Contrast baths involve alternating immersion of an area in hot and cold water to increase blood flow and decrease joint stiffness. The alternating temperatures cause vasodilation and vasoconstriction, pumping blood and removing edema. This treatment alleviates pain, stiffness, and edema by improving circulation, increasing immune cells, and suppressing pain. Contrast baths are used for injuries like sprains and arthritis of the hands, wrists, feet, ankles, elbows, and knees. The procedure involves soaking in warm water for periods, then cold water for shorter periods, totaling around 25 minutes.

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Hot and Cold Immersion / Contrast Bath
Contrast baths is a convenient, easy to apply thermal treatment modality in the treatment of
peripheral areas in physiotherapy clinics for over 70 years.
It is a method of application which involves soaking the area to be treated in alternating baths of
hot and cold water. Contrast baths combine alternating hot and cold water applications to increase
blood flow and to decrease joint stiffness.
Physiological mechanism
A hot bath produces vasodilation in our body, vasodilation is dilation or expansion of blood vessel
thereby increase in blood flow. Cold bath produces vasoconstriction, which is constriction of a
blood vessel resulting in decreased blood flow.
That means a hot bath increases the blood flow to the exposed body part and cold decreases the
blood flow. So, when the body part is exposed to alternate warm or cold temperatures, it produces
alternate vasodilatation and vasoconstriction resulting in a “pumping effect” to facilitate the
removal of edema.
Contrast bath can be used to alleviate pain, stiffness, and edema.
Benefits
 The alternating hot and cold dilates and contracts the blood vessels, bringing fresh blood
supply to the area being treated.
 The blood cells that fight infection, i.e. the white blood cells are increased in number and
activity. The waste products produced by enhanced activity of WBCs are removed by
improved circulation.
 The regular change in temperature also leads to considerable change in the sensory
stimulus. This strong sensory stimulus acts to suppress pain by means of pain gate
mechanism and accounts for suppression of pain.
 It can also significantly improve muscle recovery following exercise by reducing the levels
of blood lactate concentration.
Indications
 Infections, sprains, strains, bruises and arthritis are some of the more common conditions
that are greatly benefitted by this bath.
 Contrast baths are used to treat the hands, wrists, feet and ankles and can also be used for
the elbows and knees if the container is large enough.
Equipment Needed
 Two containers large enough to accommodate the area to be treated, i.e. hand or foot
 one container is filled with cold water of 10° to 18° C (50° to 56° F) and
 another one is filled with hot water 38° to 44° C (100° to 110° F).
 Two test tubes for hot & cold discrimination test prior to treatment.

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 Thermometer to check the temperature in the bath/tub.
Procedure
 Always begin with the warm water and end with the warm water.
 Place part in the warm water for 10 minutes
 move the part around through the full, pain-free range of motion.
 Remove and place immediately in cold water for 1 minute.
 There will be an initial short period of tingling until the part becomes accustomed to the
cold.
 Continue alternating parts in hot water for 4 minutes and cold water for 1 minute
 Keep adding ice and hot water as needed to maintain the proper water temperatures in
the two tubs.
 After the final cold or hot treatment, dry the part thoroughly.
 This treatment should be given once or twice daily.
In Summary, soak in
 Warm water for 10 Minutes
 Cold water for 1 Minute
 Warm water for 4 Minutes
 Cold water for 1 Minute
 Warm water for 4 Minutes
 Cold water for 1 Minute
 Warm water for 4 Minutes making a total time of 25 Minutes
General rules for a contrast bath are as follows.
 Always use a thermometer to check the bath temperature.
 Always treat a larger area than is injured. For example, a sprained ankle should have
the water nearly up to the mid foot.
 Always start with the hot water and end with the cold, except when treating arthritis, or
if the patient is menstruating, or if massage of the part is to follow the treatment. If any
of these three situations exist, the hot water should be used last.
Precautions
Open wounds: New granulation tissue is sensitive to heat, cold, and pressure and may not be able
to withstand heat or cold application. However, heat may enhance circulation to the area once the
wound is closed. Skin sensation must be intact to administer heat or cold.
Pregnancy: Heat may be beneficial; however, it should not be applied over a pregnant uterus as it
may increase the circulation to the fetus, and the effects of this have not been studied.

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Advanced age: If the patient has intact sensation and is reliable, then the application of heat or
cold may be indicated. However, if the patient has fragile skin that does not blanche under
pressure, they may not be able to adapt to the increased temperature from application of heat.
Menstruation: Heat applied to the lower back or over the pelvis of a female during menses may
increase menstrual flow. If she is prepared for this, then the application might be indicated
depending on the signs and symptoms of the physical therapy diagnosis.
Impaired cognitive ability: If a patient can communicate sensations of heat, cold, and pain in
some meaningful way, then they may have applied. However, these patients should be monitored
closely.
Previous experience with the physical agent: If a patient has had a poor response to the
application of a thermal agent in the past, they may be less receptive to trying it again. However, it
is important that the clinician educate the patient and explain the potential benefits of any modality
before it is applied.
Contraindications
1. Pregnancy (first trimester): Heat should not be applied directly over a pregnant uterus as
it may increase the circulation to the fetus and this has not been studied for safety in
humans.
2. Undressed or infected wounds: The infection must be cultured and treated first. The
wound must be covered to prevent cross contamination.
3. Pacemaker: If the pacemaker is a demand pacemaker, then only precautions are
necessary. Application of heat in patients with non-demand-type pacemakers may cause
undue stress on the cardiac musculature.
4. Metastasis: Heat applied directly over or proximal to a metastasis will increase circulation
to the area and may enhance the disease progression.
5. Fever: Heat applied to an area actively involved in the inflammatory process will result in
an increase in the circulation to that area and potentially increase edema.
6. Acute inflammation: Heat applied to an area actively involved in the inflammatory
process will result in an increase in the circulation to that area and potentially increase
edema.
7. Acute hemorrhage: Heat applied to an area actively involved in the inflammatory process
will result in an increase in the circulation to that area and potentially increase bleeding.
8. Peripheral vascular disease: Heat applied to an area with compromised ability to
maintain homeostasis may result in increased pain perception and other complications.
9. Lack of sensation: The safety of heat application relies on the ability of the patient to
report changes in sensation to prevent a burn.

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Presence of metal implants or jewelry: None
Operation of a mechanical traction unit: None