1. GTPT 203
Thermotherapy

2. Physiological Effects of Heat
The temperature difference between the hot application and the target tissue must be enough to increase blood flow and cell metabolism(between 40 and 45 degrees C)
Between C, the rate at which burns occur doubles for every 1C increase

3. Physiological Effects of Heat
Passive Derivation
Movement of fluid away from the core or from an inflamed or congested area toward the skin surface(to allow heat to escape)
When heat is applied, the ensuing warming of the tissue is perceived by the body as though the tissue had become inflamed

4. Factors that Influence the Effects of heat
Temperature of application
Speed that tissue is heated
Duration of application
Presence/absence of coupling agent
Size of Tx area
Amount of adipose tissue in Tx area

5. Direct Effects of Heat Increased metabolism of affected tissues
Chemical reactions occur more rapidly(2-3xs for every 10 degrees C)
Increases oxygen and nutrient uptake in tissues enhancing tissue health and performance
Altered CV dynamics
pulse rises about 6-10 bpm for every core temperature increase of 1C (over time it induces relaxation and slower deeper heartbeat)
can be a quick rise in BP, followed by a decrease in BP d/t large scale applications

6. Direct Effects of Heat Altered blood dilution Detoxification
More interstitial fluid is mobilized therefore increase in blood volume
To counterbalance sweating cause fluid to leave the body
This fluid loss requires replacement
Drinking water allows good hemodilution to be maintain and decreases chance of dehydration
Detoxification
Perspiration – reducing toxins and supporting other elimination organs(kidneys, lungs, liver)
Breathing - can increase 5-6 breaths for every 1C rise in temperature d/t large scale heat applications(rid of CO2)

7. Direct Effects of Heat Effects on Soft tissues Muscle – minimal
Fascia – loosens ground substance making it more pliable
Scar tissue – soften, reduce adherence to surrounding tissues

8. Reflex Effects of Heat
Abdomen - decreased GI motility and secretions(aids with cramping and diarrhea)
Chest – relieves congestion, relaxes smooth muscle of bronchioles
Pelvis – relaxes pelvic organs (e.g. uterus during menstruation onset)
Kidneys – increased production of urine, more filtration in kidneys

9. Reflex Effects of Heat
Trunk – relaxes bile ducts, helps relieve gallbladder conditions
One limb – induces vasodilation in contralateral limb
Nervous system – elevates pain threshold, alters nerve conductivity, decreases firing rates of muscle spindles
General sense of sedation and relaxation

10. Indications for Heat Promote injury/wound healing Muscle pain/spasm
TrP pain
Delayed onset muscle soreness(DOMS)
Conditions involving spasticity(not MS)
Chronic tendonitis/bursitis
Scars/soft tissue contracture
Non-inflammatory joint pain
Limited joint mobility, adhesive capsulitis
Poor mobility
OA, RA(not in flare up)
Labour/perineal pain
Anxiety

11. Precautions Don’t allow patient to fall asleep
Sensory/thermoregulatory disorders
Overheated before the treatment
Dehydration
CV, renal, respiratory issues
Bleeding disorders or prolonged steroid use
Diabetes mellitus/peripheral vascular disease
Over abdomen/pelvic area in pregnant women

12. Thermotherapy Applications
Warm: 33 to 38 degrees C; Hot: over 38 degrees C
Heat applications result in the same responses that fever causes
These reactions can be controlled when intentionally induced
Short Tx – stimulating
Long Tx – sedating
Most prefer heat, but tend to overuse it
Thermophore
Electric moist-heat pad with flannel cover that traps moisture from air and body surfaces(more intense than dry heating pad)
Hydrocollator
Gel filled packs stored in water tank and kept hot
Fomentations(alternating hot towels)
Used for chronic soft tissue conditions(esp. when weight of hydrocollator is too much
Foot baths
For congestive headaches, draw blood away from congested areas, warm a chilled body

13. Thermotherapy Applications
Paraffin Wax Bath
Melted paraffin wax applied to target tissues to create deep, moist heat
Paraffin creates a seal preventing release of heat, thin layer of perspiration forms under increasing heat conduction
Used for scar tissue, adhesions, stiff joints
Steam Inhalation
Inhale steam from bowl/pot of water that has been boiled
Used for respiratory congestion, loosens mucous, helps with expectoration

14. Thermotherapy Applications
Hot bath
Entire body is immersed except for the head
Induces relaxation, ideal medium for therapeutic additive
Temperatures between 36 and 38C
Caution weak, old or very young
Modifications with CV problems include temperature decrease, water level below the heart, allow water to drain so pressure on blood vessels normalizes
Apply a cool cloth on forehead and drink water during bath
Apply for up to 15 to 20 minutes, followed by cool shower to rinse and rest

15. Hot Homecare Applications
Hot water bottle
Hot wet towels
Castor oil on cotton cloth warmed in the microwave(scars, contractures, tight ITB)