Contrast therapy (aka: hot/cold therapy) has been around for centuries.  Like ice therapy (cryo-therapy) and heat therapy (thermo-therapy), contrast therapy has varied and specific applications as well as some general contraindications.  Also like ice or heat therapy, contrast therapy is most effective when using moist heat/cold (view our last blog post for more on this) versus dry. Valued because of its calming and balancing effect on the body, contrast therapy can be an ideal treatment for conditions where rest is essential to healing, as with stress, repetitive use injuries, as well as cold and flu.  Read on and we'll delve a little deeper into the benefits of contrast therapy, as well as some of the contraindications that apply when utilizing this age-old natural remedy.  Trust us, it'll be worth it in the end! 

Contrast therapy takes advantage of the effects of both heat and cold when applied to the body.  As heat brings blood and nutrients into an area, cold constricts the vessels effectively flushing blood and wastes out.  This "pump-pull" type action is what makes contrast therapy so valuable to healing and restoration (as well as prevention!). 

With conditions such as localized ischemia (areas of reduced blood flow), repetitive use injury, or trauma, contrast therapy can be especially effective.  Nearly any time there is an area in the body that is in need of speedy healing, gentle contrast therapy can be applied without great risk to the body or person.  One should never apply contrast therapy to acute injuries that are still in need of RICE therapy to combat the inflammatory process (see "Icing for -itis" article), nor should it be applied to areas of open wounds or recent surgery.  There are also considerations when utilizing whole-body contrast therapy techniques, for example, one should avoid or significantly modify application if the recipient suffers from:

• high or low blood pressure (hyper- or hypo-tension)
  
• dizziness or fainting
• dehydration 
• diabetes 
• neuropathy
• nausea or vomiting
• severe illness (NEVER complete full-body contrast sessions alone if you are severely ill!)
  

That being said, in general, contrast therapy is a lovely addition to any home-remedy arsenal and one that has little cost and can have profound overall effects.

So how does one go about applying contrast therapy?  Dr. John Harvey Kellogg did numerous studies on the application and efficacy of hydrotherapy in general, and if you're looking for in-depth reads on the subject, we highly recommend his books as reference material.  He, along with his predecessors, used time-tested methods that involved strict adherence to timed application, as well as thermal regulation.  A rotation of 6 repetitions of heat for 3 minutes and cold for 30 seconds should be applied to affect the most potent healing possible.  There are many who claim that specific timing doesn't matter, however, Kellogg thoroughly studied out the matter and discovered that in fact, as with a great many things in nature, timing is everything.  What was also discovered is that if an outcome is desired locally, the application must also be local to obtain the greatest affect.  

An important note as well is that temperature does matter, and one should generally utilize the greatest extremes that one can possibly use without burning or freezing the skin, roughly from 42F (yes! that's REALLY cold!) to 115F (however, this temperature range is reduced significantly for those suffering from diabetes, neuropathy, or extreme illness, or for those who are very young or very old; generally ranging from 70-80F to no greater than 90-104F).  Temperature tolerance will vary between individuals and this is essential in determining the correct therapy range for yourself or your loved ones (this can also change based on the season or the overall health of the individual being treated).  As the body or area being treated becomes acclimated to the temperature being used, the heat should generally be raised to a new tolerable level, and the cold temperature lowered to a new tolerable level.  If you have never done contrast therapy before, it is a good idea to begin with more neutral temperatures, and experiment to figure out what temperatures work best for you, and which extremes you can safely tolerate; again let me note here that this will typically be a bit different for everyone, so testing the area to be treated first can be especially helpful in preventing temperatures that are too extreme and thus preventing possible injuries.  Usually whole-body applications will range more towards the median of the given temperature range, whereas local application will be able to push the outer limits of the given range (yet, this doesn't seem to apply to the Russians or Canadians who regularly practice whole-body contrast therapy as a welcome health regimen, as well as a winter past-time). 

For a whole-body approach, such as with a contrast shower, the goal is to reach the most extreme temperature at each end of the hold-cold spectrum while ensuring that the temperatures used are still within the tolerable range (which tends to be a bit colder than most people actually care for!). 

As noted before, conditions such as repetitive use injury actually respond quite well to contrast therapy, particularly if applied after RICE therapy has been utilized for a period of several days to bring down the general inflammatory response.  The following is a brief list of some of the conditions that may be relieved with the application of contrast therapy:

• carpal tunnel syndrome
  
• tennis elbow
• Achilles tendinitis
• shin splints
  
• plantar fasciitis
  
• IT band syndrome

A couple other benefits worth mentioning, especially this time of year when cold and flu are in the air, is that contrast therapy has been shown to help boost white blood cell count in the body particularly if followed by a period of 30 minutes of rest which is an excellent perk if you are attempting to fight of the latest bug.  So, it might be worth it to adopt a contrast-shower regimen this winter if you'd like to improve your odds of warding off illness from those around you.  It takes a bit of getting used to, I won't lie, but when it becomes habit you actually begin to miss it when you don't have the time to indulge!  (Honest!)  Another quick note in favor of contrast showers is that they have been shown to assist in the fight against depression; which incidentally includes seasonal affective disorder (SAD) which is prevalent in this part of the country during the winter months.   

We know that the concepts of ice-therapy, heat-therapy, and contrast therapy can sometimes leave your brain in a fog. But we promise to leave these last three articles here for you to peruse for a while, just in case you need to refer back.  Now, why not go give that contrast shower a try? 

Let's begin by doing a brief recap of our last post pertaining to the use of R.I.C.E., and more specifically, ice.  Icing is used to help reduce inflammation, redness, and associated pain.  Ice is best used in the first few days post-injury.  In general, ice is indicated when you are dealing with any form of "-itis" such as tendonitis or bursitis (and other such inflammatory conditions). Ok, great!  Now, what about using heat? 

Heat, just like ice, is a wonderful therapeutic agent.  Heat is most commonly used to increase blood flow to an area (which is why it's not recommended for swelling and inflammation) and with it nutrient, oxygen, and waste transport; heat has a wonderful action in helping to calm the nervous system; and in these, heat helps facilitate faster healing.  Why then do we not use heat immediately post-injury, to help speed healing?  Remember that heat exacerbates the inflammatory process, and because of this, it is important to use ice in the first stages of healing after an injury has occurred. 

In general, heat is best for treatment of chronic (long term) pain, stress, or muscle tension (except for those "-itises," of course).  Heat can be especially effective for muscle spasm and trigger point relief (or conditions that are caused by them, such as back pain or neck pain).  Often trigger points are brought on by a combination of factors including ischemia (lack of blood flow) in a certain area, and since a local heat pack will help stimulate blood flow to a specific area, it is a wonderful remedy for relieving active trigger point pain.  Heat applied to the low back region (the caudal zone, known for it's concentration of nerve fibers) can actually stimulate a whole-body relaxation response which is especially helpful for stress relief and PMS pain.  On the contrary, ice can, and usually will, exacerbate pain caused by muscle spasms or trigger points. 

When determining whether to use heat or not, it is always prudent to be considerate of the cause of any symptoms; such as with low back pain, it is important to rule out inflammation before applying heat as heat can make inflammation worse.  However, when dealing with tension headaches, stress related bruxism (teeth grinding/jaw clenching) or TMJ disorder, or other stress induced symptoms, heat can often bring soothing relief.  For reducing cramping from conditions such as Charlie horses or PMS, heat can even be a life-saver for many sufferers, helping to reduce or alleviate spasms!*

Another important note is that, like commercial ice or gel packs, heating pads are a lot less helpful than they are marketed to be.  In fact, studies have shown that dry heat is actually 80% less effective than moist heat!  Utilizing a hot moist pack such as a fomentation pack, a homemade moist hot pack**, or even a homemade or commercial rice/flax/corn pack (they do emit a small amount of moisture for a while), can be far more therapeutic than simply slapping an electric pad on the affected area for convenience's sake.

One last consideration for you is that it is always a good idea to ensure that the rest of the body is also cared for in the proper manner prior to application of heat or ice therapy.  What do I mean?  Let's say that you have a fresh muscle injury, but it is also the middle of winter and the cold-chill of ice therapy sets off greater pain symptoms and causes chills and shivering.  If this is the case, it is important to ensure that prior to icing, the rest of the body is thoroughly warmed (by covering up with blankets, or bundling in sweat pants and a sweater, etc.).  Conversely, if you are dealing with a severe muscle spasm and it's 102 degrees Fahrenheit, you are already sweating, and you apply heat, the brain may interpret the added heat as an additional threat which could incidentally cause the body to express more pain.  If this is the case, it can be a critical factor to cool the body to a more tolerable level before introducing the heat therapy. 

The bottom line?  The first step is to try to determine the cause of your pain, and then use your best judgment. It is always critical to listen to your body too, but remember that just because something may "feel" better, it may actually be aggravating the cause of your pain.  Unfortunately these are not rules that apply to every single situation - there is almost always one or more exceptions to any medical rule - nevertheless, understanding the body's healing processes can help us rule out options that might not be best under any given set of circumstances.  We hope that this has provided some guidance for you on the best, and worst applications for both heat and ice therapies.  And as always, we'd be happy to visit more if you have further questions. 

NOTE:  Please use caution with any home remedy. Be aware that the above information is for use as a guideline only and it is always best to consult your healthcare provider to determine the proper course of action, particularly if you are not certain of the cause of your pain. 

*Symtoms such as Charlie horse, spasms, and PMS can actually be a sign of nutrient imbalance or hormonal disturbances, give us a call to find out more.
**To make a homemade hot pack, “Hot Pack Sandwich” style, begin by laying a dry towel on the skin, then applying a hot moist towel on top of that, and then cover up the hot moist towel with one ore more additional dry towels to hold in the heat.

 Since Gabe Mirkin first coined the acronym R.I.C.E. (Rest, Ice, Compression, Elevation) in 1978, healthcare providers have been utilizing the therapy as a standard practice to treat soft tissue injuries throughout the subsequent decades. And though there have been some minor adaptations to the practice, as more knowledge has been gained by researchers, most of us will have been told at one time or another to use RICE when applying self-care to manage or treat soft-tissue ailments.  That being said however, many are still uncertain exactly when to apply ice versus heat, and this can mean the difference between exacerbating an ailment or injury and speeding recovery from it. Follow us below as we review RICE as well as provide some general guidelines to help you better determine when to use which treatment. 

Rest:  Rest is critical for both repair of the body as well as prevention of continual strain which contributes to increased inflammation, pain, delayed healing, abnormal repair and possible further injury.  Depending upon the degree of severity, an injury may require complete rest for a period of time, or it may require partial rest.  The goal of applying rest is to allow the body adequate time to heal an injury, alleviate pain associated with that injury, and restore the majority of normal function.

Ice:  Ice is well known for reducing the inflammatory response.  It works to alleviate pain associated with heat generated by increased blood flow and/or blood loss.  There are various methods of applying ice therapy.  Many prefer to alternate ice with no ice for 15-20 minute increments; while others prefer to ice for 20 minutes every hour.  The actual application can best be determined by the injury in question, however a good rule of thumb is to ice the affected area at least twice a day in no more than 20 minute increments until pain is reduced to a tolerable level and for the first 72 hours after an acute injury to help relieve inflammation as well as provide some relief of swelling.  It is recommended that one never apply ice directly to the skin in order to prevent frostbite; use an old pillow case, or tea towel placed between the skin and ice pack.  (Additional note: gel-packs in general do not get cold enough to address inflammation; specialists recommend using ice packs made with water and ice cubes or crushed ice in a zip-lock bag or specialized ice pack bag to reach a therapeutic temperature.)

Compression:  Compression is mainly used to help minimize or reduce swelling that can result from a soft tissue injury.  Some swelling can actually help to "splint" the injured area and help prevent further injury, however too much swelling may actually cause further harm to the affected soft tissues, increase pain, and decrease functionality to excessive levels.  Compression may be applied in a variety of ways such as with an elastic bandage (the fit should be snug, yet not so tight as to inhibit movement or blood flow). 

Elevation:  Elevation is intended to help reduce swelling by allowing blood and lymph fluid to return to the system and leave the injured area. 

So now that we better understand the reasons for RICE, let us take a moment to just focus on Ice.  Why ice?  Let's briefly recap.  Ice is meant to reduce inflammation and relieve pain.  So, a reasonable deduction then would be to assume that we should use ice whenever there is, or could be inflammation.  When might there be inflammation?  A great hint is in the fine print.  The  suffix "-itis"  is used in medicine to indicate any disease characterized by inflammation.  You've likely heard the term "tendon-itis"; tendonitis is, in effect the inflammation of tendons in a given area.  Bursitis?  You guessed it, bursitis is inflammation of the bursa.  Colitis?  Yep!  Inflammation of the colon.  Isn't this fun!?  How about a bit more challenging one... Rhinitis?  It's the inflammation of the sinuses.  Ok, you get the idea. 

Now it's time for a pop quiz!  (Didn't know you'd be hit with that here did you?)  Let's say Joe sprained his ankle this morning.  Should Joe use ice or heat on his tender ankle?  If you guessed ice, you guessed right!  Why?  Because Joe's injury is acute, and calls for the RICE technique.  Jim is Joe's brother, and Jim also sprained his ankle, but it has been five days since his injury.  Should Jim use ice or heat on his tender ankle?  Knowing that the 72 hour mark has passed, Jim is at liberty to see which helps alleviate the discomfort in his ankle more effectively.  Often, after the initial inflammatory process has passed, heat may actually help speed healing of a given injury; however, it is important to listen to the body and determine which helps or hinders.  Sometimes the application of contrast therapy (3 minutes moist heat; 30 seconds moist cold/ice) can be even more effective still in aiding the recovery process. 

Wait a minute though, we haven't discussed Jane.  You say, "What about Jane?"  Jane is Jim's wife, and has been suffering from chronic tendonitis for nearly seven months.  Jane works in a packaging factory and has been diagnosed with a repetitive use injury; specifically, tendonitis of the elbow.  Jane has been using NSAIDS (a form of anti-inflammatory medication) but has not found permanent relief, in fact, they don't seem to be helping much at all anymore.  Should Jane use ice or heat?  Let's look at Jane's situation a bit closer.  It has been longer than 72 hours since the initial symptoms of injury came on.  The pain comes and goes but is usually worse after a day's shift.  Jane doesn't like the discomfort that ice produces and insists that heat helps her elbow feel better.  But what is Jane's diagnosis?  Tendonitis.  There it is: "-itis".  So what is Jane dealing with?  An inflammatory condition, and one that is likely exacerbated by the use of heat.  In order to facilitate healing, Jane really needs to apply the RICE technique and utilize icing to help reduce the inflammatory process that is taking place in her elbow.  In addition, it would be beneficial for Jane to take some time off to rest her elbow, or adopt different movement patterns in order to provide some partial rest periods for the affected elbow during her daily shift.  At this point, Jane might find contrast therapy beneficial as well, particularly in the morning before work (always ending with ice to combat the inflammation!), however, at the end of a day's shift after the area has been aggravated by repetitive motion, Jane's best option is to utilize ice as part of the RICE treatment technique.  The most critical thing to remember is that as long as there is inflammation (or the possibility of inflammation) present in an area, particularly within the first 72 hours post-injury, ice is likely the best option. 

In addition to RICE, therapies such as massage, gentle stretching and range of motion exercises, supplements such as bromelain with quercitin, and charcoal poultices may help facilitate healing depending upon the injury.  If you have more questions regarding the proper application of RICE (and particularly Ice), talk to your healthcare provider, if you'd like to know more about how massage therapy can help alleviate chronic or acute pain and injury such as sprains, strains or tendonitis, give us a call and we'd be happy to visit with you.  Happy icing to you! 

NOTE:  Please use caution with any home remedy. Be aware that the above information is for use as a guideline only and it is always best to consult your healthcare provider to determine the proper course of action, particularly if you are not certain of the cause of your pain.