Heating Up Your Practice Safely, Part 2

By Dixie Wall

Heating Up Your Practice Safely, Part 2

By Dixie Wall

In December's issue1 we discussed heat therapies and their positive effects in the treatment room. We covered treatment procedures such as skin typing, which will help us give an effective heat therapy treatment while minimizing the risks of burns. We mentioned the use of an informed consent document during the preliminary consultation and reviewed the most common mistakes that can lead to accidental burns. This month, we will discuss the gathering and assessment of subjective and objective information to formulate the best treatment plan for our clients.

First we will begin by reviewing the physiological effects of heat on the body. These involve the endocrine, circulatory and nervous systems. The body's temperature is regulated by the hypothalamus (endocrine system), which strives to keep the body in balance. Common therapeutic responses of the circulatory system include increased circulation and blood flow to the muscles by the vasodilatation of the peripheral nervous system. Sometimes the client will feel slightly sedated from heat by the release of neurotransmitters that tend to make us feel good and cause a decrease in pain and joint stiffness.

Nevertheless, there are certain conditions, diseases and body types that may cause abnormal reactions to heat therapy and/or compromise a client's perception of heat. There are several types of heat therapies used by massage therapists, the most popular include: hot stones, immersion baths, electric heating pads, moist heat packs (hydrocollater packs) and infra-red saunas. In order to use these tools safely, we must remain flexible to our client's individual needs by incorporating our intuition and professional knowledge. It may be best to check first with a client's primary care physician when working with sick patients. A certain client's condition or symptoms may be exacerbated by heat therapies. Considering the aforementioned therapies, what are the subjective and objective factors to consider when treating with heat therapies?

Subjective Findings

The first precautionary measure we can take is by simply asking our clients for a basic medical history. These findings are subjective unless we actually talk to, or receive a note from, a client's primary care physician confirming diagnosis given by the client. Most therapists gather subjective information by an initial interview where the client fills out a complete medical history on their first visit. This document should include, but is not limited to: medical background including medications and supplements, and an informed consent. Some therapists include an extra form specifically for hot stones, or other types of modalities to be filled out by the clients before treatment. Here are some of most common contraindicated and cautioned diseases and conditions to be aware of with use of heat therapies:

Contraindicated diseases and conditions:

  • endocrine disorders that affect the circulatory system (e.g., diabetes)
  • autoimmune diseases
  • acute inflammation for up to three days
  • bleeding disorders
  • peripheral vascular/arterial disease (e.g., varicose veins, deep vein thrombosis, chronic venous insufficiency)
  • heart conditions (e.g. hypertension, phlebitis)
  • peptic ulcer disease
  • malignant tumors and cysts
  • implants, prosthetics, pacemakers
  • acute infection
  • stroke or cerebrovascular accident

Acute conditions and special needs clients:

  • inflammation due to injuries and skin eruptions
  • pregnant women
  • elderly clients (thin skin, poor circulation and false heat perception)
  • bone diseases

Objective Findings

Subjective information is essential, however, objective observations are equally important and effective when creating a treatment plan for clients. By careful observation, we can use our intuition to determine the particular need of each client. For example, noticing that a client is generally in a hurry, feels "hot," tends to sweat easily or is easily irritated may raise a red flag for heat therapies. This client's symptoms point to a general heat pattern in the body and may be exacerbated by adding more heat.

Many types of alternative medical practitioners use subjective and objective information in order to reach a diagnosis and treatment plan for their patients. Legally we cannot diagnosis, but a therapist can still gather information to formulate the best treatment plan for each individual client.

In traditional Chinese medical theory, a practitioner may avoid heat therapies such as moxabustion and fire cupping on certain types of patterns of disharmony or disease. A diagnosis or pattern of disease may indicate whether or not the patient has a too much or not enough heat. Generally, Eastern doctors will not use heat therapies on heat patterns (excess yang or deficient yin/ hot body types) but will use them on patients who have cold patterns (excess yin or deficiency of yang/cold body types) in their diagnosis to warm up the body. The practitioner's intention is to promote the balance of hot (yang) and cold (yin) within the body.

From a similar perspective, Ayuervedic medicine also tries to achieve balance through body typing and diagnosis, and tends not to use heat therapies on people with a high pitta conditions (since pitta represents the fire-water element in the Ayurvedic tradition).

If still not sure on whether or not to use heat, a therapist can palpitate the client's pulse. From a traditional Chinese medicine perspective, pulses over 80 beats per minute (BPM) indicate a mild heat condition and a pulse over 90 BPM indicates a severe heat condition. However, pulse rates can be affected by many factors that should always be considered.

Ultimately, we must always make the client's well-being our top priority by creating balance through the use of our modalities. We must remain flexible based on our clients' needs. Coupling both our intuition and education, we can provide safe and effective treatments for our clients. As always, I welcome and appreciate any comments or concerns at dixiewall@hotmail.com.


  1. Wall D. Heating Up Your Practice Safely, Part 1. Massage Today, December 2009;9(12).