Two Local Heat Applications: 

Mustard Plaster and Castor Oil Pack

By Marybetts Sinclair, LMT @ www.marybettssinclair.com

This article is excerpted from Marybetts’ new book Modern Hydrotherapy for the Massage Therapist with kind permission of Marybetts and the publisher Lippincott Williams & Wilkins

Introduction

This article describes two types of treatments that heat one part of the body. Because they are relatively simple and inexpensive, they are more accessible to the average massage therapist than many whole-body treatments, which require installing more elaborate and expensive equipment. They are also versatile and can be used in a variety of ways.

How can applying local heat treatments improve a massage session?

Here are some examples. Before working with an area that needs concentrated stretching, deep heat from a hydrocollator pack, fomentation, hot compress, moist heating pad, hot water bottle, mustard plaster, or castor oil pack makes tissues far more pliable and stretchable.

Local heat relaxes both skeletal and smooth muscles. Hot fomentations, hot sitz baths and even electric blankets can relieve kidney stone pain, which is caused by a spasm of the smooth muscle that lines the ureter.

Local heat also makes myofascial trigger points less painful to pressure while they are treated, and reduces muscle soreness from trigger point treatment when it is applied immediately afterwards. It improves local circulation and relieves the joint stiffness and discomfort of osteoarthritis. Hot applications can be combined with cold ones to form contrast treatments to stimulate local circulation and relieve pain. Finally, the soothing and nurturing feel of local heat helps to reduce nervous tension.

While many local heat treatments – such as dry heating pads, hot water bottles, and rice-filled microwaveable bags – can be administered without the use of water and have many of the same effects, water is more efficient at transmitting heat than dry materials. For example, even if heated, dry cloth packs do not warm the body as much as heated moist cloth packs. Moist applications also have a soothing “watery” quality.

The advantages of any type of hot application must always be weighed against the two major disadvantages: hot applications can burn and so must be carefully monitored, and prolonged application of heat to the body surface can raise body temperature.

Indications are similar for all heat applications:

1. Muscle spasm, including infant colic caused by muscle tightness.
2. Poor local circulation
3. Musculoskeletal pain (muscle soreness, stiff joints, arthritis pain, chronic back pain)
4. Muscle tightness
5. Warming of tissue to make it more pliable and stretchable before massage, especially for athletic persons with very dense tissue or areas with sensitive scar tissue.
6. Soreness after deep massage.
7. Menstrual cramps.
8. Active trigger points.
9. When derivation (a tissue-shifting effect) is desired – moving blood toward the hot application and away from congested areas. Useful for migraine headache.
10. Nervous tension.
11. Chilled local area.
12. Chilled client.

Local Contraindications:

1. Loss of sensation (lack of feeling), which can be caused by spinal cord injury, diabetic neuropathy, other medical condition, or the use of some medications. These conditions can render the person unable to feel the pain of a too-hot application. Never put a hot application on a numb area.
2. Rash or other skin condition that could be made worse by heat.
3. Inflammation
4. Swelling
5. Broken skin – burn, wound, sore, cracked skin from eczema or severe chapping
6. Malignancy
7. Implanted device such as a cardiac pacemaker, stomach band, and infusion pump
8. Diabetics should not receive hot applications to the legs or feet.
9. Peripheral vascular disease, including diabetes, Buerger’s disease, and arteriosclerosis of the lower extremities
10. Sensitivity to heat, especially in those with thin skin, such as the elderly and small children, who might burn more easily.

Cautions:

1. Elderly (over 60 years of age)
2. Children

Please note that you should be a regulated health care professional in order to apply these hydrotherapy treatments with clients. Always make sure the treatment is not contraindicated with your client and check in with them visually by checking on their skin and verbally, by asking them if they are feeling comfortable.

We will be exploring two local heat applications in this article. There are many more in the chapter from Marybetts’s book - Editor

Mustard Plaster

A plaster is a paste-like mixture, usually of herbs, that can be spread upon a cloth and applied to the body. Ground mustard seeds contain chemicals and enzymes that, when combined with water, liberate compounds that encourage blood flow to the surface of the skin. The plaster also serves as a counterirritant, as substance that stimulates nerve endings in the skin, distracting the central nervous system from deeper seated pain and relieving it. Plasters made with ground mustard are used to warm muscle tissues, especially deeper tissues, and to treat chronic aches and pains, such as those of arthritis.

Mustard was used in Europe for centuries for both medicinal and culinary purposes and was brought to this country by European settlers. Mustard seed was once listed in the U.S. Pharmacopeia (list of approved medications) and was included in baths, liniments, plasters and massage oils. Mustard preparations were widely available commercially, and mustard powder was one of the medicines used by the U.S. Army.

Use of plasters became less common in the last half of the twentieth century, and they are now seen chiefly as a home remedy. Originally mustard plasters were thought to draw out “bad humors.” Practically speaking, however, the plasters were used to provide soothing heat, increase local circulation, relieve arthritis pain, and treat respiratory ailments such as chest colds and bronchitis by deeply warming the chest. Today’s massage therapist may wish to use a mustard plaster before massage to ease a painful muscle or joint and to bring heat to a deeper muscle before it is massaged.

Below is an overview of treatment details and a sample procedure for the anterior shoulder area.

Indications

1. Poor local circulation
2. Painful muscles that will be massaged after the plaster is removed
3. Frozen shoulder (ie. adhesive capsulitis)
4. Gout
5. Acute lower back pain of muscular origin
6. Chronic back pain
7. Arthritis pain (currently non-inflamed, red or swollen)

Contraindications

1. Sensitive skin
2. Allergy to mustard seed
3. Open skin (e.g. wound, rash, eczema)
4. Any area where heat is contraindicated such as diabetic neuropathy or spinal cord injury.

Temperature: Hot (110 degrees F)

Time Needed: 15 – 30 minutes

Equipment Needed: 1 tablespoon of mustard powder, 4 tablespoons of wheat flour, and enough tepid water to make a paste; spoons for measuring and stirring the paste; thin cotton cloth, approximately 10 x 12 inches; piece of plastic that is slightly larger than cloth; a small towel; fomentation (hot water bottle, or heating pad to keep plaster warm; small tray

Effect: Primarily chemical from the ground mustard, but also thermal due to the application of heat over the plaster.

Cleanup: Dispose of plaster and plastic sheet, launder the thin cloth and towel.

Mustard Plaster Protocol

• Check with the client to make sure there are no contraindications to the use of local heat.
• Explain the use of local heat to the client and get consent
• Mix mustard powder, flour, and water to make a paste that can be spread on the cloth but is not so thin that it will run.
• Place the cloth on a tray.
• Spoon the mustard mixture onto the cloth, and spread it out, leaving enough dry cloth to fold over well on four sides. Only one thin layer of cloth will be between the skin and the plaster.

Mustard Plaster Preparation Video

• Warn the client before applying the plaster, and say, “Be sure to let me know if this ever feels too hot.”
• Check the area visually before applying the plaster. This allows you to see what the client’s skin normally looks like.
• Place the plaster on the client’s anterior shoulder.
• Cover it with a piece of plastic.
• Cover the plastic with a small towel.
• Place a source of heat on top of the plaster, plastic and small towel.

Mustard Plaster Initial Application Video

• Leave the plaster on for 20 minutes.
• Monitor the client’s skin carefully. If the skin becomes very red before the 20 minutes is up, the reaction is finished and the plaster may be taken off. If the client feels any stinging or burning, remove the plaster immediately.
• To clean the skin, apply a tissue or small cloth dipped in vegetable oil and wipe off the mustard.

Checking in with Client and Removing Mustard Plaster Video

Castor Oil Pack

Castor oil is a thick, clear oil extracted from crushed castor beans. Because the castor plant grows well in many parts of the world, the oil is easy to obtain. It has been used medicinally for centuries in both Ayurvedic medicine and European folk medicine, and today it is commonly sold in drugstores. It has a high concentration of fatty acids, especially ricinoleic acid.

Castor oil packs have long been used for increasing local circulation of blood and lymph, relaxing smooth muscle, softening scar tissue, relieving muscle and joint pain, and helping relax specific areas. Vasodilation from hot applications laid over the packs increases absorption of chemicals in the oil and creates the effects of local heat.

Some practitioners of natural medicine prescribe months-long regimens of daily castor oil packs because they are believed to have strong detoxifying properties; however, no research has been done to investigate this claim. More important to the massage therapists is the use of castor oil packs to soften fibrotic nodules and adhesions. Castor oil packs may be applied at the beginning of a massage session to prepare these tissues for treatment and then taken off after 30 minutes or longer.

Rather than using castor oil packs during massage sessions, an alternative is to cover the area to be treated with a thick application of castor oil, cover it with plastic wrap, and apply heat on top. Remove after 30 minutes, cleanse the area and begin the massage. Below is a sample castor oil procedure over the lateral thigh, to warm and soften the iliotibial band. You will learn how to incorporate this procedure into a massage session.

Indications

1. Muscle pain, including menstrual cramps
2. Tight, fibrous tissue which is going to be treated with massage, including fibrotic knots, scar tissue, tight iliotibial bands, and adhesions
3. Arthritis (currently non-inflamed)

Contraindications

1. Any area where heat is contraindicated, such as in diabetic neuropathy, active rheumatoid arthritis, or where there is local inflammation
2. Broken skin
3. Tumors
4. Ulcers
5. Lower abdomen in pregnant women

Temperature: Warm from heating pad

Time needed: 45 minutes to an hour

Equipment Needed: Flannel cloth (wool is preferred, but cotton may be used); bottle of castor oil; metal pan or tray large enough to hold the flannel; piece of plastic wrap or thin sheet of plastic cut from a garbage bag that is slightly larger than the flannel; local heat source to keep the pack warm, such as a hot water bottle or heating pad; washcloth; soap or ½ tsp of baking soda to be added to 1 cup of water to cleanse the skin after the pack is removed.

Effect: Primarily chemical from the action of the castor oil itself but also thermal from the application of heat over the entire pack.

Cleanup: Dispose of the plastic sheet, wash metal pan with soap and water, launder washcloth. If desired, the oil-soaked flannel can be taken home in a plastic bag and reused by the client up to 10 times if it is kept in a plastic container in the refrigerator between uses. Otherwise, it should be thrown away. No one else should use the flannel.

Castor Oil Pack Protocol for Iliotibial Band Syndrome

• Check with the client to make sure there are no contraindications for the use of local heat.
• Explain the purpose of the castor oil pack to the client and get consent.
• Cut or fold the flannel to the appropriate size so there will be three layers of cloth, and place it on a metal pan or tray.
• Pour the castor oil over the flannel and leave it until it is well saturated. The cloth should be wet but not dripping.

Preparation of Castor Oil Pack Video

• Warn the client before applying the flannel and say, “Be sure to let me know if this ever feels too hot.”
• Check the area visually before applying the flannel. This allows you to see what the client’s skin normally looks like.
• Apply the flannel to the outside of the thigh.
• Cover it with a piece of plastic.
• Apply heat on top of the plastic covered flannel. Use a heating pad on the highest setting that can be tolerated. A high setting is preferable, but a medium setting is acceptable. Or use a hot water bottle.
• Proceed with massage on other areas of the body.

Application of Castor Oil Pack Video

• Remove the pack after 30 – 90 minutes.
• Clean the skin with 1 cup of cool water with ½ tsp of baking soda added to it, or use soap and a washcloth.
• Proceed with local massage.

Checking in and Removal of Castor Oil Pack Video

Biography  

Marybetts Sinclair has been a massage therapist for 32 years, and an Emergency Medical Technician during 8 of those years as well. She received her Oregon massage license in 1975. She has practiced massage in many different environments, including  health spa, private counseling office, children’s summer camp, home office, and chiropractic clinic. 

In addition, her work with hospice has taken her to nursing homes, adult foster homes, Alzheimer’s care units and the private homes of hospice patients. She has been uniquely privileged in being able to give massages to some of her local  clients for almost three decades. 

All of Marybetts’ massage-related work, whether giving massages, doing research for her books, writing about massage or teaching it, is informed first and foremost by her experience as a working massage therapist. For example, it was not until she had been practicing massage for at least a decade that she began to understand how many of her clients had musculoskeletal issues that had begun in childhood, and therefore, how valuable pediatric massage could be.