Fire and Ice: Utilizing Thermal Therapies in Your Practice


Many massage therapy practices and spas offer a variety of hydrotherapy or thermal therapy options. The most utilized techniques include warm water baths, saunas, body wraps, steam baths, hot packs, and hot stone massage. Each of these examples uses warm temperatures to help relax and soothe the client’s mind and body. Many offices also offer ice or cold packs for spot treatment of tender or injured tissues. The use of hot and cold has physiological benefits for the client. Cold is stimulating and causes vasoconstriction to help reduce swelling and blood flow to its applied areas. On the other hand, heat causes vasodilation, resulting in increased blood flow to the areas it is applied. Both occur at a superficial level.


The use of hot and cold individually is a very safe and beneficial add-on to any therapy assuming proper precautions are taken. A few things any therapist utilizing thermal therapy should be aware of are:


  • Do not apply heat to fresh injuries that are still hot, red, or inflamed.
  • Never place a hot/cold pack or hot stones directly on the client's skin. A towel or terrycloth cover should be placed between the pack and the client's skin, and hot stones should always be moving and never left sitting on the client's body.
  • Cryotherapy (cold) should not be used on clients who have hypertension or ischemia. Hypertension already causes vasoconstriction, and ischemic limbs already have a reduction in blood flow to tissues.
  • It is important to monitor temperatures closely when working with the client with neuropathy as they will be unable to feel whether or not the temperature being applied is too hot or too cold. This puts them at risk for heat or ice burn.


Contrast therapy is less often utilized in practices, although it can be incredibly effective and beneficial to the client. All the same precautions as above need to be taken to ensure the client's safety. For therapists not currently utilizing contrast therapies, here are several very easy to integrate options for your practice.


  • Localized contrast baths are great for clients who experience swelling in their feet or hands. Take two small tubs and fill one with hot water and the other with cold water.
  • Have the client place their feet in the hot tub for 2 minutes.
  • While the client's feet are submerged, the therapist gently massages from the foot to the hip working in a distal to proximal direction—the massage strokes toward the foot compliment the physiological effects of the heat (vasodilation).
  • The client then switches their feet into the cold water tub for 1 minute.
  • The therapist massages from the hip to the foot, working strokes in a proximal to distal direction - each stroke is toward the heart. This encourages blood flow away from the feet, complementing the cold water's physiological effects (vasoconstriction).
  • Repeat this process three times, being sure to end on the cold.
  • Switch from hot to cold quickly, but pause to massage and rest the area for 30 seconds after the cold and before returning to the hot.
  • With each round increase the intensity of the contrast slightly (make the hotter a little hotter and the colder a little colder)


  • The same technique as above can be completed using alternating ice and heat packs. It can be very beneficial, especially when combined with complimentary massage techniques, for those who have repetitive strain injuries such as plantar fasciitis, shin splints, and tennis elbow since the ice and hot packs are not quite as effective as immersion increase each rotation time by 1 min. The hot will stay on for 3 minutes and the cold for two.

Join us at Biotone's headquarters in San Diego, California, on October 6th for our quarterly open house, including a demonstration of thermal therapies.

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