II. Definition

  1. Therapeutic heat and cold to distal extremity

III. Indication

  1. Ligament Sprain or Joint capsule sprain
    1. After initial ice only for first 72 hours
  2. Stasis edema
  3. Peripheral Vascular Disease
    1. Improve circulation in contralateral extremity
      1. Occurs by consensual vasodilatation
    2. Exercise is more effective in PVD
  4. Osteoarthritis or Rheumatoid Arthritis
    1. Improves range of motion

IV. Adverse Effects

  1. Vigorous hyperemia
  2. Discomfort during cold cycle
    1. Issue of compliance

V. Preparation

  1. Warm Water Bath: 38-44 C (100-111 F)
  2. Cold Water Bath: 10-18 C (50-66 F)

VI. Technique 1: Decrementing Warm Baths (20 minutes)

  1. Warm water bath for 5 minutes
  2. Cold water bath for 1 minute
  3. Warm Water bath for 4 minutes
  4. Cold water bath for 1 minute
  5. Warm Water bath for 3 minutes
  6. Cold water bath for 1 minute
  7. Warm Water bath for 2 minutes
  8. Cold water bath for 1 minute
  9. Warm Water bath for 1 minute

VII. Technique 2: Fixed Warm Baths (30 minutes)

  1. Warm water bath for 10 minutes
  2. Cycle warm and cold baths for 4 repetitions
    1. Cold water bath for 1 minute
    2. Warm Water bath for 4 minutes

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