SUPERFICIAL HEATING MODALITIES B ELECTRO PT.ppt

SUPERFICIAL HEATING MODALITIES B ELECTRO PT.ppt

1. Thermal Agents: Heat
Dr Tabassum Saher
Assistant Professor

2. 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 Packs
Whirlpools
Paraffin Baths
Infrared Lamp

3. Heat Modalities: Deep Heat
Ultrasound and diathermies
Transmits well through superficial tissue layers
3-5cm penetration

4. Factors effecting tissue
temperature rise:
temperature gradient/rate: high or low vs. time
volume 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 treatment
Modality of treatment used

5. 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

6. Physiological effect of
superficial heat
Increase circulation 1.5-2x normal
Increased metabolism (contraindicated in 2-3 days post injury)
Increased inflammation, phagocytosis, & wound healing
Decreased pain (analgesia); not as effective as cryotherapy for acute pain
(cryokinetics, anyone?)
Decreased muscle spasm
Decreased tissue stiffness (fluids less viscous and collagen releases easier)

7. 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?

8. Physiological effect of superficial
heat: Neuromuscular
Increase sensory nerve conduction
Temperature is carried on A-delta fiber
Analgesic effects both distal and proximal to area treated
This is why non-acute back patients use heat instead of ice

9. 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

10. Contraindications for the use
of superficial heat
Acute inflammation
Decrease sensation in area
Impaired circulation (unable to dissipate Tissue Temperature Rise, TTR)
Malignancies: increased metabolic rate
Pregnancies

11. Moist Heat Packs
Canvas Pouch with Silica Gel
Pack is kept in a water-filled heating unit maintained
between 160º F -170 º F
Pack maintain temperature for 30-45 minutes
Packs transfer heat by conduction
Main benefit is superficial heat to 1cm

12. Moist Heat Packs
Set-up
Cover pack w/ terry cloth or towel covering
Place pack on patient in comfortable manner
(patient on pack is contraindicated)
Check patient within 5 to 6 minutes for
comfort
Allow 3-4 hr minimum between treatments on
the same day

13. 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)

14. 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.

15. 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

16. 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) Method
Clean 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Transitions from cold to heat:
No signs of increased inflammation; decreased swelling
No increase in tissue temperature
If decreased range from pain-stay with cold
Change to heat when effect from ice applications
plateaus
If decrease range from stiffness then use heat

23. 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)

24. Contrast Bath Set Up
Two tubs placed as close together as possible
Fill one tub in the range from 105 F- 110 F and the other 50 F
- 60 F
Position patient on chair or bench between two tubs
Heat Tx given 1st
Contrast bath 20 -30 minutes at 3-5 minute intervals or a combination
(3 min hot 5 min cold etc.)

25. 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

26. 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).