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Chapter 10 / Therapeutic Applications 461
EXERCISE #1
Using the client information provided, complete the
following two critical thinking scenarios, developing a
treatment plan appropriate for each client.
A 35-year-old female complains of stiffness and deep,
constant aching primarily in her right knee and also in her
right hip. Her symptoms increase with activity, preventing
her from running for more than 10 minutes. The discomfort
interrupts her sleep, sometimes waking her up two to three
times a night. She reports her stiffness is most noticeable
when she stands still for more than 15 minutes.
Her health information form indicates that she works as
a surgical nurse 3 days a week and normally runs 5 days
a week for 60 minutes, but her exercise is now limited
by the pain. She has sprained her knee twice in the past:
15 years ago when she twisted her knee stepping off a
curb with roller blades on and once about 8 years ago,
when she slipped on the ice. The right knee pain has been
bothering her for years, but since being diagnosed with a
sprain, she has not sought evaluation or treatment from
a medical professional. The right hip pain has developed
over the past year. She takes ibuprofen as needed for the
pain and applies ice to her right knee after running. She
drinks about 4 glasses of water and 1 cup of coffee daily,
and is fairly health conscious. Monthly massage has been
a regular part of her healthcare for several years.
Upon initial assessment, both of the client’s feet have
low arches and her ankles are slightly everted. Her right
hip is medially rotated, and AROM testing of the right hip
reveals moderately painful and limited lateral rotation.
Her left hip is laterally rotated and exhibits mildly painful
and limited medial rotation. Active and passive ROM for
bilateral ankle inversion is limited but not painful. There is
pain upon AROM of right knee flexion and medial rotation,
but no joint movements are accompanied by pain upon
PROM. The client had an imbalanced, somewhat irregular
gait, but no specific abnormality could be pinpointed.
Functional assessments can help determine whether
passive joint structures may be involved in the client’s
condition and whether the client needs to be referred to
another healthcare professional for evaluation. In the case
of a ligament sprain, massage is a local contraindication
only during the acute phase. After the acute phase, systemic
massage encourages the healing process and prevents
scar tissue and fascial restrictions from developing.
Compensation patterns commonly accompany knee pain
because the knee is such an active joint. This client is
on her feet most of her workday and frequently runs for
exercise, so it is important to address any muscles that
are working to compensate for the pain.
Condition
What current soft tissue or pathological conditions is the
client experiencing?
• What are the functional limitations associated with this
condition?
• What are the treatment options for this condition?
• Is massage indicated or contraindicated for this
condition?
• Has the client undergone any other treatment for this
condition? If so, what have the results been?
• How long has this condition been present and how long
does it typically last?
Pain
What are the past or present conditions that might be
causing pain or compensation patterns?
• Qualify the pain as sharp, dull, or radiating (radiating
pain may indicate nerve involvement and possible
referral to another healthcare professional, whereas
sharp pain may indicate a recent injury).
• Quantify the pain on a scale of 1–10.
• Does the pain increase or decrease during the day?
• What aggravates the pain?
• What tends to reduce the pain?
Sleep
If sleep seems to be affected by the condition, compare
the client’s past sleep patterns with the present:
• Bedtime
• Amount of time it takes to fall asleep
• Number of consecutive hours of sleep
• Number of times client awakens during the night
• Wake-up time
• Pain/discomfort upon waking
• Anything the client thinks might be affecting sleep
Hydration
How much water does the client tend to drink during the
day? (Insufficient water levels can result in thickened
fascia, which increases friction between tissues and can
increase pain.)
462 INTRODUCTION TO MASSAGE THERAPY
Physical Activity
What are the client’s physical activity habits?
• Duration/frequency of physical activity/exercise
• Does the client tend to warm up and/or stretch prior
to exercise? (This is an opportunity to educate clients
about the importance of warming up before exercising
and the difference between stretching and lengthening.)
• Does the client tend to increase water consumption
following exercise?
Determine which muscles to treat
What movements are involved, causing pain or are
restricted?
Consulting the special muscle section in Chapter 4, what
muscles are involved in the movement(s)?
Consulting Table 10-1, what are the antagonists to the
involved muscles?
Consulting Box 7-2, identify any compensation patterns.
Given the muscles involved and compensation patterns
revealed, choose only two or three areas to address (to
minimize the body’s recovery after treatment).
• Avoid treating areas that elicit pain upon passive
contraction (outside the scope of practice).
Determine techniques to use during the massage
Consider the client’s history and interview to decide
which techniques to use:
• People involved in sports tend to respond well to PNF
techniques.
• Avoid techniques that elicit pain.
• Long-term conditions and compensation patterns may
have fascial restrictions that can benefit from myofascial
release (MFR).
• Are there any adaptations that should be made to a
standard massage flow?
• Are there any conditions such as pain or sinus trouble
that require positioning considerations?
• Are there any local contraindications that you must
avoid during the massage?
• Are there any sensitivities or allergies to consider?
Develop treatment plan
Based on the client’s input, the physician diagnosis
and treatment, and the massage therapy assessment,
what are some appropriate short-term and long-term
goals?
Treatment
With the client’s input and all of the information you
have regarding the condition, what is a reasonable future
treatment plan for achieving those objectives/goals?
A 45-year-old male complains of constant, moderate
low back pain that resulted from shoveling snow about
3months ago. He typically runs 3 miles, five times per
week, and bicycles 5 miles to work at least 2 days a week.
The pain, which increases after exercising, has forced him
to cut back on his regular exercise. His job as a corporate
vice president requires him to sit through meetings and
conference calls every day, and he has trouble sitting at
work all day without taking 400 mg of ibuprofen to relieve
the pain. The client drinks at least 8 cups of water per
day, but he also eats a lot of fast food and tends to drink
alcohol nightly.
Upon initial visual assessment, the left side of his pelvis is
higher than the right, and his head is slightly forward. His
gait was normal, and ROM evaluations revealed no pain
upon limited active lateral flexion of the spine to the right,
and pain upon limited AROM of flexion of the left hip.
Functional assessments can help determine whether
the pain pattern results from nerve involvement, in
which case the client needs to be referred to another
healthcare professional for evaluation. In the case of
an intervertebral disc herniation, massage is a local
contraindication. Systemic massage is beneficial for
the client’s general health and can keep compensation
patterns from developing into fascial restrictions.
Condition
What current soft tissue or pathological conditions is the
client experiencing?
• What are the functional limitations associated with this
condition?
• What are the treatment options for this condition?
• Is massage indicated or contraindicated for this condition?
• Has the client undergone any other treatment for this
condition? If so, what have the results been?
• How long has this condition been present and how long
does it typically last?
Pain
What are the past or present conditions that might be
causing pain or compensation patterns?
Chapter 10 / Therapeutic Applications 463
• Qualify the pain as sharp, dull, or radiating (radiating
pain may indicate nerve involvement and possible
referral to another healthcare professional, whereas
sharp pain may indicate a recent injury).
• Quantify the pain on a scale of 1–10.
• Does the pain increase or decrease during the day?
• What aggravates the pain?
• What tends to reduce the pain?
Sleep
If sleep seems to be affected by the condition, compare
the client’s past sleep patterns with the present:
• Bedtime
• Amount of time it takes to fall asleep
• Number of consecutive hours of sleep
• Number of times client awakens during the night
• Wake-up time
• Pain/discomfort upon waking
• Anything the client thinks might be affecting sleep
Hydration
How much water does the client tend to drink during the
day? (Insufficient water levels can result in thickened
fascia, which increases friction between tissues and can
increase pain.)
Physical Activity
What are the client’s physical activity habits?
• Duration/frequency of physical activity/exercise
• Does the client tend to warm up and/or stretch
prior to exercise? (This is an opportunity to educate
clients about the importance of warming up before
exercising and the difference between stretching and
lengthening.)
• Does the client tend to increase water consumption
following exercise?
Determine which muscles to treat
What movements are involved, causing pain or are
restricted?
Consulting the special muscle section in Chapter 4, what
muscles are involved in the movement(s)?
Consulting Table 10-1, what are the antagonists to the
involved muscles?
Consulting Box 7-2, identify any compensation patterns.
Given the muscles involved and compensation patterns
revealed, choose only two or three areas to address (to
minimize the body’s recovery after treatment)
• Avoid treating areas that elicit pain upon passive
contraction (outside the scope of practice).
Determine techniques to use during the massage
Consider the client’s history and interview to decide
which techniques to use:
• People involved in sports tend to respond well to PNF
techniques.
• Avoid techniques that elicit pain.
• Long-term conditions and compensation patterns
may have fascial restrictions that can benefit from
MFR.
• Are there any adaptations that should be made to a
standard massage flow?
• Are there any conditions such as pain or sinus trouble
that require positioning considerations?
• Are there any local contraindications that you must
avoid during the massage?
• Are there any sensitivities or allergies to consider?
Develop treatment plan
Based on the client’s input, the physician diagnosis
and treatment, and the massage therapy assessment,
what are some appropriate short-term and long-term
goals?
Treatment
With the client’s input and all of the information you
have regarding the condition, what is a reasonable
future treatment plan for achieving those objectives/
goals?
Find a partner who can be a “sample client” and follow
the critical thinking format below to design a therapeutic
massage treatment that is appropriate for the client’s
condition.
FORMAT FOR DESIGNING A THERAPEUTIC
MASSAGE
Condition
What current soft tissue or pathological conditions is the
client experiencing?
• What are the functional limitations associated with this
condition?
• What are the treatment options for this condition?
• Is massage indicated or contraindicated for this
condition?
• Has the client undergone any other treatment for this
condition? If so, what have the results been?
464 INTRODUCTION TO MASSAGE THERAPY
• How long has this condition been present and how long
does it typically last?
Pain
What are the past or present conditions that might be
causing pain or compensation patterns?
• Qualify the pain as sharp, dull, or radiating (radiating
pain may indicate nerve involvement and possible
referral to another healthcare professional, whereas
sharp pain may indicate a recent injury).
• Quantify the pain on a scale of 1–10.
• Does the pain increase or decrease during the day?
• What aggravates the pain?
• What tends to reduce the pain?
Sleep
If sleep seems to be affected by the condition, compare
the client’s past sleep patterns with the present:
• Bedtime
• Amount of time it takes to fall asleep
• Number of consecutive hours of sleep
• Number of times client awakens during the night
• Wake-up time
• Pain/discomfort upon waking
• Anything the client thinks might be affecting sleep
Hydration
How much water does the client tend to drink during the
day? (Insufficient water levels can result in thickened
fascia, which increases friction between tissues and can
increase pain.)
Physical Activity
What are the client’s physical activity habits?
• Duration/frequency of physical activity/exercise
• Does the client tend to warm up and/or stretch prior
to exercise? (This is an opportunity to educate clients
about the importance of warming up before exercising
and the difference between stretching and lengthening.)
• Does the client tend to increase water consumption
following exercise?
Determine which muscles to treat
What movements are involved, causing pain or are
restricted?
Consulting the special muscle section in Chapter 4, what
muscles are involved in the movement(s)?
Consulting Table 10-1, what are the antagonists to the
involved muscles?
Consulting Box 7-2, identify any compensation patterns.
Given the muscles involved and compensation patterns
revealed, choose only two or three areas to address (to
minimize the body’s recovery after treatment).
• Avoid treating areas that elicit pain upon passive
contraction (outside the scope of practice).
Determine techniques to use during the massage
Consider the client’s history and interview to decide
which techniques to use:
• People involved in sports tend to respond well to PNF
techniques.
• Avoid techniques that elicit pain.
• Long-term conditions and compensation patterns may
have fascial restrictions that can benefit from MFR.
• Are there any adaptations that should be made to a
standard massage flow?
• Are there any conditions such as pain or sinus trouble
that require positioning considerations?
• Are there any local contraindications that you must
avoid during the massage?
• Are there any sensitivities or allergies to consider?
Develop treatment plan
Based on the client’s input, the physician diagnosis and
treatment, and massage therapy assessment, what are
some appropriate short-term and long-term goals?
Treatment
With the client’s input and all of the information you
have regarding the condition, what is a reasonable future
treatment plan for achieving those objectives/goals? ■
Chapter 10 / Therapeutic Applications 465
SUGGESTED READINGS
Chaitow L. Modern Neuromuscular Techniques . London: Churchill Living-
stone, 1996.
Chaitow L, DeLany JW. Clinical Application of Neuromuscular Techniques . Vol 1.
London: Churchill Livingstone, 2000.
Chikly B. Silent Waves: Theory and Practice of Lymph Drainage Therapy: An
Osteopathic Lymphatic Technique . 2nd ed. Scottsdale, AZ: I.H.H. Publishing, 2004.
Chik ly B, Wel ey S. Lymphedema and lymph-drainage techniques. AMTA
Massage Ther J 2001; Fall:80–88.
Cohen BJ, Wood DL. Memmler’s Structure and Function of the Human Body . 7th
ed. Philadelphia: Lippincott Williams & Wilkins, 2000.
Dixon MW. Myofascial Massage . Baltimore: Lippincott Williams & Wilkins, 2007.
Fritz S. Fundamentals of Therapeutic Massage . 2nd ed. St. Louis: Mosby, 2000.
Granger J. Neuromuscular Therapy Manual . Baltimore: Lippincott Williams &
Wilkins, 2011.
Gray H, Lewis WH. Anatomy of the Human Body . 23rd ed. Philadelphia: Lea &
Febiger, 1936.
Kneipp S. The Kneipp Cure . New York: The Nature Cure Publishing Company,
1949.
Lidell L, Thomas S, Cook CB, et al. The Book of Massage . New York: Gaia
Books Limited/Simon and Schuster, 1984.
Maxwell-Hudson C. K.I.S.S. Guide to Massage . New York: DK Publishing, 2001.
Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement
Therapists . 2nd ed. New York: Churchill Livingstone Elsevier, 2009.
Persad RS. Massage Therapy and Medications General Treatment Principles .
Toronto: Curties-Overzet, 2001.
Salvo SG. Massage Therapy: Principles and Practice . 2nd ed. St. Louis: Saunders/
Elsevier Science, 2003.
Schuemann DW. The Balanced Body: A Guide to Deep Tissue and Neuromuscular
Therapy . 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2002.
Simons DG, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and
Dysfunction: The Tri er Point Manual . Vol 1. 2nd ed. Baltimore: Lippincott
Williams & Wilkins, 1999.
Sjøvold T, et al. Der Mann im Eis . Berlin: Springer, 1995:279–286.
Spindler K. The Man in the Ice . London: Weidenfeld & Nicolson, 1994.
Thompson D. Hands Heal: Communication, Documentation, and Insurance
Billing for Manual Therapists . 2nd ed. Baltimore: Lippincott Williams &
Wilkins, 2002.
Werner R. A Massage Therapist’s Guide to Pathology . Philadelphia: Lippincott
Williams & Wilkins, 1998.
http://aaomed.org/about/index.php, accessed 3.5.06.
http://erikdalton.com/media/published-articles/pain-game-part-1/, accessed
5.27.12.
http://erikdalton.com/media/published-articles/pain-game-part-2/, accessed
5.27.12.
http://medweb.bham.ac.uk/http/depts/path/teaching/foundat/repair
/healing.html, accessed 3.5.06.
http://www.amtamassage.org/articles/2/PressRelease/detail/2545, accessed
5.30.12.
http://www.chiroweb.com/archives/19/08/21.html, accessed 3.5.06.
http://www.cityhealthcentre.nildram.co.uk/cranial.htm, accessed 3.5.06.
http://www.csha.net/advanced/spa.html, accessed 4.11.05.
http://www.cyriax.com/default.html, accessed 3.5.06.
http://www.dayspaassociation.com/mainpages/spaglossary.htm, accessed
4.16.05.
http://www.e-antiin ammatory.com/, accessed 3.5.06.
http://www.efunda.com/materials/piezo/general_info/gen_info_index
.cfm, accessed 3.5.06.
http://www.esomc.com/orthopaedic_medicine.htm, accessed 3.5.06.
http://www.exrx.net/Lists/Articulations.html, accessed 3.5.06.
http://www.hendrickhealth.org/rehab/strain.htm, accessed 3.5.06.
http://www.iahe.com/html/therapies/ldt.php, accessed 6.23.12.
http://www.jdaross.cwc.net/in ammatory_response.htm, accessed 3.5.06.
http://www.lymphatics.net, accessed 3.5.06.
http://www.massagemag.com/spa/body/mud.html, accessed 4.21.05.
http://www.m-w.com/cgi-bin/dictionary?thixotropic, accessed 3.5.06.
http://www.myotherapy1.com/myotherapy_faq.htm, accessed 3.5.06.
http://www.pathwaysmag.com/cranios.html, accessed 3.5.06.
http://www.ptcentral.com/muscles/, accessed 3.5.06.
http://www.qub.ac.uk/cm/pat/education/In amm/tsld004.htm, accessed
3.5.06.
http://www.stjohnseminars.com/phil.html, accessed 6.11.12.
http://www.thespacenter.com/gscframeset.html, accessed 8.5.05.
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_upledger.html, accessed 3.5.06.
http://www.upledger.com/therapies/cst_faq.htm, accessed 3.5.06.
http://www.upledgerinstitute.com, accessed 3.10.06.
http://www.woundcare.org/newsvol4n1/ar2.htm, accessed 3.5.06.
11
(with contributions from
Marybetts Sinclair, LMT, and Debra C. Howard, AOBTA-Certified
Instructor, Dipl. ABT [NCCAOM], LMT)
Objectives
Upon completion of this chapter, the student will be
able to:
■
Describe how hydrotherapy can enhance a
massage session
■
Describe how Qi and the Oriental concept of
energy meridians relate to each other
■
Name the five vital substances in Chinese medicine
Key Terms
Acupoints: Specifically located points on the body that
influence, and are influenced by, body energies.
Acupressure (AK-yoo-preh-sher): A bodywork modality
in which firm fingertip pressure is applied to acupoints
along the energy meridians to regulate the flow of Qi.
Asian Bodywork Therapy (ABT): The term used to
encompass all bodywork modalities that have their
theoretical roots in Chinese medicine.
Bioenergy: The electrical, electromagnetic, and/or
bioelectromagnetic qualities of living tissue.
Contrast therapy: Heat application followed by cold
application, also called alternating therapy.
De ciency : The term used to describe a depleted
condition in Chinese medicine.
■
Name the five elements of nature in Ayurveda
■
Describe the concept of a chakra
■
Name at least four benefits of reflexology
■
Demonstrate a basic reflexology treatment
■
Describe the concept of polarity therapy
Excess : The term used to describe an overly strong
condition in Chinese medicine.
Five Vital Substances : Defined by Chinese medicine
as the five basic substances that supplement the
tissues in a human body: Qi, Blood, Essence, body
fluids, and Shen (consciousness).
Hydrotherapy: The external or internal use of water for
therapeutic use .
Meridians: Precise and orderly channels or pathways
through which Qi flows.
Meridian therapy: The art of working to open and
move the joints, release blockages in tissue, balance the Qi moving in the meridians, and stimulate
the actions of acupoints as needed.
466
Chapter 11 / Complementary Modalities 467
Polarity (poh-LAIR-ih-tee) therapy: A modality in
which very light massage strokes and energy
movements are applied on and off the client’s body
to balance electromagnetic fields, energy nutrition,
and develop a higher consciousness.
Qi (C’hi, Ki) (pronounced CHEE): Life force or vital
energy; the bioenergy of living things.
Re exology (REE- eks-AH-loh-jee): A modality in
which fingertip compression is applied to reflex
any complementary therapies can be incorporated
into massage sessions. These bodywork modalities
M
have a specific intent and are applied for a specific
purpose. Some of these complementary therapies may use
massage strokes, but others may not.
Hydrotherapy (HAHY-droh-THAIR-ah-pee) uses water of different temperatures and in various forms to aid in the treatment of soft tissue, and it can easily be used by massage therapists. A number of complementary modalities manipulate energy in and around the body. The concepts of Oriental medicine, including the philosophy of life force energy that flows through orderly patterns, can be incorporated into massage therapy via acupressure (AK-yoo-preh-sher) and Shiatsu (shee-AHT-soo). Ayurveda is a holistic approach to wellness that incorporates bodywork, nutrition, meditation, and exercise.
points on the hand, foot, or ear that affect other
parts of the body.
Yang (YAHNG): Energy that flows down from the
sun and is associated with the active, bright,
warm, consumptive, and outward activities of
thebody.
Yin (YIHN): Energy that flows upward from the earth
and is associated with the passive, dark, cool,
supportive, and inward activities of the body.
It teaches that the energies of things in and around us influence our health by affecting the energy balance of our body.
Reflexology (REE-fleks-AH-loh-jee) is a modality in which you
apply fingertip compression to specific reflex points on the hand,
foot, or ear to affect other parts of the body. Polarity (poh-LAIR-
ih-tee) therapy uses very light massage strokes, both on and off
the client’s body, to balance electromagnetic fields. There are
too many specialized forms of energy therapy to introduce
them all in this text, but they are certainly worth discovering.
Many complementary modalities require advanced
study; this chapter only serves as an introduction to some
that are commonly used in massage practices. Before apply-
ing any new or complementary modality to a client, make sure
the client has no pathological conditions for which the particular modality may be contraindicated.
Hydrotherapy utilizes water internally or externally for therapeutic treatment. “Taking the waters” is a phrase that describes
the ancient practice of using water to heal. Since the beginning
of time, ancient cultures revered water as a gift from the gods
and used it for bathing and healing. In Oriental cultures, water
was considered a source of Qi (life energy). Similarly, in Indian
and Vedic cultures, water was used as a source for the same life
energy, referred to as prana. The ancient Romans discovered
the mineral springs in Spa, Belgium; the springs were so well
known for healing various health conditions that “spa” became
synonymous with healing waters. Greek and Roman cultures
used water for bathing as well as medicinal purposes from then
on. As civilizations evolved, water became a foundation for
classic medical philosophy linking physical, spiritual, mental,
emotional, and energetic health of the human body.
Water is considered sacred in many religious traditions. It
is used in the Christian tradition of Baptism, which is the universal symbol of purification and regeneration. The Judaic tradition uses ritual cleansing baths for spiritual healing. Millions
of people every year visit the sacred basilica in Lourdes,
France, in hopes of being healed from the water pools there.
The modern use of water for hydrotherapy is often attributed
to Father Sebastian Kneipp (1821–1897) and his Water Cure
(Fig. 11-1). During his training to become a priest, he came
across a small book by a German physician, Johann Siegmund
Hahn (1696–1773), called Instructions on the Wonderful Curative
Powers of Fresh Water . Kneipp was able to cure himself from
pulmonary tuberculosis by using Hahn’s teachings and
immersing himself in the icy cold waters of the Danube River.
He believed that God had provided the book of treatments
that he then refined over time, enabling him to heal hundreds
of people. He divided his water applications into the following:
• Wet sheets
• Baths
• Vapor baths
• Gushes
468 INTRODUCTION TO MASSAGE THERAPY
of Water
Temperatures
Temperature
Category
Range Description
Figure 11-1. Father Sebastian Kneipp. (Reprinted with
permission from Kneipp S. The Kneipp Cure. New York: The
Nature Cure Publishing Company, 1949.)
• Ablutions
• Wet bandages (packages)
• Drinking of water
These treatments had a threefold goal: to dissolve,
to evacuate the morbid matters, and to strengthen the
organism. Essentially, the Water Cure would diminish disease by removing the diseased substances from the body as
well as by cleansing and returning the blood to the cells and
tissues while maximizing circulation.
This section focuses on hydrotherapy applications you
can use during massage sessions and in spa work, and those
you can recommend as self-care activities, including applications of cold or heat, chemical substitutes that provide cold or
heat, contrast therapy, or neutral baths. Table 11-1 describes
the general categories of water temperatures. You must
understand how the different temperatures affect a person’s
physiology so you can use hydrotherapy safely and effectively.
Box 11-1 outlines the physiological effects of cold and heat.
Effects of Hydrotherapy
Before turning to the specific applications of hydrotherapy
that you may consider incorporating into your massage
Very
cold
Cold 55° to 65°F Uncomfortable
Cool 65° to 92°F Slightly
Neutral 92° to 98°F Skin temperature,
Warm to
hot
Very hot 104° to 110°F Tolerable
Painfully
hot
practice, it is important to know some of the general effects
of hydrotherapy on the body. These include the effects of
cold, heat, contrast, and neutral treatments, which are
addressed below.
32° to 55°F Painfully cold
below skin
temperature,
goose flesh
comfortable
98° to 104°F Tolerable,
reddens skin
for very short
periods
Over 110°F Possibly
injurious,
contraindicated
Effects of Cold Hydrotherapy
Temperatures between 55° and 65°F are generally considered cold, and temperatures between 32° and 55°F are considered very cold. Cold and very cold temperatures applied
for a short duration (1 minute or less) cause vasoconstriction, or a narrowing of the blood vessels. When the cold is
removed, vasodilation occurs, opening up the blood vessels
and allowing arterial blood to rush into the blood vessels
and supply the tissues with oxygen. Short applications of
cold ultimately increase circulation.
The same mechanism occurs when cold temperatures
are applied longer than a minute, but during the extended
application, swelling (edema) decreases due to reduced circulation, muscle spasms relax because of the reduced chemical
activity of muscle contraction, and pain decreases because
of the reduced chemical activity of nerve transmission.
Chapter 11 / Complementary Modalities 469
Physiological Effects of Cold and Heat
COLD
Reduces
• Circulation (with prolonged use)
• Acute inflammation
• Swelling (edema)
• Muscle spasm via reduction of muscle spindle activity
• Nerve sensation and pain
• Metabolism
• Tissue damage
• Local oxygen supply (temporarily)
Increases
• Circulation and vasodilation (with short use)
• Urine production
Very cold temperatures (think ice packs) are particularly
beneficial following an injury. Applications of very cold temperatures reduce capillary permeability and the amount of
inflammatory substances produced, relieve muscle spasms,
and decrease pain. As a result, very cold temperatures prevent swelling and encourage movement of the injured area
to enhance circulation to the area. To successfully anesthetize or numb the tissues, ice or very cold temperatures must
be applied for 20 to 30 minutes. Because of all these effects,
ice is one of the most beneficial treatments during the acute
phase of an injury (24 to 72 hours following the injury). The
reason ice is so much more beneficial than heat at treating
injuries is because of our body’s natural homeostatic mechanism for maintaining body temperature. The difference
between normal core body temperature and ice is somewhere around 65°F, whereas the difference between normal core body temperature and heat is only about 10°F. To
restore normal core body temperature, a longer duration of
increased circulation is required in an area that has had ice
applied than in an area that has had heat applied. In addition
to increased circulation, the delivery of oxygen and nutrients, as well as removal of waste products, also increases.
Ice is cold and initially uncomfortable, and the discomfort often becomes worse before numbness sets in. As a
result, many people avoid ice applications. If the body part
to be iced can be submersed in a bucket or bowl of water,
you can reduce the shock of the cold by starting the water
at room temperature and gradually adding ice cubes to drop
HEAT
Reduces
• Pain
• Stiffness and soreness
• Superficial fascia tightness
Increases
• Vasodilation
• Local blood flow/circulation (facilitates healing)
• Oxygen absorption
• Metabolism
• Relaxation
• Joint range of motion
• Sweating, creating a cooling effect on the body
HEAT APPLICATIONS BETWEEN 102° AND 104°F
Increase
• Immune function via inhibition of bacterial and viral growth
• White blood cell count via creating an “artificial” fever
the temperature. Other ways to minimize the shock and discomfort of very cold temperatures are to take a warm bath
or shower while applying the ice pack, or to apply a hot pack
on another area of the body for distraction and to move
blood flow to another area of the body. Although there are
many benefits and indications for the use of cold applications, there are some contraindications as well. Box11-2
lists indications and contraindications of cold and very cold
applications.
Alert
When using a chemical gel pack, you must use
a layer of fabric between the pack and the skin to
avoid damage to the skin and nerves.
Postinjury treatments such as RICE (rest, ice, compression, and elevation) and MICE (mobilization, ice, compression, and elevation) facilitate healing using the same ICE:
• Ice causes vasoconstriction, reduces blood flow, pre-
vents further inflammation, and creates an analgesic
(pain-relieving) effect.
• Compression prevents lymph from accumulating,
thus minimizing edema.
• Elevation of the injured area encourages lymph to
return to the heart, which decreases inflammation.
470 INTRODUCTION TO MASSAGE THERAPY
Indications and Contraindications of Cold and Very Cold Applications
INDICATIONS
• Acute or chronic muscle spasm
• Acute or chronic pain
• Acute inflammation or injury
• Muscle strain
• Ligament sprains
• Tissue that has received any kind of myofascial work
• Bursitis, rheumatoid arthritis, osteoarthritis (unless cold
aggravates the pain)
• Minor burns
• Fever
RICE and MICE are similar treatments, but the “R” in
RICE refers to the “rest” or restricted activity that prevents
further injury, and the “M” in MICE refers to the “mobilization” or gentle, non–weight-bearing range-of-motion exercises recommended to prevent connective tissue adhesion.
Effects of Heat Hydrotherapy
Temperatures between 98° and 104°F are considered warm
to hot, they are usually tolerable, and they redden the
skin. Very hot temperatures are generally between 104°
and 110°F and are tolerable only for very short periods.
Temperatures above 110°F are dangerous and should be
avoided for hydrotherapy purposes.
Heat applied for 5 minutes or less stimulates circulation by promoting vasodilation, which brings more oxygen
and nutrients to the tissue and carries away lymphatic fluid
and cellular waste. The increased oxygen can reduce muscle spasms, relieve muscle tension, and provide pain relief
by breaking the pain cycle. Collagen fibers soften with
heat, which increases tissue flexibility and range of motion.
Heat applications used in the subacute phase of an injury
(72 hours to 6 weeks following the injury) increase blood
flow and promote healing in the injured area. In the chronic
phase, which occurs between 6 weeks and 1 year after the
injury, heat can be applied to tissues as long as the tissues are
not swollen because heat can increase edema. As the heat
increases the temperature of the underlying tissues, cellular
activity increases and immune functions can be enhanced.
CONTRAINDICATIONS
• Decreased cold sensitivity or hypersensitivity
• Compromised local circulation
• Circulatory or sensory impairment
• Spasm of the blood vessels (vasospastic disease)
• Cardiac disorders
• Respiratory disorders
• Use over chest during acute asthma
• Raynaud’s syndrome
• Hypertension
• Uncovered open wounds, infections, or rash
discoloration developing on the skin, lightheadedness,
dizziness, and headache. If any of those symptoms develop
during heat application, stop the treatment immediately and
monitor the client for improvement.
Despite the many benefits and indications for heat therapy,
there are some important contraindications to consider
before applying it (Box 11-3).
Effects of Contrast Therapy
Interestingly, when heat is applied longer than 5 minutes, circulation decreases. The tissues get congested with prolonged
exposure to heat because although vasodilation delivers more
blood to an area, the venous and lymphatic flows are not
equally enhanced. Unless there is enough muscular activity
to encourage these flows toward the heart, you must use a
cold application after long applications of heat. The cold temperatures help the blood and lymphatic vessels constrict to
their normal size and return circulation to normal. Contrast
therapy
application of heat followed by the application of cold or very
cold temperatures. By alternating vasodilation and vasoconstriction (and the associated benefits of each), contrast therapy is beneficial for reducing pain, promoting healing, and
enhancing immune function. As long as you take into account
the client’s sensitivity and overall health and make sure there
are no contraindications for applications of either heat or
cold, you can safely apply and recommend contrast therapy.
, sometimes called alternating therapy, involves the
Alert
Any client who is being treated with temperatures
above 99°F should be watched for nausea, splotchy
Effects of Neutral Hydrotherapy
Neutral baths use water at 92° to 98°F (body temperature)
to increase relaxation and sedate the nervous system.