Contrast Therapy: Best Start to Healing Painful or Swollen Joints

Contrast therapy is the first part of our two-part protocol for when you hurt yourself and you’re looking for something to get you out of pain.

We’ve used this protocol for years. I’ve used it personally on many different body parts, and I’ve recommended it to a bunch of different clients. Overall, it’s been very, very successful, and everybody reports positive results. Definitely no negatives to it.

If you hurt a joint or muscle, especially if there is swelling, start with contrast therapy for quick relief that’s faster and better than popping a pill and doesn’t have those negative side effects. Then add part two of our protocol, and you’ll know exactly what to do the next time you hurt yourself, which will get you on the fastest path to recovery.

Now, this article came about because Youssef, our operations guy, messaged both Dr. B and me. He’s crying and screaming in agony, saying, “I popped the outside of my knee.” What happened was Dr. B and I independently recommended the same advice. (Don’t worry, he’s fine.)

Because we both recommend this all the time, we wanted to break it down for you and share it in case you suffer an injury. That way, you know what to do right away to get on the complete path to recovery.

To follow along with our YouTube video Contrast Therapy for Painful or Swollen Ankles, Knees, and Elbows, click here.

DISCLAIMER: If you have significant pain and swelling or deformity of the body, you need to get checked by your doctor and then follow this advice if deemed appropriate.

Part 1: Contrast Therapy

Part one of the protocol is contrast therapy.

Now, you might have heard of this before. Maybe not. It also goes by the name of contrast baths or alternating hot and cold therapy.

We use this directly on the joint that’s affected. I personally think that it’s more beneficial, for example, if you injure your knee, do this directly on the knee as opposed to doing it for the whole body.

How To Do It Right

How do you do it? We’re cutting right to the chase here because if you’re in pain, maybe you want to do this right now. Just leave the page open and do it right away. It’s very simple.

We recommend five sets of 30 seconds hot followed by 30 seconds cold. For both hot and cold, you do it as hot as possible and as cold as possible. Obviously, you don’t want to burn yourself or get frostbite. But if you’re doing it in the shower, generally, it’s pretty safe. You’re not going to get boiling water coming out of the shower (unless you’ve done something strange with the settings on your water heater.)

So go as hot as possible and as cold as possible. Switch between the two as quickly as you can. You can really overshoot it as well if you can, and then bring it back down to as hot as you can bear.

When you’re doing it, make sure that you breathe. This is because of the mechanisms that we’re going to talk about.

If you’re in pain right now, whether it’s your elbow, your knee, ankle, or other joints (I’ve used it on my shoulder, elbow, knee, low back, hip, and even my groin, which was not very fun…remember the Seinfeld episode where George just got back from the pool and was blaming the cold water for his shrinkage?)

Use it wherever you’re hurting. Give it a shot and rate your pain before, move your joint (or whatever is injured) around a bit, and then rate your pain again, move some more, and rate again.

You could be your own lab rat in this case. You’ll get your own results and see for yourself.

Benefits of Contrast Therapy

Now, after you do this, common benefits include increased range of motion, decreased pain, and you’ll just feel better.

What I’ve found is even with doing nothing else, I’ll feel better the next day just doing the hot and cold contrast. I play hockey late at night, so I don’t typically like to do exercises or anything the next morning. I wake up and just feel better if I tweaked my knee or injured something the night before.

Those are very typical benefits that people report after doing just one round of contrast therapy.

Why It Works

Now, what makes these benefits happen?

I used to recommend this, and I never looked into the science before creating this, but basically, cold constricts vessels. Heat dilates or expands vessels. What do tissues, whether a muscle or ligament or a tendon, need to repair and recover? They need blood flow.

Blood flow brings oxygen and other nutrients for those processes. By pumping blood through rapid constriction, expansion, constriction, expansion, you’re pumping more blood flow through. You’re increasing circulation, so you’re bringing oxygen and nutrients in that theoretically would help facilitate recovery and repair.

For this article and the corresponding video, I did a little bit of a literature review. I went through PubMed, read a bunch of studies, and I found a good study that looked at the physiological mechanisms that take place from contrast therapy.

The title of the study is “Contrast Baths Intramuscular Hemodynamics and Oxygenation as Monitored by Near-Infrared Spectroscopy.” It was published in the Journal of Athletic Training in 2018. The protocol they used is they immersed the subject’s lower leg in hot water for 10 minutes, and they alternated to cold water for a minute, followed by four minutes in hot and one minute in cold for another three reps. Take a look at the graph below. [1]

Now, the black bars are the contrast bath condition, and the white bars are the control condition. The first pair of bars shows tissue oxygenated, and you can see that the contrast bath condition has much more tissue oxygenated compared to the control. The next set of bars is HHb, and this is tissue deoxygenated. There’s no change here. Now tHb is total hemoglobin, and you can see a big difference. There’s way more total hemoglobin in the contrast bath compared to the control.

The final pair of bars is TSI, which is the tissue oxygen saturation level, and there’s a greater tissue oxygen saturation in the contrast bath versus the control.

From this study, the authors conclude that the effect of contrast bath application and improving the tissue hemodynamics and oxygenation, there are considered essential mechanisms of tissue repair and may therefore support the therapeutic use of contrast baths in rehabilitation and sports medicine.

That right there is a very clear result as to why this works.

Basically, increased blood flow equals increased nutrients and the factors needed for recovery. Every tissue needs oxygen and other nutrients to recover, and by increasing blood flow, you’re bringing more of those things into that area. You’re taking the waste products out.

That’s part one of our protocol.

Now, this is really good, and this can take your pain from a kind of sharp, really, really severe, annoying, you-can’t-think-about-anything-else pain down to a level where it’s there, but you can get on with your everyday life.

Part 2: Isometrics

Part two is what you need to ensure that you have a full recovery.

What we like to do right away in part two is isometrics or isometric muscle contractions. This is where you’re contracting the muscle, but there’s no joint movement.

If you have an injury because you’re not moving the joint, you’re putting very, very little stress and strain through that joint. But by getting the contraction of the muscle, you’re preventing atrophy of that muscle and further weakness from occurring. You’re also telling your brain, “Hey, this muscle’s still working, so we don’t have to kick in other compensatory mechanisms.”

You might have seen or even experienced if you ever had an ankle sprain or a knee problem where you’re limping around. You might be fully recovered, but you’re still limping somewhat, you’re still changing the way you’re moving.

When you start to contract the muscle and use the injured area as soon as possible after an injury, you’re going to help prevent those long-lasting compensatory effects from really taking hold. Then, they’re way less likely to affect the way you move long-term.

Now, I’m not going to go through every joint and show you how to perform isometrics for each movable body part. (That’d be a book, but don’t worry, you can start off with the links below.)

• Sprained Ankle
• Golfer’s or Tennis Elbow
• Knee Osteoarthritis

Basically, if I’m looking at my arm, an isometric is simply contracting all the muscles around the elbow joint. So if I injure my elbow, I would do contrast and then do isometrics. Then ramp it up.

We like to ramp things up so that you can get to a level before you get any sharper, sudden pain. Hold it there for 10 to 15 seconds. Then you ramp it back down.

Your other goal with isometrics is to restore range of motion. It might not be possible, but if you can, try to restore full extension.

Go slowly. Do a rep here. Do a rep there and keep going. If you don’t have any sudden or sharp, scary pain, keep going until you get that full extension (in the case of the elbow, you’d straighten your arm all  the way but not hyperextend.)

Try to get full extension within the first 24 hours of injury, assuming no sharp pains. If you can’t, make sure you get it as soon as possible.

Isometrics is part two of our protocol, and we use this to make sure that you get on the fastest path to recovery.

Long-Term Solution – Addressing the Root Cause

Now, this isn’t all that you need to do. Once you’re getting your pain settled and your range of motion back, the most important thing you can do for your movement longevity is to address the root cause of the injury.

Wear and tear injuries accumulate over time. For example, you might be running, and you tweak something. You might think, “Oh, I just landed funny.” But usually, those types of injuries are wear and tear. The tissue is already broken down, and it’s just that one way you moved that added the straw that broke the camel’s back.

You’ve got to get to the actual root cause.

What we’ve done is put together our Pain Solution Programs that get to the root cause and address all of the factors and areas that need to be handled to ensure that you don’t incur the same injury over and over and over. Whether your injuries are at the neck, thoracic spine, shoulders, elbow, wrists, hips, low back, knees, ankles, or feet, we got you covered.

The next step is to click this link to be taken to an image where you just click on what hurts. That will take you to the appropriate program to get you into a full recovery.

Dr. B also gave a great presentation on how to manage joint swelling. Luckily, we got it on video. It’s a deep dive, so check that out.

While I hope you don’t ever get injured, now you have a tool you can use for the rest of your life the next time you get hurt or are looking for some quick joint pain relief.

Thanks, and keep moving.

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This article was reviewed and updated on April 20, 2023 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include new research and information on latest surgical developments. Read more about Dr. B here.