Infrared radiations physiotherapy

INTRODUCTION, SOURCES OF IRR, TYPES OF IRR, PRODUCTION OF IRR, NON LUMINOUS LAMP, LUMINOUS LAMP, ABSORPTION & PENETRATION, PHYSIOLOGICAL EFFECTS, THERAPEUTIC EFFECTS, CHOICE OF LAMPS, DANGERS, CONTRAINDICATIONS,

1. INFRA
RED
RADIATION
DR NIYATI PATEL
MPT IN NEUROLOGICAL CONDITIONS

2. Infraredradiationsarepartofanelectromagneticspectrum,
withwavelengthof750nm-1mm,andfrequencyof4x10
14
and7.4x10
11
,andlocatedbetweenmicrowaveandvisible
light.
Infrared is superficial Heating modality (penetration depth 1-
10mm).
Infrared is radiant heat transmits energy by radiation.

3. Sourcesof IR
Artificial
Luminous
Non-
luminous
Natural Sun 60%
Near IRR
Far IRR

4. TYPE WAVELENGTH
IR A 750 –1400 nm
IR B 1400 –3000 nm
IR C 3000 nm –1mm (not used in
therapy)
FORMER
CLASSIFICATION
Near or short IR 750 –1500nm
Far or long IR 1500 –15000 nm

5. Near (short)=
750-1500nm
Far (long)=
1500-15000nm
Types
IRA=750-1400nm IRB=1500-3000,
IRC=3000nm-1m
Source
Luminousheatedbody
-Incandescentbodies
-Sun
-Tungsten
Non-luminousHeatedbodies
-Hotpack
-Electricalheatingpads
Penetration
Deeper;
penetratestoepidermis,dermis
&subcutaneous(5-10mm)
Superficial;
penetratestotheepidermis
≤5mm
Absorption
Deep Superficial

6. IR radiation :
Emitted from any heated body.
Divided into long & short wavelength for
therapeutic purposes.
Produce heat when absorbed.

7. AnyheatedmaterialwillproduceIRradiation,the
wavelengthbeingdeterminedbythetemperature.
IfshortIRistobeproducedefficiently,thematerialmust
notbeoxidized(burnt)bythehighertemperatureused.
Mostconvenientmethodistoheataresistancewireby
passinganelectriccurrentthroughit.
Anordinaryhouseholdelectricfirecanbemadeofacoilof
suitableresistancewire,suchasnickel–chromealloy,wind
onaceramicinsulator.

8. Infrared lamps are used for therapy
Non luminous generators Luminous generators
1.Nonluminousgenerators
Ceramicmaterialwhenheatedtoalowertemperaturethan
thewire,givesonlyIR&novisibleradiation.Therefore
therapylampshavewireembeddedintheinsulating
ceramic(orporcelainorfireclay).
Theheaterwirecanalsobemountedbehindametalplate
orinsideametaltubewhichdoesnotbecomered-hotbut
emitsIR.
Allpartsofthelampbecomeshotter–theemitter,themetal
plateontheendoftheemitter,theprotectivewiremeshand
thereflector–givingIR.

9. Emitterisplacedatthefocusofa
hemisphericalorparabolicreflectorto
reflecttheradiationsintoanapprox
uniformbeam.
Whensuchlampsareswitchedon,they
requiresometimetowarmupb’cozofthe
thermalinertiaoftheconsiderablemassof
themetal&insulatingmaterialthathasto
beheated;thussmalllampstakeabt5mins
butlargeronetakes15minstoreachmax.
emission(Forster&Palastanga,1985).

10. 2.Luminousgenerators
alsok/aincandescentlamps.
Consistoftungstenfilamentinalargeglass
envelopewhichcontainsinertgasatlow
pressure.
PartofInsideofglassbulbissilveredto
providereflector.
Currentpassfilamentheated
continuousspectrumofIR&visible
radiations.
NooxidationcoznoO2onlytraceof
inertgases.
RadiationfromlonginfrareduptoUVare
absorbedbyglass&thereforenot
transmittedbylamp(Ward,1986).

11. Non-Luminous Luminous
Sources &types Electrically heated
resistancewirecoiled.It
takesabout5-15minutesto
beheatedandemittheir
maximumintensity,e.g.
Hotpack
Electricallyheatedfilament
e.g.Quartzlamp,Tungsten
lamp,Carbonfilament
lamp
wavelength 1500-12000nm(maximum
4000nm)
350-4000nm(maximum
1000nm)
Emission 90%farIRR,and10%
nearIRR.
70%nearIRR,24%far
IRR,
5%visiblelight,&1%UV
Penetration Epidermis&superficial
dermis(2mm)
Epidermis,dermis&
subcutaneoustissue(5-
10mm)
Uses Acuteconditions. Chronicinflammation
Physiological effectPainreductionviasedative
effect
Painreductionviacounter-
irritanteffect
Treatment time 20-30minutes 15-20minutes

12. Infraredraysareelectromagneticwaveswithwavelengthof
750nm–1mm.
Thereare2maintwogroupstheNON–LUMINOUS&
LUMINOUSgenerators.
NON–LUMINOUS=Infraredraysonly.
LUMINOUS=Infraredrays+visibleandfewUVrays.
RADIANTHEAT=Treatmentwithluminousgenerators.
INFRARED=Radiationfromnon–luminoussources.

13. Smaller lamps (luminous & non luminous) = 250 –500 W.
Larger non luminous= 750 –1000 W.
Larger luminous = 600 –1500 W.

14. Non –Luminous
3000 –4000 nm (long IR) , 10% between 1500 nm & visible
(short IR)
Luminous
Approx 70% short IR.
5% visible.
24% long IR.
1% UVR absorbed by glass of bulb.
(Wadsworth & Chanmugan, 1980)

15. reflected
Radiationstriking penetrated
onsurfaceofskin scattered
refracted
absorbed

16. 95%absorptiontakesplacewhenradiationapplied
perpendicular(Ward,1986).
Water&ProteinsarestrongabsorbersofIR.
Thereforeanyradiationenteringtheskindependsupon---
1.Structure
2.Vascularity
3.Pigmentationoftheskin
4.Wavelengthoftheradiation

17. Usualmethodistogivepenetrationdepth.
Penetrationdepth=Itisthedepthatwhichapprox.63%of
theradiationenergyhasbeenabsorbed&37%remains.

18. 1.Cutaneous vasodilation
Heating with IR
Local cutaneous vasodilation
After a short latent period of 1-2 min (Crockford& Hellon, 1959)
Direct effect on blood vessels
thru polymodal nociceptors by
axon reflex mechanism
Liberation of chemical
Vasodilators like histamine &
other substances

19. 2.Sweating
Prolonged heating
Sweating
absorb the applied IR radiation
surface cooling as it evaporates
allow better penetration

20. 3.Sensation
Thermalheatreceptorsstimulatedintheskinsopatientis
awareoftheheat.
4.Increaseinmetabolism
Increase in temperature
Increase in metabolism.

21. 5.Chronicchanges
Excessive & prolonged IR application
Destruction of erythrocytes
Releasing pigments
Brown discoloration

22. 1.Reductioninmusclespasm
2.Accelerationofhealing&repair
3.Fungalinfectionwhicharedifficulttocontrol&thrivein
moistconditione.g.paronychia.
4.Treatmentofpsoriasisalsopressuresores
5.Forpainrelief
Increaseinsensorynerveconductionmightinfluence
sensoryresponsesviaincreaseinendorphins,whichcould
affectthepaingatemechanism(Kitchen&Partridge,1991)

23. Luminous=efficientfortissueheatingsinceitpenetrates
further(bcozpeakemissionisinshortIR)&thereforethe
energyisdistributedinalargervolumeoftissue.
Non–Luminous=peakemissionaround4000nm,absorbed
almostentirelyintheskin
Asthetotalheatingislimitedbythesensationfeltby
thepatient,&thermalsenseorgansareclosetotheskin
surface,itisevidentthatthenon–luminousradiationwill
reachthelimitoftolerableheatingwithalowerintensity
thantheluminous.

24. Ifthedesiredeffectsaredueto:
Heating=LuminousshorterIRsourceispreferred.
Sensorystimulation=Non–Luminous

25. 1.BURNS
Occursifthepatient
Unawareofheatcozofdefectivesensationorreduced
consciousness.
Mentallyabnormalormasochisticpatientmaystoically
toleratepainful&damaginglevelsofheat.
Accidentaltouchingthehotelementsifthereisno
protectiveguard
Avoidedby:
Carefulapplication
Adequatewarningstopatient
Checkingtheeffectofheatduringtheapplication

26. 2.SKINIRRITATION
Acuteinflammatorycondition
Chemicalirritantsontheskin
3.AREASOFDEFECTIVEARTERIALBLOODFLOW
Areasaffectedbyarterialdiseasesuchasatherosclerosis,
arterialinjuryorafterskingrafting.
Thiscanresulttotissuenecrosis(gangrene)ofsuchaffected
tissues.

27. 4.LOWEREDBLOODPRESSURE
IR
Cutaneousvasodilation
Temporary lowering BP esp. in elderly patient having less
vasomotor control
Faintness on getting up immediately after T/t can also cause
headache.

28. 5.EYE DAMAGE
Long term irradiation, corneal burns = far IR
Retinal & lenticulardamage = near IR
( Moss et.al , 1989)
IR applied to the eyes causes the dryness & thus dehydration.
6.DEHYDRATION
Prolonged & intensive T/t to large parts cause sweating &
provoke dehydration if water is not replaced

29. 1.Defective cutaneous circulation.
2.Acute skin disease, e.g., dermatitis or eczema.
3.Following radiotherapy
4.Superficial infections or tumors.

30. 1.INCREASESTHEEXTENSIBILITYOFCOLLAGENTISSUES
Tissuesheatedto45°Candthenstretchedexhibitanon-
elasticresidualelongationofabout0.5–0.9%thatpersists
afterthestretchisremovedwhichdoesnotoccurinthese
sametissueswhenstretchedatnormaltissuetemperatures.
Thus20stretchingsessionscanproducea10–18%
increaseinlengthintissuesheatedandstretched.
Thiseffectwouldbeespeciallyvaluableinworkingwith
ligaments,jointcapsules,tendons,fasciae,andsynovium
thathavebecomescarred,thickenedorcontracted.

31. ›Suchstretchingat45°Ccausedmuchlessweakeningin
stretchedtissuesforagivenelongationthanasimilar
elongationproducesatnormaltissuetemperatures.
›Theexperimentscitedclearlyshowedthatlow-force
stretchingcanproducesignificantresidualelongationwhen
heatisappliedtogetherwithstretchingorrange-of-motion
exercises,whichisalsosaferthanstretchingtissuesat
normaltissuetemperatures.
›Thissaferstretchingeffectiscrucialinproperlytraining
competitiveathletessoastominimizetheir"down"time
frominjuries.

32. 2.DECREASESJOINTSTIFFNESS
›Therewasa20%decreaseinstiffnessat45
°
Cas
comparedwith33
°
Cinrheumatoidfingerjoints,which
correlatedperfectlytobothsubjectiveandobjective
observationofstiffness.
›Anystiffenedjointandthickenedconnectivetissues
shouldrespondinasimilarfashion.

33. 3.RELIEVESMUSCLESPASMS
›Musclespasmshavelongbeenobservedtobereduced
throughtheuseofheat,betheysecondarytounderlying
skeletal,joint,orneuropathologicalconditions.
›Thisresultispossiblyproducedbythecombinedeffectof
heatonbothprimaryandsecondaryafferentsfrom
spindlecellsandfromitseffectsonGolgitendonorgans.
›Theeffectsproducedbyeachofthesemechanisms
demonstratedtheirpeakeffectwithinthetherapeutic
temperaturerangeobtainablewithradiantheat.

34. 4.PRODUCESPAINRELIEF
›Painmayberelievedviathereductionofattendantor
secondarymusclespasms.
›Painisalsoattimesrelatedtoischemiaduetotensionor
spasmwhichcanbeimprovedbythehyperemiathat
heat-inducedvasodilationproduces,thusbreakingthe
feedbackloop,inwhichtheischemialeadstofurther
spasmandthenmorepain.

35. ›Heathasbeenshowntoreducepainsensationbydirect
actiononbothfree-nerveendingsintissuesandon
peripheralnerves.
›Inonedentalstudy,repeatedheatapplicationsledfinally
toabolishmentofthewholenerveresponseresponsible
forpainarisingfromdentalpulp.
›Heatmaybothleadtoincreasedendorphinproduction
andashuttingdownoftheso-called"spinalgate"of
MelzackandWall,eachofwhichcanreducepain.

36. 5.INCREASESBLOODFLOW
›Heatingofoneareaofthebodyproducesreflex-
modulatedvasodilationsindistant-bodyarea,eveninthe
absenceofachangeincorebodytemperature;ie.heat
oneextremityandthecontralateralextremityalsodilates:
heataforearmandbothlowerextremitiesdilate;heatthe
frontofthetrunkandthehanddilates.
›Heatingofmusclesproducesanincreasedbloodflow
levelsimilartothatseenduringexercise.

37. ›Temperatureelevationproducesanincreaseinbloodflow
anddilationdirectlyincapillaries,arteriolesandvenuies,
probablythroughdirectactiononthesmoothmuscles.The
releaseofbradykinin,releasedasaconsequenceofsweat-
glandactivity,alsoproducesincreasedbloodflowand
vasodilation.
›Whole-bodyhyperthermia,withaconsequentcore
temperatureelevation,furtherinducesvasodilationviaa
hypothalamic-induceddecreaseinsympathetictoneonthe
arteriovenousanastomoses.
›Vasodilationisalsoproducedbyaxonalreflexesandby
flexesthatchangevasomotorbalance.

38. 6.ASSISTINRESOLUTIONOFINFLAMMATORYINFILTRATES,
EDEMA&EXUDATES
›Theincreasedperipheralcirculationprovidesthe
transportneededtohelpevacuateedemawhichcanhelp
endinflammation,decreasepainandhelpspeedhealing.

39. 7.MOSTRECENTLY,CANCERTHERAPY
›Thisisanewandexperimentalprocedure.
›Itshowsgreatpromiseinsomecaseswhenusedproperly.
›Americanresearchersfavorcarefulmonitoringofthe
tumortemperature;whereas,thesuccessesreportedin
Japanmakenomentionofsuchprecaution.

40. 8.AFFECTSSOFTTISSUEINJURY
Infraredhealingisnowbecomingaleadingedgecarefor
softtissueinjuriestopromotebothreliefinchronicor
intractable"permanent"cases,andacceleratedhealingin
newerinjuries.