Hydrocollator Packs / Hot Packs in Physiotherapy

How hydrocollator pack is used in Physiotherapy Treatment

1. HYDROCOLLATOR PACK DR. MOHIT KUMAR CHATTERJEE (PT) ASSISTANT PTOFESSOR DEPT. OF NEURO PHYSIOTHERAPY DR. APJ ABDUL KALAM COLLEGE OF PHYSIOTHERAPY, PIMS (DU)

2. HYDROCOLLATOR PACKS / HOT PACKS Hot packs are the packs which are immersed in an apparatus called hydrocollator unit They provide superficial moist heat to the part where it is applied Hot packs are the way to transferring the heat to patient by conduction It is a process by which heat is transferred from a hotter end to colder end of the object.

3. A hydrocollator pack is a fabric envelope containing Bentonite , a hydrophilic silicate gel. Bentonite is used as it can hold large quantity of water for the efficient delivery of heat There are several pockets in the fabric, which is filled with the gel in such a way that the whole pack is flexible. The packs are made of different sizes for application to the different body parts. The hot packs are stored in water kept at about 75-80ºC, in the hydrocollator tank with electric heater controlled by thermostat. The packs are supported on racks in the tank and take about 2 hrs to become fully heated from cold and 30 minutes to be reheated between each use.

4. HYDROCOLLATOR UNIT It is a Stainless steel tank It is usually insulated with fiberglass The units contain a wire rack which acts as a divider for the packs and prevents the contact of the packs with the bottom of the hydrocollator tank

5. The packs are packed in Turkish Towels Special terry cloth blankets Large packs may be wrapped in bath blankets The packs lasts about 6months When they begin to wear out the filler leaks out and makes the water cloudy, then they should be replaced When used, hydrocollator packs are taken out of apparatus by means of tongs and wrapped inside a towel. Six to eight layers of towel is made around the pack to provide thermal insulation

6. Types of Hot Packs Reusable Disposable 2 types of Reusable Hot Packs Hydrocollator Packs Microwavable Packs

7. Disposable Hot Packs These are single use items as heat is produced by chemicals reacting inside the pack The chemical reactions are exothermic (release heat) which maintain a therapeutic temperature range for 1-8hrs. They come in variety of shapes and sizes and forms wraps to hand warmers

8. Microwavable Hot Packs These are soft packs filled with water based Gel that can be heated in a microwave. Designed to retain heat for about 15-20 minutes

9. Hydrocollator Pack Preparation of the Apparatus Select the hot pack of particular size depending upon the area to be treated. A plastic sheet is required b/w the towel & the pack that prevents the towel from getting wet & enhances the insulating effect. Select the towel of particular size to wrap over 4-8 layers while maintaining a 1-2cm gap between the pack & skin. This provides thermal insulation, largely because of the air in the towelling , so that although the pack is about 75 ℃ the skin temperature does not rise above 42℃ or so. During this time the pack temp is falling but the towelling prevent the pack and skin surface from losing heat so that the skin and superficial tissue temperature rises.

10. Preparation of the Patient The patient should be explained about the treatment. The part to be treated is undressed. Any jewellery present over the part to be treated is removed and the patient’s skin is tested for thermal sensation. Any other contraindications to treatment are also checked. The patient’s part to be treated is positioned in the required position of therapy.

11. Application of the Hot Pack The pack is taken out from the tank & is shaken to remove the excess water. A plastic sheet is put over the pack & a dry towel is wrapped around. The pack is placed over the part to be treated and kept in position for 20-30 minutes. A bell/other calling devices may be given to the patient, so that he/she can ask for help is there is any discomfort. The physiotherapist should remain nearby to make necessary adjustments and should check periodically.

12. During the application of heat therapy, the patients supposed to feel a sensation of mild warmth. The patient should not feel excessively hot or feel any sensation of increased pain or burning. After 5min, check the patient’s report and inspect the area being treated for excessive redness, blistering or other signs of burning. Discontinue if there is presence of burning. After 20minutes, remove the pack & inspect the treatment area. It is normal for the area to appear slightly red and to feel warm to the touch. Return the hot pack to the hydrocollator unit and allow to reheat before using the pack again.

13. Physiological Effects Increased Blood supply The response of the body to heat is dilating local blood vessels. The amount of dilation is greater in the superficial vessels than in deeper vessels. As a result of the vasodilatation there is an increased flow of blood through the area, so that the necessary oxygen and nutritive materials are supplied to the affected area and waste products are removed. The superficial vasodilatation causes erythema of the skin

14. Increased metabolism This is in accordance with Van’t Hoff’s statement , that any chemical change capable of being accelerated is accelerated by a rise in temperature. Consequently, heating of tissues accelerates the chemical changes i.e. metabolism. The increase in metabolism is greatest in the region where most heat is produced, which is in the superficial tissues. As a result of the increased metabolism there is an increased demand for oxygen and nutrients which in turn removes waste products like pain metabolites i.e lactic acid.

15. Increased Nerve Conduction Velocity Nerve conduction velocity is directly proportional to the temperature. Nerve conduction velocity increases by approximately 2m/sec for every 1 ºC increases in temperature

16. Increased pain threshold Application of local heat can increase pain threshold Two mechanisms are involved in analgesia, the direct and instant effect is caused by the activation of the pain gate mechanism. And an indirect, later and more persistent effect is caused by a decrease of muscle spasm or acceleration of tissue healing

17. Increased elasticity of ligaments, capsules and muscle Increasing the temperature of soft tissue increases its extensibility. When soft tissue is heated before stretching, it maintains a greater increase in length after the stretching force is applied, only a less force is required to achieve the increase in length and also the risk of tissue tearing is reduced

18. Indirect effects of Heating General rise in body temperature : as blood passes through the tissues in which the rise of temp has occurred, it becomes heated and carries heat to other parts of the body. If heating is extensive & prolonged a general rise in body temp occurs. Increased activity of sweat glands: There is reflex stimulation of the sweat glands in the area exposed to the heat, resulting from the effect of the heat on the sensory nerve endings. As heated blood circulates throughout the body it affects the temp regulating centres and increases the activity of sweat glands. When generalized sweating occurs there is increased elimination of waste products.

19. 3. Fall in blood pressure: if there is generalized vasodilatation the peripheral resistance is reduced, this causes a fall in blood pressure. 4. Muscle tissue : Rise in temperature induces muscle relaxation and increases the efficiency of muscle action.

20. Therapeutic Effects 1. Reduction of Pain: Hot packs can be used to obtain analgesia. Pain relief following hot pack application may occur due to elevated pain threshold. It may be due to sedative effect or counter-irritant effect by heat.

21. 2 . Muscle spasm: Relaxation of muscles is achieved by heating the tissues. Mild heating causes relaxation of muscles and thus relieves spasm. Relaxation of muscles provides greater range of motion to the exercising part as it relieves muscular spasm.

22. 3. Increased ROM and decreased joint stiffness These effects are due to the decreased joint viscosity and warming of intra articular fluid, increases the soft tissue extensibility 4. Accelerated healing Heating can accelerate tissue healing by increasing circulation and enzymatic activity rate and by increasing the availability of oxygen to the tissues. This increase in circulation can be beneficial when chronic inflammation is present.

23. 5. Adhesions: Hot packs in conjunction with other physical measures such as mobilization techniques, exercises will help to stretch the adhesions and contractures of tissues. The raised temp of the collagen will make it easier to stretch adhesions.

24. Indications Sub-acute, chronic inflammatory conditions (Rheumatoid arthritis) Sub-acute or chronic Osteoarthritis Musculoskeletal conditions (tendinitis, tenosynovitis, bursitis, capsulitis) Reduction of chronic low back pain, neck pain DOMS Trigger points pain Muscle spasm Prior to stretching, manual therapy and mobilisation of stiff joints

25. Contraindications Acute inflammatory conditions: Moist hot pack may aggravate the inflammatory response in the area. Hyper pyrexia (high graded fever) may be elevated further by heating Active bleeding following acute trauma may be prolonged. Poor thermal regulation. Area with impaired circulation. Severe oedema. Malignancies may metastasize due to the increased blood flow produced by heating. Infected tissues or persons with tuberculosis

26. Precautions Anterior neck and carotid sinus Pregnant women. (Avoid large areas, or at sufficient intensity to raise core temperature) People with cardiac failures. Existing edema may be aggravated by heating. Patient with sensory loss may be unreliable judges of heating levels. Patient's, who is confused, thus becoming unreliable judges of heat levels, should be treated with extreme caution and careful monitoring.

27. Advantages Easy to use Inexpensive materials (packs and towels) Saves time Low level of skill is needed for application Can be used to cover moderate to larger areas as packs are available in a variety of sizes and shapes Hot packs are safe, because it will become cool during the treatment. The risk of burning is minimized

28. Disadvantages Requires frequent removal to inspect the treatment area Sometimes patient fails to tolerate the weight of the pack Pack may not be able to maintain good contact with small or irregular areas Active motion is not possible during the treatment Moderately expensive equipment (hydrocollator unit) is needed

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