Thermotherapy Flashcards
What is thermotherapy?
The therapeutic application of heat
What is thermotherapy used to do?
Control pain
Increase tissue extensibility
Increase circulation
What are the effects of thermotherapy?
Hemodynamic effects
Neuromuscular effects
Metabolic effects
Altered tissue extensibility
What are the hemodynamic effects caused by thermotherapy?
Vasodilation
What is vasodilation?
Increase in blood flow occurs mostly where heat is applied but also occurs in more distal and deeper vessels
What are the local hemodynamic effects of thermotherapy?
Superficial heat stimulation of cutaneous thermoreceptors -> release of bradykinin and NO-> smooth muscle relaxation -> vasodilation
What are the global hemodynamic effects of thermotherapy?
Cutaneous thermoreceptors also project to the DRG, where they synapse with sympathetic neurons in the lateral grey horn of the spinal cord, inhibiting firing and decreasing sympathetic output -> smooth muscle contraction
How is vasodilation a safety mechanism?
It occurs in response to increase in tissue temperature to protect the body from overheating
where would we place a hot pack for someone with peripheral artery disease?
More proximal to the problem to improve vasodilation dismally and avoid burns at the problem
Where would we apply a hot pack for a patient with a diabetic ulcer?
Proximal to the ulcer to improve vasodilation dismally without irritating that ulcer
can we increase blood to muscles with heat?
Changes in skeletal muscle blood flow is dictated by metabolic factors > sympathetic activity
Superficial heating agents only increase superficial tissues
What may be a better intervention to increase blood flow to muscles?
Therapeutic exercise or ultrasound
what are some neuromuscular effects of thermotherapy?
changes in nerve conduction velocity (increases) and firing rate
increased pain threshold
changes in muscle strength
would a patient with multiple sclerosis or any demyelinating disease respond well to thermotherapy?
NO it could make them worse and more fatigued because heat shortens the duration of opening of sodium channels at nodes of Ranvier
how does thermotherapy increase pain threshold?
increased activity of superficial thermoreceptors which can have “gating” effect at spinal cord level and increase in blood flow
what effect on muscle strength does thermotherapy have?
there is a decrease in muscle strength for 30 minutes after applying heat, then muscle strength increases above pre-treatment levels for approximately 2 hours after
what is the metabolic effect of thermotherapy?
increase in tissue temperature shifts oxygen hemoglobin dissociation curve to the right making more oxygen available for tissue repair
how can thermotherapy alter tissue extensibility?
increase in collagen extensibility
tissue temp should be maintained at 40-45º for 5-10 minutes
can only heat superficial tendons or muscles
which is a more effective combo:
just heat
just stretching
heat and stretching combined
heat and stretching combined
what are the clinical indications for superficial heat?
pain control
increase ROM
decrease joint stiffness
accelerate healing
how can thermotherapy help pain control?
gating of pain through activation of cutaneous thermoreceptors
increase in blood flow via vasodilation
heat modalities are just relaxing and we know pain can be influenced by stress
not recommended for acute inflammation but has been shown to be effective for acute low back pain
how can thermotherapy help increase range of motion and decreased joint stiffness?
increasing soft tissue temperature increases tissue extensibility
decrease in joint stiffness
what is the best temperature to increase tissue extensibility?
40-45º C
104-113º F
how can thermotherapy help accelerate healing?
increase in circulation and increased oxygen availability to tissues
most beneficial during the proliferative or remodeling stage of healing
if edema is present, proceed with caution as heat can increase edema
what are some contraindications for thermotherapy?
recent or potential hemorrhage
thrombophlebitis/DVT/ blood clot
impaired sensation/mentation
malignant tissue/cancer
why is a recent or potential hemorrhage a contraindication to thermotherapy?
heat causes vasodilation and increase in blood flow which can increase bleeding
do not apply over site of ecchymosis is recently developed over past 48-72 hours
why is a thrombophlebitis/DVT/blood clot a contraindication to thermotherapy?
may cause blood clot to become dislodged which may result in stroke, infarct, or pulmonary embolism
why is an impaired sensation or mentation a contraindication to thermotherapy?
can easily burn a patient
why is malignant tissue/cancer a contraindication to thermotherapy?
heat may increase growth rate of malignant tissue
what are some precautions for thermotherapy?
acute injury or inflammation
pregnancy
impaired circulation or poor thermal regulation
edema
cardiac insufficiency
metal in treatment area
over open wound
over area where topical medications have been applied
demyelinated nerves
why is an acute injury or inflammation a precaution for thermotherapy?
may aggravate symptoms
why is pregnancy a precaution for thermotherapy?
potential fetal damage with maternal hyperthermia
it is ok for peripheral joints but want to be careful around the abdomen and low back and monitor closely
why is impaired circulation or poor thermal regulation a precaution for thermotherapy?
may not have appropriate vasodilation in response to heat… increase risk for burns
why is edema a precaution for thermotherapy?
heat in dependent position can increase edema especially in the acute phase
why is cardiac insufficiency a precaution for thermotherapy?
increase in cardiac demand- need to monitor closely
slight decrease in BP and increase in HR are normal
why is metal in the treatment area a precaution for thermotherapy?
metal has a higher specific heat; can become very hot
remove jewelry and clear any superficial metal
(knee and hip replacement ok stables bad)
why is over area where topical medications have been applied a precaution to thermotherapy?
icy-hot or similar substance mimics heat and causes vasodilation
what are some questions to ask the patient for screening?
when did this injury occur/did you have any bleeding?
do you have a blood clot in this area?
do you have normal feeling in this area?
malignancy
are you pregnant do you think you may be pregnant?
impaired circulation
do you have a problem with your heart?
if a patient doesn’t have normal feeling in the area what should you do?
apply the heat proximally because they cant tell you when it gets too hot
what are some adverse reactions to thermotherapy?
burns
fainting
bleeding if vascular lesion
what is the number one adverse reaction to thermotherapy and what should you look for?
burns look for mottling
why do some people faint from thermotherapy?
decrease in cerebral blood flow caused by peripheral vasodilation, decreased blood pressure and decreased heart rate. can occur during or when getting up from thermotherapy
what should you do if a patient starts to faint from thermotherapy?
raise feet of patient or lower head
allow patient to remain in treatment position for BP to normalize
what are some applications of thermotherapy?
moist hot pack
paraffin bath
hydrotherapy
what is a moist hot pack?
canvas pack filled with silicate gel kept in hot water around 70-75º C or 158-167º F
how long should a hot pack heat before its ready to use?
if room temp (cold) 2 hours
if between uses 30 mins
what are some advantages to moist hot packs?
easy to use
inexpensive
low level of skill for application
cover larger areas
can use at home if needed
what are some disadvantages of moist hot packs?
must remove to observe area
can be heavy
not as good for small or hard contact areas- like hand
what is the general procedure for thermotherapy?
determine which thermotherapy application is best
introduction
explain the procedure and reason
why?-relate to impairments
expectations (mild warmth, decrease in pain, increase in blood flow, possible adverse reactions)
screen for contraindications
inspect area to be treated
have patient remove jewelry and clothing from area
check sensation
what is the specific procedure for moist heat?
wrap the hot pack in 6-8 dry towel layers
apply hot pack to area to be treated- on patient not under
provide patient with bell and timer
check skin after 5 mins to ensure no adverse event
recheck after 20 mins
then intervention- normally mobility
how many layers does a hot pack cover equal?
3
how many layers does a towel if doubled equal?
2
what are moist pack parameters?
15-30 mins
what is paraffin?
use of warm melted paraffin wax for thermal effect (mix of paraffin and mineral oil)
good for heating distal extremities because it can maintain good contact with irregularly contoured areas
stored in temperatures controlled by containers at 52-57º C (126-134ºF)
what are some advantages of paraffin?
good contact with contoured areas
easy to use
what are some disadvantages of paraffin?
messy and time consuming
risk of cross contamination
how can paraffin be applied?
dip wrap is most common, dip, immersion
what is the specific procedure for paraffin?
wash and dry hands
with fingers apart dip hand into paraffin as far as possible without touching the sides or bottom then remove
don’t move fingers wait until wax is completely dried
repeat 6-10 times
wrap hand in plastic bag then place in mitt or towel
elevate patient extremity
provide with call bell and timer
remove after 15-20 minutes- look for excessive redness, blistering
intervention
what is the parameters for paraffin?
15-20 minutes
what should be included in documentation?
area
type of thermotherapy
treatment duration
patient positioning
response
interventions/parameters -layers and time
