Passive therapeutic services

Passive therapeutic services are treatments that use physical stimuli like pressure, traction (pulling), heat, cold or electricity to have a particular effect on a person’s body. They are intended to ease pain, improve blood circulation and increase suppleness. Passive therapeutic techniques are mostly used by physical therapists, masseurs or hydrotherapists (healthcare professionals who use water to treat medical problems) as part of physical therapy treatment.

Common methods include massage, electrotherapy, ultrasound therapy, bathing, inhalation and hot/cold packs. The following are examples of typical passive therapeutic services.

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 nervous system but can also stimulate the 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 the person lying in a bath of warm water and the therapist using a hose to apply a strong jet of water to massage them.

Manual lymphatic drainage

Lymphatic drainage is a special type of passive therapy 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’s been prescribed, sometimes the therapist will put a compression bandage on the affected body part after the treatment to stop fluid accumulating in the tissue again.

Traction therapy

This therapy uses traction (pulling) instead of pressure. Pulling on a body joint can help distribute the fluid in it better, the idea being to relieve pain and improve flexibility. This treatment can be used for things like spine problems or osteoarthritis.

To have the treatment, you lie on a special table and the therapist attaches the painful parts of your body to slings hanging from a stable wire frame above the table. Then the therapist pulls the slings up to stretch (pull) the body part(s) in question.


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 completely 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 and start working again so that they don’t waste away.


Balneotherapy is the name for a range of treatments using baths, packs and drinking cures. The baths might contain salts or other minerals and the packs might be plant-based, using peat for example. 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 lots 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.

Inhalation therapy

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

Thermotherapy (heat/cold therapy)

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

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,
  • hot baths, and
  • ultrasound.

Cold applications mostly take the form of cold air, cold packs or ice packs.

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

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

How can I get passive therapeutic services?

Passive therapeutic services are often part of a treatment plan at a hospital. They are then carried out at the hospital. To get outpatient treatment at a physical therapy practice, you need a prescription from your doctor. Unless you are exempt from copayments, you have to pay 10 euros per prescription plus 10% of the treatment costs yourself. 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).

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

The first prescription is for up to six sessions, lasting 15 to 20 minutes each. People have about one to three appointments per week, depending on what the doctor prescribes. 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.

Bundesministerium der Justiz und für Verbraucherschutz (BMJV). Gesetz über die Berufe in der Physiotherapie (Masseur- und Physiotherapeutengesetz - MPhG). 15.08.2019.

Deutscher Verband für Physiotherapie (ZVK). Physio Deutschland: Patienteninformationen. 2020.

Gemeinsamer Bundesausschuss (G-BA). Richtlinie über die Verordnung von Heilmitteln in der vertragsärztlichen Versorgung (Heilmittel-Richtlinie/HeilM-RL). 01.07.2020.

Verband der Ersatzkassen (vdek). Rahmenvertrag Physiotherapie vdek, Anlage 1: Leistungsbeschreibung. 01.04.2013.

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. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on July 14, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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