INTRODUCTION:

Contrast is a principle of art. When defining it, art experts refer to the arrangement of opposite elements (light vs. dark colors, rough vs. smooth textures, large vs. small shapes, etc.) in a piece so as to create visual interest, excitement, and drama. If so, ‘Contrast therapy’ has become a more curious term and we may look for what it does mean .Contrast bath though not a new technique, is quite a novel concept to most people. Simply, It is only going back and forth from hot water to cold water. In contrast bath the individual immerges his body in warm water for a few minutes and then in very cold water (ice water) for another few minutes. This process is then repeated multiple times, going back and forth between the hot and cold, ending with the cold.²

Definition:

A contrast bath is a hydrotherapy using hot and cold water alternatively for reducing pain and increasing circulation in the area of injury and restricted blood flow.

It is also called hot/cold immersion therapy

History of Contrast Bath:

The therapeutic use of water has a long history dating back to ancient cultures. In traditional medicine water therapy were classified into Hydrotherapy, Balneotherapy and Thalassotherapy. Hydrotherapy is the use of water for therapeutic purpose. Balneotherapy is the therapeutic bathing in medicinal and thermal spring. Thalassotherapy is the use of sea water and marine products for therapeutic bathing.² Hydrotherapy has become the most popular of the water therapies. Hydrotherapy has been advocated using number of variations including, Kniepp bath, Schlenz baths, Sitz bath and Stranger bath. A variety of disorders were recorded as being treated and aided by hydrotherapy including fibromyalgia, osteoarthritis, insomnia and rheumatoid arthritis. One of the later development of hydrotherapy was Galvanic baths a low voltage electric direct current circuit. Physical therapy continue to recommend a derivation of derivation of water cures, most commonly in the form of ‘contrast bathing’.

Mechanism of Action:

According to studies, hot water warms our body, in response it helps your circulatory areas — your arteries and veins — to expand and carry blood more effectively throughout your body. Cold water just do the opposite that means it causes vasoconstriction of the arteries and vein. Contrast bath is the combination of the both. Immersing the part in hot or cold water leads vasodilation and vasoconstriction respectively. The rapid opening and closing of the arteries creates a pumping action. This pumping is thought to help decrease swelling and inflammation around the body part. By decreasing the swelling and inflammation, pain can be reduced and improved mobility can be achieved.^1,3

Purposes:

The contrast bath helps in alleviating and enhancing different physiological parameters and responses of the body. It mainly used for the following purposes,

1. Reducing pain

2. Reducing/controlling inflammation

3. Restoration of muscle power

4. Decreasing swelling

5. Improving mobility

6. Enhances healing^3,4

Indications:

A contrast bath is a good treatment of choice for injuries that cause swelling and pain around the joints and soft tissue in the body. These can include:

· Diabetes clients with neuropathies can benefit from a contrast bath

· Conditions with reduced blood flow

· Acute injuries to limbs or joints (over 72 hours)

· Upper and lower extremity fractures

· Plantar fasciitis, Achilles tendinitis, hand and finger arthritis

· Muscle hyper tonicity resulting in cramps or spasms

· Repetitive strain activities, such as carpal tunnel syndrome

· Chronic Regional Pain Syndrome (CRPS)^1,3

Contraindication:

DO NOT do Contrast Baths if the following problems exist

· Local malignancies

· Peripheral vascular disease (PVD)

· Bleeding and acute inflammation.

Equipment Required for Administering a Contrast Bath.

Ideally it requires,

· Receptacles or sinks large enough to accommodate the body part to be treated

· Thermometer -2

· Bath towels (for drying and to put under the basins)

· Jug to remove and add hot water

· Means for heating water if not near a tub or sink

· Ice for cold compress and cold bath

HOW DO WE PERFORM A CONTRAST BATH?

· Avail two tubs/buckets/ a double sink suitable for immersing the body part to be treated

· Fill one of them with hot water

· Fill the other one with cold water

· Prescribed temperature

· Verify the temperature throughout the treatment using a thermometer.

· Dip the affected area.

· Starting with the hot water for 3-4 minutes.

· Switch immediately to soaking in the cold water for 1 minute.

· If the cold water is not tolerated for the full minute, place it back in the hot water for 3-4 minutes then return it to the cold water for as long as tolerated up to one minute. Always start with hot water and end with cold water.

· Repeat the process for 3 – 4 more times (about 20 minutes).

· The extremity being treated will be desensitized from being in the cold water making it difficult to discern if the temperature is too hot.

Type of water	Temperature in Fahrenheit
Hot water	98-110 ⁰F
Cold water	45-70 ⁰F

Notes:

· If swelling is present, keep the temperature below 102⁰ F and make it shorter in duration. If a joint is swollen and hot, use cold; never heat

· End in hot water in the case of rheumatoid arthritis.

· More hot water may need to be added to maintain the right temperature for the “hot bath” (it might decrease from switching back and forth between the hot and cold water).

· Add hot water while soaking in the cold bath.

· Make sure to stir while adding the hot water to avoid increasing the temperature too much (do not exceed 110⁰F), which can result in a burn.

· Use only cold water, if the joint in swollen and hot

· To increase the effectiveness of the contrast bath, add ice or ice packs to the cold water to help maintain the temperature between 45 and 70 degrees Fahrenheit.

· Alternate Method if water baths are not available or practical for the area being treated.

· Use a heating pad or a hot wet towel to the affected area for 3-4 minutes

· Alternate using an ice pack wrapped in a towel or a dampened frozen wash cloth or towel for 1 minute.

· Repeat the above steps three more times

Risks of Contrast Bath Therapy:

There are very little risks associated with engaging in contrast baths. If the water is too hot, scalding of your skin may occur. Immersing in water that is too cold may also create a situation where skin is damaged. Ensuring that the water you use for contrast baths is correct is the best way to mitigate these risks. Contaminated water can cause infection if the wound is present over the area

WHAT THE RESEARCH SHOWS:

A systemic review was conducted to study the nature and quality of evidences regarding the use of contrast bath. Among 28 clinical article on contrast bath, ten met the inclusion criteria. The study addressed the physiological changes of hot and cold on blood flow, intramuscular temperature, subcutaneous temperature and inflammation of room temperature and age. The subjects under the study included normal / healthy volunteers and patient with a diagnosis of rheumatoid arthritis, diabetes, or foot /ankle injuries. This study disclosed that the contrast bath procedure improves superficial blood flow.

Another systematic review was conducted to explore the effect of Contrast Water Therapy (CWT) on recovery following exercise induced muscle damage. Controlled trials were identified from computerized literature searching and citation tracking. Eighteen trials met the inclusion criteria; Pooled data from 13 studies showed that CWT resulted in significantly greater improvements in muscle soreness at the five follow-up time points (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Pooled data also showed that CWT significantly reduced muscle strength loss at each follow-up time (<6, 24, 48, 72 and 96 hours) in comparison to passive recovery. Despite comparing CWT to a large number of other recovery interventions, including cold water immersion, warm water immersion, compression, active recovery and stretching, there was little evidence for a superior treatment intervention. The current evidence base shows that CWT is superior to using passive recovery or rest after exercise; the magnitudes of these effects may be most relevant to an elite sporting population. The evidences support the use of contrast bath.⁵

CONCLUSION:

Contrast bath therapy is one technique that can be used quickly and safely restore normal mobility and function after injury or surgery. This provides a noninvasive and generally safe and cost-saving treatment modality.

REFERENCE:

1. Brett sears, Contrast bath in physical therapy -in-physical-therapy very wellhealth, Available from:URL: https://www.verywellhealth.com/contrast-bath-in-physical-therapy

2. Hydrotherapy [Internet]. Wikipedia, the free encyclopedia. 2019 [cited 17 February 2019]. Available from: https://en.wikipedia.org/wiki/Hydrotherapy

3. Game Ready, 4 ways contrast therapy helps improve patient outcome, game ready blog, Available from: blog.gameready.com/blog/4-ways-contrast-therapy-helps-improve-patient-outcomes.

4. Stanton DE, Lazaro R, MacDermid JC. A systematic review of the effectiveness of contrast baths. Journal of Hand Therapy. 2009 ;22(1):57-70.

5. Bieuzen F, Bleakley CM, Costello JT. Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis. 2013; 8(4): e62356.

Received on 01.03.2019 Modified on 31.05.2019

Int. J. Nur. Edu. and Research. 2019; 7(3):415-417.

DOI: 10.5958/2454-2660.2019.00094.2