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. 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.