Dating hot and cold treatment
As with many therapies, there has been little investigation of the effectiveness of contrast treatments. (1988) reported that swelling increased in sprained ankles after contrast therapy administered over 3 days after acute lateral ankle sprain.Models of descending influence over dorsal horn processing of nociceptive input certainly offer a plausible explanation for the analgesic response to contrast.A decrease in pain and spasm, combined with active, pain-free range of motion, would in turn increase lymphatic drainage from the area and decrease swelling.
A cold-to-warm ratio of 1 to 3 min or 1 to 4 min appears reasonable based upon clinical observations and experience.
Several physiological effects have been proposed to explain the benefits of contrast therapy.
Contrast therapy, which consists of alternating applications of heat and cold, is also used to treat athletic injuries.
The most common approach to contrast treatment consists of alternately immersing the foot, ankle, and leg in a cold water whirlpool or bath and a warm whirlpool (figure 8.13).
Many have suggested that contrast therapy results in cycles of vasodilation and vasoconstriction, thus creating a pumping action to reduce swelling.
However, tissue temperatures are not affected by contrast treatments (Myrer et al. The brief exposure to cold and the fact that superficial heating has minimal effect on deep blood flow suggest that there is little vascular response to contrast therapy.