Thermotherapy Techniques

Techniques Without Pressure

• Compresses should be changed or cooled every 10 minutes using cold water or ice as a local cryotherapy method
• Hot compresses (40-45°C) are less wrung out and should be covered similarly to cold compresses

Whole Body Baths

• Immersion is performed in bathtubs, tanks, or pools with the patient immersed up to the neck
• Bathtubs: thermal actions are predominant
• Tanks/pool immersions: mechanical and thermal actions are predominant
• Spa bathtubs: thermal and hydrokinetic factors are present

Regional Baths

• Half baths: patient sits waist-deep in hot water with the upper body out of the water
• Three-quarter baths: patient sits chest/nipple-deep
• Sitz baths: warm bath used for cleansing or healing purposes, covering only the hips and buttocks
  • Used for hemorrhoid surgery, episiotomy, sciatica, dysmenorrhea, and kidney stone pain

Partial Baths

• Hand or foot baths
• Temperature ranges:
  • Very hot: 37-44°C
  • Hot: 11-20°C
  • Cold: 11-20°C
  • Contrast baths: alternating between hot and cold water

Hot Baths

• Temperature: 37-40°C for total baths, up to 45°C for partial baths
• Duration: 5-20 minutes
• Superficial thermal agents

Hydrotherapy Techniques Classification

• 1. Techniques without pressure: ablations, affusions, wraps, compresses, fomentations, baths, hot packs, paraffin, peloids, sauna, steam baths
• 2. Techniques with pressure: showers, jets, whirlpool baths, massage
• 3. Pool therapy: Hubbard tank, pools, and swimming

Ablutions

• Application of water using a hand covered with a towel dipped in cool/cold water
• Fast application to avoid heat loss
• Entire body is draped except for the treatment area
• Local/regional/general applications in a centrifugal direction
• Upper-body, lower-body, and whole-body applications

Ablutions (Cont.)

• After ablution, the body is not dried but covered with blankets for 30 minutes
• The body must be warm before and after the treatment
• Never begin this treatment with a patient feeling cold or in a cold room

Affusions

• Pouring of water in a stream on the body/segment without pressure
• Water is applied using a rubber tube 10 cm from the body surface and pointing downwards
• Patient is seated, leaning forward, or lying down

Affusions (Cont.)

• Cold affusions: less than 20°C for 1 minute
• Hot affusions: start from neutral (34-36°C) and increase 1°C per minute up to 45°C for 3-5 minutes
• Procedure:
  1. Start with 37°C and increase 1°C per minute till 40-45°C
  2. After the bath, the patient will be dried and rest for 1 hour

Showers Classification

• Classified based on shape, body area, water temperature, pressure, and special showers
• Shapes: spray, needle, circular, fan, filiform, and rain
• Body areas: total-body, partial-body, abdominal, arm, and others
• Water temperatures: cold, cooled, hot, very hot, warm, neutral, and contrast/Scottish shower
• Pressures: affusions (no pressure) to filiform shower (6-12 atm)

Techniques with Pressure

General Pressure Jets/Percussion Showers

• A strong spray of water applied with a hose to the posterior aspect of the body
• Pressure: not very important (not harmful to the head)
• Temperature: neutral to hot
• Duration: 2-4 minutes

Scottish Shower

• Applied by one operator using 2 hoses (one hand for hot water and the other for cold water) to change temperature
• Not applicable to the head or anterior chest
• May be applied to: spine, posterior thorax, abdomen, and lower extremities
• 12 minutes: 3 cycles starting with hot applications (38-40°C) for 1-3 minutes, followed by cold applications (20-25°C) for ¼ or 1/6

Effects/Indications of Scottish Shower

• A strong general stimulus
• Used for insomnia, stress, depression, and to stimulate blood flow to the skin
• Used as a general tonic and to prevent muscle soreness after exercise

Swiss Shower

• Multiple showerheads mounted on the shower wall at different levels and on all sides of the patient
• The entire body is sprayed from head to toe
• May have outlets in all four corners of a shower stall with 8-16 streams of water coming from each outlet

Fan Shower

• A fan-shaped stream
• Usually cool or cold
• Used to finish a treatment
• Duration: 10 seconds
• Temperature: 25.6-26.7°C
• Position of patient: standing
• Jet pressure: 1-3 atm
• Distance: 3-4 m

Cold Douche

• A single stream of water under pressure used at a distance of 2-3 m from the patient
• Temperature may be regulated and can be general or local
• Followed by rubbing
• Indications: anemia, insomnia, headaches, acne, chronic constipation, malnutrition, and intoxication

Needle/Spray/Circular Shower

• Water is projected horizontally against the body in very fine sprays from many jets
• Sharp stimulus to the skin from the numerous jets
• Duration: 1-2 minutes
• Temperature: no more than 40°C

Rain Shower

• The rosette is an apparatus behind the head of the patient and at a moderate angle to strike the back of the neck and shoulders
• Uses small sprays not as fine as the spray douche

Filiform Shower

• An extremely small douche applied at high pressure
• Duration: 30 seconds to 2 minutes
• Acting as a skin counterirritant and stimulant
• Used for skin lichen lesions, acne, pruritus, and burns

Aix Douche/Massage Douche

• A combination of the douche with vigorous massage
• Requires the services of 2 operators
• Combination of a massage with a thermal sulphurous water application (with temperature variations from cold to very hot water)

Vichy Shower

• A metal arm with 5-7 shower heads that run parallel and at a distance of 60-80 cm to a cushioned treatment table
• Massage applied by 1-2 persons
• Temperature: cold, warm, hot, and contrast temperatures
• A general shower at 37°C is recommended before
• Duration: 35-40 minutes followed by a rest of 40 minutes

Subaquatic Jets

• The patient, inside a hot bath-tub, receives a water pressure jet
• Jet temperature: hot or cold, being 1-2°C hotter than the bath-tub water temperature
• The massage applied with the jet can be general or local, manual or automatic

Techniques Without Pressure

• Cold baths: 11-20ºC, total baths, sensitivity to hotter temperatures, body part introduced slowly and progressively, duration varies (10-20 seconds, 30 seconds, 15-20 minutes)
• Cold baths reduce pain, muscle spasm, and edema
• General baths: reduce body temperature faster, used in hyperthermia or heat stroke, and to reverse vasodilation after heat treatment
• Partial baths: hand baths, foot baths, and sitz baths (for hemorrhoids)

Contrast Baths

• Combine hot and cold water, mainly used for extremities
• Procedure: start with hot tub (37-44ºC) for 7-10 minutes, then cold tub (11-20ºC) for 1 minute, repeat for 30 minutes, finishing with hot bath
• Cold water or ice can be used for local cryotherapy

Hot Baths

• Temperature: 37-40ºC (total baths), up to 45ºC (partial baths)
• Duration: 5-20 minutes
• Superficial thermal agents

Whole Body Baths

• Immersion in bathtubs, tanks, or pools with the patient immersed to the neck
• Bathtub: thermal actions predominant
• Tanks/Pool: mechanical and thermal actions predominant
• Spa bathtubs: thermal and hydrokinetic factors present

Regional Baths

• Half baths: patient sits waist-deep in hot water, upper body out of the water
• Three-quarter baths: patient sits chest/nipple-deep
• Sitz baths: warm bath for cleansing or healing, used for hemorrhoid surgery, episiotomy, sciatica, dysmenorrhea, and kidney stone pain

Partial Baths

• Hand or foot baths, very hot, hot, cold, or contrast baths
• Temperature ranges: 37-44ºC (hot), 11-20ºC (cold)

Techniques With Pressure

Scottish Shower

• Applied by one operator using 2 hoses (hot and cold water) to change temperature
• Not applicable to the head or anterior chest, but can be applied to spine, posterior thorax, abdomen, and lower extremities
• Duration: 12 minutes, 3 cycles starting with hot applications (38-40ºC) and then cold applications (20-25ºC)

Scottish Shower (Effects/Indications)

• A strong general stimulus
• Used for insomnia, stress, and depression, to stimulate blood flow to skin, and as a general tonic
• Prevents muscle soreness after exercise and speeds recovery after vigorous exercise, but very hard to tolerate

Swiss Shower

• Multiple showerheads mounted on the shower wall at different levels and on all sides of the patient
• The entire body is sprayed from head to toe

Fan Shower

• A fan-shaped stream, usually cool or cold
• Used to finish a treatment, duration: 10 seconds, temperature: 25.6-26.7ºC