CONTRAST THERAPY

INTRODUCTION

Contrast therapy consists of alternating hot and cold treatments.

Alternating heat and cold modalities are thought to cause a cycle of
vasoconstrictions and vasodilations of the superficial blood vessels.

Contrast therapy is often used as an edema reduction technique by

“pumping” blood flow.

There is little evidence that supports the use of contrast therapy in

decreasing pain thresholds, especially when compared to other therapeutic
interventions.

The most effective time ratio between hot and cold has not been
determined; some protocols are based on the temperature and medium
used. Commonly used ratios are 3:1 and 4:1 (i.e., 3 and 4 minutes in the
hot immersion to 1 minute in the cold).

Other approaches use 10 minute immersion in hot water, 1 minute

immersion in cold water,followed by alternating 4:1 hot/cold bouts for
the duration of the treatment.

Alternating 6-minute bouts of moist heat pack and cold pack application
produces a more pronounced differential in temperatures than
immersion techniques used for shorter contact times. This method keeps
the temperature gradient high, resulting in a greater exchange of energy.

The treatment may end after either the hot or the cold application,
depending on the stage of the injury, the desired effect of the treatment.
When a state of vasoconstriction is desired, the treatment is terminated after
cold application. If vasodilation is desired, the treatment is terminated after a
warm application.

In subacute conditions, it is generally beneficial to finish the treatment

with following cold exposure.
PRIMARY EFFECTS:-

Alternating periods of vasoconstriction and vasodilation of cutaneous

vessels.

Temperature Range
COLD IMMERSION

50°F to 60°F (10°C to 16°C). The temperature is increased as the

proportion of the body area immersed increases.
HOT IMMERSION

105°F to 110°F (40.6°C to 43.3°C). Temperature is decreased as the

proportion of the body area treated increases.

TREATMENT DURATION:-

■ 20 to 30 minutes and may be repeated as needed.When treating deep

structures, the treatment duration should be increased as the amount of

adipose tissue increases.

■ Hot immersions are typically 3 or 4 minutes in duration.

■ Cold immersions are typically 1 or 2 minutes in duration.

INDICATIONS:-

■ Subacute or chronic inflammatory conditions

■ Impaired circulation (monitor the patient closely)

■ Pain reduction

■ Increasing joint ROM

CONTRAINDICATIONS:-

■ Acute injuries

■ Hypersensitivity to cold

■ Contraindications relative to whirlpool use

■ Contraindications relative to cold applications

■ Contraindications relative to heat applications

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 edema.

SETUP AND APPLICATION:

Immersion Technique

1. Ensure that the patient is free of contraindicationsfor this treatment

technique.

2. If an immersion technique is being used, position the tubs as close

together as possible without touching each other. (“Tubs” refers to either

immersion buckets or whirlpool tanks.) The patient should be able to

remove the body part from one tub and immediately immerse it in the
other.
3. Fill one tub with water in the range from 105°F to 110°F (40.6°C to
43.3°C) and the other with water between 50°F and 60°F (10°C to
15.6°C).

4. Position the patient on a chair or bench in a manner requiring a

minimal amount of motion from tub to tub.

Hot/Cold Pack Technique

1. Ensure that the patient is free of contraindications for this treatment

technique.

2. Position the patient so the hot and cold packs are within reach.

3. Instruct the patient on how and when to remove one pack and apply
the other pack.

4. Because of cooling, the original hot pack should be replaced with a

fresh, heated pack at approximately 15 minutes into the treatment.