Hot/Cold Applications in Massage Therapy

Instructor: Cara Sherman

I have a master's degree in Science. I have taught Anatomy & Physiology, Kinesiology, Medical Ethics, Resume writing, Cultural Diversity, and Medical Terminology.

In this lesson, explore the use of hot and cold applications in a massage therapy session. Learn the effects of each of the modalities, and how to utilize them to compliment the massage experience.

Bodily Reactions to the Environment

How do you feel using something hot or cold? Think about how your body reacts if you take a nice hot bath versus standing outside without a jacket in winter. This is related to the use of a hot modality versus a cold modality in massage, especially in how muscle or soft tissue will respond to either.

A hot bath can relax your body, while outside in the cold have the opposite effect.

Hot Application

When heat is applied it causes the soft tissue to relax, to become more supple. The heat application will result in an increase of blood flow to the area or what is also known as vasodilation. The result of this increased relaxation can be used to decrease joint stiffness, decrease muscle stiffness, and reduce pain.

From a hands-on approach, if your client presents to you with a complaint of a 'tight muscle' or a 'stiff joint', the use of a heating pad or moist heat wrap prior to massage will help relax that area, making it easier to manipulate the soft tissue involved. Hot stone massage is another way to implement a heat application directly into your massage routine.

Hot stone massage.
stone massage

It is also important to remember that longer doesn't mean more effective. The effects of heat on soft tissue is limited, and can only do so much. The maximum benefit from the use of heat is between 15 - 20 minutes. Anything longer will not increase the benefit for the client.

Also remember to make sure you check the area the heat is being applied to avoid a superficial skin burn. It is important to communicate with your client and work together.

Practical Scenario

David comes to Terri for a massage today. He has not had one for about a month. He complains that he has been having some low back pain and stiffness, and he thinks it was from sleeping the wrong way. He also tells her that he has had these pains for the past two weeks.

As Terri works through her massage routine, she has David lying face down to work on his back. She uses a warm hot pack on his back while working on massaging his legs. This may or may not be outside of her normal routine. Placing the hot pack on the area of complaint will allow the muscles to start to relax, increase blood flow to the area, and help with David's complaints of stiffness and pain.

Cold Application

When cold is applied, it causes a decrease in temperature or heat to the area of application. This decrease results in lower blood flow or a slowing of circulation to that area referred to as vasoconstriction. This can cause a decrease in inflammation and often times lower pain.

The use of cold can be used in an acute complaint or injury to decrease pain, to reduce muscle spasms, and to help break up a bruised area. Ice packs, ice cubes, or cryocups (ice cups) can all be used for cold applications in your massage.

From a hands on approach, this can be effective when there is swelling or edema in an area, or the client is complaining of a 'knot', muscle spasm, or trigger point that they may want you to address during their massage.

Stages of a Cold Application

When you apply a cold application, it is important to remember to take a minute to explain to your client what they will experience an in what order:

  1. A feeling of cold
  2. A burning sensation
  3. Some aching
  4. A numbing of the area

This is all the normal progression when applying this modality. Each client may react differently to the application and some stages may be longer or shorter, depending on the individual.

Watch the skin for frost bite or an ice pack burn. You can avoid this by placing a towel between the ice and the area of skin that is being treated. Keep in mind that this may slow down the stages of the cold application.

Frost bite to the back side of the hand. This can occur due to improper use of an ice pack.

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