Contrast bathing for the hand and wrist

This patient information is aimed at teaching a technique to reduce swelling, pain, joint stiffness and joint inflammation.

What is contrast bathing?

Contrast bathing is a way of improving the blood supply to the fingers and hand and reducing swelling by immersing your hand in a bath of warm water and then cold water. This process is repeated several times alternating between the two temperatures.

How does it work?

Contrast bathing encourages the blood vessels to open and close, thus acting as a pump to move fluid away from the area. Heat causes blood vessels to get bigger and cold causes blood vessels to get smaller.

Why is it useful?

Contrast bathing can help with swelling, pain, joint stiffness and joint inflammation.

When should it not be used?

Contrast bathing should not be used if you have any open wounds, exposed k-wires, a current infection, a cardiac condition or high blood pressure.

If you have reduced sensation/ability to detect temperatures, please be careful when using warm water and do not exceed the length of time advised in the water. Please check with your doctor before using if you have any conditions that affect your circulation such as Raynaud’s.

Sometimes, varying between different temperatures can exacerbate certain pain conditions. If contrast bathing makes your pain or any of your symptoms worse. Please stop immediately and inform your therapist when you next speak to them.

What you will need

• Two bowls/buckets/large basins (large enough to put your whole hand in).
• Two containers (large enough to put your whole hand in eg bowls, buckets/large basins)
• Warm water (not boiling). The same temperature that you would have in a warm bath, not burning to your skin, and no hotter than 37 degrees Celsius.
• Cold water – this could be just cold water from the tap, or you could add ice cubes to the water too, but it should be no cooler than 22 degrees Celsius.
• If you don’t have a thermometer, just make sure it does not feel too hot and or too cold and is a temperature you can tolerate.
• A stopwatch or clock with a second hand for timing.
• A towel for drying.

Contrast bathing method

1. Fill one container with cool water from the tap. Fill the other container with warm water from the tap.
2. Test the temperature of the water with your uninjured hand first to make sure it is not too hot or too cold. Extra care must be taken if you have injured a nerve, as you may be more sensitive to temperatures.
3. Put your whole hand in warm water for about one minute, then immediately switch to the cool water for about 30 seconds. Repeat this rotation at least four to five times a session.
4. If your therapist advises you to, move your fingers/thumb when in the water.
5. End the sequence with the warm water. However if the hand feels inflamed then you may prefer to finish the sequence with the cold water.

Start date _______________________________
Repeat three to four times per day.
If you are completing other treatments, such as exercises or massage, please complete these directly after contrast bathing as reducing the swelling will make the other treatments more effective. Contrast bathing can also be used after completing your exercises if you have swelling or inflammation after doing the exercises.

Additional instructions

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Name of therapist _______________________________
For advice, please email the hand therapy team or call 01223 216769.

MyChart

If you have not already done so, we would encourage you to sign up for MyChart (opens in a new tab). This is the electronic patient portal at Cambridge University Hospitals which allows patients to securely access parts of their health record held within the hospital's electronic patient record system (Epic). It is available via your home computer or smart phone.

If you are interested in this please visit our website for more information or contact us.

References/sources of evidence

• Breger-Stanton D, Bear-Lehmann J, Graziano M, Ryan C (2003) Contrast baths: What do we know about their use? Journal of Hand Therapy, Oct-Dec 343-346.
• Hardy M & Woodall W (1998) therapeutic effect of heat, cold and tissue stretching on connective tissue. Journal of Hand Therapy, 11(2), 148-156.
• Skirven TM, Osterman AL, Fedoroczyk JM, Amadio PC. Rehabilitation of the hand and Upper Extremity. 6th ed Mosby Inc 2011.
• Cooper C. Fundamentals of Hand Therapy. Clinical reasoning and treatment guidelines for common diagnoses of the upper extremity. 2nd Edition. Mosby inc; 2014.
• Tom EK & Joseph V (2019) Contrast Bath. International Journal of Nursing Education and Research [Online] 7 (3)

Contacts/further information

The occupational therapy department is in clinic 30 in the Addenbrooke’s Treatment Centre (ATC). Occupational therapy reception: 01223 216769.