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Saturday, January 2, 2016

Swelling: Contrast Bathing to reduce swelling after injury

Contrast bathing is one of the best ways of reducing swelling. This is even true for deep swelling in the bone/soft tissue which is not visible to the eye. The normal routine involves:

  • Obtain two containers large enough to accommodate the body part involved.
  • Place the two containers side by side, one is filled with ice and cold tap water (approx. 55 degrees F), and the other filled with warm/hot water typical for a hot tub (approx. 100 degrees F). Use your fingers first to test that the warm water is not too hot.
  •  Place the body part in the warm water first for 4 minutes, and then immediately into the cold water for 1 minute. This is a perfect technique for feet, ankles, and hands.
  • Repeat this cycle for a total of 4 times totaling 20 minutes.
  • You should also feel that you are looser and less swollen.
  •  Attempt to do this once a day on work days, and twice daily on your days off.
  •  Move the body part through a pain free range of motion while immersed in the warm water.
  • Continue contrast bathing for 1 week longer than you think you would need based on your symptoms.

As long as you are using ice in the cold bath, it is not necessary to try to keep the warm container near 100 degrees F during the full 20 minute cycle. As long as there is a good difference in temperature, you will obtain the desired result. The warm water causes vasodilation increasing blood flow, while the cold water causes vasoconstriction decreasing blood flow. By going back and forth between the two water baths, you can create a mechanical pump for the swollen area. While immersed in the warm water for foot or ankle injuries, pretend your big toe is a paint brush. Gently move through the letters of the alphabet, using both big and small letters, then on to hieroglyphics, or Chinese lettering. While immersed in the cold water, keep the body part still.

This is an 80% heat to cold ratio with the goal of reducing swelling. Following the typical 3 days (72 hours) of ice after an acute injury, I find it helpful to slowly build up to this amount of heat/cold ratio. For 3 days, I will use a 1 minute heat alternating with 1 minute cold cycle (1hot/1cold ratio), repeating 10 times, for the same 20 minutes. If the body part is less swollen and the patient feels less stiff, I will advance the patient to 3 days of 2 hot 1 cold ratio repeating 6 times for 18 minutes. Again, if the swelling is reducing and the range of motion feels better, I will advance the patient to 3 minutes heat and 1 minute cold repeating 5 times for 20 minutes. After 3 days of further improvement, then on to 4 hot and 1 cold as described above. Normally, if the swelling has been around for 2 weeks or more following an injury, it is okay to start at the 4 to 1 ratio. If you aggravate your injury during the contrast bathing phase, just return to ice for 3 days or more until the symptoms have stabilized. Following the aggravation, normally the 4 to 1 ratio is fine to restart. Never use heat, only ice, immediately after an injury or with re-aggravation of an injury.  To summarize the above:

Days 1 to 3 Ice Alone
Days 4 to 6 Alternating 1min warm/1min cold cycles repeat 10 times
Day 7 to 9 Alternating 2min warm/1min cold cycles repeat 6 times
Day 10 to 12 Alternating 3min warm/1min cold cycles repeat 5 times
Day 13 and on Alternating 4min warm/1min cold cycles repeat 4 times

Contrast bathing should never make a patient feel more swollen and stiff. If so, you are using too much heat and must begin to experiment with less heat as mentioned above. However, it is worth the effort. Contrast bathing can produce incredible gains in range of motion, pain reduction, and lead to quicker returns to activity. A wonderful addition to contrast bathing is elevation. With the increased blood flow due to contrast bathing, immediately dry off, wrap the area with some form of compression, lie on the floor, and elevate the injury as high as possible for 20 minutes. You can gently move the ankle up and down to help the drainage process. For most foot and ankle injuries, lie on the floor and get the foot up on the wall or couch way above your heart level. I call this Super Elevation!!!

Since the typical ankle sprain leads to swelling for 3 to 4 months, and a bad ankle sprain can be swollen for over 1 year, you may be contrast bathing for awhile. Be a good multi-tasker, but never do contrast baths near a power surge. As the soreness goes away, you may experiment with just 20 to 30 minutes of warm water soaking alone. See if you get the same results. Good luck.

Rehabilitation of any injury is a logical game if you know the rules. Inflammation can get much worse with heat, so ice initially, and then as you aggravate or irritate the injury as you move through the rehabilitation process, ice some more. Ice is for initial injury for 4 days, and for months and months with repeated irritations. So, there will be many days where you ice and contrast bath both at different times of the day. You have to distinguish between the chronic pain with swelling (time for contrast bathing) and the acute pain of aggravation (back to ice). At times the aggravation can be for 2 days to 2 weeks, so the icing alone will feel like you are back at square one. The rehabilitation process for patient, therapist, and healthcare provider is one of learning to minimize these aggravations/irritations while allowing as much function as possible.

And more Adele....


  1. I wanted to send a big thank you for the contrast bath recommendation! After trying it the first time I was able to walk around the house pain free! I admit was in shock, how well it worked. I am not completely pain free as my foot is still in the healing process. Needless to say, It takes plenty of patience, but if you do the work, you will feel a difference.

  2. This works great for the people with sore arms that pitch in baseball and softball!

  3. First I want to say that I've had Achilles tendonitis in both ankles for the past 5 years. I've had cortisone injections every 6 months for the first 2 years from my local Doctor then went to a Physiotherapist and had 6 months of Shock Wave treatments that didn't help. I then went to a Specialist and received more injections which only helped for about a month each time and then I was back again for more. Then on the 24th September 2011 I sprained my ankle as I was getting out of bed - yes, before I even touched the floor with my foot. I heard a very loud crack and it hurt really bad - even my husband heard it! It started swelling and aggravated my Achilles tendonitis to the point where I couldn't wear my shoes. I had to buy a pair the next size up if I wanted to go somewhere. It stayed very sore and swollen for months until I had a intensive set of cortisone injections in February 2012. It helped (until now) and the ankle swelling and tendonitis went away but I still have a strange swelling on the top of my foot. It starts where my toes join and then goes up the foot almost to my ankle. It swells and hurts more if I'm on my feet a lot or even just a few hours so I'm going to try your hot and cold bath method to see if it helps.

    I still have the Achilles tendonitis (in both ankles now again) and was referred back to a different Physiotherapist. After 5 treatments he said I had too much inflammation in my body and couldn't treat me - the more he and I worked on it, the worse it got. The strange thing is, all my doctors etc. have told me doing The Negative Heel Stretch is the only way it will help it but in one of your videos, you say they should be avoided. I've tried doing them (because my doctors have told me) but I had excruciating pain and had to stop. It only makes my problems worse and for some reason they don't believe me. Anyway, I'm going to follow your advice with the calf, ankle and foot stretching instead and hope it works.

  4. Thanks for the comment, I will be posting my response on 6/28/13. Hope it helps. Rich

  5. Yes contrast bathing can be really helpful for sore muscles. I just suggest people should start having hot tub baths. Hot tubs or whirlpools are not the best way to speed recovery after a long and hard training session (especially a run). Your body tends to be battling inflammation or swelling of joints and muscles, while Immersing in warm water raises your body temperature, causing your blood vessels to dilate and increasing circulation. This results in less swelling and pain, and increases mobility a clear benefit for the people who deal with arthritis. Please check out dealers like Lazyboy Hot Tub Manuals to get clear idea on which one you want to purchase. Relax and Renew your body, mind & sprit with full featured & full size after spas hot tubs. Thanks

  6. Sport researcher and manual massager foot therapy center is the best place to take treatment when a player Fallon an injure.Their service is very healthy and medical bases.

  7. I was just advised to do contrast bathing for my swollen foot following great toe fusion. However, my directions say start with warm water for 5 minutes, cold water for 5 minutes and repeat finishing with warm of 25 minutes. 5 minutes of ice water sounds like a long time. But my aim is to get back into a regular shoe. Hope it works

  8. Before go to sleep foot massage is give us so much relax. For a sound sleep foot massage help me a lot. Many people think that foot massage machine is not good for our health. But it's not right. Massager have no side effect.

  9. They wash their feet day by day, now and again a few times each day, when school. They wear clean permeable socks and turn their shoes to give their shoes a chance to let some circulation into between each wearing. Nothing appears to work. 8 Things your feet are saying about your health

  10. 18 yr old xc runner with sesamoid fracture - currently weaning out of the boot (he has been in it for 11 weeks), sesamoid fracture is healing according to xray, and he has been casted for orthotics. Still swollen and there is some pain (less than before). Would contrast bathing help him? We know this is a long process. Just want to get him out of boot and back to some activity (not running - yet) Thank you!

    1. Also, do you think a bone stimulator would still help? Even though we see the bone forming a union on xray?


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.