissue. Contrast bath therapy is a Thermotherapy in which all or part of the body is immersed first in hot water, then in cold water, and this procedure of alternating hot and cold immersion is repeated several times.

Aim of Treatment

  • Decreased pain
  • Decreased swelling
  • Controlled inflammation
  • Improved mobility

How Contrast Bath Therapy Work

Such treatment causes considerable sensory stimulation due to the activation of cutaneous hot and cold receptors. The treatment helps to modulate pain, as the strong sensory stimulation does the same by the pain gate mechanism and it also reduces local edema by the alternate vasoconstriction and vasodilation. It also increases circulation in the deeper part of the body reflexively.

Methods of Application

Precaution-

  • Avoid use on areas with poor blood flow (such as on hands or feet that are always cold) or
  • Decreased sensation (areas that feel numb or tingling).

Procedure-

  • Select two baths of a suitable size depending upon the size of the limb.
  • Fill one bath with hot water maintained at a temperature of 40-45°C and the other with cold water maintained at a temperature of 15°C.
  • Undress the part to be treated and remove the jewelry and check the skin sensation for hot and cold as described for the wax treatment
  • Check any other contraindications to treatment as is done for heat and cold.
  • If treatment is for pain relief, it is usual to start and end the treatment with hot water, whereas if treatment is for reducing edema, start and end the treatment with immersion in cold water.
  • Place the limb in hot water for 3-4 minutes followed by immediate immersion in cold water for 1 minute.
  • Repeat the treatment cycles for 3-4 times,
  • Treatment duration- 15-25 minutes.

contrast bath therapy. timing of alternate hot and cold immersion

  • During treatment maintain the hot and cold water at a constant temperature.
  • Check the skin after treatment. The skin may show mild erythema after the treatment.  

Risk of contrast bath therapy

  • Burns from water that is too hot
  • Skin damage from water that is too cold

Evidence of Physiological effects

A growing body of research has been built looking at the physiological effects of contrast therapy.

Changes in arterial blood flow in response to contrast therapy
have been measured by a number of researchers using a variety of techniques.

Study
author(s)		 Number of
participants
in
study		 Physiological
process
measured		 Intervention time
ratio (heat
to cold		 Total
duration
of
intervention		 Effect produced
Myrer et
al.
(1997)		 9 men,
7
women

 Subcutaneous and
intramuscular
muscle temperatures		 1:1 (5
minutes
heat and
cold
repeated
twice)		 20
minutes		 Cutaneous
circulation only
affected
Coffey et
al.
(2004)		 14 men Blood lactate
concentration and
blood pH		 2:1 15
minutes		 Lowers post-exercise
lactate
Fiscus et
al.
(2005)		 24 men Arterial blood flow
in the lower leg		 4:1 20
minutes		 Unclear
Morton.
(2006)

 6 men,
5 women		 Blood lactate
concentration		 4:1 30
minutes		 Hastens reduction of
plasma lactate decrease after
exercise
Hamlin
MJ.
(2007)

 20 men Blood lactate
concentration and
repeated sprint
performance		 3:1 12
minutes		 Decreases blood
lactate concentration;
little effect on
subsequent repetitive
sprint performance (1
hour later)
Vaile JM
et al.
(2007)

 Athlete
s: 4
male, 9
female		 Creatine kinase
concentration,
perceived pain,
thigh volume,
isometric squat
strength and
weighted jump
squat performance		 2:1 15
minutes		 Smaller reduction
and faster restoration
of strength and
power measured by
isometric force and
jump squat
performance. Thigh
volume was
significantly less.
No significant
difference was found
in perceived pain and
creatine kinase levels
French et
al.
(2008)

 26 men Limb girth (midthigh and mid-calf),
range of motion,
lower body power,
speed and agility,
whole body
strength, soreness
(using a visual
analogue scale)
and serum creatine
kinase and
myoglobin levels		 3:1 Not
disclosed		 Creatine kinase and
myoglobin levels
were elevated;
soreness fell
transiently and midthigh girth increased
no other significant
recovery effects
noted

Indications of Contrast Bath

  • Post traumatic swelling.
  • Pain due to swelling.
  • Chronic inflammation.

Contraindications

  • Advanced peripheral vascular disease.
  • Arterial insufficiency.
  • Diabetes mellitus.

Reference-

1)https://www.ncor.org.uk/wp-content/uploads/2012/10/Contrast-bathing-a-brief-summary-of-the-evidence.pdf

2)Electrotherapy Simplified by Basant Kumar Nanda