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 mineraloil.
– 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:
1. Pain and Muscle Spasm:
Wax reduces the pain and muscle spasm.
2. 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.
3. Adhesions and Scars:
Wax softens the adhesion and scar in the skin
and thus facilitates the mobilization and stretching
procedures.

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

15. Cont…
6. Cancer, tumors or tuberculosis ( TB) in the area to be
treated as it ↑ the metabolic activity & rate of growth.
7. Gross oedema with a very thin and delicate skin covering
the area .
8. Lack of comprehension ( children, senile , head injuries,
confused, agitated,…)
9. Deep X~ray therapy within three months prior to
treatment ↓ bloodflow thus impaired sensation.
10. 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:
1.Effective only for distal extremities in the terms of ease of
application.
2.No method of temperature controls once applied.
3.Sedimentation occurs at the bottom.
4.It is a passive treatment: exercise may not be performed
simultaneously.
5.The bath must be cleaned regularly & emptied at least twice a
year.
6.Contamination of oil by atmospheric dust.
7.It also poses environmental concerns regarding its disposal.

19. 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.

20. 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.

21. iii.
i. When the dipping process is done, put hands in a plastic
liner, or wrap in warm towels.
ii. 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.

22. Techniques/Methods of application:

23. 2. Brushing / Painting method:

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

26. 4. Dip & Wrap / Glove method:

28. 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.

29. 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.

30.  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

31.  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.

32.  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

33.  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

34. 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.

35. 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..

36.  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.

37. 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.

38. 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

39. 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.

40. 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.

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

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

43. 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

44. 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.

45. 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.

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

47. 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.

48.  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.

49. 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).

51. Efficacy of Paraffin Wax Baths for Rheumatoid Arthritic
Hands.
•Objective:
Toprovide 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.

52. • 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.

53. 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).

54. • 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.

55. • 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.

56. • 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.

57. 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.

58. 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 groupA.

59. • 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.

60. 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) ?

61. 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.

62. 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.

63.  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