Massage therapy

Massage therapists use various hand motions to apply pressure to the skin, fascia (connective tissue), muscles and tendons. The idea is to get the blood circulation going and release tension. Massages have an effect on the nerves and lymph and blood vessels, and can also stimulate internal organs.

There are lots of different types of massage – from traditional (Swedish-style) to methods from the Far East. They use different techniques or focus on specific areas of the body. Some of them use equipment or additional external stimuli. Underwater pressure massage, for instance, involves lying in a bath of warm water with the therapist using a hose to apply a strong jet of water to massage you.

Manual lymphatic drainage

Lymphatic drainage is a special form of massage that aims to reduce swelling and the fluid that collects in the tissues (usually in the arms or legs). The therapist uses special hand motions to help drain the excess fluid through the vessels. Depending on what is prescribed, a compression bandage is sometimes put on after the treatment or the use of compression stockings is recommended. That is done to prevent fluid from building up again. Manual lymphatic drainage and compression therapy together with skin care and decongestive exercises make up what is called complex decongestive therapy (CDT).

Electrotherapy

Electrotherapy involves electrodes being attached to a person’s skin to conduct a weak electrical current through specific parts of their body.

The current levels are harmless and usually don’t cause any pain. Depending on the technique used, you might feel a slight tingling in your muscles. This therapy is intended to relieve pain, improve circulation and ease muscle tension.

There are also special techniques that use electrical stimulation to treat paralysis. They stimulate the paralyzed or weakened muscles to contract so that they don't degenerate.

Thermotherapy (heat/cold therapy)

Cold and heat are also used to relieve pain, tension and inflammation.

Heat therapy uses things such as:

• Hot air
• Hot packs (pads filled with heat-retaining substances like mud or wax)
• Hot towels, which are used to apply heat to specific points of the body,
• Warm baths
• Ultrasound

Heat can have a particularly soothing and relaxing effect. Cold is also used to treat circulatory disorders, nerve irritation and inflammation.

Thermotherapy is usually combined with physiotherapy. For example, it might be used to get the person’s body ready for a massage or physical therapy exercises.

Balneotherapy

Balneotherapy is the name for a range of treatments using baths, packs and drinking cures. The baths may be enriched with salts or other minerals. The packs often use plant-based substances such as moor mud or peat. Drinking cures containing spring water with a high mineral content are often available at spas.

Baths can also have gases added to them. A carbon dioxide bath, for instance, consists of an open tub of lukewarm water with a certain amount of carbon dioxide (CO2) dissolved in it or an enclosed tub in which CO2 is passed around the outside of the body. The aim in both cases is to improve the blood flow to the skin and stimulate the metabolism.

Galvanic baths are also used. These baths combine balneotherapy with electrotherapy: Metal plates are used in the tub to pass a weak current between them.

Inhalation therapy

If you have a respiratory infection, your doctor might prescribe inhalation therapy. This involves an inhalation device being filled with water and sometimes salts or essential oils, or even medicine. The water is then evaporated and you breathe in the vapor. Inhalation is intended to provide relief for coughs and respiratory tract inflammation.

How can you get passive therapeutic services?

In Germany, passive therapeutic services are included in the "Heilmittel." Passive therapeutic services are often part of a treatment plan at a hospital. They are then carried out at the hospital or in a rehabilitation clinic. To get outpatient treatment at a physiotherapy practice, you need a prescription from your doctor. Adults have to pay 10 euros per prescription plus 10% of the treatment costs yourself, unless they are exempt from co-payments. The cost of different treatments varies. If, for instance, one session costs 10 euros, you will have to pay 16 euros for six sessions (the basic fee of 10 euros per prescription, plus 6 x 1 euros). Public health insurers cover the full costs for children and teenagers.

The costs of passive therapeutic services (apart from the co-payments) are often covered by statutory health insurers. If they’re needed as part of rehabilitative care, your accident insurer or pension fund will cover the costs.

Depending on the specific medical condition, the first prescription is for up to ten sessions, lasting 15 to 20 minutes each. Manual lymphatic drainage lasts 30 to 60 minutes. People have about one to three appointments per week, depending on what the doctor prescribes. Normally, the treatment has to start within 28 days of the date on the prescription. If the treatment is needed urgently, it must start within 14 days. Breaks of up to 14 days between appointments are allowed without having to give a reason. Longer breaks (up to 28 days) are possible as long as you explain the reasons. If you leave more than that between appointments, the remaining sessions will be canceled.

Sources

• Bundesministerium der Justiz (BMJ). Gesetz über die Berufe in der Physiotherapie (Masseur- und Physiotherapeutengesetz – MPhG). 2023.
• Deutscher Verband für Physiotherapie (ZVK). Physio Deutschland: Patienteninformationen. 2024.
• Gemeinsamer Bundesausschuss (G-BA). Richtlinie über die Verordnung von Heilmitteln in der vertragsärztlichen Versorgung (Heilmittel-Richtlinie/HeilM-RL) [zuletzt geändert am 16. Mai 2024 veröffentlicht im Bundesanzeiger (BAnz AT 02.08.2024 B2) in Kraft getreten am 1. Oktober 2024]. 2024.
• GKV Spitzenverband. GKV-Heilmittel-Informationsportal: Verträge nach § 125 Abs. 1 SGB V. 2024.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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