CHAPTER 3: Superficial Heating Modalities PHYSIOLOGICAL EFFECTS OF GENERAL HEAT

By Alyssa Batas INC: CO, PR, RR DEC: BP, ms activity, SV

vasodialtion Blood to internal organs (due to proper
Heat distribution of blood)
- a form of energy Blood to resting ms
- state of matter characterized by evaluation of temp PHYSIOLOGICAL EFFECTS OF LOCAL HEAT
Mode of Heat Transmission (CO3RE) INC: vasodilation DEC : ms spasms
a) Conduction Metabolism Ms strength and endurance
Edema Stiffness
- with physical contact / one surface to another
Capillary permeability pain
- warmer to cooler Elasticity of vessels
- direct contact with different temperature
- e.g hot packs
b) Convection General Indication
- transfer of heat through fluid or air - Joint stiffness
- warmer to cooler - musculoskeletal Pain
- direct contact where in source of heat is circulating - ms spasm
- e.g: whirlpool - late subacute and chronic inflammation
c) Conversion - preparation for electrical stimulation and massage
- conversion of one type to another - preparation for PROM/AROM activities
- non thermal to thermal to CTERM energies Contraindications
- direct contact which uses medium (okay) - acute and early subacute inflammation
- e.g : ultrasound - DEC/ altered sensation
d) Radiation - DVT and circulatory dysfunction
- uses radiant energy - impaired cognitive function
- direct transfer of heat without medium or contact - too young and too old
- e.g: UV rays/sunlight - malignat tumor/ TB (will metastasize)
e) Evaporation - pt with hemorrhage and edema tenderness
- liquid changing to a form of a vapor - deep x-ray therapy (3mos) (will further cause damage to the tissues)
- e.g : vaporcoolant sprays - implants
Conversion Formulas: Reflex Heating
- C = (F-32)5/9 - used when area to be heated is contraindicated
- F = (C x 9/5) + 32 - application of heat to the proximal part of the desired area to be heated
- K = C + 273.15 Factors that determine extent of effectiveness in heating:
Laws. Theories a) Temperature of the tissue
a) Vant Hoffs Law b) Duration of heat application
- states that the chemical reaction INC by 2-3 times for every 10C IN in temp of the - the longer the better
tissues c) Rate of temp is INC
- indicates an INC in metabolism rate of tissues Thermal Conductivity (cal/s)
b) Gate Control Theory Aluminum 0.5
- GATE: Substancia Gelatinosa Silver 1
- Melzack and Wall, 1965 Ice 0.005
- Proposes that non-painful input closes the "gates" to painful input, which prevents H20 20degrees 0.0014
pain sensation from traveling to the central nervous system. Bone and Muscles 0.0011
Fat 0.00005
- Therefore, stimulation by non-noxious input is able to suppress pain
Air
- ANALOGY The Bridge owns the Castle hahaha
- counters the irritation or the pain that first happens and relaxation is substituted
d) Size of the area being treated
- the smaller the area the easier it can distribute the heat
 Important values - Hydrocollator Packs
- Maximum Therapeutic Range : 44C - 45C -- canvas pack incased in fabric
- Hyperemia : 43C -- contains: silica gel/ bentonite/ hydrophilic substances
- Cell death: 60 mins with 43C -- Advantage: silica gael absorbs quite amound of H2O thus retains heat up to
7.5 min of 46C 30mins if heated up to 140-160F (60C)
Kirchoffs Law -- towel wrapping provides 115F to the skin
- greatest amount of heat is developed in the region of greatest current density -- teny cloth, rubber sheet or Turkish towels
- Minimal: 5 mins -- towels are removed layer by layer thus maintaining that 115F
- Maximal: 20-30mins Effects
- Plateau/detrimental: >30mins - Superficial INC 100% circulation
- the modality that rapidly INC in temp, the more the effect - INC metabolism
- the larger the area, the lesser the rise of temp due to the dissipation of heat - ms ______ analgesia
Advantages
HEATING MODALITIES - ease of application
Superficial Heating Deep Heating - local heat without heating the whole body
- only up to 3cm of the subcutaneous layer - up to the muscles and bones - multiple treatments
-- HotPacks -- ultrasound - inexpensive and durable
-- Paraffin -- shortwave and microwave diathermy
- uniform temperature and portable
-- Radiant
-- Fluidotherapy -treat over open wound without spreading of germs
-- Other - heats surface and intramuscular tissues more than the paraffin (deeper
penetration)
- more sedative effects
Superficial Heating Disadvantages
- 2-3 cm subcutaneous where it reaches its max temp in 8-10mins of heat application - weight may sometimes be uncomfortable
- skin subcutaneous INC 5-6C after 6mins and maintained after 30mins - time consuming (needs to be reheated)
- 15-30mins if necessary for INC ms - difficult to contour to some body parts
-- for maximal benefits - only superficial and short lived
Subjective Classification of External Temp.
0-13 Very cold - difficult to perform exercises
13-17 Cold Indications
17-27 Cool - pain ms spasm
27-33 Neutral
- inflammation
33-37 Warm
- edema
37-40 Hot
40-43 Very hot - adhesions
Contraindications
- same with general c/i
a) Hot Packs b) Paraffin Wax
Types - application of molten paraffin wax
- Hot water bottle - melting point: 51-55C
- Kenny Pack - mineral oil lowers the temperature
-- wool pack steamed, heated and spun dry - heat maintained at 40-44C and lowers specific heat enhances heat tolerance
-- Advantage : Intense Initial heat - Ratio: 7:1 paraffin: oil
-- Disavantage: only intense at the start - Container made of enameled baths/ stainless steel and ______
-Hot Towel -- outer: fiberglass shell
-- towel dipped and wrung out -- inner: stainless steel
-- 5-10mins -- bottom: Bakelite salts
-- burns too easily
 - Application techniques:
-- always make a first dip as a glove that will serve as an insulator
1. Dipping
- most common
- dipped approximately 10X
- wrapping it with wax paper then towel
2. Immersion
- glove then 15-20mins immersed
- no glove, no immersion
3. Brushing
- 8-10 coats with paint brush
- should have even and rapid strokes
- Advantages:
Pt has lower tolerance to heat
For dry and scaly skin
Can be combined with exercise
Can mold around body contours
- Disadvatages:
Water collects at the bottom
Sedimentation (replace 2X a year?)
Contamination of the oil by the dust (should be covered with a lid when not
in use)
c) Fluidotherapy / Hot Air Bath
- convection method
- warm air is circulating through the container
- Advantages:
Exercise can be applied
Control of temperature and agitation to hypersensitive areas
d) Peloids/ Mud Packs/ Peat
- Immerse or applied
Mud Packs
- organic and has more minerals
- sulfur, iron, and silicas
Organic Moor-Peat
- decaying vegetable matter
- Disadvantage: irritation of the skin
Impeding the venous circulation
- Advantage: help/release adhesions or tightness