Superficial Heat Modalities Flashcards
Superficial vs deep heat
superficial ( CONDUCTION OR CONVECTION
Deep (2 - 5 cm):
- ultrasound
- diathermy
- –> CONVERSION
Fore every 1.8 deg F rise in skin temp
cellular metabolic rate increases by 13%
Local Effects of superficial heat
increase cell metabolic rate
- -> increasing cell demand for Oxygen
- —-> more nutrients available for healing
- using heat too soon after injury can cause cell damage due to HYPOXIA
- -> increasing oxygen demands on already suffocating cells causes further damage
Vascular Effects
- vasodilation of skin bv
- increase delivery of oxygen
- increase delivery of WBC
- increase delivery of chemical mediators
heat –> mild inflammatory rxn –> release of chemical mediators:
- histamine + prostoglandins ==> vasodilation
- increase capillary permeability
- increase lymphatic/venous return
===> engorges area = NOT for acute phase - increase removal of metabolic wastes
Vascular Effects
- vasodilation of skin bv
- increase delivery of oxygen
- increase delivery of WBC
- increase delivery of chemical mediators
heat produces mild inflammatory rxn –> release of chemical mediators:
- histamine + prostoglandins ==> vasodilation
Effects on Pain
- increase analgesia of sensory nerves
- decrease pain via gate control theory
Effects on Inflammation
increases inflammation
effects on muscle spasm
- decrease muscle spasm
- decrease muscle spindle sensitivity
- increase delivery of oxygen to the area
neuromuscular effects
- elevation of pain threshold
- alters nerve conduction velocity
- change mm spindle firing (relaxation)
connective tissue effects
IMPROVES plastic deformation of tissue
LESS likely to change shape
tissue elasticity
- extensibility of collage is increased
- plasticity of and deformation capabilities increased
- –> assist this with gentle stretching (low load, long duration)
rebound vasoconstriction
mechanism of heat dissipation:
previously vasodilated vessels constrict after 20min to save underlying tissue by sacrificing superficial layers (burns) after tx at a constant intensity
rxn is slowed/decreased by keeping hot pack on past point of evening temperature gradient to get the maximum benefit over the time period
mottling
warning sign that skin temp are rising too quickly
Indications for Superficial Heat
- subacute / chronic inflammation
- subacute / chronic pain
- subacute / chronic muscle spasm
- decreased ROM
- reduction of joint contractures
- hematoma resolution (post acute stage)
Contraindicaitons of Superficial Heat
- acute injuries
- impaired circulaiton
- poor thermal regulation
- anesthetic areas
- impaired sensation
- impaired cognitiion
- fx
- post surgical
- neoplasms
- infection (increases spread through body)
- systemic infection
- elderly / kids (more difficulty controlling their own body temps or sensing the temp, may burn unknowingly)
- abnormal proliferation of cells, uncontrolled/progressive tumor
USE HEAT (over cold) if….
- body feels cold
- no sensitivity to light/mod touch
- no swelling increase
- selling does not increase with activity
- pain does NOT limit ROM
- acute inflammatory stage is over
- pt no longer improves with cold
dry heat
- does not increase skin temp as rapidly as moist heat
- does Not make good contact with skin directly
- burns more likely (no decrease in heat)
- possible fires
moist heat packs
- canvas pouches of silica gel
- kept in hot water 160-170 deg F (kills off bacteria but can burn!)
- CONDUCTION heat transfer
- can maintain therapeutic heat level for 30-40 min
- max heating potential at 15 min
- 20-30 min tx duration
- insulate packs with 5-7 layers
- layers should not be compressed
—-> allow air pockets to remain = more insulation
if lay on pack…
—-> increasing heat conduction
——> decrease capillary flow (via body wt)
——–> less release of heat from body
=========> increased chance of burning - check on pt ever 5 min (look for mottling)
- used for localized areas or areas that can’t be tx in water
- not as effective over irregular areas
- various sizes
- more comfortable than dry heat
- increase skin temp more rapidly than dry heat
- -> vasodilation of bv increase flow to area –> cool tissue
- average temp rise: ~3.8 deg C at ~1cm
- direct relaxation of tissue (<1cm)
- secondary relaxation of deeper tissues by relaxation of superficial motor and sensory nerves
warm whirlpools
TEMP: 100-105 or 110 deg F
- more body area in water ==> colder it should be (avoid hyperthermia)
[for CWP…more body = warmer it should be –> avoid hypothermia]
Benefits: assist in promoting muscular relaxation
- turbulence of water
- -> sedative and analgesic effect on sensory nerves
tx duration: 20-30min
indications for wwp
- (primarily) decreased ROM and
- muscle relaxation
- peripheral vascular disease (neutral temp)
- peripheral nerve injuries (avoid extreme tens)
Contraindications for WWP
- fever
- pts needing postural support
- skin conditions
Contrast Therapy
alternation of cyrotherapy and thermotherapy
theory: stimulates pumping action (from vasoconstriction and dilation)
- increases peripheral blood flow
- increases venous / lymphatic return
- decreases pain/spasm –> more ROM
- subacute or chronic conditions
—> remove edema and ecchymosis - 3 or 4: 1 hot to cold ratio
ex: 3 min hot, 1 min cold
Hot: 105-110 deg F
Cold: 50-60 deg F
~ 20 min tx time
~3-5 cycles - end with what you start with
- can end on either hot or cold
cold: - subacute
- proprioceptive follow up activity
warm: - chronic
- relaxing end-note
Effects of contrast bath on injury response cycle
- not clear
- does NOT appear to affect subcutaneous tissue deeper than 1 cm
- increased circulation in tx extremity
- removes edema (unclogging vasculature)
- increases jointROM
- decreases pain
Indications for Contrast
- ecchymosis removal
- edema removal
- sub acute or chronic inflammatory conditions
- impaired circulation
- pain reduction
- increasing joint ROM
Contraindications
- acute injuries
- hypersensitivity to cold
- contraindications for WP, cold, heat
Paraffin bath
1 parts wax: 1 part mineral oil
lower specific heat than water - feels cooler = able to tolerate higher temps
— UE: 118-126 deg F
— LE: 113- 121 deg F (circulation is less efficient)
- used for tx of small, irregular areas
- may increase articular temp by 6.3 deg F
- best used for chronic inflammatory conditions
- heat + moisturizes skin
- 6-12 layers (dry between dips)
- more layers = more insulation = more temp
tx time: 15-20 min
indications for paraffin bath
- sub acute or chronic inflammatory conditions
- limitation of motion after immobilization (tendon repairs)
contraindications
- open wounds
- skin infections
- sensory loss
- peripheral vascular disease
- acute injuries
- normal heat contraindications
