Wax therapy

Wax therapy, which uses a bath of molten paraffin wax, is one of the most effective ways of applying heat to improve mobility by warming the connective tissues. Wax therapy is mainly used on your hands along with an exercise program.

1. PARAFFIN -WAX THERAPY:

2. WAX: Paraffin wax approx: 54c contained with mineral oil such as liquid paraffin to produce temperature controlled bath at a temp b/w 42 to 50c. These temperature are higher slightly than would be tolerated if placed in hot water. Specific heat of paraffin wax is less than of water (2.72kj/per degree for wax and 4.2 kj/per k for water).

3. DIP AND WRAP METHOD: Repeated 6-12mins develop wax gloove. The technique increase greater temprature.   HEATED PADS AND PACKS: Use for provide heat to small area. Temprature 40-42c. Moist Pads ,packs immersed in hot water approx:36-41c.APPROX 5mins. Provide prolong heating.   Precaution Cardiac insufficiency Metal in the area

4. WAX THERAPY: Wax therapy, which uses a bath of molten paraffin wax, is one of the most effective ways of applying heat to improve mobility by warming the connective tissues. Wax therapy is mainly used on your hands along with an exercise program.

5. • • The temperature of the paraffin wax is maintained at 47 - 55°c . In the case of parraffin, it provides superficial heat with a depth of 1 cm . • • COMPOSITION: It is a combined immersion technique with Paraffin wax + mineral oil for conductive heat gains. For therapeutic use: – 7 units of wax ---------1unit mineral oil. – The paraffin wax is then kept at low temperature and remains warm for a longer time than water .

6. Principal of wax therapy: The mode of the transmission of heat (heat exchange) from paraffin to the patient skin is by conduction method.

7. Characteristics of wax: Low thermal conductivity , provides superficial heat with a depth of 1 cm. Gives of heat very slowly – no rapid loss of heat. Temperature is maintained at 47 - 55°c. Melting point of wax is 55˚C. It is self insulating. (The first layer creates a thin layer of air next to the skin which acts as an insulator)

8. Parts of Paraffin Bath unit: Container, Mains, Thermostat, Thermostat pilot lamp, Power pilot lamp, Lid, and Caster.

9. Care of apparatus: Clean part before immersion. Clean unit regularly. Remove wax from unit. Remove slat from bottom and clean. Remove residual wax with paper towel. The complete wax & oil should be changed every six months.

10. PHYSIOLOGICAL EFFECTS : 1.Heat production: There is a marked increase in skin temperature in the 1st two minute, up to 12-13°c. This drop, while in the wax wrapping to an increase of about 8°c at the end of 30 minutes. In the subcutaneous fascia, there is an increase of 5°c at the end of the treatment. In the superficial muscles, is only about 2-3°c rise in temperature at the end of the treatment. 2. Circulating effect: Stimulation of superficial capillaries and arterioles cause local hyperaemia and reflex vasodilatation. This is marked only in the region of the skin.

11. The hyperaemia is due to response of the skin to its function of heat regulation. The effects of vasodilatation in the muscle are negligible, but then may be some reflex heating in the joints. Skin and subcutaneous tissue temperature drop after15-20 minute, reducing the vasodilatation. Exercise after the wax is essential to increase the muscle circulation and sedative effect of heat to obtain more range of movement and muscle strength.

12. 3. Analgesic effect: The most important effect of wax its marked sedative effect on the tissue. The moist heat is remarkable soothing to the patient. It is this effect that is used prior to the exercise, in the treatment of superficially placed joints. It is very comfortable to the patient. 4. Stretching effect: Wax leaves the skin moist, soft and pliable. This is useful for stretching scar and adhesion before applying mobilization techniques.

13. Indications: Pain and Muscle Spasm: Wax reduces the pain and muscle spasm. Oedema and Inflammation: The gentle heat reduces post-traumatic swelling, rheumatoid arthritis or degenerative joint disease , of the hands and feet and also swelling in hands particularly in the sub-acute and early chronic stages of inflammation. Adhesions and Scars: Wax softens the adhesion and scar in the skin and thus facilitates the mobilization and stretching procedures.

14. Contrindications: Impaire skin sensation (hot/cold sensation test): anaesthesia, hypostasia, hyperesthesia, parastesia. Some dermatological conditions : eczema,dermatis. (report any reactions after ttt). Circulatory dysfunction ( varicose veins, DVT, arterial disease) Analgesic drugs as pain tolerance to heat is impaired. Infections and open wounds ( as it increases the infective activity) such as in blood born infections. 14

15. Con t … Cancer, tumors or tuberculosis ( TB) in the area to be treated as it ↑ the metabolic activity & rate of growth. Gross oedema with a very thin and delicate skin covering the area . Lack of comprehension ( children, senile , head injuries, confused, agitated,…) Deep X~ray therapy within three months prior to treatment ↓ bloodflow thus impaired sensation. External or internal metal fixators, implants ( metal plates in orthopedics). 15

16. Advantages: 2 or 3 patients can be treated in the same time. Useful for pt. with poor heat tolerance, dry scaly skins, after Plaster of Paris removal. Can be followed by therapeutic exercises. Can be carried out at home. Wax can mold around the bony contours of feet & hands. Heat is applied evenly by conduction.

17. Disadvantages: Effective only for distal extremities in the terms of ease of application. No method of temperature controls once applied. Sedimentation occurs at the bottom. It is a passive treatment: exercise may not be performed simultaneously. The bath must be cleaned regularly & emptied at least twice a year. Contamination of oil by atmospheric dust. It also poses environmental concerns regarding its disposal.

18. Preparation of patient: The nature of wax treatment is explained and the area to be treated is inspected for contraindication. Look for any wound, skin infection, rashes etc. on the part to be treated. Wash the area thoroughly & dry by using tissue paper or cotton. Tell the patient in brief about temperature of the wax and benefits.so that he/she can prepare psychologically and fear of heat is minimized. The patient is instructed to remove any jewelry or metal in the area . Position of the patient should be such that the part to be treated comes closer to the wax bath container. Instruct the patient to avoid touching the sides and bottom of the heating unit because burns may result. Instruct the patient who is receiving an immersion method not to move the joints that are in the liquid. The cracking of the wax will allow fresh paraffin to touch the skin, increasing the risk of burns.

19. Treatment: Dip the client’s hand into the paraffin up to the wrist, making sure the hand is -relaxed, for a few seconds, then remove. Repeat this dip 4 or 5 times until hand is fully coated.

20. ii i . When the dipping process is done, put hands in a plastic liner, or wrap in warm towels. Place a mitt over the plastic liner, or just leave the hands sitting in the towels. Allow the wax to stiffen for five to 10 minutes, then remove the mitts, liner, or towels. iv. Remove the paraffin and throw away the used wax.

21. Techniques/Methods of application:

22. 2. Brushing / Painting method:

23. 3. Dip & Immerse / Dip & Leave in method:

24. 4. Dip & Wrap / Glove method:

25. 5. Towelling/Bandaging method: A lint cloth / towel is immersed in molten paraffin wax and then wrapped around the body part. Several layers can be made over the body part. This method is preferably used for treating proximal parts of the body.

26. PARAFFIN WAX Along with the use of hydrotherapy, the use of paraffin wax therapy can be traced all the way back to Roman Empire. In those ancient times, the Roman would pour hot waxes on the body in preparation for message therapy. Later the French embraced paraffin therapy by melting paraffin wax and spreading it on wounds to accelerate healing. In world War I, the British used paraffin wax therapy as a protocol to treat orthopedic disorders in military hospitals.

27. In modern times, paraffin therapy is quite common and widely used to aid in the treatment of conditions such as the following: Arthritis Bursitis  Eczema  Fibromyalgia  Inflammation Muscle spasms Overworked/fatigued muscles Psoriasis Scar Tissue Stiff Joints Tendonitis Tennis Elbow

28. Can moist heat therapy help my pain and stiffness? How about my dry weary skin? Paraffin therapy is one of the most effective method of applying deep heat to relieve pain and stiffness. The warm paraffin also moisturizes for healthier looking softer skin. Therabath warm paraffin wax treatment are fast acting, drug-free and versatile, providing heat therapy for many different applications from arthritis joint pain relieve.

29. Paraffin wax is known as retaining a great amount of heat as it has a good absorbing power When one uses paraffin wax bath the wax goes through a phase change and starts melting and becomes the paraffin then takes the shape of s coating on the dipped part of the hands or feet This way the heat present in the paraffin bath is transferred to the affected are where you experiencing pain

30. The heat from a paraffin wax bath helps in the opening the pores of the skin which, in turn increases blood circulation in that specific area. This not only revitalizes the skin but also rejuvenates it, making  the skin look smooth and radiant a paraffin wax bath is drug  free painless  and fast  acting therapy that can help in getting rid of the pain in no time

31. Paraffin Wax: The melted wax needs to be maintained at a temperature of 40°C - 45°C  for treatment purposes. The temperature of the wax must be checked before  treatment  is given. This method of heating  the tissue  has the advantage  that it is the most convenient  way of applying conducted  heat to the extremities.  As the wax solidifies  from its molten  state it releases its energy  of latent heat and this heat energy  is conducted  into the tissue. The composition of solid wax , liquid paraffin , petroleum jelly 7:3:1.

32. METHODS OF PARAFFIN WAX BATH DIP METHOD: The part to be treated must be clean and free from cuts, rashes or infection. Fingers apart, dip hand and remove. Wait, harden and opaque Redip 6 to 10 times. Wrap in plastic bags, wax paper then towel. Don't move hand during dipping or rest which prevent to crack coating and allow air to penetrate and cool rapidly..

33. Elevate extremity Treatment time=20 minutes. After this remove the towel and the wax. Inspect and dry the part. The discarded wax is finally remelted strained and place back in the bath at the end of the day.

34. PAINT OR BRUSHING METHOD. Paint a layer of paraffin onto treatment area with a brush. Wait for opaque and harden. Paint another layer. (not larger than 1st layer) Repeat 6 to 10 times. Cover with plastic bags then towel and don't move the area. Wait for 20 minutes or until cool. Peel off, replace or Discard. 

35. DIP IMMERSION METHOD. Finger apart, dip and remove. Wait 5 to 15 seconds, harden and opaque. Remain in it for upto 20 minutes. Remove, when temperature should be at lower range When treatment completed for all above methods, Inspect the area  Any sign of adverse effects Sterilized the wax by heating it to 80°C(176°F) then allow it to cool overnight.  Its temperature should be allowed to return to b/w 45°C to 50°C 

36. DIRECT POURING METHOD. The molten wax is directly poured by a mug or utensil on the part to be treated and wrapped around a towel. The wax is allowed to solidify for about 10-12 minutes.

37. TOWELLING OR BANDAGING METHOD. A towel or roll of bandage is immersed in in molten paraffin wax and then wrapped around body part. This method usually used for treating proximal parts of the body.

38. Physiological effects Increase metabolic activity Increase blood supply Increase tissue fluid exchange Nerve stimulation Decrease viscosity Increase extensibility of collagen

39. Therapeutic uses Encourage healing Decrease edema Decrease pain Decrease muscle spasm Increase joint range Precursor to stretching

40. Advantages Maintain good contact with highly contoured areas Easy to use Inexpensive Body part can be elevated. Oil lubricate and conditions the skin Can be used by the patient at home

41. Disadvantages Messy and time consuming to apply Cannot be used an open skin lesions as it may contaminate the lesion Risk of cross contamination if paraffin is reused. Part in depended position for dip immersion method.

42. Contraindications  Open wound: Wax shouldn't enter in open wound because it will set in tissue acting as an inert foreign body and delay healing. Skin condition Acute dermatitis may be worse by wax or any other form of heat on skin. Skin infections are not usually treated as heat may increase the inflammation activity. Defective arterial blood supply including DVT and vericose vein. Impaired skin sensations, defective thermal sensation couple with deficient cutaneous circulation as occur with recently skin graft do not treat. Impaired skin sensation, defective thermal sensation couple with deficient cutaneous circulation as occur with recently skin graft do not treat. Defective arterial supply.

43. DANGER Inflammable, if it becomes overheated for precaution have Fire blanket, Suitable CO2 or Foam extinguisher.

44. EFFECTS OF PARAFFIN Marked increase in the temperature of skin Less increase in other superficial tissue. CIRCULATORY EFFECTS: Stimulating of Superficial capillaries and arterioles causing local hyperemia and reflex vasodilation. Neurogenic vasodilation due to the action of vasodilator formed as a result of sweat gland activity. 

45. EFFECTS ON SKIN: Skin become moist and soft after wax application which helps to soften adhesions and scars in the skin prior to mobilizing and stretching procedures. EFFECTS ON SENSORY NERVES: Mild heating appears to have a sedative effect on sensory nerve endings. In RA or degenerative joint diseases, decrease pain and muscle spasm.

46.  Paraffin wax, with a melting point of approximately 54 C, is combined with a mineral oil such as liquid paraffin to produce a temperature-controlled bath at a temperature between 42'C and 50C. These temperatures are slightly higher than would be tolerated if the body part were placed in hot water. This is because the specific heat of paraffin wax is less than that of water (2.72 kJ/kg per degree centigrade for Wax and 4.2 kJ/kg per degree centigrade for water). Wax therefore releases less energy than water when cooling. Selkins and Emery (1990) note that the amount of heat imparted to the tissue due the solid­ification of the wax - the latent heat of fusion - is small. At the same time, heat loss is prevented owing to the insulating nature of the material. The net result is a well-insulated, low-temperature method of heating tissue. Slightly higher temperatures may be used for the upper extremities than for the lower extremities and newly healed tissue (Bums & Conin 1987, Head & Helms 1977).

47. Efficacy of Paraffin Wax Baths for Rheumatoid Arthritic Hands. Objective: To provide an overview on the therapeutic application of paraffin wax to the hands of people with rheumatoid arthritis and to examine critically whether paraffin wax is efficacious for this condition in light of this information. Methods: A systematic database search using the MeSH heading ‘rheumatoid arthritis' combined with the terms: ‘therapeutic use of heat' and ‘therapeutic use of cold' was implemented. All relevant basic studies, clinical trials examining the effect paraffin wax has on hand tissue temperature, and randomised controlled clinical trials specifically examining the use of paraffin wax for treating rheumatoid arthritis, and their methodological quality were rigorously assessed according to standardised criteria.

48. Results: Of the four randomised trials identified concerning the outcome of paraffin wax applications to rheumatoid arthritic hands, one yielded equivocal results, while three reported that after three to four weeks, paraffin wax applications were accompanied by significant improvements in rheumatoid arthritic hand function when followed by exercise. The modality also relieves pain and stiffness immediately after its application with no documented detrimental effects on the disease process, even though paraffin wax temporarily raises joint temperature Conclusions: As a whole our data suggest there may be some benefit with few side- effects in the application of paraffin wax to the hands of people with non-acute rheumatoid arthritis prior to exercise. However, the data are insufficient and preclude any definitive conclusions concerning the efficacy of paraffin wax for treating painful hand arthritis.

49. Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand osteoarthritis. ABSTRACT: PURPOSE: To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA). METHODS: Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreiser's index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA).

50. RESULTS: Both groups had a significant reduction in their 'current' pain 15 min after the first and twelfth treatments compared to pre- treatment but there was no difference between groups (t = 0.10, p > 0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t = 2.92, p < 0.05) and with movement (t = 4.73, p < 0.05) than the PO group. The PTA group also showed greater improvement in their FIHOA following 12 treatments than the PO group (t = 3.52, p < 0.05). CONCLUSION: Our results indicate that the addition of a topical analgesic to paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.

51. Evaluation of paraffin bath treatment in patients with systemic sclerosis. ABSTRACT: OBJECTIVE: To investigate the effects of treatment with paraffin bath in patients with systemic sclerosis (scleroderma). METHODS: In 17 patients with scleroderma one hand was treated daily with paraffin bath in combination with hand exercise. The other hand was treated with exercise only and was considered a control. Hand function was estimated before treatment and after 1 month of treatment, concerning hand mobility and grip force, and perceived pain, stiffness and skin elasticity.

52. RESULTS: At the follow-up, finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity had improved significantly in the paraffin-treated hand compared with the baseline values. The improved hand function was independent of skin score and disease duration. Improvements in function were significantly greater in the hand which was treated with paraffin bath and exercise than in the hand treated with exercise only concerning extension deficit, perceived stiffness and skin elasticity. CONCLUSIONS: In this pilot study hand exercise in combination with paraffin bath seemed to improve mobility, perceived stiffness and skin elasticity. However, further studies with larger sample size are needed to attain more reliable results of the effect of paraffin bath treatment in patients with scleroderma.

53. Efficacy of Paraffin Wax Bath with and without Joint Mobilization Techniques in Rehabilitation of post-Traumatic stiff hand. Abstract Objective: Post-traumatic stiff hand is common a condition which causes pain and disability, the paraffin wax bath and joint mobilizations have the key role in its rehabilitation. We conducted the present study to determine the efficacy of paraffin wax bath with mobilization techniques compared with joint mobilization alone. Methodology: This single blind randomized control trial was conducted on 71 patients in department of physical therapy and rehabilitation, Riphah International University Islamabad, and patients with post-traumatic stiff hand after distal upper extremity fractures, were included.

54. The patients were randomized into two groups: the joint mobilization techniques with paraffin wax bath were included in group A, and joint mobilization techniques without paraffin wax bath in group B. The study variables were pain score on visual analogue scale (VAS) 0/10, thumb function score (TFS) and passive range of motion (PROM) of wrist flexion, extension, radial and ulnar deviation, and were compared at baseline and at completion on plan-of-care after six weeks. Results: Seventy one patients with post-traumatic stiff hand were enrolled and placed randomly into two groups. The baseline characteristics were similar in both groups. Six week after intervention, patients in group A had more improvement in pain score (p=0.001), TFS (p=0.003), and PROM of wrist flexion (p=0.002), extension (p=0.003), radial deviation (p=0.013), and ulnar deviation (p=.004), as compared to group B. However, in group B the improvement was less in pain score (p=0.104), TFS (p=0.520), and PROM of wrist flexion (p=0.193), extension (p=0.1081), radial deviation (p=0.051), and ulnar deviation (p=.168), as compared to group A.

55. Conclusion: Paraffin wax bath with joint mobilization techniques are more effective than mobilization techniques without paraffin wax bath in the rehabilitation of post traumatic stiff hand.

56. Case study: A 65 year old woman with a history of moderate RA physical examination reveals painful walking, bilateral ankle joint and toe stiffness, light toe deformity and chapped dry skin on the feet and ankles.examination of the upper limb reveals adequate wrist and hand function .she is concerned about her reduced and declining ability to walk and perform activities of daily living ( ADL's) ?

57. Intervention parameters: Thermal agent = paraffin bath. Application method = dipping with continous immersion. Dosage: ( T∞ag -s) 20 °   ± 2° C (68° ± 2F) Treatment frequency = daily,  7 days a week . Intervention period = 21 days.

58. Case study: MP is a 75 years old woman referred for physical therapy with a diagnosis of osteoarthritis of the hands. MP complains of stiffness and aching in all her finger joints, causing difficulty in gripping cooking utensils and performing other household tasks and resulting in pain with writing.

59. Thermal agent: Paraffin bath   Temperature of Paraffin: 50'C (106F) Application method used: 10 min, dip-wrap, seven dips Dosage ( T∞  ag -s) 20'C + - 2'C ( 88+- 2F) Treatment frequency: daily, 7 times a week Intervention period : 21 days