1. Thermal Agents: Heat

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 HP
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)
Duration of treatment
ÞF is needed to get an effect

5. Factors effecting tissue temperature rise:
Beyond 113 ÞF protein denaturization and tissue burning may occur
Heat is dissipated faster because of increased blood flow
Best general tissue temperature and blood flow increase is via exercise

6. Physiological effect of superficial heat: Metabolic
Increase metabolic rate
Increase oxygen demand
Therefore the is increased cell death with swelling

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: Hemodynamic
Capillary dilation is the main effect from:
axon reflex (non-synaptic) release of substance from axon causing arterioles to relax
Chemical mediators released causing mild inflammatory reaction
Spinal cord reflex: A-delta fibers carry temperature to spinal cord to inhibit sympathetic activity causing vasodilatation

9. 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

10. 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

11. Physiological effect of sup. heat: Connective tissue
“plastic” or viscous properties permit residual elongation after stretch is applied and released (plastic deformation)
elastic properties result in recoverable deformation
Heat aid elongation (heat with stretch works best)

12. Indications for the use of superficial heat
Muscle spasm
Subacute inflammation
Trigger points
Thromboflabitis
Local inflammation (caution!)

13. Contraindications for the use of superficial heat
Acute inflammation
Decrease sensation in area
Impaired circulation (unable to dissipate heat)
Malignancies: increased metabolic rate
Pregnancies

14. Superficial Heating Modalities
Moist Heat Pack
Infrared Heat Lamp
Whirlpool
Paraffin Bath
Slides in Packet for specific review of each Clinical Application

15. 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

16. 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

17. 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 pattern on chair or bench between two tubs
Heat Tx given 1st
Contrast bath minutes at 3-5 minute intervals or a combination (3 min hot 5 min cold etc.)

18. Contrast Bath Precautions Indications Contraindications
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

19. 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 minutes
Packs transfer heat by conduction
Main benefit is superficial heat to 1cm

20. Moist Heat Packs Set-up Cover pack with t6erry cloth covering
Place pack on patient in comfortable manner
Check patient within 56 minutes for comfort
Allow pack to reheat for a minimum of 30 minutes before reuse

21. Moist Heat Pack Precaution Contraindications 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
Precaution
infected areas must be covered with gauze
Contraindications
Acute conditions
Peripheral vascular disease
Impaired circulation
Poor thermal regulation

22. Paraffin Bath
A mixture of wax an mineral oil in a ration of 7 parts wax to 1 mart 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 (.5 to .65)

23. Paraffin Bath
Used to deliver heat to small irregularly shaped areas (hands, fingers, wrist and foot)
Increases intrarticular heat 6.3 ºF

24. Paraffin Bath Set Up Immersion Bath
Clean body part
Dip both part an allow coat to dry
Dip the extremity 6-12 more times
Then place extremity back in paraffin for duration of tx (10-15 min)
DO NOT touch sides or bottom of bath (burns)
After tx scrape of was 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, aluminum foil, or wax paper. Then wrap in terry cloth towel
If indicated elevate body part
Following tx remove wax and return to bath

25. Paraffin Bath Precautions Contraindications Indications
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
Skin infections
Sensory loss
Peripheral vascular disease
Indications
Subacute and chronic inflammation
limitation on ROM after immobilization

26. 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

27. Infrared Lamp Set-up Warm lamp if necessary
Clean area for any sweat, dirt, or oils and remove jewelry
Position patient in a comfortable manner
Place lamp so that the source of heat is approx 24 inches away from patient
To prevent burns, instruct patient not to move
Check patient periodically
Duration minutes

28. Infrared Lamp Indications Contraindications
Subacute or chronic inflammatory conditions
Skin infections
Peripheral nerve injuries before electrical stimulation
Contraindications
Acute conditions
Peripheral vascular disease
Areas with sensory loss or scarring
Sunburns

29. Whirlpools
Tx temperature is between 105º-110º F the larger the area the less the temperature down to 100º F for whole body
Tx times begin with 5-10 minutes and may be increased to minutes once or twice daily

30. 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
Flowing water may nauseate some patients
Patients under the influence of drugs

31. Warm Whirlpool Indications Contraindications Decreased ROM
Subacute or chronic inflammatory conditions
Peripheral vascular disease
Peripheral nerve injuries
irregular shaped areas
Contraindications
Acute conditions where water turbulence would further irritate injured area
Fever
Patients requiring postural support
Skin conditions