Having completed this lesson, you will be able to:

• Match these terms to their written descriptions: cryotherapy, thermotherapy, hydrocollator, hot pack, warm pack, cold pack, ice massage, footbath, ice immersion, paraffin dip, hot, warm, cold, neutral.
• List two guidelines for the proper application of a hydrocollator pack.
• List two guidelines for the proper application of a microwavable warm pack.
• List two guidelines for the proper application of a cold pack.
• List two guidelines for the proper application of ice massage.
• List two guidelines for the proper application of an ice immersion treatment.

Common methods of application include hot, warm, or cold packs, local applications like ice massage and mustard plasters, therapeutic showers and immersion baths, hot air baths, friction treatments, and specialized body wraps. In a wellness setting, hydrotherapy is most often used to relax the client, revitalize the body, or remove a treatment product like mud or seaweed. In medical spas, certain types of wellness centers, many European spas, massage clinics, and private massage practices, hydrotherapy applications might be used for relaxation but also for condition management or injury rehabilitation.

Hydrotherapy Packs and Compresses

“Pack” is a general term for any local hydrotherapy treatment (hot, warm, cool, or cold) that uses a gel pack, hydrocollator pack, fomentation pack (moist heat), or commercially made chemical pack. Some packs are electric, some are heated in the microwave, some are chilled in a freezer, and some require specialized equipment. Probably the most effective hot pack is the hydrocollator pack shown in Technique 45. This type of pack has a canvas casing filled with either silicon granules or clay particles that can hold moist heat for up to 30 minutes. These packs are submerged in water kept at 165°F in a specialized heating unit called a hydrocollator. Hot and warm packs are most often used to relax tense muscles, keep the client warm and comfortable, or soften tissue before massage is performed.

Gel-filled commercial packs or homemade ice packs can be used effectively as cold packs. In fact, large bags of frozen peas make an effective cold pack because the small size of the peas feels lighter on an injury site than ice in a plastic zip-lock bag or large ice cubes. Gel-filled packs are also useful because they don’t freeze in a solid block and can be shaped to fit a body area. Cold packs are an effective treatment for acute inflammation or after a massage treatment using friction techniques. Methods for using and applying packs are demonstrated in Technique 45.

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Compresses are wet cloths soaked in warm, hot, cool, or cold water (sometimes with additives dissolved in the water), and wrung out before they are applied to the skin. Compresses are used to provide comfort or enhance the enjoyment of a session. A cool compress might be placed over a client’s forehead while wrapped in a detoxification wrap. Alternately, a warm compress might be applied to the back of the neck while a cold pack is placed on a shoulder injury. The compress helps the client deal more easily with the cold of the cold pack.

Local Applications

You might use a variety of local hydrotherapy applications for condition management or injury treatments. Ice massage, mustard plasters, castor oil packs, and paraffin dips are popular. Ice massage is massage provided with ice. A paper cup is filled with water and frozen. The edges of the cup are then peeled away while the base of the cup is left intact. Hold on to the base of the cup while applying the ice to the affected area in a circular motion. Ice massage of an area can last up to 20 minutes and is used to reduce inflammation during the acute inflammatory stage, or to cool tissue after using intensive heat-producing techniques like friction.

The term plaster refers to herbal pastes (herbs mixed with either water or oil) that are spread on a particular body area or onto a piece of cloth that is then applied to a particular body region. Mustard plasters are warming and useful for the treatment of osteoarthritis, poor circulation, back stiffness, joint stiffness, and general muscular aches and pains. To make a mustard plaster, mix 1 tablespoon of mustard seed powder and 4 tablespoons of wheat flour with warm water until you have a paste of medium consistency. Spread the paste onto a muslin or cotton cloth, and place it over the region being treated. Because a mustard plaster gets hot and can even blister the skin, monitor it constantly. Cover the plaster with a warm pack to increase the therapeutic benefits of the application. Mustard plasters can irritate sensitive skin.

Castor oil packs and castor oil applications have been used in both European folk medicine and ayurvedic medicine (the traditional medical system of India) for centuries to increase blood and lymph circulation, relax tight muscles, reduce pain, ease joint stiffness, and break down scar tissue. Castor oil is extracted from castor beans and is high in the fatty acid ricinoleic acid. It is believed to support natural detoxification in the body. Apply castor oil to the affected area in a thick layer, and cover it with plastic wrap. Place a hand towel and an electric heating pack over the top of the plastic. The castor oil “pack” can be left in place for 30-45 minutes.

Paraffin is a waxy substance obtained from the distillates of wood, coal, petroleum, or shale oil. It is used to coat the skin and trap heat and moisture at the skin’s surface. This increases circulation and softens the local tissue, which improves joint mobility and decreases pain. A paraffin dip is an effective treatment for chronic arthritis, tight muscles, and painful joints. It also leaves the skin soft, and it feels warm and sumptuous. To apply paraffin to the hands or feet, first wash the area to be dipped or mist the area with alcohol so that it is properly sanitized. Dip the hand or foot into the paraffin, and allow the paraffin to harden slightly before dipping the area again. Dipping up to five times should be sufficient. Wrap the paraffin-covered hand or foot in cellophane wrap or a plastic bag before placing it into a heated mitt or a warm towel. To remove the paraffin, simply peel off the cellophane wrap together with the wax all in one piece. The hands can be dipped while the client is on the table in the prone or semi-reclined position. The feet can be dipped while the client is on the table in the supine position (Fig.16-1). <fig16-1>

Therapeutic Baths

Therapeutic baths (sometimes called balneotherapy) encompass a range of different hydrotherapy methods including footbaths, whirlpool baths, steam baths, saunas, full immersion baths, partial baths, and sitz baths (Table 16-4). Hydrotherapy tubs with multiple air and water jets are designed for professional use and are used to apply full immersion baths. Additives are often used with baths to increase their therapeutic benefits.

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Footbaths ease foot fatigue or pain, cleanse the feet, warm the body, and relax the client in preparation for a massage. Sometimes they are used therapeutically to draw fluids down towards the feet as in a footbath delivered to reduce sinus congestion. Massage therapists often use footbaths as a complimentary treat for the client while the client fills out paperwork before the session. Some clinics encourage clients to arrive early and relax with a footbath in a quiet room where soothing music, a cup of warm herbal tea, and dim lights to facilitate the process of releasing tension. A therapist might start every massage with a five-minute footbath while the client’s neck and shoulders are massaged in a seated position.

Whirlpool baths contain turbines that mix air with water. The agitated water is directed at specific body areas so that soft tissues are manipulated by the force of the water hitting the body.

Steam baths, steam showers, steam cabinets, and saunas are considered hot air baths because the client is “bathing” in water vapor. Steam baths use steam to facilitate perspiration and help the body to detoxify. Steam baths are often applied before another treatment to warm and relax the muscles, or before the application of a particular product. They are also used to clear the sinuses and respiratory congestion, or to clear clogged and congested skin.

Saunas combine hot air (160-210°F) with low humidity to stimulate metabolism, increase core body temperature, and facilitate detoxification. They are useful as a support treatment for a number of different conditions. For example, people living with chronic fatigue syndrome often experience debilitating feelings of fatigue, musculoskeletal pain, and low-grade fever. One study found that regular use of a sauna improved these symptoms significantly.¹⁶ The humidity in a sauna must not be allowed to drop below 10% or else the hot air will start to dry out the mucus membranes of the respiratory system. Like a steam bath, a sauna can be used to pre-heat the body in preparation for another treatment.

Partial baths involve the submersion of body areas like the feet, legs, arms, or hands into baths of water heated to specific temperatures. A sitz bath is a type of partial bath in which the patient sits in water that comes up to the navel but no higher. Naturopathic doctors use it to treat reproductive or urinary disorders.

Methods for applying footbaths, full-immersion baths, steam baths, and saunas are demonstrated in Technique 46.

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Therapeutic Showers

Chapter 15 (Spa Therapies and Other Approaches) introduces the use of therapeutic showers for product removal. Technique 34 in that chapter demonstrates the use of a Swiss shower, Vichy shower, hand-held shower, and standard shower. Therapeutic showers use hot, warm, cool, or cold temperatures to facilitate desired physiological and reflex effects. Often they are used to warm the body in preparation for another treatment or to cool the body at the end of a treatment. Swiss and Vichy showers have control panels with which you can manage the temperature of the water. In a standard home shower in which the client controls the water temperature, the temperature will not be exact or provide the same benefits.

Hot showers (100-104°F) are stimulating and pain relieving. They might also be used to raise the core body temperature of the client in preparation for another service like an herbal detoxification wrap. A hot shower begins at 100° F. As the client acclimates to the temperature, it is gradually increased. A healthy client may tolerate very hot temperatures up to 110° F, but the temperature should not exceed 110° F. The hottest temperature that is safe and tolerable for the individual client is held for 2 minutes and then decreased rapidly to a neutral temperature to end the shower.

A graduated shower is used to cool the body after a prolonged heating treatment like a steam bath or sauna. The water temperature begins at 102° F and is increased quickly to the tolerance of the client. The elevated temperature is held for 2 minutes and then lowered at intervals. Each interval is held for 1-3 minutes. The final ending temperature is in the range of 80-85° F. This temperature is held for 4 minutes to finish the shower.

Cold showers (56-70° F) are stimulating and toning for muscles and skin. They are often used to refresh the body after the application of a treatment that heats the body. They are short and used only on healthy individuals with no contraindications.

Hot and cold contrast showers stimulate metabolism, increase circulation, and revitalize the body. They are effective for fatigue, mental burnout, and low energy. Hot and cold temperatures are reversed for three sets of one interval each; the timing per interval ranges from 1 to 3 minutes. The treatment ends on the cold water setting.

A Scotch hose directs a strong stream of water at the client to increase circulation, stimulate function, tone muscles, decrease pain, and decrease congestion in a particular body area. It is an effective treatment to use on areas that are prone to stagnation (e.g. poor circulation). Application of a Scotch hose is shown in Technique 47.

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Friction Treatments

Chapter 15 (Spa Therapies and Other Approaches) introduced friction treatments. Salt glows, dry skin brushing, and loofah scrubs all trace their origins back to the traditional methods of Sabastian Kneipp. Kneipp’s classic frictions were carefully chosen for each patient. Frictions could be delivered soft and dry with the palms flat, covered in powder, buffed across the skin to warm and invigorate, or wet and brisk, with water, vinegar, or rubbing alcohol mixed with salt. Cold mitt friction is still widely used to prevent colds, boost immunity, increase circulation, increase endurance, and invigorate the body. Review Techniques 36, 37, and 38 in Chapter 15 for the application of salt glows, dry skin brushing, and loofah scrubs. Technique 48 in this chapter demonstrates cold mitt friction.

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Body Wraps and Wet Sheets

Like frictions, body wraps originated in Kneipp hydrotherapy. One of his most famous body wraps was the cold, wet sheet wrap. Kneipp believed that this treatment strengthened the patient’s body so that it could overcome a disease or resist diseases. Kneipp’s patients lay on a cold wet sheet or were covered with a cold wet sheet, and then wrapped in blankets for up to an hour.¹⁸ The patient would experience a vascular flush effect in which body temperature was elevated so that the patient perspired. Kneipp used cold wet sheet wraps successfully for menstrual cramps, digestive complaints, fever, weakness, lower back pain, and for general revitalization. Review Techniques 39 and 40 in Chapter 15

<cb16-4> Concept Brief 16-4: Hydrotherapy Applications