Perhaps without knowing exactly why, primitive man instinctively used cold to relieve pain and heat to induce relaxation. And evidence shows that thousands of years ago nomadic tribes, whether Native Americans, Scandinavians or Central Asians, used the contrast of heat and cold to maintain their health and vigor. The most familiar to us might be the traditional Nordic sauna where one first steeps in herb-infused steam rising off heated rocks and then plunges into the icy nearby body of water. The icy plunge, though invigorating, is not appropriate for everyone. Many choose to just use the heat, invigorating themselves instead with branches of birch trees.

Physiological Effects

The effectiveness of heat and cold in therapeutic circumstances can be attributed to two basic physical rules. Heat expands, cold contracts. Physiologically this translates into the use of heat as a vasodilator – bringing nutrient rich blood to surface areas – and the use of cold acting as a vasoconstrictor – driving blood to the body’s core – nourishing and protecting the inner organs of the body. Used alone, heat can help to relax aching muscles, while cold reduces inflammation and inhibits pain. Pain reduction happens, in part, because the body’s pain receptors are particularly sensitive to changes in temperature. Cooler temperatures slow the velocity of nerve transmission, while heat tends to increase the velocity.

Variations in heat and cold also have a physiological effect on the body’s pain gate mechanism. In very simple terms, the brain is momentarily distracted away from sending or receiving pain messages through the use of contrasting temperatures.

Methods of Use

Heat and cold, as a therapeutic tool, can be used independently of each other or alternating every few minutes. Used in an alternating mode it is often referred to as contrast therapy, and can be used either locally using hot and cold packs or systemically using contrast baths or steam rooms and cold pools.

Heat and cold can be applied to the body in several ways. Perhaps most commonly is through the use of water or hydrotherapy. Steam baths, ice, wet compresses, immersion baths, hydrocollator heated pads and saunas are the most familiar tools of moist heat and cold. Heating pads and infrared lamps can provide dry heat, while vasocoolant topicals and sprays or sealed ice packs can provide dry cold. Warmed or cooled stones can provide wet or dry, heat or cold, depending on the method used to control the temperature.

Total Immersion vs. Local Use

There are two basic methods using contrast therapy.

  1. Total immersion – would be where the person’s whole body is exposed alternately to heat and cold. A prime example of this would be in the use of a hot sauna, followed by a quick dip in to a cold pool of water. In a medical setting this might be done through the use of temperature controlled water-filled tubs and should only be used with proper training.
  2. Used locally – contrast therapy has less of a systemic effect and can be useful in the easing of pain, reducing localized inflammation and increasing superficial circulation. With practice, and the understanding of the basic dilation and contraction action provided by the contrast in temperatures, the use of localized contrast therapy can be effective in assisting the body’s own pumping action, both in the superficial portion of the circulatory system and the lymph system.

How Hot, How Cold?

The human body has certain tolerance levels when it comes to temperature extremes. Applying direct heat above 115 degrees to the skin can be damaging, though steam vapors up to 140 degrees can usually be tolerated by a person in good health. A hot bath is considered anywhere from 100 – 115 degrees. A cold bath would be in the range of 40 – 65 degrees. Always make sure to check in with your client, as some people are much more sensitive than others with regard to temperature. Before using heat or cold applications, ask the client to inform you if there is any pain or discomfort associated with the treatment. If there is, the source of heat or cold should be removed immediately.


Each person reacts differently to the application of heat and cold:

  • A person with diabetic neuropathy, for example, has little or no feeling when it comes to pain and would not be able to give adequate feedback as to temperature.
  • A person with heart disease or kidney infection would be adversely affected by the body’s attempt to accommodate the rapidly changing temperatures.
  • Contrast therapy should never be used on open wounds or immediately following surgery, as it can cause bleeding or increase the chance of infection.
  • Some people have hypersensitivity and/or allergic reactions to the application of cold. Any form of cryotherapy is to be avoided on clients with a history of frostbite or other cold related injury. The use of cold on such a person can result in prolonged burning sensations and extreme pain.
  • Other pathologies adversely affected by the use of cold would be Raynaud’s disease, lupus, rheumatoid arthritis and Buerger’s disease.
  • Any indication of peripheral vascular disease or compromised circulation is a basis for precaution.
  • Heat and cold therapies should not be used in persons with any kind metal implants. Metal reacts differently than the human body when exposed to heat or cold. As a result, those changes, including heating to injurious temperatures and/or modifying the shape of the implant, can cause serious internal injuries.
  • Never leave a client unattended when using heat or cold during a session.

Done correctly and with the understanding of precautions, the use of contrasting temperatures can greatly enhance the efficacy of a massage session and result in the ease of symptomatic pain and inflammation.

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