Contrast hydrotherapy: Out of the frying pan, into the ice bath Blog by Victoria Butler In a recent interview with our CEO, Clare Jacklin, actress Sheila Hancock told us that one of her top tips for managing her RA symptoms is to alternate between very hot and very cold water in her shower, which she switches between 3 times. Hot and freezing cold showers are marvellous… I think the shock of cold is really good for you.” Sheila Hancock So what is this therapy? How might it help and is there any evidence for it? Well, sadly, evidence seems so far to be quite limited. That said, there have been some studies, including a 2016 Dutch study, which found that having hot to cold showers, whilst not reducing the number of days of illness, did reduce sickness absence from work by 29%, which would imply that illness symptoms were easier to manage under this regime. In this particular study, participants followed a regime of hot-to-cold showering, with 30-90 seconds at a time of very cold water for 30 consecutive days. Those taking part in this study did not have serious health conditions, so the results were more generalized, rather than treating a specific condition or injury. Perhaps most telling was the fact that 91% of participants reported a will to continue the therapy after the study period, which 64% actually did. In another study, pain relief and improved function were found in people with knee osteoarthritis who tried contrast hydrotherapy. Variations on this technique (known as contrast hydrotherapy) have been around for a long time. Romans used to bath in heated rooms, then by plunge into cold water, and this practice is still used in saunas today. Contrast hydrotherapy is also commonly used by many athletes, in order to aid recovery from injuries, though evidence of its effectiveness is lacking. In this case, rather than showering, athletes will often submerge their body or an affected limb into and out of very cold water. Both heat and cold therapy are not uncommon in managing rheumatoid arthritis. Heat therapy can help to increase blood flow, by making blood vessels dilate (i.e. widen) to pull in more oxygen and nutrients. This can help to relieve stiffness in joints and is commonly used in RA, particularly with morning joint stiffness. Cold therapy, on the other hand, causes the blood vessels to constrict (i.e. tighten). This reduces blood flow to the area, which can help to relieve swelling. This is why cold packs are often applied to affected joints to relieve swelling during a flare. Much of the evidence for contrast hydrotherapy is, at this stage, anecdotal, and a wide variety of benefits have been attributed to this technique from converts, including reduced pain, stiffness and inflammation, improved mood, focus, attention and energy levels and improved appetite regulation. A lack of study data to back this up could simply be down to a lack of studies in this area. The number of people who want to stick with the therapy after trying it is very compelling though. Questions People with RA Often Ask “I keep hearing people rave about switching between hot and cold water. Is contrast hydrotherapy actually helpful for RA or is it mostly just a trend?” There isn’t strong scientific evidence yet, but some small studies and a lot of personal experiences suggest it might help with things like stiffness, swelling and general recovery. Heat and cold both have known effects on blood flow and inflammation, so alternating between them could make sense for some people. It’s not a replacement for RA treatment, but some people do find it gives them a bit of relief or a boost in how they feel. “If I wanted to try hot to cold showers, is there anything I should keep in mind before jumping straight into freezing water?” It’s worth easing yourself in and paying attention to how your body reacts. The studies that exist used short bursts of cold water (around 30 to 90 seconds) and people generally tolerated it well. Keep in mind that everyone’s sensitivity is different, especially with chronic conditions, so it’s sensible to start gently and check with your healthcare team if you’re unsure. The goal isn’t to shock your system, it’s to see whether the contrast feels helpful for you. “People say contrast hydrotherapy boosts mood and energy. Is that actually a thing, or just something fans of cold showers like to say?” A lot of the reported benefits are anecdotal, but they’re common enough that they’re hard to ignore. Many people say the temperature changes make them feel more awake, more focused or less stiff, even if the science hasn’t fully caught up yet. The interesting part is how many people choose to keep doing it after trying it, which usually means they’re feeling something positive from it. Do you practise hot and cold therapy or are considering giving it a try? Let us know if you find benefits on Facebook, Twitter and Instagram. You can also catch up on our previous Facebook Lives and watch Sheila Hancock’s full NRAS interview through our YouTube channel.