Water treatments have a universal and timeless appeal. In this episode, MaryBetts Sinclair discusses how she “found” hydrotherapy, when—and why—hydrotherapy re-emerged in modern times, how massage therapists can incorporate hydrotherapy into their practices, and whether MTs should charge more for these services.
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0:01:25.5 Darren Buford: Welcome to The ABMP Podcast. My name is Darren Buford, and I'm editor-in-chief of Massage and Bodywork magazine and Senior Director of Communications for ABMP.
0:01:33.0 KC: And I'm Kristin Coverly, licensed massage therapist and ABMP's Director of Professional Education.
0:01:37.9 DB: Our guest today is MaryBetts Sinclair. MaryBetts has been a massage therapy practitioner and educator since 1975. She is the author of several books and articles, including, Hydrotherapy for Bodyworkers, MaryBetts feels passionate about using hydrotherapy techniques as a complement to bodywork, by working with the body's natural self-healing mechanisms, they can greatly deepen the effectiveness of bodywork. For more information about this and all the great work MaryBetts does, visit marybettssinclair.com. ABMP podcast listeners, ABMP members get 20% off the list price on Handspring Publishing books, including MaryBetts' book, Hydrotherapy for Bodyworkers, second edition, visit handspringpublishing.com to learn about these and other books. ABMP members visit abmp.com/discounts to access your discount code to save 20% off list prices with free shipping to US and UK addresses, find your next favorite book at handspringpublishing.com. Hello, MaryBetts and hello Kristin.
0:02:40.8 MaryBetts Sinclair: Hello, Kristin. Hello, Darren. Hello, everybody.
0:02:44.6 KC: Hello and welcome MaryBetts, we're so excited to have you with us. Let's start by introducing you to our listeners, please tell us a little bit about your background in massage, and how did you find hydrotherapy? Or maybe a better question, how did hydrotherapy find you?
0:03:00.6 MS: So in 1973, I was going to college at Berkeley, California, and I took a community education class on Esalen massage, which was very new at the time, and was really just Swedish massage with some slight modifications. And I was very excited about it, and I thought, you know, I think I was searching at that time for what I was gonna do for professional life, and I thought, "This is something I can do the rest of my life." I had started doing massage when I was four years old, because my mother had a chronic back injury, she fell off a horse when she was a girl, and she loved being touched anyway. So I had worked with my hands for a long, long time. So then I moved to Eugene, Oregon and took classes, massage classes at Lane Community College, and there was a wonderful elderly massage therapist named Thurman Petty, who was born in 1917 and was teaching massage at Lane.
0:04:03.7 MS: He had run YMCAs and done massage for... And this really... The time he was practicing was when massage was really not mainstream, and he had been through a lot of different experiences. And in fact, he was going to give President Kennedy a massage on the day he was assassinated in Dallas, and he was an amazing therapist. So I took a hydrotherapy class from him, and so he was very knowledgeable about combining bodywork with massage. So that was very inspiring. The other thing I think that really helped me blend hydrotherapy with massage was I had an accident, I was rock climbing and fell and I broke my sacrum and injured both my hands, and the physical therapist back then... They don't really do this anymore, when I went to her office, she would put me in a whirlpool for 20 minutes, and then help me get out of the whirlpool, wrap me up and put me on a massage table and let me just rest during the next 20 minutes, which is something you could have in a spa now. And then she would do hands-on work with me and do exercises, and that was just a wonderful experience, I really felt a strong connection with her and I really felt healed by her, and so that was another thing that really motivated me.
0:05:36.4 DB: So MaryBetts, for our listeners who maybe weren't trained or aren't aware exactly of what hydrotherapy is, can you give us a definition and a broad overview of what it encompasses?
0:05:48.0 MS: Yeah, so hydrotherapy is using water to treat a wide range of problems and also to enhance wellness, so that ranges from hot water to cold water, to ice, to paraffin, anything that is put on the skin. So hot stones are not hydrotherapy because they're a heated object and even if they're heated in water, you're not treating the client with them. So water is always involved, so that can go from a sauna, a steam bath, a whirlpool to ice massage, a hot and cold foot bath. And when a hot application is put on, it penetrates deeper if there's water, for example, if I put a dry hot towel on somebody, it's gonna cool off in about 10 seconds, and if I put a moist cloth on, the heat will penetrate in about a half a centimeter deeper and it'll stay hot longer and people feel more soothed and nurtured with water.
0:06:56.1 DB: Absolutely. Can you give us some case studies or an example of working with some clients using hydrotherapy?
0:07:03.1 MS: Yeah. So I try to do some kind of a small hydrotherapy treatment with every one of my clients, and it may just be something very simple, I don't have big expensive facilities. So someone that I worked with recently was a gentleman who fell 45-feet out of a tree, trying to put some owls that had been rehabbed back, a branch broke, so he broke 15 bones. He broke seven ribs, a shoulder, his radius, his ulna, his pelvis on both sides was crushed, and he had a lot of smaller fractures in his legs. So he had six surgeries, and then he was at home and he was a friend of a friend. I offered to see him at his house, and one of the main reasons was I thought no other massage therapist in town would have the courage to work with him. They would be so afraid of hurting him. But I had worked with so many people with different types of disabilities and injuries, people that were on hospice that I felt with massage, you can always find some way to get touched in and find a way to convince the person that they can trust your touch.
0:08:19.4 MS: So I took a crock pot along and I had some towels rung out, I heated them up until they were steamy and they were big enough, each of them to cover his entire back, or his entire torso, so he was still in a hospital bed in his house, and I could see that he was very tentative about being touched 'cause he'd had a great deal of pain and a great deal of... All kinds of surgical intervention. So I took that first towel and I just laid it across his chest and across the top of his shoulders, and he just took a big sigh like... This is gonna be good. So each time I massaged a different part of his body and there were lots that I couldn't touch because of the injuries, I would switch from the towel that had had been on to another warm towel and put it on that area. And so it was helping his circulation somewhat but really, it was just giving him that message, "I can be massaged, I can be touched, I can trust this person not to hurt me."
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0:10:10.7 KC: Now, MaryBetts, hydrotherapy is not a new treatment technique, it's been around a long time. Can you briefly tell us about the ancient history?
0:10:18.6 MS: Sure. So almost all cultures have a combination of hydrotherapy and massage, and people crave heat the same way, so any place where there are hot springs, people are drawn there. So some good examples, in ancient Greece they used to have temples dedicated to Asclepius who was their god of healing, and people who were ill who went there were bathed in big tanks first, so that was a spiritual cleansing, an emotional cleansing, and a physical cleansing all at the same time, and then they were to go to sleep at night and receive a dream that would tell them something about their healing, so that was given at the same time. The spiritual and the emotional and the water all at the same time, and very soothing, of course, for someone who's sick for whatever reason. Ancient Rome, they built baths all over their empire, and they often had massage rooms. The bath house, which is at Bath in England that's been excavated, has a huge massage room that's for women. And the reconstruction that I saw when I was there, there was massage therapists working on the therapists... Excuse me, on the people who've just gotten out of the bath. And in Bath, their soldiers would go there, their wounded soldiers to recuperate, and Bath has the hottest amount of hot water of any place in Europe.
0:12:01.8 MS: So it's been used since 6000 BC, is what they say, it was dedicated to a Celtic goddess who was of healing and then the Romans took it over, then later it was a Christian hospital, then it became a mineral water hospital, and now it's a very expensive, very beautiful spa, and a thousand people a day in the summer come there and they have a team of 50 massage therapists. One other example, I did a hike in Spain, Santiago de Compostela hike and there was a very similar, right outside of the town, people had come on pilgrimage and walked long ways, there were baths there that were specifically for them to be spiritually and physically cleansed before they were able to enter the cathedral, and they're just fun. Right, people just go for fun.
0:12:53.6 DB: We have a lot of hot springs here in Colorado where we're based. So we're very familiar.
0:12:58.5 MS: Yeah. Yeah, in Oregon, we have some, Breitenbush Hot Springs is a resort that is a very beautiful place. And Oregon School of Massage has its beginning massage class there.
0:13:09.7 DB: So MaryBetts, how did hydrotherapy get kind of "rediscovered and re-emerged" in modern times?
0:13:16.8 MS: I think the idea really, was that it was gonna be fun for physical therapy to use a lot more machines and a lot more new technology. And that massage and hydrotherapy were old-fashioned because they were time and labor intensive. And I think that was really the key. So this therapist that I saw, she took time to wrap... To put me in the whirlpool and then leave me there for 20 minutes, so she wasn't optimizing her every second. Maybe she went off and worked with someone else, but she took a great deal of more time now. And physical therapists now are not reimbursed for doing hydrotherapy, even putting hot packs on. For example, Medicare does not reimburse for that. So as massages start to come back into the mainstream, I think that the hydrotherapy is also belongs to that same natural remedy idea.
0:14:21.4 DB: MaryBetts, I have a physical therapy session today, I'm gonna make sure I suggest the whirlpool before. They're probably gonna look at me a little weird when I suggest it, but maybe it'll generate a good talk about hydrotherapy with my practitioner.
0:14:33.6 MS: Yeah, and massage, and you know, I need more hands-on work here, people. [laughter]
0:14:39.2 DB: Always.
0:14:40.0 MS: You could try it.
0:14:42.7 KC: Well, speaking of hands-on work, MaryBetts, I have a two-parter for you.
0:14:46.0 MS: Okay.
0:14:46.1 KC: Why does hydrotherapy complement massage so well? And then also, I'm sure listeners are starting to think, how can I incorporate some of these hydrotherapy techniques into my own practice in my home office?
0:14:58.3 MS: Okay, that's a very good question. Two very good questions. So the reason that I became interested in hydrotherapy is I started to think, "Okay, what can I do with massage as a practitioner?" And I was just... When I first had my license, I was just on fire. I thought, "Let's see what we can do, not only to help people relax, but I'm gonna work with the most disabled, the sickest, homeless people, most troubled people to see what you actually can do with body work." And then I started to realize, "Gee, if you add the hydrotherapy component, a lot of what the hydrotherapy does, its effects are the same as massage." So that would be helping the person settle on the table. If people come in and they're restless, they're stressed, they're talking a mile a minute and they're anxious, putting some kind of a heat application on is gonna help them settle and then I'll be able to start working really deeper right away.
0:16:10.9 MS: So that's a more of the kind of the emotional side. The technical side would be that most hydrotherapy treatments will increase their blood flow. So one of the primary things we are doing, at least with Swedish massage, is we're trying to enhance the circulation because the nutrients that help the body heal are in the blood stream. So anytime I put heat on, the blood vessels are gonna dilate and the blood flow is gonna increase to that area. So that's a good reason. And also, when the tissue is warmed, it's actually stretchier. So if the person has a huge knot, if they have a scar, if they have some old just really tight fascia, any time they put a hot pack on there first, it's gonna make the tissue easier to stretch, and that's gonna make my work easier. And scars often when people go for hand therapy, if they've had injuries to their hands, they use a paraffin bath for that. And that's the reason is because it really deep heats the tissue, and then the scar is gonna be less painful to stretch and manipulate. So those are all... Just like what we're trying to do with massage. Yeah. And also because the hydrotherapy treatments generally feel very nurturing.
0:17:36.9 KC: And for the listeners who are starting to get really excited about bringing and incorporating hydrotherapy into their own practices, what suggestions do you have for techniques that they can do in their own home office? Not in the spa or a wet room, but in their own practice.
0:17:51.0 MS: In their home office. That's a great question. The spas really are a good place to work for many people, and they have the big fancy stuff. But in my home office, I have a sink in my office, and that's about as high tech as I get. So I sometimes will do something very simple. I use hot towels a lot because people just love them. But I use the ice massage for people that have injuries. I use hot cold hand bath for someone with carpal tunnel. A hot and cold foot bath for somebody who just got their ankle out of a cast. So all you need really, is a supply of water. And then I use a crock pot which is very inexpensive and towels. So that's very inexpensive as well. I have a paraffin bath. I've probably had the same paraffin bath for 20 years. And people with osteoarthritis, particularly older people with a lot of arthritis in their hands, I will just have them dip their hands at the beginning. We cover them, put a little warm knit on and then they lay back on the table for 20 minutes until I get to their hands. So all of those are very, very simple to do. And I sometimes will do... Just as a relaxation technique, I will do a salt glow on someone's back, and then I will use hot towels to take the salt off. And then I start massaging. And this is all very inexpensive. You just have to get the idea.
0:19:32.6 KC: Yeah, and then start getting creative with things that they have in their own homes and practices.
0:19:35.2 MS: Yeah, and they can add all kinds of fun things like essential oils and herb teas, and just all kinds of neat stuff.
0:19:46.1 DB: Now, MaryBetts, I happened to read the foreword to your book. And in there I noticed that you mentioned that there was a lack of hydrotherapy training in a lot of massage schools, and I just wanted to ask Kristin first because Kristin's a practicing massage therapist, Kristin, were you trained in any way in hydrotherapy in school?
0:20:06.2 KC: I was, but not in a traditional sense of there was a class on hydrotherapy. We learned hydrotherapy techniques sprinkled in with our other modality classes and in our clinic training. So we used a hydrocollator, so that's moist heat. We use those in our clinics and we learned about them there. We learned about ice techniques in some of our sports classes. We did learn some hydrotherapy techniques, but not a focused training in the subject.
0:20:32.8 MS: Yeah. Some schools do a lot more of the... Body Wisdom School, which is in Iowa, originally the owner is from Germany, so she has more of a hydrotherapy background and teaches there. The class that I teach at the Oregon School of Massage, I've been teaching for about 20 years is, it's five sessions of three hours each. So it's not hundreds of hours of training, but then you learn to combine and again, it's not high tech, it goes perfectly with message.
0:21:10.9 DB: So MaryBetts let me jump in, if you're doing extra hydrotherapy services, should massage therapists charge extra for these services? Is there a possibility for revenue generation here? Or is that something you're just seeing as part of your normal practice, your normal sessions?
0:21:26.9 MS: So I think it can be both ways. I have not charged myself partly because I think that's just more of my personality, I'm excited about something, I wanna try it, and my clients still let me experiment on them. And I have a very, very loyal client base. I have people I've been seeing for 20 to 30 years. So I think that's part of what has built that relationship with them is the hydrotherapy, they know when they come in, they're gonna get that along with their body work. But for other people, I can see it can work really well. I've heard of people charging, for example, for paraffin, they might charge $10 or $15 to have the person do paraffin dip on their hands or on their feet, something like that. Or if they were gonna do a whole body salt glow, they might charge... I'm not sure exactly how much, maybe $25 to $30 that they would add on to the massage. So, it can be. It just depends on how the therapist wants to do it, I think.
0:22:39.9 DB: So MaryBetts, you've been talking a little bit about using hydrotherapy during the session. So I'm a client, at the end of the session, do you send any self-care information of how I can incorporate hydrotherapy at home between sessions?
0:22:53.6 MS: Okay. So this is also an excellent question. It depends on the scope of practice in your state. So in Oregon, it is legal for me to suggest to the person... They came in, and they had a sprained ankle maybe a week ago, and their ankle is still very puffy, so I did a hot-cold foot bath with them and then did massage. So in Oregon, I can say to them, "If you do that at home in between sessions, it's really gonna help you make a lot of progress." But you'd have to look at your state to see whether that was legal or not. Maybe this is a good time for me to say there is sometimes a problem with people overusing heat. Okay. So my understanding is, the most common reason for a massage therapist to be sued in this country is from burning somebody. So that could be hot stones, it could be a heating pad, it could be a hydrocollator pack that's not well covered. And so I think we have to be very, very careful about that. So in my book, I have a whole section that's on heat when it's too much of a good thing.
0:24:14.3 MS: So that's the reason why people need training actually is heat, and I have heard in nail spas of someone who was diabetic having their foot put in 105-degree water, and then the therapist or the nail technician walked away and came back and the person was burned and developed sores. And in one case, they sued because they had to have their foot amputated. So massage therapists are very careful and they are very tuned in with their clients, so that's not really likely to happen, but it is still really important for people to check the person's skin when they're doing heat, really being careful about that. So that's again, that's not exactly scope, but to think about if I'm gonna send the person home and say to them, "Why don't you try doing a hot foot bath?" I need to give them something, and in the back of my book, there are treatment sheets that can be copied, you can give to your client that have the contraindications right there, so you can check and make sure, for example, someone who's diabetic is not putting their feet in blazing hot water. But yeah, it can really help people make progress between sessions.
0:25:34.2 DB: And finally, MaryBetts, is sanitation something that comes into play when doing hydrotherapy?
0:25:40.8 MS: Yes. So any time that the person's skin has touched an item, it will need to be sanitized and it'll need to be laundered, and because of COVID in particular, we wanna be really careful about, you know, the person should never get off their table with bare feet and step on your floor, for example, there needs to be a towel, and once all their linens have been laundered, surfaces should be sanitized as well, and this is good hygiene, actually, for any of us. And I think this may help younger therapists really get in a better habit of good hygiene. Oh, one other thing I'd like to mention is that humidity is very important. I've written an article that's on the Oregon School of Massage about that, that you're more likely to transmit cold, flu, or COVID if the air is very, very dry. So the hydrotherapy treatments, and I actually took a humidity monitor in my office and tried these out, are putting some more moisture into the air, so that's really... For this coming winter, I recommend that a therapist get a humidity monitor and make sure that the temperature is between... Or the percentage of water in the air is between 40% and 60% while they are in there. So if you take that hot towel out and you put it on the person's back, you're getting some moisture into the air, the same as someone who has a wood stove, you'll see them put a little iron teapot on top of that thing. Yeah, yeah.
0:27:22.3 MS: So, this is one other actually a really cool thing about hydrotherapy, is it will prevent people from working and your clients from being exposed to air that is too dry. If the person comes in and coughs or heaven forbid, you should cough on them. And that can be found, if anybody wants to look it up on the Oregon School of Massage blog on their website.
0:27:51.0 DB: I wanna thank our guest today, MaryBetts Sinclair. Listeners, find out more information about MaryBetts and her work at marybettssinclair.com. Thank you so much, MaryBetts, and thanks, Kristin.
0:28:01.0 MS: Thank you very much.
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