Paper·3 min read·June 2026

Harnessing Contrast Therapy for Pain Relief and Recovery

Sauna|Cold Therapy|Recovery • 3 min read • Based on research by Bailey McLagan, Kyle Silvey, Timothy Roberts, David Erceg, Jonathan C. Sum, E. Todd Schroeder (2025)

Many of us have experienced the discomfort of muscle soreness after a workout or the sharp sting of an injury. Whether you are an athlete pushing your limits or someone navigating daily life, finding effective relief is essential. Recent research highlights the power of contrast therapy—combining heat and cold—to manage pain, enhance recovery, and elevate performance.

A recent Delphi study led by an expert team sought to clarify how different therapeutic interventions, including local heat and cryotherapy, can be used most effectively. With 94 participants contributing their insights, this research provides a thoughtful guide for both practitioners and individuals seeking balance in their recovery rituals.

Understanding Heat and Cold Therapy

Heat therapy involves applying warmth to the body, promoting blood flow and relaxation of muscles. This can ease stiffness and improve mobility. In contrast, cryotherapy uses cold to reduce inflammation, numb sharp pain, and promote recovery by constricting blood vessels.

The Delphi study found consensus among experts on using local heat therapy before physical activity and local cryotherapy for recovery afterward. This means that applying heat can prepare your muscles for movement, while cold can help soothe and heal them post-activity. The body benefits from this cycle, creating a harmonious approach to recovery.

Practical Applications in Recovery

When it comes to managing pain from injuries or athletic exertion, the study emphasizes the effectiveness of local cryotherapy for treating acute joint pain and muscle soreness. This means that if you experience a sudden ache or strain, cold therapy can be a valuable tool in your recovery protocol.

Interestingly, the research also highlighted that while percussive therapy—a method that uses rapid bursts of pressure—was considered for some situations, there was no consensus on its use for acute joint pain. This suggests that while it may be beneficial, more clarity is needed on its application.

Building Resilience Through Ritual

Integrating contrast therapy into your wellness routine can foster resilience and promote long-term recovery. The study's findings suggest that alternating between heat and cold applications can help manage both acute and chronic pain effectively. By adopting this as a ritual, you can create a sanctuary of recovery that empowers your body to heal and thrive.

To establish an effective protocol, consider starting with heat therapy to prepare your muscles, followed by cold exposure to aid recovery. This mindful practice not only nurtures your body but also cultivates a sense of clarity and stillness amidst the demands of daily life.

Key Takeaways

Utilize local heat therapy before physical activity to prepare your muscles and enhance mobility.
Incorporate local cryotherapy after exercise to reduce inflammation and alleviate acute pain.
Establish a regular contrast therapy ritual to promote resilience and long-term recovery.

Based on: Consensus on the Use of Therapeutic Interventions in Pain Management, Recovery, and Athletic Performance: A Delphi Study
Bailey McLagan, Kyle Silvey, Timothy Roberts, David Erceg, Jonathan C. Sum, E. Todd Schroeder (2025). International Journal of Sports Physical Therapy

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Consensus on the Use of Therapeutic Interventions in Pain Management

What This Study Is Actually Saying

Here's the honest truth about this paper: the researchers set out to find definitive consensus on when practitioners should use heat, cold, percussive, vibration, and infrared therapies. After four rounds of surveys with 94 physical therapists and athletic trainers, they couldn't get there. Not a single modality crossed the 70% agreement threshold for "always" or "never." So they redefined success. They asked instead: would you consider using this intervention? And on that question, patterns emerged.

That's not a failure. That's intellectual honesty. The body is complicated. Patient presentation varies. And anyone who tells you there's one right answer for every case of knee pain or muscle soreness is oversimplifying.

The Pattern That Matters

What the experts did agree on follows a logic your body already understands. Heat before activity, cold after. Before you move, you want blood flowing—heat dilates vessels, relaxes tissue, prepares the neuromuscular system for load. After you've stressed the body, you want inflammation contained—cold constricts vessels, slows tissue metabolism, interrupts the pain signaling cascade.

For chronic pain, the picture is more nuanced. Both heat and cold showed consideration for chronic joint pain, and for chronic soft tissue pain, almost every modality on the list made the cut. That's not contradictory—it's a reflection of what chronic pain actually is. It's not one thing. It's a system that's been dysregulated for long enough that it needs multiple entry points.

The body doesn't care about your protocol. It cares about the signal you send it. Heat says: prepare, open, move. Cold says: recover, contain, restore. The intelligence is in knowing which signal the moment requires.

Where Experts Actually Agreed—And Disagreed

The one firm consensus the study reached was a caution: percussive therapy directly on an acutely inflamed joint is rarely appropriate. 81.3% agreement in Round 4. That makes biomechanical sense. A massage gun driving repetitive compressive force into a joint that's already hot and swollen isn't treatment—it's provocation. This is worth noting because percussive devices have become mainstream consumer products, and most people using them have no idea this contraindication exists.

Worth flagging: two of the five authors are affiliated with Therabody Inc., the company behind the Theragun. This doesn't invalidate the study—the methodology is sound, the Delphi approach is appropriate for this kind of consensus-building, and the results don't read as a marketing document. But it's context you should have when you read the percussive therapy findings.

The Practical Protocol

If you're designing a recovery ritual, this study gives you permission to trust the intuition most experienced practitioners already have. Warm up with heat. Cool down with cold. For stubborn chronic pain, cycle between both. Don't apply mechanical pressure to an acutely inflamed joint. And recognize that "what works" will vary by person, by injury type, by stage of healing.

The Surprising Connection

What strikes me most about this paper is what it reveals about how we develop clinical knowledge. Decades of practice, thousands of patient interactions, and we're only now formalizing the consensus through a Delphi study. This is how intuition becomes evidence. Practitioners figured this out through trial, observation, and feedback long before anyone ran the surveys. The research is catching up to the wisdom already embedded in skilled hands.

That's not a criticism of science. It's a reminder that embodied knowledge—the kind built through direct therapeutic contact with real humans in real pain—has always led. The data follows.

Recovery by Consensus

Harnessing Contrast Therapy for Pain Relief and Recovery

Understanding Heat and Cold Therapy

Practical Applications in Recovery

Building Resilience Through Ritual

Key Takeaways

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