Warm Hydrotherapy for Chronic Injury Pain

The use of warm hydrotherapy, also known in therapeutic massage as deep moist heat, is an excellent way to control and alleviate the pain and achiness associated with chronic injuries.

Most of us have experienced at one point or another the nagging achiness that comes with a chronic injury. Deep, moist heat is an excellent way to help control this pain as a part of homecare, and is also used pre-massage treatment to prepare and warm up the tissues.

Often when an injury has been long-standing, previously damaged muscle fibres have been replaced with tough collagen fibres, aka scar tissue, which reinforce and strengthen a muscle that has been damaged. Collagen fibres do not have the blood vessels that muscle has, and this avascular quality means that decreased blood flow in this tissue interrupts or decrease cell metabolism, oxygen delivery and metabolic waste removal. While scar tissue development is a normal part of the healing process, when collagen fibres are laid down, the muscle becomes more inelastic – unable to elongate and then return to its original length. This affects not only the comfort of the client, but also the power and strength of the affected muscle.

The goals, therefore of deep moist heat in the form of a hydrocollator or thermaphore are:

-         to warm up an area by increasing blood flow
-         increase the delivery of oxygen and nutrients to muscle cells, and speeding up metabolic processes. This decreases pain and achiness.
-         the heat itself will decrease the viscosity of the “ground substance” in muscle tissue, allowing the massage therapist to break down any scar tissue and realign the affected muscle fibres with those of the surrounding tissue

Contraindications for using heat:

-         uncontrolled high blood pressure
-         diabetes or any conditions with neuropathies or altered sensation – the client won’t be able to tell if the application is too hot, and tissue could be damaged
-         any condition where tissue is fragile or circulation has been compromised (i.e. immediately after a cast is removed) – the circulation may be too impaired for extreme heat, so mild applications can be used until the condition of the tissue improves
-         tissue is broken (i.e. a cut, or skin condition such as psoriasis – the tissue is likely already inflamed – heat will make it worse,  and infection can be introduced)
-         metal implants – pins, plates, rods, wire – these will heat up quickly and can really injure a client
-         heat sources should NEVER be placed over major arteries or over the heart

How to use heat properly

You may have never heard of a thermaphore or a hydrocollator, but if you have used a gel pack or grain-filled bag you can heat in the microwave, these same principles apply:

-        heat should only be left on for 20 minutes maximum – any longer and the tissue can get very congested and be even more painful.  You can take it off and use it on another area, or reapply after an hour or so.
-         For hygiene and to prevent burns, the heat source should always be wrapped in a clean towel. For a gel pack (I boil mine on the stove in a cooking pot), I wrap a clean, damp dishcloth around it when it is hot, then a thicker cloth over top. I get the benefit of the moisture that way.
-         it is a good idea to do any stretching that needs to be done after a heat application – you muscles will be much more pliable and stretch more easily.
- use caution if you have taken any analgesics (pain killers), your perception of heat and pain may be off and you could get burned.
-         NEVER lie on a heat source – in the case of a gel pack, hydrocollator or grain-filled bag, it could burst from your weight and you could get seriously burned.

The use of heat in this manner is a great way to control pain from a chronic injury, as well as prepare the muscles in the area for stretching.

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