Contrast bathing (sometimes referred to as hot/cold immersion therapy) is a type of hydrotherapy that I find most people have not specifically heard of, but probably intuitively know about. A contrast bath is more or less exactly what it sounds like: submerging your body (or more commonly, a limb) into two contrasting high- and low-temperatures of water, one after the other.

Simple enough, but is there a catch? No! It is cheap, easy, and can be quite soothing. Contrast bathing may be helpful for enhancing circulation; lessening aches, pains, and stiffness; as well as helping to boost recovery times after a workout or athletic event.

 

 

 

From the outset, I do want to make it clear that this post is for information purposes only. If you choose to do this without me having explicitly given it to you to you as homecare –  you are doing so at your own risk and discretion.

 

I would also like to make note that there is not a lot of high quality research to support the use and effects of a contrast bath. And what research is out there has generally been done with athletes as the study focus. HOWEVER I think it is easy to overlook the lack of research and take some educated guesses as to what is really going on during this process.

The reason that I believe this to be the case is because contrast bathing is simply using hot and cold temperatures [of water] to stimulate tissues, joints, and organs. We already know what both hot and cold temperatures do on their own; this is backed by plenty of research. Not to mention that we have already talked about the differences within this post from April. It is armed with these facts that we can start to make educated guesses as to how combining the two in rapid succession will work.

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To streamline this: warmer temperatures will help to dilate blood vessels and loosen dense soft tissue, while colder temperatures will slightly constrict blood vessels (for more detailed information on heat vs cold, see the linked post from April that was mentioned above). Heat also has an analgesic effect on the area that it is applied. This means that it can alleviate pain and may help to relax the area. The cold, on the other hand, can soothe areas dealing with inflammation and provide the all important vascular flush.

 

The current thought process with most research in regards to contrast bathing, is that by alternating back and forth between the two temperatures you are replicating certain conditions present with both activity & recovery. Why would you want to do this? It is thought to not only increase the circulation to the area, but could greatly improve your healing times as a result. This can be particularly beneficial for joints and soft tissues.

Not to mention that all of this is being done while you are putting in virtually no effort at all. That is to say that a contrast bath is low impact, which can be especially beneficial when dealing with overuse injuries (such as plantar fasciitis, shin splints, or tennis elbow). That being said, there are still times when you would NOT want to use a contrast bath… (see below).

Contraindications

— Acute injuries (in that specific area that you are trying to perform the contrast bath)

— For infants & the elderly (vascular changes will impact these populations more)

— Problematic vascular conditions

— Blood pressure issues

— Heart disease

— Raynaud’s disease

— Diabetic neuropathy

— Sensation / nerve issues (in that specific area that you are trying to perform the contrast bath)

— Sensitivity to either hot or cold temperatures

— Metal pins, rods, or plates (present in that specific area)

— Malignant tumor

— Thrombophlebitis / embolism / blood clot

 

 

Image found via Google image search, and pulled from EuroStoneCraft

Required Items / Supplies / Equipment

The biggest decision you will have to make is deciding what the best container will be to hold the water. Hopefully this is obvious, but you will need two basins; one for holding the warmer water, and one for the colder water.

I am partial to using five gallon pales, but you could just as easily use: rubber / plastic storage containers, large tupperware containers, large pots, a bathtub (though you will need an additional one of the aforementioned containers [likely] for the colder water), or a dual-sided sink (if using your own kitchen sink, it is best practice to not have any dishes in there at the same time)!

→ Honestly, it is more about being creative with what you use to hold the water. If you are simply using this for your hands then maybe you don’t need a giant storage container or five gallon pale. If you are contrasting both of your lower legs at once, you obviously wouldn’t be able to use tupperware or a pot. You could say that size is important here; but again it is more about being creative.

Please also keep in mind that you will need to have some way of keeping the temperature constant, having a thermometer present is ideal, but not necessary (more on that shortly). This could mean having another (third) container with hot water that you can add whenever your warm water is cooling down. This could also mean the reverse of what was just said. For example, quite a few of my clients prefer to simply add ice to help keep the cooler water the desired temperature. A wiser solution is to do both of these things.

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It would also be smart to lay down a towel below the containers, as you will likely spill some water when transferring from one container to the other. In general though, you will not need a towel for drying off at the end. In fact it is smarter to let your body air dry after, so that it can naturally adapt to the environment again. Wiping this water away at the end may in fact result in undoing some of the contrasting that you just spent the last little while completing!

 

 

Image found via Google image search, and pulled from hbci[dot]com

Specific Temperatures

Most people want me to give them a specific number or parameters in regards to what temperature the hot one should be and which temperature the colder one should be. These can be helpful to know, but there is not much scientific basis to support them. I am still going to tell you, but the best guideline that I can give you is that there really only has to be a minimum of a 10° Celsius difference between the hot and cold water to obtain the positive / desired effect(s). Back when I was attending Grant MacEwan, the suggested temperature for the hot water was between 33 – 42º C (91 – 107º F); while colder water was between 8 – 20º C (46 – 68º F).

 

Going back to the 10° C difference, this can hypothetically mean that you could have hot water and then slightly cooler water than luke-warm water (as opposed to cold water) to gain the positive effects of the contrast bath. However I would not necessarily recommend going the minimum amount. It is much more difficult to maintain the temperatures at this point, because it is easier for it to dip lower than that 10° C difference (essentially wasting your time if you do not stay on top of keeping the temperatures constant).

This is why using further apart temperatures, as well as me using the terminology of hot and cold is beneficial. It is just easier for people to wrap their minds around, while also making it difficult to muck-up the execution. I must advise to you that you do not go above the high end, or below the low end of those temperatures. Common sense should dictate if something will burn you or not, but you would be surprised what I hear about people doing sometimes.

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No matter where you get your information, these parameters will fluctuate slightly. It is confusing, but you can sum it up as: wanting the heat to be up to as hot as is tolerable – (again) you obviously do not want to burn yourself. Whereas the cold you cannot really ever make too cold. It is still water after all; it is not like you are dipping your body in to liquid nitrogen. One more time: just try to use some common sense.

 

How-to / Method

The how-to with regards to contrast bathing is actually quite simple. In this example, we will use our left foot / ankle as the portion of the body that we are contrasting.

1. Fill one container with your desired temperature of hot water and the other with cold water (and potentially ice as well).

→ If using a thermometer, make note of these temperatures.

2. Submerge left foot and ankle in the hot water, about ¼ to ½ of the way up your lower leg / shin.

→ this amount of submersion is important to ensure that you are getting above and below the the specific area that you are trying to help heal. Say for example that you did not submerge enough above the ankle, you may not get the desired vascular flush from the area.
→ you are going to keep your foot in the hot water for 3-5 minutes. I personally shoot for that 4 minute sweet spot.
→ ensure that every now and then you wiggle your toes and move your ankle around a bit. This will help with “opening up” the area.

3. Switch your left foot from the hot water, and quickly (but safely) submerge it in to the cold water. try to ensure that roughly the same amount of your foot, ankle, and lower leg is covered by the water.

→ when you take your foot out of the warmer water, you are immediately switching your foot to being submerged into the cooler water.
→ you are going to keep your foot in the cold water for 30-60 seconds.
→ ensure that every few seconds you are wiggling your toes and moving your ankle around. This will help to keep the area active and stimulated, while not allowing it to become somewhat stagnant in the cooler water.

4. Congratulations! You have completed your first cycle. Now repeat this 3-5 more times, or up to 30 minutes in total length.

→ ALWAYS FINISH IN THE COLD WATER. Not only does this help with any inflammation from the heat, this also generally is a natural “closing off” of that area. Remember that the cold is pumping the fresh circulation back out, causing a vascular flush of the area. So again, always finish your contrast bath in the cold water.
→ There should never be a point in time that your left foot is out of the water for more than three seconds. Once again, there is no delay between switching from hot to cold; but there must also not be a delay when switching back to the hot when you start a new cycle.

** If you are starting to feel light headed from the hot, just switch to the cold and complete that cold step (even if you were only a minute in to the hot step). Do not attempt any more cycles, as you may pass out. Refer back up to the contraindications list and note that vascular conditions or blood pressure issues were not supposed to be doing this in the first place. It may also be wise to consult with your doctor on any recent changes your body may have gone through (there are plenty of people with undiagnosed blood pressure issues out there, after all).

** If you have one, do not forget to use your thermometer to check the temperatures often (think every 45-60 seconds). Ideally you had ice and another container with hot water ready and within arms reach, so that you could add them into your already filled bins in an effort to maintain that temperature consistency.

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Now that you know how to do it, what materials you can use, and when you should not be using this type of hydrotherapy; how about we get in to a fuller list of benefits as opposed to the few general things listed near the beginning of this post.

General Benefits List

— Reduce joint swelling (especially stemming from arthritic / rheumatic conditions)

— Alleviate soft-tissue & joint pains

— Reduce muscle spasms / cramping

— Stimulate circulation to improve tissue health (beneficial for repairing a tendonopathy in particular)

→ this may also help in strengthening your vascular system

— Increases awareness (for that specific area)

— Helps to move along metabolic wastes

— Reduce stress

 

Final Musings

— As you progress through the contrast bath, you will have reduced sensation. Meaning that it is more difficult to tell if something is too hot or too cold. This is why using a thermometer is a wise idea. It will help you to keep the temperatures consistent, without having to rely on your own sensation alone.

Additionally, if both near-extremes of hot and cold are used, you could create huge temperature fluctuations in your body. This can open you up to fainting – especially if already prone to them (and the already covered bp issues). This applies to localized area contrast bathing as well as full body contrasting. In short: be smart!

 

— Yes, you can do this with your full body! I sometimes go to a pool / recreation center so that I can use their hot tub for the hot water, and then their regular pool for the colder water. Remember that 10º C is all that is required between the two temperatures to stimulate positive results.

There are three catches however:

1. I would never submerge above the top of my shoulders in the water. Your head and top of your neck are extremely vascular areas, and can be affected quite intensely by heat in particular. If doing a full body contrast: omit your head in the hot, but add it in to the cold water for a soothing effect. But also putting your face in a hot tub is just generally gross; so maybe that alone is a good enough reason to leave it out?

2. the changes in temperature should be as quick as you can possibly can make them, but I should still point out that you should not ever compromise your safety by running with wet feet between the two bodies of water.

3. If you just have very localized issues (i.e. plantar fasciitis), a full body contrast is not the most appropriate option. Plus you could do this with less time and effort in your own home.

 

— Some people may wonder why a different delivery method cannot be used, or rather be asking why you cannot simply use a hot water bottle / heating pad, and then an ice pack or towel soaked in cold water (slightly wrung out) as opposed to fully submerging an area into hot and cold water? The answer for this can really be summed up as: submerging envelopes your limb and has an encompassing effect. To maybe give a bit of a better reason: very few people have an ice pack that can wrap around their entire arm.

Likewise, you could say that a shower head, or some sort of light-flow moveable head (i.e. with a garden hose or from the kitchen faucet) would work at delivering the hot / cold water. Unfortunately, this is just not accurate. Let me remind you that transitioning between the two temperatures of water must be immediate, you cannot dilly-dally between one temperature and the next.

Please also note that if you just had your leg submerged in a tub of warm water, but then use the shower to direct cold water to the same area. There is no way to guarantee that this method hits all the same areas, let alone keeps the temperature constant in all those areas at once. This also does not take into account that you would only be able to do it that way once, as the cold water would be cooling your warmer water below. I suppose that you could argue that one time is better than not doing it at all. I just think that it would be of little long term value.

 

— If you would like to read about some of the back and forth of research with regards to this topic of contrast bathing, hydrotherapy, recovery methods for athletes specifically – but individuals in general – give this page a quick read. I will forewarn you that it is a bit dry. But it may give you an appreciation for our ever evolving understanding of hydrotherapy.

 

— Want to add some excitement to your contrast bath-life? Try adding epsom salts or essential oils into the hot water! You may enhance certain aspects of the hydrotherapy effects in this way; making it a more dynamic and flexible form of recovery.

 

— Who is Luke, and why does he get a temperature of water? I would like to formally submit that luke-warm water should now be known as mike-warm. Good day to you, Luke. I said good day, sir!