Contrast bath involves alternating immersion of body parts in hot and cold water to provide vascular exercise. It consists of 4 minutes in hot water (106°F) followed by 1 minute in cold water (50°F), repeated for 20-30 minutes. The hot water should be 40-45°C while cold water is 10-18°C. It causes alternating vasodilation and vasoconstriction, mimicking a pumping effect and increasing local blood flow while reducing edema. Indications include musculoskeletal injuries and peripheral vascular disorders, while contraindications include loss of sensation and various vascular diseases. Research shows contrast bath and other contrast therapies can improve blood flow, muscle tone, and pain threshold.

1. CONTRAST BATH

2. • Contrast bath is an alternating immersion of
body segments like hands and legs in warm
and cold water so as to produce alternating
vasodilation and vasoconstriction in the
peripheral blood vessels to provide vascular
exercise to the part.
• Traditionally contrast bath consists of
alternating immersion of the body segment in
hot (106°F ) and cold (50°F ) water typically 4
minutes of hot followed by 1 minute of cold.
Treatment time generally lasts about a period
of 20 to 30 minutes.

5. TECHNIQUE OF APPLICATION
• The temperature of the hot water should be
40 to 45 degree celsius and cold water around
10 to 18 degree celsius. while instructing the
patient for home programme explain for the
ease of understanding that the hot water
should be as hot as can be tolerated on the
immersed part and cold water should feel ice
cold to the skin without any discomfort on
prolonged immersion.

7. • Stationary water immersion, tandem whirlpools, or
moist heat packs and ice packs can be used for this
• The treatment commences with hot water
• The part to be treated is first immersed in hot water for
6 to 10 minutes at a stretch
• If the water feels too hot or not warm enough hot
water can added or diluted according
• After soaking in warm water the part is transferred to
the cold tub and allowed to soak 1 minute
• The part is then transferred to warm water and allowed
to soak for 4 minutes
• The cyclic immersion in hot and cold water in the ratio
of 4:1 is continued for 30 minutes or for
• 4 0r 5 cycles . min treatment time is 20 minutes

8. • The treatment cycle ratio of 4:1 is variable
depending upon the underlying disorder in acute
conditions the ratio maybe be changed to 2:1
• Alternating between hot and cold water is
thought to trigger a vascular pumping action
caused by vasodilation ( hot water )and
vasoconstriction (coldwater ) does stimulating
local circulation in the treated extremity .
• In chronic conditions with indurate oedema the
contrast bath treatment should commence and
end with hot water soak and in acute conditions
with significant effusion treatment should be
terminated with cold soak .

9. PHYSIOLOGICAL EFFECTS
• Alternating immersion in hot and cold water
causes alternating episodes of
vasoconstriction and vasodilation which
mimics a pumping effect in the treated part
and does increasing the local blood flow.
• Oedema is decreased
• Reduction of necrotic cells at the cellular level.

10. LIMITATIONS OF CONTRAST BATH
• Contrast baths probably cause only a superficial capillary
response resulting in inability of the larger deep blood
vessels to constrict and dilate in response to superficial
heating.
• lymphatic capillaries contain only epithelial cells and are
unable to change sizes, so they are unable to vasodilate
or vasoconstrict the solid matter in edema must be
removed by the lymphatic system and lymph vessels are
not affected by temperature. Only gravity, muscle
contractions, or external pressure moves matter through
the lymph system.

11. INDICATIONS
Contrast bath is indicated for any conditions that
needs stimulation of peripheral circulation and a
Choice of modality for acute and chronic
musculoskeletal injuries like :
• Sprain
• Strain
• post fracture stiffness
• peripheral vascular disorders like lymph oedema
vasculitis, varicose veins.
• Increasing joint ROM
• Pain reduction

12. CONTRAINDICATIONS
• Loss of thermal sensation
• Hypersensitivity to cold
• Arteriosclerosis in advanced stage with
chronic insufficiency of blood supply
• Arteriosclerotic endarteritis
• Patient with microvascular disease secondary
to diabetes
• Buergers disease ( Pt may not be able to tolerate the rapid
change in temperature depending upon the severity of the disease)
• Deep vein thrombosis

13. PRECAUTIONS
• A Neoprene toe cap may be used to decrease
the discomfort associated with cold
Immersions.
• The combination of increased circulation and
placement of the extremity in a gravity
dependent position tends to increase
Oedema, so inspecting the treated part post
session to assess whether the treatment has
not actually increased the amount of
oedema.

14. RECENT RESEARCHES
• EFFECTS OF CONTRAST THERAPY USING INFRARED AND CRYOTHERAPY
AS COMPARED WITH CONTRAST BATH THERAPY ON BLOOD FLOW,
MUSCLE TONE, AND PAIN THRESHOLD IN YOUNG HEALTHY ADULTS :
The aim of this research was to compare the effects of contrast bath
therapy (CBT) and contrast therapy (CT) using infrared (IR) and
cryotherapy (CR) on blood flow, muscle tone, and pain in the forearm. The
variables measured were blood flow, muscle tone, and pain before and
after intervention. Both types of CT produced fluctuations in the blood
flow (P<0.05). The pain threshold increased on both therapies; a
significant increase was noted with IR and CR (P<0.05) therapies. Muscle
elasticity was induced and stiffness was reduced with all therapies
(P<0.05). IR and CR resulted in significant changes (P<0.05) in blood flow
as compared with the CBT. The results of this study suggest that CT using
IR and CR is more effective in improving blood flow than CBT and has the
same effect on muscle tone and pain. Nonetheless, using IR and CR is
efficient with regard to mobility and maintaining temperature; therefore,
it would be convenient to use these in clinical settings. Further studies
involving CT should be carried out to determine whether our findings are
clinically relevant.

15. • ACUTE EFFECTS OF CONTRAST BATH ON SYMPATHETIC SKIN
RESPONSE IN PATIENTS WITH POSTSTROKE COMPLEX
REGIONAL PAIN SYNDROME
Each group consisted of 20 participants. No significant difference
was detected in stroke duration, aetiology, and Brunnstrom stages
between groups. Elbow spasticity level was significantly higher in
CRPS group (p = .034). SSR amplitudes of plegic hands were
significantly decreased after CB in CRPS and control groups (p =
.0002, p = .013 respectively). Also, CB reduced the SSR amplitude of
healty side in CRPS group (p = .003). There was no statistically
significant change in SSR latency or percentage changes of SSR
amplitude and latency after CB in both groups. CB leads to a
significant reduction in sympathetic activity of plegic side of stroke
patients. Also, CB to the plegic side has an inhibitory effect on
sympathetic activity of healty side in poststroke CRPS.

16. • VARIATION OF SKIN TEMPERATURE DURING AND AFTER
CONTRAST BATH THERAPY :
Twenty volunteers were randomly separated into two groups of 10
subjects and submitted either protocol A (PA), beginning therapy with
4 minutes/immersion in warm water and ending with 1 minute in cold
water or protocol B (PB), beginning with 1 minute/immersion in cold
water and ending with 4 minutes in warm water, each protocol was
performed four times 20 minutes of total treatment time. Skin
temperature was measured with an infrared thermometer above the
anterolateral ankle skin before, during and after CWB. Skin
temperature measurements were taken 3, 6, 9 and 12 minutes after
CWB to measure the time to return to resting body temperature (RBT)
Significant variations in the skin temperature were obtained in both
protocols. PA showed a greater delay in returning to the resting local
temperature after the contrast bath as compared with PB or control
group implying treatment should terminate depending upon factors of
blood circulation or muscle repair. Further studies should be
conducted to evaluate CWT in specific populations where
inflammation or injury has already occurred.

17. • RESULTS OF REST, SOFT SOLE SLIPPERS, CONTRAST BATH
AND PLANTAR STRETCHES PHYSIOTHERAPY IN CASE OF
PLANTAR FASCIITIS :
To study the effectiveness of Rest, exercises (Plantar fascia stretching
technique), soft sole slippers and contrast bath with in patients with
plantar fasciitis in fresh as well as recurrent cases. The Present study
concluded that 2-weeks treatment program performed on subjects
with plantar fasciitis demonstrated that both contrast bath and plantar
fascia stretching exercises combined with rest & soft sole slippers were
effective in reducing pain intensity and improving functional activities.
There are conflicting results in the short and long term, probably
because the exact etiology of plantar fasciitis and the subjective
component of the pain do not allow a proper standardization of
results; therefore, it is difficult using this type of review to identify
which is actually the best treatment during various stages of plantar
fasciitis. So long terms follow up is required to support our conclusion.
But still this regimen is followed in all primary plantar fasciitis due to
reduced costs and the safety of the procedure.

18. • THE COMPARISON OF THE EFFECTS OF CONTRAST BATH ON CIRCULATION
OF CONTRALATERAL LOWER LIMB IN TYPE 2 DIABETIC AND HEALTHY
WOMEN
Contrast bath is a thermal agent that is used as alternative heat and cold
water on a target limb. Type 2 diabetes mellitus in long term leads to vascular
insufficiency. It seems that contrast bath is useful for patients with diabetes
mellitus due to the increase in blood flow and vascular pumping. The purpose
of this study is to investigate the effect(s) of contrast bath on circulation of
contralateral lower limb in women with type 2diabetes mellitus compared to
healthy subjects. The contrast bath protocol included the immersion of the
right foot in the warm bath (38-440C) for four minutes and then in the cold
bath (10-180C) for one minute. These processes were repeated five times as
the total duration of the intervention was 24 minutes. The treatment was
started and terminated with warm water. The dorsalis pedis pulse was
significantly higher at all times of the measurements except between
immediately post the contrast bath and after 10 minutes of applying it in the
diabetic group .The results of the skin temperature measurement
demonstrated incremental changes in the healthy and the diabetic groups.
The oral temperature at all times was not significantly different in the normal
and the diabetic groups (P > 0.05). The results of this study showed that
contrast bath can increase circulation in the contralateral limb. However, its
influence on superficial and deep blood flow is uncertain.

19. REFERENCES :
• Physical Agents in Rehabilitation An Evidence-Based Approach
to Practice - Michelle Cameron
• Michlovitz'S Modalities for Therapeutic Intervention
• Therapeutic Modalities in Rehabilitation - William E. Prentice
• Therapeutic modalities - Chad starkey