Fire v Ice - Part 3 Contrast Therapy

I am frequently asked about the use of hot and cold in the self treatment of injury.  Is hot better than cold? Are ice baths effective? Should I treat pre or post exercise? How long should I treat for? As this is quite a large topic I've split this article into three parts.  This is Part 3 of a series of 3.  It is advised to read Part 1 and Part 2 before reading below as they contain more detail information on cold and heat as separate treatments as well as when not to use heat and ice!

Temperature treatments are a free and easy form of self treatment and can be an effective part of rehabilitation and recovery from injury.  Although there is little scientific evidence as to the effectiveness of temperature treatments for injury recovery, they are frequently prescribed by sports doctors and therapists and many patients and athletes report having beneficial effects.  

Generally speaking ice is used for acute injuries and heat is used for muscles.  It is important to use temperature treatments correctly otherwise they can make injuries worse! However, you can combine heat me cold treatments for injury recovery. It's called contrast therapy. 


The Theory

** Contrast therapy is a stronger form of regular icing or heating.  When you use just ice or heat you are changing the tissue temperature and then allowing the tissue to return to normal.  Contrast therapy just makes the temperature change more extreme. Contrasting has a more soothing affect as after icing it is soothing to warm up the tissues again and vice versa. Contrasting is most effectively done by water immersion.  For extremities like the ankle it is possible to treat a larger surface area than treating with an ice pack when you immerse the limb in water. 


It's good for...

The theory of changing temperatures on the site of injury is that it encourages circulatory and metabolic changes in the tissues whilst resting them form exercise. With this in mind, contrasting is particularly effective for overuse injuries which are often slower to heal because the limb in question, for example tennis elbow, is often used for daily functional movements so complete rest is not ever possible.  Common overuse injuries include tendinopathies, tennis elbow, golfer's elbow, Achilles tendinitis, shin splints, runner's knee, jumper's knee, swimmer's shoulder. 


How to do contrast therapy

A common method is to use heat for 2 minutes, then cold for 1 minute, then 2 minutes hotter, then 1 minute colder. Lastly do a minute as hot as you can handle without burning yourself and then 1 minute as cold as you can handle without getting frost bite!  Always finish with cold. If you are under the care of a therapist or sports doctor consult their advice on contrast therapy to make sure it complements the rest of your rehabilitation plan. 


When not to use contrasting

Contrast therapy should not be used on acute injuries up to 72 hours after trauma as it can increase inflammation and pain. Contrasting is also not advised for injuries of a spasmodic nature such as low back pain or areas that have a number of trigger points as this does not respond well to cold. Contraindications to temperature treatments are Raynaud's phenomenon and cold urticaria

Always seek the advice of a qualified Physio or sports doctor to make sure you use the right type of treatment for your injury.  

For any further questions on heat and injury recovery please do email me at Sign up to our mailing list to get our articles sent directly to your inbox. 

* Sports Injuries Their Prevention and Treatment 3rd Edition. Lars Peterson & Per Renström.