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  • Writer's pictureKirby Clark, MMT

Thermodynamics of Massage

Updated: Dec 19, 2023

I know we've covered in past discussions about the different ways to employ hot and cold treatments as a part of your self care practice, but what are the different ways thermodynamics can be used in your massage appointments?

The first thing to know about Thermodynamics of Massage Therapy is the difference between Thermotherapy & Cryotherapy. If you’re familiar with the prefixes of those words you may have already guessed that Thermotherapy is the use of heat and Cryotherapy is the use of cold. Hot and Cold treatments both have their time and place that make them most appropriate as a form of self-care and massage treatment. The best part about Thermodynamics is that there is little to no negative side effects when used safely and with professional discretion. This makes thermal treatments the perfect tool in massage therapy as well as the self-care regiment of clients.

Let’s get a brief discussion of contention out of the way first. The old standby rule for hydrotherapy/thermodynamics was that Cold treatments were stimulating while Hot treatments were sedating. There is newer evidence to discredit that standard. The new standby rule is that (regardless of temperature) short applications are arousing or stimulating and long applications are depressive or sedating.

Think about getting into a cold pool of water, at first, it’s abrasive (or it stimulates your sympathetic “fight or flight” response), but the longer you stay in it, the less shocking it feels, you begin to relax into it. However, if the pool was extremely cold, eventually the longer you stayed in it- your systems would be sedated to the point of hypothermia. The same is true about hot water. Getting into a hot bath can arouse you to retract your body immediately, but if you stay in hot water long enough it depresses your response to be parasympathetic (the “rest and digest” response). We’ve come to learn that the temperate isn’t as important as the length of application is when it comes to how the body will respond.


Again, Thermotherapy is the therapeutic use of heat. Heat reduces pain using the gate control method. In a nutshell, the gate control method works by the thermoreceptors (that pick up and interpret thermal sensations) interfering with the signals given by pain receptors (nociceptors). The great thing about heat is that it will always reduce muscle pain, muscle tension, and muscle spasm. This may be why Thermotherapy is most commonly used in spa settings; in the forms of heat packs, hot bottles, fomentations, compressions(hot towels), saunas, steam rooms or steam cabinets, hot stones, paraffin baths, baths or showers, and body wraps to name a few.


Cryotherapy is the therapeutic use of cold. Cold is going to reduce pain through numbing tissue making the pain threshold temporarily lowered. An important thing to keep in mind with Cryotherapy is the potential risks. Did you know there are approximately 20 times more cold receptors in the skin than heat receptors? This would suggest that cold is considered a bigger threat to the body and wellness than heat is. Cryotherapy treatments should not exceed an application length of 20 minutes without a 30-minute rest before re-applying the cold. That doesn’t make cold treatments worse or impractical. In fact, it is recommended that when in doubt about thermodynamics you should err on the side of using Cryotherapy. It’s also a rule of thumb to always start and end any combination treatments with cold applications. Cryotherapy is less common in spa settings but not unseen; there are cold wraps, ice packs, ice bags, compresses (cold towels), ice massage, cold stone, and showers or baths just to name the most common.

Combination Treatments: Contrast & Derevation/Retrostasis

Contrast treatments is a term used to often describe alternating between Cryo- and Thermo- applications on the same body region, repeatedly. Alternating thermal applications on the same region like that will create a pump or suction of fluid (specifically blood and lymph), the pumping simulation increases local circulation more than just hot or just cold treatments on their own.

And my personal favorite, Derevation and Retrostasis. Distinct from Contrast or Alternating treatments because you use hot and cold applications on different body regions simultaneously. Derevation is the use of heat to draw blood toward the localized area where the heat is placed on the body. Retrostasis is the use of cold to push blood away from a specific region where the cold is applied. The best and most common use for Derevation & Retrostasis is to treat headaches, you apply Cryotherapy to your neck and head regions while simultaneously applying Thermotherapy to your lower legs and feet. The cold on your neck/head pushes blood away from that region and the hot on your lower legs and feet pulls the blood toward your lower body, relieving the pressure from your headache.

Thermodynamics is a fascinating and practical method in the massage therapist’s and client’s tool belt for easily manipulating the body.

Peace and Healing,

Kirby Clark, MMT, BCTMB

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