As massage therapists, just like our clients, we often focus more on some of our other aches and pains from our daily activities without giving much thought to the foundation of our physical house—our feet.
We stand on them for most of the day during our sessions and while they may become fatigued, other parts of our physiology complain a bit louder to demand our attention.
There is something to be said about starting from the ground up when it comes to caring for our foundation; our feet. Before discussing specific methods of using hot and cold applications for our feet, we need to understand some basic, physiological effects of the use of hot and cold therapies.
Although the effects may vary, the following general principles apply to all hot and cold therapy applications:
The greater the variance in temperature between the tissues being treated and the hydro-agent, the greater the therapeutic effect of the application.
The effects of an application are dependent upon many variables:
• Temperature of the chosen application
• Length of time the application is used
• The depth of adipose tissue in the area of the application
• The depth of the barrier between the tissue and the application
• The chosen application
We also need to understand various stages and signs and symptoms of tissue repair so we can better gauge which application of hydrotherapy will be most beneficial.
Acute Stage may include signs of inflammation: heat, swelling or edema, redness, pain and dysfunction. There is likely tissue damage, ischemia and possibly muscle spasms. The objective is to help reduce and minimize tissue damage (in most cases; there are situations where the goal is to re-create tissue damage in an effort to enhance restoration.)
Subacute stage may still have signs of inflammation but they are no longer increasing. The objective is to maximize restoration of normal tissue, reduce symptomatic experience and to initiate gentle movement.
Chronic stage may include pain and dysfunction however heat and redness are no longer present and swelling may be decreasing or is no longer present. It is common to bounce back to the acute stage to the chronic stage, depending on the situation.
Heat for Foot Care
Thermotherapy is defined as a therapeutic application using a thermal agent that has a temperature greater than the temperature of the targeted tissue area.
The purposes for using a heat application are to increase tissue temperature, increase local metabolism, increase local circulation, soften connective tissue and diminish trigger point activity
The use of heat applications can also decrease pain and decrease muscle spasms. It can also promote overall relaxation. Incorporating heat can also increase inflammation. If there is already inflammation present, adding more heat can intensify inflammation so be aware this can happen if you are choosing a heat application.
Cold for Foot Care
Cryotherapy is defined as the use of cold application for therapeutic purposes in the treatment of disease or injury. Cryotherapy superficially draws heat from the body by lowering the temperature of the targeted area.
In doing so, is can act as an analgesic, decreasing pain, muscle spasms and local cellular metabolism. It also increases tissue stiffness. Depending on the length of time as well as other variables, cryotherapy can increase or decrease local circulation
It is important to understand what to expect as far as progression of sensations associated with cryotherapy as to not create tissue damage such as frostbite. The stages of response during cold applications are as follows:
Cold – The first sensation that the client perceives is the almost immediate feeling of coolness evolving to an uncomfortable cold sensation.
Burning – The client will feel the sense of cold turn in to an almost burning sensation. This stage usually lasts about 3 minutes.
Aching – The third stage is one of deepening cold, which actually seems to ache.
Numbness – Eventually the area being treated becomes progressively numb (almost analgesic).
When the reaction reaches numbness, the cryotherapy should be terminated to not cause tissue damage such as frostbite. It is important to note that the RICE method that many of us learned for injury has been updated to other more effective methods when addressing injured tissue.
Contrast Therapy
What happens when you use both hot and cold applications alternating each other? It promotes a type of vascular exercise causing alternate constriction and dilation of the local blood vessels, thereby, stimulating an increase in local circulation. Contrast therapy, therefore can be a very effective tool during sub-acute and chronic phases of healing.
Now that we have a foundational understanding of the purpose and effects of hot and cold applications, we can determine better which is going to be more appropriate to use in any given situation.
Next, let’s talk about some simple ways we can address overall fatigue and even minimize some of the chronic foot pain complaints massage therapists have using hot and cold applications for self-care.
Warm Soak
Whether you have an actual foot spa or a makeshift soaking apparatus, soaking your feet in a warm, sudsy bath can feel like you’re washing the day off. Top it off with your favorite additives such as aromatherapy and the day just got less stressful.
Frozen Water Bottle
When you’ve been on your feet all day, maybe longer than usual and perhaps your foundation is feeling sore and achy, a frozen water bottle can be just the trick to reduce inflammation. It can also be helpful for those who may have plantar fasciitis or even soreness from wearing incorrect shoes.
Take the Plunge
If you’re feeling brave or need a quick pick-me-up, there is nothing that will do the job faster than plunging your feet into cool water! Remember, the greater the variance in temperature, the greater the therapeutic effect. Why not try a little contrast hydrotherapy?
Begin with a 10-minute warm soak followed by a five-minute cool plunge for your feet.
Alternating three to five times may also increase local circulation and decrease local edema. Add some plantar flexion and dorsiflexion while soaking and one can really reduce edema surrounding the joints.
Know that the lymphatic system does not have its own pump like the circulatory system does. The lymphatic system relies on muscle contraction and breath to move. Adding pain free joint movement such as plantar flexion and dorsiflexion can reduce edema.
About the Author
Angela Reiter, LMT, BCTMB, has been a massage therapist since 1994 and a graduate of the Chicago School of Massage Therapy. She currently resides in Phoenix, Arizona, where she also has a thriving private practice that includes serving the public as well as providing continuing education for licensed massage therapists. She has been appointed and currently is holding the position of chair at the Arizona State Board of Massage Therapy.