Thermotherapy

1. Thermotherapy By Ren Peterson, Laurel Petersen, Jason Neilsen, Angela Perkins

2. Objectives 11 • Educate on the physiologic effects of different thermotherapy agents. • Inform on the indications, contraindications, precautions, and recommendations for a variety of thermotherapy agents. • Identify and demonstrate how various thermotherapy agents are applied to biological tissues. • Have fun while learning.

3. Instructions • Click to learn more about that topic • Click to move to next slide • Click to move to previous slide • Click to go to Main Menu • Click to see the last slide viewed • Click to hear audio • Click to end program 

4. MainMenu • History Perspective • General Information on Thermotherapy • Moist Heat Packs • Paraffin Baths • Fluidotherapy • Infrared Lamp • Warm whirlpool/Immersion 

5. Historical Perspective of Thermotherapy 8 • Heat has always been used in various form for therapeutic benefits. • The first sources of heat that provided an effective treatment for ailments and pain included sunlight, heated sand, and heated water. • Early users of thermotherapy also obtained heat form hot stones and coals, open fire, and irons. • The earliest hot water containers consisted of hollow dried fruits and bladder or skin of animals. • The first scientific inquiries into the use of thermotherapy were conducted in the early 19th century.

6. Considerations1 • Pre treatment considerations • Adipose tissue thickness • Stage of healing • Contraindications • During treatment Considerations • Patient comfort/Safety • Post Treatment Considerations • Treatment efficacy

7. Moist Heat Packs 10 • Biophysical Characteristics • Application • Recommendations • Evidence-Based Research

8. Biophysical Characteristics 1Moist Heat Packs • Increased blood flow/vasodilatation. • Increased cell metabolism. • Muscular relaxation secondary to reducing muscle spindle sensitivity.

9. Application 10Moist Heat Packs • Indications • Contraindications • Dangers/Precautions • Demonstration of set-up • Proper Application

10. Indications 1Moist Heat Packs • 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

11. Contraindications 1Moist Heat Packs • Acute conditions- because of increase of inflammation • Peripheral vascular disease (PVD) • Impaired circulation • Poor thermal regulation

12. Dangers/Precautions 1Moist Heat Packs • Do not allow the moist heat pack to come into direct contact with the skin because burns may result. • If the packs are changed during the course of the treatment, additional care must be taken to prevent buns. • Infected areas must be covered with sterile gauze or another type of material to collect seepage. • Do not allow the patient to lay on the pack. If you must, increase space between by adding extra layers.

13. Demonstration of set-upMoist Heat Packs

14. Proper Application 1,9Moist Heat Packs • Moist heat packs should be stored in hydrocollator at 160°F to 170°F. • Use 6 layers of toweling or insulation to protect patient. • Recheck patient after 5 minutes for comfort and mottling. • Treatment time should be between 20 to 30 minutes. • Treatments may be repeated as needed, but allow skin to cool before next treatment is given

15. Recommendations 1Moist Heat Packs • Localized superficial heating • Pain • Muscle spasm • Chronic inflammatory conditions • Increasing muscle, tendon, and fascial elasticity.

16. Evidence-Based Research 2,12Moist Heat Packs • STUDY 1: 30 healthy subjects compared the efficacy of a 30 second static stretch to a 20 minutes moist heat pack application on hamstring flexibility. The study found that applying a moist heat pack increased hamstring flexibility significantly more than using a static stretch (p<0.03). • STUDY 2: 30 subjects (9 men and 21 women) with frozen shoulder used a single-blinded randomized controlled study comparing shortwave diathermy & stretching, hot pack & stretching, and stretching alone one pain, function, and ROM. The study found that There was not a significant difference found in pain or function between groups, all improved. However, shortwave diathermy and hot pack administration both improved ROM, with diathermy showing greatest improvement (p<0.05)

17. Paraffin Baths • Biophysical Characteristics • Application • Recommendations • Evidence-Based Research

18. Biophysical Characteristics 1Paraffin Baths • Increases perspiration • Increases blood flow/vasodilation • Increased cell metabolism

19. ApplicationsParaffin Baths • Indications • Contraindications • Dangers/Precautions • Demonstration of set-up • Proper Application

20. Indications 1Paraffin Baths • Subacute and chronic inflammatory conditions • Limitation of motion after immobilization

21. Contraindications 1Paraffin Baths • Open wounds: Wax and oil would irritate the tissues. • Skin infections: The warm, dark environment is excellent for breeding bacteria • Sensory loss • Peripheral vascular disease

22. Dangers/Precautions 1Paraffin Baths • General Population • Do not allow the patient to touch the bottom or sides of the paraffin tank as burns may result. • Elderly • The sensation of the paraffin is misleading as to the actual temperature of the treatment. The temperature of the paraffin is sufficient to cause burns, but its specific heat requires more time to transfer the energy

23. Dangers/Precautions1Paraffin Baths • Athletes • Avoid using paraffin with athletes who are required to catch or throw a ball or workers who are required to maintain good grip after the treatment. The mineral oil in the paraffin mixture tends to make the hands slippery, making the task of catching a ball or holding onto a hammer difficult.

24. Demonstration of Set-upParaffin Baths

25. Proper Application 1,9Paraffin Baths Glove Method • The extremity should be dipped into the paraffin for a couple of seconds, then remove to allow wax to harden. • Repeat process 7 to 12 times. • The paraffin-coated extremity should be wrapped in a plastic bag with several layers of toweling around it to act as insulation. • Treatment time is 15 to 20 minutes. • Treatment may be repeated several times a day.

26. Recommendations 1Paraffin Baths • Paraffin is used for delivering superficial heat to small, irregularly shaped areas. • The treatment of chronic inflammatory conditions • Softening of the skin

27. Evidence-Based Research 4Paraffin Baths  • A study of 17 patients with Sclerosis compared two treatment methods. One group received a paraffin bath treatment followed by hand exercises. The other group only performed hand exercises. • Improvements in function were significantly greater in the hand which was treated with paraffin bath exercise than in hand treated with exercise only. • Improvements were increased finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity.

28. Fluidotherapy • Biophysical Characteristics • Application • Recommendations • Evidence-Based Research

29. Biophysical Characteristics1Fluidotherapy • Increased blood flow/vasodilation • Increased cell metabolism • Muscular relaxation secondary to reducing muscle spindle sensitivity.

30. ApplicationFLuidotherapy • Indications • Contraindications • Dangers/Precautions • Proper Application

31. Indications 1Fluidotherapy • Pain reduction • Aid in joint mobilization • ROM exercises while doing treatment • Non-rheumatoid arthritis

32. Contraindictions 1Fluidotherapy • Uncovered open wounds • Sensory Loss • Peripheral vascular disease • Over cancerous lesions • Decreased tolerance to heat.

33. Dangers/Precautions 1Fluidotherapy • Cover open wounds prior to treatment. • Be aware that some patients are sensitive to allergic reactions caused by dust or pollen.

34. Ensure that the patient is free of contraindications. Preheat the fluidotherapy unit. Remove jewlery from body part being treated. Wash and dry patients extremity using an antimicrobial soap. Prevent medium from entering open wounds by a nonpermiable covering. Proper Application1Fluidotherapy

35. Recommendations1Fluidotherapy • Superficial heating of the skin of the upper or lower extremities. • Decreases pain. • Increase ROM.

36. Evidence-Based Research10Fluidotherapy • In a study by Borrell it was found that fluidotherapy produced a greater increase of joint capsule and intramuscular temperatures than that of hydrotherapy and paraffin wax. • Joint capsule and intramuscular temperatures were as follows: fluidotherapy +16.2, +9.5; paraffin wax +13.5, + 8.1; and hydrotherapy +10.8, 7.7 degrees Fahrenheit respectively.

37. Infrared Lamp • Biophysical Characteristics • Application • Recommendations

38. Biophysical Characteristics 1Infrared Lamp • Increased blood flow/vasodilation • Increased cell metabolism • Muscular relaxation secondary to reducing muscle spindle sensitivity.

39. ApplicationInfrared Lamp • Indications • Contraindications • Dangers/Precautions • Proper Application

40. Indications1Infrared Lamp • Subacute or chronic inflammatory conditions. • Skin infections. • Peripheral nerve injuries before electrical stimulation: Another modality should be considered if the patient lacks temperature perception.

41. Contradications 1Infrared Lamp • Acute inflammatory conditions. • Peripheral vascular disease. • Areas with sensory loss. • Over areas of scars. • Sunburns.

42. Dangers/Precautions 1Infrared Lamp • The infrared heating element does not cool during the treatment, thus providing a constant level of energy. The unchanging temperature source increases the risk of burns. Check with the patient regularly. • Do not use on a sleeping or unconscious patient.

43. Proper Application 1Infrared Lamp • Check for any contraindications. • Clean area to be treated. • Position patient so that the lamp is perpendicular to the targeted tissue. • Position the lamp 24 inches from target tissue. • Instruct patient to not move. • Check the patient often. • Instruct the patient to tell the clinician of any burning sensation.

44. Recommendations 1Infrared Lamps • Often used as a superficial heating agent. • Drying superficial tissues. • Sedating sensory nerves.

45. Warm whirlpool/Immersion • Biophysical Characteristics • Application • Recommendations • Evidence-Based Research

46. Biophysical Characteristics 1Warm whirlpool/immersion  • Provides a good supportive medium for active ROM exercises • Due to the physical characteristics of water, buoyancy, resistance, and hydrostatic pressure. • Promotes muscular relaxation • Decreases pain & muscle spasms • Due to the agitation & aeration of the water causing sedation, analgesia, and increased blood flow.

47. ApplicationWarm whirlpool/immersion  • Indications • Contraindications • Dangers/Precautions • Demonstration of set-up • Proper Application

48. Indications 1Warm Whirlpool/Immersion • Decreased ROM • Subacute or chornic inflammatory conditions • Peripheral vascular disease (neutral temp) • Peripheral nerve injuries

49. Contraindications 1Warm Whirlpool/Immersion • Acute conditions in which water turbulence would further irritate the injured area or in which the limb is placed in a gravity-dependent position. • Fever • Patients requiring postural support during treatment • Certain skin conditions speared by water • General contraindications for thermotherapy

50. Dangers/Precautions 1Warm Whirlpool/Immersion • Heat loss can only take place in two forms: evaporation & respiration. Therefore, a patient’s core temperature can be increased too much and cause hyperthermia. • The pressure associated with full-body immersion may impair breathing in individuals suffering from advance respiratory disease