The document discusses various thermal agents used in therapy, focusing on heat modalities such as superficial and deep heat, their physiological effects, and contraindications. It details methods like moist heat packs, paraffin baths, infrared lamps, and whirlpools, including their applications, precautions, and ideal temperature ranges. Contrast treatments transitioning from cold to heat are also mentioned, alongside indications for therapy and the necessity for appropriate clinical judgment.

1. Thermal Agents: Heat
Dr Tabassum Saher
Assistant Professor

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
 Hot Packs
 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)
 Heat Sink: as long as the heat can be dissipated as fast as the modality
adds heat, it is considered safe
 Duration of treatment
 Modality of treatment used

5. Factors effecting tissue
temperature rise:
 Beyond 113 F protein denaturization and tissue burning may occur
 Best general tissue temperature and blood flow increase is via exercise

6. Physiological effect of
superficial heat
 Increase circulation 1.5-2x normal
 Increased metabolism (contraindicated in 2-3 days post injury)
 Increased inflammation, phagocytosis, & wound healing
 Decreased pain (analgesia); not as effective as cryotherapy for acute pain
(cryokinetics, anyone?)
 Decreased muscle spasm
 Decreased tissue stiffness (fluids less viscous and collagen releases easier)

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: 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

9. 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

10. Contraindications for the use
of superficial heat
 Acute inflammation
 Decrease sensation in area
 Impaired circulation (unable to dissipate Tissue Temperature Rise, TTR)
 Malignancies: increased metabolic rate
 Pregnancies

11. 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 30-45 minutes
 Packs transfer heat by conduction
 Main benefit is superficial heat to 1cm

12. Moist Heat Packs
 Set-up
Cover pack w/ terry cloth or towel covering
Place pack on patient in comfortable manner
(patient on pack is contraindicated)
Check patient within 5 to 6 minutes for
comfort
Allow 3-4 hr minimum between treatments on
the same day

13. Moist Heat Pack
 Precaution
 infected areas must be
covered with gauze
 Contraindications
 Acute conditions
 Peripheral vascular
disease
 Impaired circulation
 Poor thermal regulation
 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 (discuss)

14. Paraffin Bath
 A mixture of wax an mineral oil in a ratio of 7 parts wax to 1 part 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.

15. Paraffin Bath
 Used to deliver heat in uniform amounts to small
irregularly shaped areas (hands, fingers, wrist and foot)
 Wax moistens skin, water tends to dry skin

16. Paraffin Bath Set Up
 Immersion Bath
 Clean body part
 Dip part quickly; allow 10
sec. to dry (turns milky)
 Dip the extremity 6-12 more
times
 Then cover with cellophane
or towel for duration of tx
(10-15 min)
 DO NOT touch sides or
bottom of bath (burns)
 After tx scrape off 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, or wax paper.
Then wrap in towel
 If indicated elevate body part
 Following tx remove wax and
return to bath

17. Paraffin Bath
 Precautions
 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 (options?)
 Skin infections
 Sensory loss
 Peripheral vascular disease
 Indications
 Subacute and chronic
inflammation
 limitation on ROM after
immobilization

18. 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

19. Whirlpools
 Tx temperature is between 105º-112º F for
extremities and 100-108º F for whole body (recall
TTR)
 Tx times usually last 10-20 minutes; watch for
lethargy with WWP

20. 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
 Clean tank pre and post infectious wound tx
 Patients under the influence of drugs
 Keep clothing and bandages out of whirlpool

21. Warm Whirlpool
 Indications
 Decreased ROM
 Subacute or chronic
inflammatory
conditions
 Stiffness or soreness
 Irregular shaped areas
 Contraindications
 Acute conditions where
water turbulence would
further irritate injured
area
 Fever above 101 F
 Tx within 24-48 of acute
injury
 Comprimised circulation

22. 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

23. 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 (Knight &
Draper this summer presented this information;
also on p. 232)

24. 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 patient on chair or bench between two tubs
 Heat Tx given 1st
 Contrast bath 20 -30 minutes at 3-5 minute intervals or a combination
(3 min hot 5 min cold etc.)

25. Contrast Bath
 Precautions
 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

26. Heat Case Study
 Similar to Cold Case Study, use at least 3 primary sources in this assignment.
Appropriateness of source will be reflected in grade.
 Cite source as (Author name, date) within answer and full source in
“Citations” at end of answer.
 Each question should be answered concisely in 3-4 sentences (short
paragraph).