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Chapter Objectives
new part of the body is massaged, a fresh hot silica gel 8. Diabetics should not receive hot applications to
pack is warming the area that has just been massaged, and the legs or feet.
the total effect is one of warmth and deep relaxation. This 9. Peripheral vascular disease, including diabetes,
use of hot towels and silica gel packs is only one way local Buergers disease, and arteriosclerosis of the lower
heat treatments can be used; there are many more. extremities
Indications are similar for all heat applications: 10. Sensitivity to heat, especially in those with thin
skin, such as the elderly and small children, who
1. Muscle spasm, including infant colic caused by
might burn more easily
muscle tightness
2. Poor local circulation Cautions:
3. Musculoskeletal pain (muscle soreness, stiff joints,
1. Elderly (over 60 years old)
arthritis pain, chronic back pain)
2. Children
4. Muscle tightness
5. Warming of tissue to make it more pliable and
stretchable before massage, especially for athletic SILICA GEL HOT PACKS
persons with very dense tissue or areas with sensi-
tive scar tissue Silica gelfilled hot packs, marketed under such names as
6. Soreness after deep massage Hydrocollator and Thermollator, are one of the most
7. Menstrual cramps popular ways for hands-on therapists to apply heat to the
8. Active trigger points body. Because they are easy to heat up and to apply to the
9. When derivation (a tissue-shifting effect) is desired client, silica gel packs are the most commonly used hot
moving blood toward the hot application and moist application in chiropractic offices and physical ther-
away from congested areas. Useful for migraine apy clinics. They provide a simple way to help clients
headache. relax, ease muscle tension before hands-on treatment, and
10. Nervous tension warm cold clients. In offices with multiple practitioners, it
11. Chilled local area is common to see the hot pack heater turned on through-
12. Chilled client out the day and packs being used, returned to the heater to
rewarm, and used again. Usually only one pack per person
Local contraindications:
is used, but on occasion multiple packs are used. Packs are
1. Loss of sensation (lack of feeling), which can be available in various sizes and shapes, from large ones that
caused by spinal cord injury, diabetic neuropathy, cover the entire back to small ones that fit over the hand.
other medical condition, or the use of some med- Silica gel packs cause the greatest temperature eleva-
ications. These conditions can render the person tion in the skin and the subcutaneous tissue. Properly
unable to feel the pain of a too-hot application. used, they can raise the temperature of the skin as much
Never put a hot application on a numb area. as 20F and that of the subcutaneous tissue as much as
2. Rash or other skin condition that could be made 15F. However, even the temperature of the muscle tis-
worse by heat sue underneath that can increase up to 6F. The joints of
3. Inflammation the hand, foot, wrist, and ankle can also be significantly
4. Swelling warmed with the application of these packs. As tissues
5. Broken skinburn, wound, sore, cracked skin from warm, muscles relax, joint stiffness decreases, and colla-
eczema or severe chapping gen fibers become more stretchable. (The tissue must be
6. Malignancy stretched when it is still hot, however, to have this
7. Implanted device such as cardiac pacemaker, stom- effect.) Combining silica gel pack applications with gen-
ach band, and infusion pump tle prolonged stretching produces greater long-term
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 91
improvement in flexibility than stretching alone. Silica gel Packs cool at various rates depending upon how hot
packs, however, may not always be the best choice when they are when they come out of the water and how
applying moist heat, because they dont conform to body thick the towels are, so it is not possible to say exactly
curves as well as fomentations or hot compresses, are too how fast they will cool off. Assume they have the
heavy to be applied to very sensitive areas, and cannot be potential to burn clients throughout the treatment and
applied underneath the body. The client should not lie monitor them at all times.
on the pack for three reasons: (1) They are bumpy and
Time Needed: 15 to 20 minutes on the skin for a relax-
uncomfortable; (2) the clients body weight could
squeeze water out of the pack and possibly cause a burn; ing sedative effect.
and (3) the skin cannot be continuously monitored with- Equipment Needed: Metal hot pack container, hot pack,
out rolling the client to one side to examine it. tongs or gloves to remove hot pack from the container,
The packs are made of canvas and filled with silica gran- enough towels to make four to six layers of towel
ules, which can absorb a great deal of water and then form between the clients skin and the hot pack. Specially
a gel-like substance which holds heat very well. They are made terry cloth covers may be purchased from manu-
heated on racks in special metal containers with electrical facturers of the packs, but at least one layer of towel is
heating elements. Once the metal container is filled with still needed between the cover and the clients skin.
water and turned on, the water will reach a temperature of Effect: Primarily thermal
160 to 166F in 1 to 2 hours. The gel-filled packs lie in the Cleanup: Return hydrocollator pack to container, dis-
hot water and absorb its heat. Or the container can be left pose of used towels. Water in the tank should be
on overnight, and then the packs will be hot and ready to changed periodically, depending upon how frequently
use right away. The packs can be taken directly out of the it is being used, as the water in the tank will become
hot water, wrapped in towels, and applied to clients. They contaminated with small silica particles.
can also be taken from the hot water, wrapped in towels,
Procedure
and kept hot in an ice chest for 20 minutes.
1. Check with client to make sure there are no con-
If you are going to use only one silica gel pack at a time
traindications to the use of local heat.
and you are not using them more or less continuously, it
2. Explain the use of local heat to client and get his
may be more economical to buy individual silica gel packs
or her consent.
and heat them for 20 minutes in simmering water on a
3. Check the water temperature, which is displayed
hot plate or stovetop. Hot pack water heaters require a
on the lower part of heater.
fair amount of energy; the heater in the smallest con-
4. Remove the silica gel pack from the hot water
tainer, which holds four silica gel packs, uses 1000 watts
with tongs, or put on gloves and pick up the pack
(the same as ten 100-watt light bulbs). However, there are
by the loops on the edges (Fig. 5-2A).
some simple strategies for reducing the amount of energy
5. Wrap it in one or more towels. You may fold a
you use. If you use your hot silica gel packs for just a few
large bath towel in half and wrap the hot pack in it
hours every day, it may save both energy and money to
or use several smaller towels. The layers of towel
empty the container in the morning and fill it with hot
will protect the clients skin from burning and pre-
tap water rather than reheat cold water. The water will
vent the pack from cooling off too fast. Silica gel
heat to the proper temperature far more quickly. For the
packs generally require four to six layers of towels,
smallest metal containers, an insulating foam wrapper
but keep extra towels on hand to use if needed.
may be used to reduce heat loss from the tank
Specially made terry cloth covers may also be
(NAIMCO, 425-648-7730). Tanks that hold more than
used. More towels may be needed for an elderly
four packs use more energy when turned off at night and
person or a child (Fig. 5-2B).
reheated in the morning than left on overnight so the
6. Check to make sure the pack is not too hot by feel-
water in the tank stays hot.
ing it with your own hand or wrist (Fig. 5-2C).
The following discusses a step-by-step procedure for
7. Warn the client the hot pack is going on, and say,
using a silica gel pack on the upper back, but gel packs can
Be sure to tell me right away if this feels too hot.
be adapted to treat almost any area of the body. They can
8. Check the area visually before applying towel-
also be combined with cold applications to create contrast
wrapped pack (Fig. 5-2D). This allows you to see
treatments.
what the clients skin normally looks like.
9. Place the hot pack on the clients lower back
Temperature: Silica gel packs are heated in water that (Fig. 5-2E).
is 160 to 166F, and they come out of the hot water 10. Check the skin every 2 or 3 minutes at first: lift
at that temperature. They begin to cool off as soon the pack and check the tissue. It will be bright
as they are taken out of the water but will present pink due to increased blood flow, which is normal,
a burn danger until they have cooled off considerably. but check for any signs of blistering or burning.
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A B C
D E F
FIGURE 5-2 Silica gel hot pack. A. Remove the silica gel pack from the hot water with tongs, or put on gloves
and pick the pack up by the loops on the edges. B. Wrap it in one or more towels. C. Check to make sure the hot
pack is not too hot by feeling it with your own hand or wrist. D. Check the area visually before applying towel-
wrapped pack. E. Place the hot pack on the clients lower back. F. Check the skin every 2 or 3 minutes at first: lift
the pack and check the tissue.
Also ask the client how it feels. Add more towels FOMENTATIONS
to protect the skin if needed. The hot pack will
stay warm for about 20 minutes but will begin to A fomentation, from the Latin word fomentum, which
cool off right away, so that danger of burning means soothing application or poultice, is any warm,
decreases as time goes on (Fig. 5-2F). moist application that delivers heat to the body for heal-
11. As the hot pack cools off, you may wish to remove ing. This book refers to fomentations as the large pads
a layer of towels to keep the area warm and con- specially made for moist heat applications, composed of
tinue to monitor the clients skin. many layers of thick laundry flannel, toweling, or other
12. Remove the hot pack if there are any signs of dam- thick material that can absorb hot water and hold heat
age to the skin or if the client tells you the area is effectively. (Box 5-1 has directions for making fomenta-
too hot. tions.) Like other moist heat applications, fomentations
13. Dry the skin, apply oil or lotion, and begin mas- raise local tissue temperature, improve local circulation,
sage. You will find the clients tissue warm, pink, relax and soften muscles and fascia, and relieve many
and pliable. kinds of musculoskeletal pain. Fomentations have been
used in various forms by many ancient medical traditions.
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 93
Fomentations are relatively easy to make, and a miniature and monitor the skin carefully, as with all hot
fomentation can be made on the spot from a few simple ingredi- applications.
ents. Directions are included for making both a miniature and a
full-size fomentation.
STANDARD SIZE FOMENTATION WITH COVER
MINIATURE FOMENTATION Once you have made the fomentation, follow the directions in
Equipment needed: Boiling water, protective gloves, kitchen this chapter for preparing and applying it.
sponge, hand towel, and microwave oven
Equipment needed: 1 yard of heavy cotton laundry flannel,
Effect: Thermal terry cloth material, or a thick towel for the fomentation and 1
yard of wool or polar fleece for the cover
Cleanup: Wash hand towel.
Procedure
Procedure
1. Cut the fabric into a piece measuring 25 40 inches.
1. Lay the sponge on the hand towel.
2. Fold it in half and then in half again, so the finished size
2. Using gloves, wet the sponge with a small amount of
is 10 25 inches.
boiling water.
3. Sew the pack together around the edges (a serger is
3. Now fold the towel around the sponge to make a small
good for this) or make about six quilting stitches through
pack, and pick it up by the dry ends of the towel.
all the layers to hold them together.
4. Microwave it for 30 seconds.
4. Cut the wool or polar fleece material so it measures
5. Remove it from the microwave by holding the dry ends of
30 32 inches, which is large enough to overlap the
the towel.
fomentation on all sides.
6. Check the temperature of the miniature fomentation
against your skin before applying it to your clients skin, For purchasing information, see Appendix D.
In the twentieth century they were used extensively in Wet the fomentation, roll it up in heavy-grade alu-
water cure institutions, for rehabilitation of wounded sol- minum foil, and heat in a 425F oven for 25 minutes.
diers during the World Wars I and II, and during many Wet the fomentation. Roll it up and stand it rolled
polio epidemics (Box 5-2). end up in the steamer basket of a spaghetti cooker.
Some practitioners prefer silica gel packs to fomenta- Put the steamer basket over simmering water for
tions, and each has its advantages. Silica gel packs can be about 20 minutes. Use a pot that holds 2 gallons of
wrapped only in towels, whereas fomentations necessitate water or more.
a layer of wool and a layer of towels. Fomentations may To make a large homemade fomentation when none
initially be more intensely hot, but preparing them takes is available, you will need protective gloves and a large
more time than for silica gel packs, and they cool off bath towel. Put on the gloves, then carefully twist the
faster. Fomentations can cover larger areas and drape to towel, dip it in boiling water, and twist it again to
fit body curves, whereas silica gel packs are smaller and squeeze out excess water. A hot, wet towel can go
are not flexible. directly against the clients skin rather than being
Because they are very hot when ready to use, fomenta- wrapped in wool and dry towels if you use common
tions are generally wrapped in wool felt, which retains heat sense. First check the hot, wet towel against your own
well, and then in additional layers of towels which protect skin to make sure it is not too hot and then monitor
the clients skin. Once applied, fomentations may be kept the clients skin carefully for burning. Hot towels lose
warm longer if they are covered with a waterproof material heat faster than ready-made fomentations, but they
(such as a sheet of heavy plastic) and then an electric heat- can be covered with a waterproof material and then
ing pad. Hot fomentations can be wrapped and then put an electric heating pad to keep them warm longer.
into a cooler and will stay warm for 10 to 20 minutes.
Below is a step-by-step procedure for using a hot fomen-
To prepare fomentations, first soak them in water to
tation on the anterior thigh. Fomentations can be adapted
wet them all the way through, then wring them out so
to treat almost any area of the body. They can be espe-
that they are thoroughly wet but not dripping (Fig. 5-3A).
cially useful when the client is in a side-lying position,
Then heat them. Here are four options for heating a
over the chest muscles, or if you wish to apply heat to the
fomentation:
front and back of the body at the same time.
Wet the fomentation, then place it inside a gallon- They can also be combined with cold applications to
size resealable plastic bag and heat in a microwave create contrast treatments. For an example, see the sec-
oven, approximately 5 minutes for a standard-wattage tion in this chapter on the full-body treatment using
microwave, longer for a low-wattage one. three local treatments.
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Wool was used because it retained heat well. The wool pieces
were heated in very hot water, removed with tongs, run through a
wringer twice, and then placed on the patient. During the acute
phase, hot packs were applied once per hour around the clock. (In
the nearby photo, the young girl in the acute phase of polio is
shown receiving this treatment.) Even though the fomentations
gave relief to tight, painful muscles, they were very hot, and burns
sometimes occurred. As soon as the initial fever receded, nurses and
physical therapists began to work with patients by applying fomen-
tations and moving limbs passively to maintain range of motion.
Later, the fomentations were again applied to relax tight spasmodic
muscles prior to massage, stretching, and active exercise, which
were all designed to restore muscles to their full function.
Kennys regimen was quite different from the standard medical
treatment for polio patients, which consisted of prolonged bed rest
and immobilization of the limbs with splints and casts. The stan-
dard treatment actually did more harm than good, as it caused
atrophy and contractures in limbs which were already weak. The
medical profession grudgingly accepted Sister Kennys techniques,
Girl with polio in hospital crib, wrapped in fomentations. San and they had became standard treatment for polio victims by the
Angelo, Texas, June 1949. (Photo courtesy of March of Dimes mid-1940s. Sister Kenny became a household name, and in 1946 a
Birth Defects Foundation.) movie was made about her life, with Rosalind Russell in the title
role (see Recommended Resources list at the end of the chapter).
In the 1930s an Australian army nurse named Elizabeth Kenny References
developed a treatment for polio victims that began with wrap- 1. Campion M. Hydrotherapy in Pediatrics. Rockville, MD: Aspen Systems,
ping the limbs of acutely ill polio patients with hot fomentations 1985, p 236.
to reduce muscle spasms and the pain they caused. Foments 2. Wilson D. Living with Polio: The Epidemic and Its Survivors. Chicago:
were made of wool blankets, individually cut to fit each patient. University of Chicago, 2005.
Temperature: Properly heated fomentations are very do not have to be laundered except occasionally. The
hot. Although they begin to cool off as soon as they are towels must be laundered after each use, just like sheets
removed from the heat source, whether that be a and any other linens that touch the clients skin.
microwave oven, regular oven, or steam bath, they
present a burn danger until they have cooled off con- Procedure
siderably. Fomentations cool off at varying rates 1. Check with client to make sure there are no con-
depending upon how hot they are when they come out traindications for the use of local heat.
of the water and how thick the covering towels are, so 2. Explain the use of local heat to client and get his
it is not possible to say exactly how fast they will cool or her consent.
off. Assume they have the potential to burn clients 3. Soak fomentation and wring it out (Fig. 5-3A).
throughout the treatment and monitor them at all 4. Place in zipper closure bag and heat in microwave
times. When checking the clients skin, slide your hand (Fig. 5-3B) or roll up and stand in steam basket
under the wrapped fomentation and feel the clients over boiling water.
skin as well as checking it for signs of blistering or 5. Carefully remove the fomentation from its heat
burning. source (microwave oven, steamer, oven) using
Time Needed: 15 to 20 minutes for a relaxing, sedative gloves (Fig. 5-3C).
effect 6. Wrap the fomentation in a layer of wool felt or polar
fleece (Fig. 5-3D) and then in towels (Fig. 5-3E). You
Equipment Needed: Protective gloves, fomentation, wool
may double a large bath towel and wrap the fomen-
felt, one or two towels, and a heat source, such as a tation in it. The towels will protect the clients skin
microwave oven, regular oven, or a canner with a rack from burning and prevent the fomentation from
has can be placed over boiling water cooling off too fast. Fomentations generally require
Effect: Primarily thermal about four layers of towels, but keep extra towels on
Cleanup: Hang the fomentation and the felt cover up hand to use if needed. Work quickly to prevent the
to dry. Because they never touch the clients skin, they fomentation from losing too much heat.
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 95
A B C
D E F
G H I
FIGURE 5-3 Fomentation. A. Soak fomentation and wring it out. B. Place in zipper closure bag and heat in
microwave oven (shown) or roll up and stand in steam basket over boiling water (not shown) or roll up in alu-
minum foil and heat in oven (not shown). C. Remove the fomentation from its heat source (microwave oven,
steamer, oven) using gloves. D. Wrap the hot fomentation in a layer of wool felt, or polar fleece. E. Wrap the hot
fomentation in towels. F. Check to make sure the fomentation with its covers is not too hot by feeling it with your
own hand or wrist. G. Check the area visually before applying towel-wrapped fomentation. This allows you to see
what the clients skin normally looks like. H. Place the fomentation on the clients thigh. I. Check the skin every 2 or
3 minutes at first: lift the pack and check the tissue.
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Treatment
Rebecca was able to sit straddling a chair, and so the massage therapist draped a hot fomentation around her mid back and
secured it in place with an elastic bandage while listening to her history. Although her mid back was still very painful and get-
ting on the massage table was impossible, the fomentation reduced Rebeccas pain slightly after just a few minutes. She
remained seated on the chair, however, and her husband helped her to remove her shirt. Then the therapist proceeded to mas-
sage Rebeccas back above and below the area still covered by the fomentation. Rebeccas pain gradually began to decrease,
although it was still severe. After 15 minutes of massage above and below the painful area, the therapist removed the fomen-
tation, and with her husbands assistance Rebecca was able to get on the massage table so that the therapist could give more
specific massage to the painful muscles. Her mid back area was pink, pliable, and ready for treatment.
Discussion Questions
1. How did the fomentation relieve Rebeccas pain?
2. What other local heat or cold applications could have been used in this situation?
7. Check to make sure the fomentation with its cov- 13. Remove the fomentation if there is any sign of
ers is not too hot by feeling it with your own hand damage to the skin, if the client tells you the area
or wrist (Fig. 5-3F). is too hot, or if he or she is uncomfortably hot.
8. Warn the client the fomentation is going on, and 14. Dry the skin, apply oil or lotion, and begin mas-
say, Be sure to let me know if this ever feels like it sage. You will find the clients tissue warm, pink,
is too hot. and pliable.
9. Check the area visually before applying the towel-
wrapped fomentation (Fig. 5-3G). This allows you
to see what the clients skin normally looks like.
10. Place the fomentation on the clients thigh
COMPRESS
(Fig. 5-3H).
A hot compressa folded cloth dipped in wateris a
11. Check the skin every 2 or 3 minutes at first.
milder form of the intense moist heat of the silica gel
Lift the pack and check the tissue (Fig. 5-3I).
pack or the hot fomentation. An advantage to using hot
It will be bright pink due to increased blood
compresses over silica gel packs or fomentations is that
flow, and this is normal, but check for any signs
hot compresses may be easily made and applied with
of blistering or burning. Also ask the client if it
simple items.
feels too hot.
All the massage therapist needs to make a hot com-
12. The fomentation will stay warm for about 20 min-
press is hot water, cloths to use for the compress, and
utes but will begin to cool off right away, so dan-
gloves to protect the hands when wringing out the cloths.
ger of burning decreases as time goes on. As the
A disadvantage to hot compresses is that they cool off
fomentation cools, you may wish to remove a layer
faster than silica gel packs or fomentations. Historically,
of towels to keep the area warm, but then you
hot compresses have been used to apply countless sub-
must keep checking the skin.
stances to the skin by soaking the cloths in hot water
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 97
mixed with herbs, essential oils, minerals and salts, to 6. Warn the client the compress is going on, and say,
name just a few. They have also been combined with vari- Be sure to let me know if this ever feels like it is
ous cold applications to create contrast treatments. too hot.
You can make compresses to suit the individual client 7. Check the area visually before putting on hot appli-
quite easily. For example, a tiny hot compress to cover the cation. This allows you to see what the clients skin
eyes may be made by soaking a washcloth in hot water normally looks like.
and then wringing it out. Small or medium-size hot com- 8. Place the hot cloth on the clients skin (Fig. 5-4D).
presses may be made with a few layers of cloth or with A small sheet of plastic may be put on top to help
small towels. Large hot compresses that can cover the prevent heat from escaping.
entire back can be made with a large bath towel. There 9. Monitor the clients skin, and ask for feedback
are many ways to prepare hot compresses. Water for occasionally.
compresses can be heated on a stovetop, in a slow cooker 10. Replace with a new hot cloth every 2 minutes if a
or turkey roaster on a low setting, in a microwave, or even heating pad is not used. If a heating pad is placed
from tap water if the water heater is set quite high. You over the sheet of plastic (Fig. 5-4E), the compress
can soak cloths in a bowl of hot water and then wring need not be replaced and can stay on 10 to 20
them out, or you can roll them up in the shape of a minutes.
sausage, place them in an ice chest, and pour boiling 11. When you remove the compress for the last time,
water over them. Wet washcloths can also be heated in a gently dry the area with a dry cloth. You will find
resealable plastic bag in a microwave oven for a short the clients tissue warm, pink, and pliable.
time. The amount of time will vary depending upon the
wattage of the microwave. Commercial heating cabinets
marketed under such names as Hot Towel Cabi not only
heat small and medium-size cloths that you have wrung MOIST HEATING PAD
out in water, they also keep them warm until needed.
To make sure the compress does not burn the client, Electric heating pads are one of the options you may
as always, check the compress with your own hand or consider when you feel the client will benefit from a
wrist, monitor the clients skin, and let the client deter- warm or hot application. They take no preparation
mine whether the hot compress is uncomfortably hot. time, as they are hot with the flip of a switch; they are
Compresses must never be allowed to burn the client or easy to take with you; and they are very flexible and can
feel unpleasantly hot. be draped around almost any part of the body. Because
An overview of treatment details and a sample proce- they do not have to be wrapped in layers of towels, they
dure using the forearm follows. are less bulky and easier to work around than silica gel
packs or hot fomentations, for example when you wish
Temperature: Hot (110120F) to warm the lower back while massaging the upper back.
Time Needed: 10 to 20 minutes, depending upon the size However, heating pads lack the penetrating intense heat
of the compress and whether more than one is to be of silica gel packs and hot fomentations, and they cannot
used. Small compresses cool off faster than large ones. be used without electricity (such as at an outdoor sport-
ing event). Also, once the pad is plugged into a nearby
Equipment Needed: Water thermometer, hot water, outlet, the therapist must work around the electrical
towels of appropriate size, gloves to protect hands cord. Heating pads can also be combined with various
Effect: Primarily thermal cold applications to create contrast treatments, although
Cleanup: Clean and sanitize water container and launder the clients reaction will be milder because the heat is
used towels. not intense.
There are two kinds of commercial electric heating
Procedure
pads, moist and dry ones. Moist heating pads are elec-
1. Check with the client to make sure there are no
tric heating pads with outer covers that draw humidity
contraindications for the use of local heat.
from the air and retain it. When the pad is turned on,
2. Explain the use of local heat to client and get his
the moisture is heated, then forced out of the cover and
or her consent.
onto the area being treated. Any dry electric heating
3. Check the water temperature and adjust if it is not
pad can be made into a moist heating pad by laying a
within 110 to 120F (Fig. 5-4A).
wet cloth over the area to be treated, covering that with
4. Wearing gloves, wring out the cloth in hot water
a thin sheet of plastic, and then putting a dry heating
(Fig. 5-4B).
pad on top of that. Moist heat is preferred to dry
5. Check to make sure the cloth is not too hot by
because it penetrates deeper. A hazard of both wet and
feeling it with your own hand or wrist (Fig. 5-4C).
dry pads is falling asleep with them on; burns can then
If it is, let it cool to a safe temperature.
occur. Many heating pads now come equipped with an
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A B C
D E
FIGURE 5-4 Hot compress. A. Check water temperature. B. Wearing gloves, wring out the cloth in hot water.
C. Check to make sure the cloth is not too hot by feeling it with your own hand or wrist. D. Place the hot cloth on
the clients skin. E. Place a heating pad over the sheet of plastic (optional).
CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 99
A B C
D E
FIGURE 5-5 Moist heating pad. A. Inspect heating pad. B. Plug in heating pad and turn on to desired setting.
C. Check the area visually before applying heating pad. D. Place the heating pad on the clients abdomen. E. Check
the skin every 5 minutes at first by lifting the pad and checking the tissue.
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 101
CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 103
A B C
D E F G H
FIGURE 5-8 Mustard plaster. A. Mix mustard powder, flour, and water to make a paste that can be spread on
the cloth but is not so thin that it will run. B. Place the cloth on a tray. C. Spoon the mustard mixture onto the cloth
and spread it out, leaving enough dry cloth to fold over well on all four sides. Only one thin layer of cloth should be
between the skin and the plaster. D. Check the area visually before applying the plaster. E. Place the plaster on the
clients anterior shoulder. F. Cover it with the piece of plastic. G. Place a source of heat on top of the plaster, plas-
tic, and small towel. H. At end of treatment time, remove pack, apply a tissue or small cloth dipped in vegetable
oil, and wipe off the mustard.
Effect: Primarily chemical from the action of the castor 2. Explain the purpose of the castor oil pack to the
oil itself but also thermal from the application of heat client and get consent.
over the entire pack 3. Cut or fold the flannel to the appropriate size so
Cleanup: Dispose of plastic sheet, wash metal pan there will be three layers of cloth, and place it on a
with soap and water, launder washcloth. If desired, the metal pan or tray.
oil-soaked flannel can be taken home in a plastic bag 4. Pour castor oil over the flannel and leave it until it
and reused by the client up to 10 times if it is kept in a is well saturated. The cloth should be wet but not
plastic container in the refrigerator between uses: oth- dripping (Fig. 5-9A).
erwise, it should be thrown away. No one else should 5. Warn the client before applying the flannel, and
use the flannel. say, Be sure to let me know if this ever feels too
hot.
Procedure 6. Check the area visually before applying the flan-
1. Check with the client to make sure there are no nel. This allows you to see what the clients skin
contraindications for the use of local heat. normally looks like.
A B C
D E F
FIGURE 5-9 Castor oil. A. Soak flannel in castor oil. B. Apply to skin. C. Cover flannel with plastic. D. Cover
plastic with heating pad or water bottle. E. Remove treatment. F. Clean skin with 1 cup cool water mixed with 12
tsp of baking soda.
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 105
7. Apply the flannel to the calf (Fig. 5-9B). from a warm bath or other full-body heat treatment but
8. Cover it with the piece of plastic (Fig. 5-9C). cannot get in and out of a tub, such as someone with
9. Apply heat on top of the plastic-covered flannel. severe arthritis or Parkinsons disease. At the end of this
Use a heating pad on the highest setting that can treatment, the massage therapist can begin a massage
be tolerated. A high setting is preferable, but a with a relaxed client who has enhanced circulation and
medium setting is acceptable. Or use a hot water warm tissue. By combining three simple treatments, the
bottle (Fig. 5-9D). massage therapist can do the entire procedure without
10. Proceed with massage on other areas of the body. expensive hydrotherapy equipment.
11. Remove pack after 30 to 90 minutes (Fig. 5-9E).
12. Clean skin with 1 cup cool water with 12 tsp of
Indications
baking soda added to it (Fig. 5-9F) or use soap and
1. Relief of musculoskeletal pain, including arthritis
a washcloth.
pain, muscular pain, and rigidity of Parkinsons
13. Proceed with local massage.
disease
2. Scalene, intercostal, or pectoralis major muscles
which are sore or tight after a great deal of coughing
COMBINATION TREATMENT caused by allergy, pneumonia, bronchitis, asthma, or
emphysema. Nervous tension or poor breathing
This whole-body treatment is actually a combination of habits can cause habitual patterns of tightness as well.
three local treatments that stimulate local circulation and 3. Muscle spasm and muscle soreness
warm the entire body. A contrast treatment to the chest 4. Nervous tension
using a hot fomentation and ice rub is combined with a 5. General tonic
hot fomentation to the back and a hot footbath. 6. Insomnia
Combining three heat treatments causes the core tem-
perature to rise rather quickly. At the end of the treat- Contraindications
ment, clients generally feel soothed and stimulated and 1. Diabetics should not have heat applied to the feet.
find that their breathing is more relaxed. 2. Lack of sensation
Because it promotes good circulation in the chest, the 3. Any condition that specifically contraindicates
full combination treatment is a classic treatment for chest whole-body heating, such as cardiovascular prob-
congestion in colds, influenza, pneumonia, and bronchi- lems, diabetes, hepatitis, lymphedema, multiple
tis. Heat helps liquify chest secretions so that they can sclerosis, and seizure disorders, unless treatments
be expelled, eases breathing, and pulls white blood cells are specifically prescribed by a doctor.
into the area to help fight infection. This treatment has 4. Great obesity
also been used for problems in internal organs, such as 5. Pregnancy
cirrhosis of the liver. It has also been used after abdominal 6. Ingestion of alcohol or drugs
surgeryunder doctors supervision onlywith an addi- 7. Inability to tolerate heat
tional hot fomentation over the organ. A direct applica- Temperature: Hot, combining hot fomentations and
tion of heat to the chest followed by a cold application hot footbath (110F) with cold mitten frictions, cold
(contrast treatment) is given to increase circulation to the compress to forehead, and cold water poured over the
chest, and both the fomentation to the back and the hot feet
footbath are given to draw congestion away from the Time Needed: 30 minutes
chest and/or abdominal organs. Equipment Needed
Massage therapists do not treat any of these problems; Water thermometer
however, sometimes this combination of treatments is Kitchen timer
useful within our scope of practice. This treatment, Table or counter space to hold equipment
especially if the fomentations are given very hot for brief Rubber gloves to protect your hands when handling
periods and followed quickly by short, very cold applica- fomentations
tions, can be a tonic and stimulating treatment for the Plastic bed sheet or thick towels to cover the massage
circulation. It is also excellent to relieve musculoskeletal table
discomfort, such as soreness in the chest muscles from Cotton sheets
prolonged coughing, deep tension in the chest muscles, A blanket
or arthritic pain in the back. Fomentations that are mod- Footbath (a rectangular plastic dishpan works well)
erately warm and are applied for a longer period provide Two pitchers
a more sedative, relaxing treatment which can relieve A drinking glass with straw
nervous tension, insomnia, and muscle spasm. This About six towels
treatment is well suited for a client who would benefit
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Three fomentations with fabric covers cover that with the plastic sheet, and cover that
Two washcloths for cold applications to the forehead with one cotton sheet (Fig. 5-10C ).
Basin for ice cubes 4. Using rubber gloves, wrap the first hot fomenta-
Hot water for the fomentation tion in its cover. Lay it down on the sheet where
Cold water for the cold compress to the forehead the clients back will be, and cover it with one or
Ice cubes and cold water for the cold friction two towels (Fig. 5-10D).
Drinking water for the client 5. Have the client quickly get on the table and lie
Effect: Primarily thermal, some mechanical supine, and make sure that the pack is warming the
entire back from sacrum to shoulders (Fig. 5-10E).
Cleanup: Clean and put away all equipment and laun-
(A flat plastic hot water bottle filled with water at
der used linens.
110F may also be used.) Should it feel like it is
Procedure going to burn the clients skin at any time, add
1. Wet the fomentations by soaking them in a con- another towel or two over it. Be sure to ask the
tainer of warm water and wringing them out client for feedback, especially in the first 10 min-
(Fig. 5-10A). utes, before the fomentation cools at all, and if it
2. Heat the fomentations in the microwave in a reseal- feels too hot, add another layer of towel.
able plastic bag for 5 minutes or over boiling water 6. Fill the dishpan with hot water (110F) and place
on the rack of a canner for 15 minutes (Fig. 5-10B). the clients feet in it. The clients knees should be
3. While the fomentations are heating, prepare a bent and feet flat on the surface. Check with the
place for the client to lie during the treatment. client to make sure the water temperature is toler-
Cover the surface of a massage table with a blanket, able (Fig. 5-10F).
A B C
D E F
FIGURE 5-10 Combination treatment. A. Wet the fomentations by soaking them in a container of warm water
and wringing them out. B. Heat the fomentations in the microwave in a resealable plastic bag for 5 minutes or
over boiling water on the rack of a canner for 15 minutes. C. While the fomentations are heating, prepare a place
for the client to lie during the treatment. Cover the surface of a massage table with a blanket, then the plastic
sheet, then a large bath towel, and finally a cotton sheet. D. Using rubber gloves, wrap the first hot fomentation in
its cover. Lay it on the sheet where the clients back will be and cover it with one or two towels. E. Have the client
quickly get on the table and make sure that the pack is warming the entire back from sacrum to shoulders. F. Fill
the dishpan with hot water (110F) and place the clients feet in the bath. (continued)
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 107
G H I
J K L
M N O
FIGURE 5-10 (Continued) G. Place one or two towels on the clients chest, lay the second fomentation on top,
then lay one more towel on top. H. Cover the client with a sheet and then a blanket. I. When the timer rings, rub
the entire chest briskly for 30 seconds with a washcloth or terry cloth mitt wrung from ice water. J. Place another
hot fomentation on the chest. Set the timer for 5 minutes. K. Add hot water to the footbath if needed. L. Provide
water to drink as needed, and place a washcloth wrung out in ice water on the forehead. M. Remove the fomen-
tation on the chest and rub the chest with ice water as before. Dry the chest thoroughly. N. Remove the fomenta-
tion and rub the entire back briefly with ice water. Dry the back. O. Take the clients feet out of the hot water, pour
ice water (left from the cold application to the chest) over them, and dry them off.
7. Place one or two towels on the clients chest, 8. Cover the client with a sheet and then a blanket.
place the second fomentation on top, then place Set a timer for 5 minutes. During this time you
one more towel on top. Again check with the may perform a brief facial massage (Fig. 5-10H).
client to make sure it is not going to burn the skin 9. When the timer rings, rub the entire chest briskly
(Fig. 5-10G). for 30 seconds with a washcloth or terry cloth mitt
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wrung from iced water (Fig. 5-10I). Do not apply REVIEW QUESTIONS
this friction over a womans breasts. Alternatively, a
small towel may be wrung out of ice water, laid over Short Answer
the entire chest, and rubbed for 30 seconds. This
may be more appropriate for a woman, as then the 1. What is the primary hazard of heat applications?
breasts will not be exposed. To minimize exposure,
slide the ice-cold towel onto the chest from above
just as you pull the fomentation down off of the
chest. Be sure to warn your client that the cold is 2. Name five conditions for which local heat is
coming, and encourage him or her to take a deep contraindicated.
breath just as you lay on the cloth. Although the
contrast will be dramatic, the clients chest will be
very warm, and most clients find the cold refreshing.
10. Place another hot fomentation on the chest. Set
the timer for 5 minutes (Fig. 5-10J).
11. Add more hot water to the footbath if needed so that
the water remains at 105 to 110F (Fig. 5-10K).
Scoop some of the cooler water out, then remove
the clients feet for a moment while you add more 3. Name three conditions for which local heat may be
hot water and stir. Replace the clients feet. indicated.
12. By now, the client is usually becoming getting
quite warm; provide water to drink as needed, and
place a washcloth wrung out in ice water on the
forehead (Fig. 5-10L).
13. When the timer rings, repeat steps 9 to 12. 4. Discuss the difference between the heat provided
14. After 5 more minutes, remove the fomentation on by a hot water bottle or dry heating pad versus that
the chest and rub the chest with ice water as in of a silica gel pack or fomentation.
step 9 (Fig. 5-10M). Dry the chest thoroughly.
15. Immediately have the client sit up. Remove the
fomentation on the table and rub the entire back
briefly with ice water (Fig. 5-10N). Dry the back. 5. Describe the effect of local heat on myofascial
Do not let the client become chilled. trigger points.
16. Take the clients feet out of the hot water, pour ice
water (left from the cold application to the chest)
over them, and dry them off (Fig. 5-10O).
17. Make sure the client is dry.
18. The towel under the client will be damp, and it Multiple Choice
should be removed and the client covered with a
dry sheet. The massage session may begin. 6. Local application of heat
a. Relaxes connective tissue
b. Improves healing
c. Causes local vasodilation
CHAPTER SUMMARY d. Relieves pain
e. All of the above
In this chapter you have learned about a variety of treat-
7. Which of these treatments has a heating effect?
ments that heat only one part of the body without immer-
a. Local salt glow
sion in liquid water and their effects and benefits. During
b. Cold footbath
massage sessions, therapeutic heat can help relieve muscu-
c. Tepid footbath
loskeletal pain and promote mental relaxation and
d. Cold compress
increased local circulation, as well as helping to warm and
e. Castor oil pack
soften stiff muscles before exercise and stretching. Your
therapy toolbox has just begun to expand, however; each 8. Local application of heat is indicated for all but one:
of the chapters ahead discusses more new treatments, and a. Chronic arthritis
you will learn even more about how to fine-tune them for b. Increased circulation
yourself and for your clients. Soon you will be able to c. Acute sprain
combine treatments, if desired, for particular clients. d. Prior to exercise
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CHAPTER 5 Hot Packs, Fomentations, Compresses, and Other Local Heat Applications 109
9. The combination treatment is indicated for all but 14. Castor oil packs are used to soften adhesions.
one of these conditions: 15. The combination treatment, when administered
a. soreness in the chest muscles from prolonged correctly, causes a drop in core temperature.
coughing
b. deep tension in the chest muscles
c. kidney failure REFERENCES
d. arthritic back pain 1. Belanger A. Evidence-Based Guide to Therapeutic Physical
e. muscle spasm Agents. Baltimore: Lippincott Williams & Wilkins, 2002.
2. Boyle W, Saine A. Lectures in Naturopathic Hydrotherapy.
10. The desired effects of a mustard plaster include all Sandy, OR: Eclectic Medical, 1988.
but one: 3. Doub L. Hydrotherapy. Fresno, CA: Author, 1971.
a. provide soothing heat 4. Kober A. et al. Local active warming: An effective treatment
b. prepare muscles for massage for pain, anxiety and nausea caused by renal colic. J Urol
c. increase local circulation 2003;170:741744.
d. cause a blister 5. Simons D, Travell J. Myofascial Pain and Dysfunction: The
e. relieve arthritis or muscular pain Trigger Point Manual, vol 1, 2nd ed. Baltimore: Lippincott
Williams & Wilkins, 1999, pp 133, 170.
True/False 6. Thrash A. Thrash C. Home Remedies: Hydrotherapy, Charcoal,
and Other Simple Treatments. Seale, AL: Thrash, 1981, p 75.
11. Moist heat has the same effect as dry heat.
12. A hot pack application prior to massage aids in
muscle relaxation. RECOMMENDED RESOURCES
13. Mustard plasters must be carefully monitored Sister Kenny. 1946. Movie starring Rosalind Russell.
because they can burn the skin. Ice Therapy. 1993. Video by massage therapist Harold Packman.
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