Thermal Agents: Heat

KIN 195

Heat modalities: Superficial Heat

Skin temperature rises but subQ tissue increase is minimal

1cm penetration depth of

penetration is related amount of fat in area

Hot PacksWhirlpoolsParaffin BathsInfrared Lamp

Heat Modalities: Deep Heat

Ultrasound and diathermiesTransmits well through superficial tissue

layers3-5cm penetration

Factors effecting tissue temperature rise:temperature gradient/rate: high or low vs.

timevolume of tissue: if treatment area is great

there may be a decrease in BP from hypothalamus (vasodilatation) Heat Sink: as long as the heat can be

dissipated as fast as the modality adds heat, it is considered safe

Duration of treatmentModality of treatment used

Factors effecting tissue temperature rise:

Beyond 113 F protein denaturization and tissue burning may occur

Best general tissue temperature and blood flow increase is via exercise

Physiological effect of superficial heat

Increase circulation 1.5-2x normalIncreased metabolism (contraindicated in 2-

3 days post injury)Increased inflammation, phagocytosis, &

wound healingDecreased pain (analgesia); not as effective

as cryotherapy for acute pain (cryokinetics, anyone?)

Decreased muscle spasmDecreased tissue stiffness (fluids less

viscous and collagen releases easier)

Physiological effect of superficial heat: Hemodynamic

Depth of effects are not as great as with cold

Vascular changes are confined to skin (1cm)

So Why use it?

Physiological effect of superficial heat: Neuromuscular

Increase sensory nerve conductionTemperature is carried on A-delta fiberAnalgesic effects both distal and proximal

to area treated

This is why non-acute back patients use heat instead of ice

Physiological effect of superficial heat: Neuromuscular

Firing of II fibers results in a decrease in muscle firing, reducing muscle spasm

Increased golgi tendon organ firing which inhibits muscle contraction

Contraindications for the use of superficial heat

Acute inflammationDecrease sensation in areaImpaired circulation (unable to dissipate

Tissue Temperature Rise, TTR)Malignancies: increased metabolic ratePregnancies

Moist Heat Packs

Canvas Pouch with Silica GelPack is kept in a water-filled heating unit

maintained between 160º F -170 º FPack maintain temperature for 30-45

minutesPacks transfer heat by conductionMain benefit is superficial heat to 1cm

Moist Heat Packs

Set-upCover pack w/ terry cloth or towel coveringPlace pack on patient in comfortable

manner (patient on pack is contraindicated)Check patient within 5 to 6 minutes for

comfortAllow 3-4 hr minimum between treatments

on the same day

Moist Heat Pack

Precaution infected areas must be

covered with gauze

Contraindications Acute conditions Peripheral vascular

disease Impaired circulation Poor thermal regulation

Indications Subacute or chronic

inflammatory conditions Reduction of subacute or

chronic pain Subacute or chronic muscle

spasm Decreased ROM Hematoma resolution Reduction of joint

contractures Infection (discuss)

Paraffin Bath

A mixture of wax an mineral oil in a ratio of 7 parts wax to 1 part oil

Temperature of 118º F to 126 ºF for upper extremity tx.

Temperatures of 113 º F to 121 º F for lower extremity (circulation is less efficient)

Paraffin can provide approx. 6x the amount of heat as water due to low specific heat.

Paraffin Bath

Used to deliver heat in uniform amounts to small irregularly shaped areas (hands, fingers, wrist and foot)

Wax moistens skin, water tends to dry skin

Paraffin Bath Set Up

Immersion Bath Clean body part Dip part quickly; allow 10 sec. to

dry (turns milky) Dip the extremity 6-12 more

times Then cover with cellophane or

towel for duration of tx (10-15 min)

DO NOT touch sides or bottom of bath (burns)

After tx scrape off and replace in bath

Pack (Glove) MethodClean extremity Immerse extremity in bath and

allow wax to dry - repeat 7-12 more times

After final withdrawal from wax, cover extremity with plastic bag, or wax paper. Then wrap in towel

If indicated elevate body part Following tx remove wax and

return to bath

Paraffin Bath

Precautions Sensation is different

from specific heat and thermal capacity - may cause burns

Avoid using with athlete who are required to catch or throw a ball - skin becomes slippery

Contraindications Open wounds (options?) Skin infections Sensory loss Peripheral vascular disease

Indications Subacute and chronic

inflammation limitation on ROM after

immobilization

Infrared Lamp

Radiant energy 2 types luminous (infrared)

and nonlumious (far infrared)

Luminous produces some visible light (as opposed to nonluminous), nonlumious is less penetrating than luminous

Whirlpools

Tx temperature is between 105º-112º F for extremities and 100-108º F for whole body (recall TTR)

Tx times usually last 10-20 minutes; watch for lethargy with WWP

Warm Whirlpool

Precautions Must be connected to ground-fault indicator Instruct patient not to turn whirlpool motor on or

off while in whirlpool Patient should be continually monitored Do not run while turbine is dry Clean tank pre and post infectious wound tx Patients under the influence of drugs Keep clothing and bandages out of whirlpool

Warm Whirlpool

Indications Decreased ROM Subacute or chronic

inflammatory conditions Stiffness or soreness Irregular shaped areas

Contraindications Acute conditions where

water turbulence would further irritate injured area

Fever above 101 F Tx within 24-48 of acute

injury Comprimised circulation

Transitions from cold to heat:

No signs of increased inflammation; decreased swelling

No increase in tissue temperatureIf decreased range from pain-stay with coldChange to heat when effect from ice

applications plateausIf decrease range from stiffness then use

heat

Contrast Treatments:

Used as a transition between cold and heat Allows type of vascular pumping via

cold/hot/cold treatment ? May use water or ice packs/hot packs etc.. May vary the length of time in cold vs.. heat

depending on effects desired Ending of treatment should reflect effect you

want to end with Latest research says ineffective (Knight &

Draper this summer presented this information; also on p. 232)

Contrast Bath Set UpTwo tubs placed as close together as possibleFill one tub in the range from 105 F-

110 F and the other 50 F - 60 FPosition patient on chair or bench between

two tubsHeat Tx given 1stContrast bath 20 -30 minutes at 3-5 minute

intervals or a combination (3 min hot 5 min cold etc.)

Contrast Bath

Precautions Same as with all

whirlpools

Indications Ecchymosis removal Edema removal Subacute or Chronic

Inflammation Impaired circulation Pain Reduction

Contraindications Acute injuries Hypersensitivity to cold Contraindication relative

to whirlpool use Contraindications relative

to cold application Contraindications relative

to heat application

Heat Case Study

Similar to Cold Case Study, use at least 3 primary sources in this assignment. Appropriateness of source will be reflected in grade.

Cite source as (Author name, date) within answer and full source in “Citations” at end of answer.

Each question should be answered concisely in 3-4 sentences (short paragraph).