Thermotherapy lesson 2 23_24 with class notes.pdf

THERMOTHERAPY LESSON 2 General Intervention Methods in Physical Therapy Degree in Physiotherapy Academic Year 23-24 USP-CEU SCHEME EFFECTS, INDICATIONS, CONTRAINDICATIONS APPLICATIONS 2 GUIDE TO CHOOSE A THERMAL AGENT 1. ¿STRONG OR SOFT THERMOTHERAPY? 2. ¿STRONG OR SOFT HEATING? 3. TEMPERATURE DISTR...

THERMOTHERAPY LESSON 2 General Intervention Methods in Physical Therapy Degree in Physiotherapy Academic Year 23-24 USP-CEU SCHEME EFFECTS, INDICATIONS, CONTRAINDICATIONS APPLICATIONS 2 GUIDE TO CHOOSE A THERMAL AGENT 1. ¿STRONG OR SOFT THERMOTHERAPY? 2. ¿STRONG OR SOFT HEATING? 3. TEMPERATURE DISTRIBUTION PATTERN 4. THERMAL TISSUE PROPERTIES 1. SPECIFIC HEAT 2. THERMAL CONDUCTIVITY 3 1. ¿STRONG OR SOFT THERMOTHERAPY? Strong Thermotherapy: Agent which quickly produces a high temperature increase over the injury and is able to maintain it for a specific period of time. Soft of Moderate Thermotherapy: Deep agent with low power doses to obtain a relative low increase over the injury. Reduce the length of the application. Reduce the velocity for the temperature increase. Superficial agent to achieve a limited effect in a deeper area Highest superficial temperature to produce an effect in a distant area. 4 2. ¿STRONG OR SOFT HEATING? Strong Heating: Chronic pathologies to increase its extensibility of the fibrous tissue in muscle spasms. To increase blood flow in chronic inflammatory disorders to stimulate tissue healing. Soft of Moderate Heating: Subacute disorders. 5 3. TEMPERATURE DISTRIBUTION RELATIVE HEATING PATTERNS: Skin and subcutaneous tissues heated by superficial thermotherapy agents. Deeper subcutaneous tissues and superficial muscles can be heated with shortwave diathermy (27MHz, capacitive method), Microwave (2450 MHz) and TECAR (capacitive, 0,448 MHz). 6 3. TEMPERATURE DISTRIBUTION RELATIVE HEATING PATTERNS: Deeper muscles are selectively heated with shortwave diathermy (27 MHz, inductive method), UHF (434 MHz) and TECAR (capacitive, 0,448 MHz). Joints, ligaments, fibrous scars, tendons and tendon sheaths are selectively heated with ultrasound (1-3 MHz) and TECAR (resistive, 0,448 MHz) Pelvic organs may be selectively heated with internal electrodes using shortwave diathermy (27 MHZ). 7 4. THERMAL TISSUE PROPERTIES 4.1. SPECIFIC HEAT: Skin has a higher specific heat than fat or bone, and water has a higher specific heat than air. Materials with a high specific heat hold more energy than materials with a low specific heat when both are at the same temperature. Thermal agents with a high specific heat (WATER) are applied at lower temperatures. 8 4. THERMAL TISSUE PROPERTIES 4.2. THERMAL CONDUCTIVITY: Fat tissue presents low thermal conductivity. Superficial thermal agents over : areas with plenty of fat tissue will cause soft heating of the deeper tissues. Small areas will cause a strong heating due the lack of fat and soft tissues. 9 INDICATIONS Soft Tissues Chronic and Subacute Inflammatory Injuries: Degenerative Joint Conditions. Rheumatoid Arthritis and other rheumatisms. (Brosseauet al 2004 NICE 2008, Zhang et al 2007) Epicondylitis. Bursitis. Tenosynovitis. Scapulohumeral periarthritis. 10 INDICATIONS Subacute and Chronic Postraumatic Injuries Other conditions: Complex Regional Pain Syndrome (CRPS) Raynaud Disease Dupuytren Disease Osteoporosis (Chartered Society of Physiotherapy 1999) 11 INDICATIONS Acute LBP: – Evidence says better thermo than cryo but both relieve pain in short term (Dehgan M, Farahbod F, 2014) – Continuos thermotherapy better than intermitent 12 INDICATIONS Primary Dysmenorrhea (Jo J, Lee SH, 2018) Local heat reduces muscle tension and increases pelvic blood circulation to eliminate local blood and fluid retentions and reduce swelling Heat wraps, hot water bags, heated patch, ceramic belts 13 PRECAUTIONS Pregnancy over the abdomen/lower back Impaired circulation or poor thermal regulation Edema Cardiac insufficiency Metal in the area Over an open wound Over areas where topical counterirritants have recently been applied. 14 CONTRAINDICATIONS In areas of an acute injury or acute inflammation. Over areas of recent or potential hermorrhage. Thrombophlebitis Impaired sensation Over or near malignant tissue 15 ADVERSE EFFECTS Burns. Fainting Bleeding Skin and eye damage Permanent damage in skin pigmentation Permanent damage to the eyes 16 CONDUCTIVE METHODS Hot Packs Hot Gel Packs Chemical Hot Packs Pain and joint stiffness Trigger point in fibromialgia Primary Dysmenorrhea (Nadler et al 2003a, 2003b) for acute LBP (Hot packs with longer applications) 17 HOT PACKS Made of bentonite. Various sizes and shapes. Stored in hot water (70-75ºC) 2 hours to heat and 30’ minutes to reheat. Treatment 15-20’ 18 HOT GEL PACKS Hydrocoloid gel plastic packs used as thermo/cryotherapy. Various sizes and shapes. Gel heating produced by thermic transfer from the water. Towel between pack-skin 19 INSTANT CHEMICAL HOT PACKS Filled with a supersaturated solution of sodium acetate. A portable source of heat. Used once or reusable. If the liquid leaks, it can burn the skin! 20 BUT WHAT IS BETTER MOIST OR DRY HEAT? Delayed onset muscle soreness (DOMS) (Wang et al, 2021) Heat and cold reduce pain within 24 h (HOT PACKS) (Petrofsky J et al, 2013) Heat wraps with dry and moist heat applied Immediately or 24 h after exercise. Dry heat applied for 8 hours and moist for 2 hours. Immediate application of heat either dry or moist had a similar preservation of quadriceps muscle strength/activity The higher increase in pain reduction was found after immediate application of moist heat but dry heat had similar effect to a lesser extent. 21 PARAFFIN WAX BATHS Paraffin with mineral oil. Safely applied on the skin: Low specific heat Low thermal conductivity Various shapes/sizes. Thermostat switch to keep constant the temperature. 22 PARAFFIN WAX BATHS Thermostat to allow sterilization setting the heat to 80ºC for few hours. Area washed with water and soap and dryed before application. Metallic objects not allowed. After the treatment, paraffin-wax is peeled off the skin and discarded or replaced in the bath. 23 PARAFFIN-WAX THERAPY APPLICATIONS DIP IMMERSION WITH WRAPPING. CONTINOUS IMMERSION. CONTINOUS IMMERSION WITH RETENTION BRUSHING WITH WRAPPING. 24 DIP IMMERSION WITH WRAPPING 1º. 8-12 consecutive dip immersions to form a glove 2º. Then is immediately wrapped in different layers of wax paper, or plastic 3º. Then in a towel and left to dry for a period of 15-20 minutes with the extremity elevated. 25 CONTINOUS IMMERSION 1º. 7 consecutive dip immersions to form 7 layers. 2º. Then a continuous immersion in the bath for 30’. 3º. Then removed. 26 CONTINOUS IMMERSION WITH RETENTION 1º. 7 consecutive dip immersions to form 7 layers. 2º. A continuous immersion in the bath for 30’. 3º. A retention period (30’) of the wax outside the bath (wrapping optional) 27 BRUSHING WITH WRAPPING 1º. 7 -10 superimposed and consecutive coatings applied with a paint brush. 2º. Then is immediately wrapped in different layers of wax paper, or plastic. 28 INDICATIONS Pain and joint stiffness. Rheumatoid arthritis. Muscle spasm. Edema and inflammation. Adhesions and scars. 29 PARAFANGO Mixture of paraffin, volcanic mud and mineral salts such as carbonic acid, iron, sulphur and lime melted in special containers. Wrapped in a sheet of transparent plastic and applied as a plaster (47-52 º C) 30 OTHERS Wrappings. Dry compresses. Hot sand. Peloids. Muds. 31 CONVECTIVE METHODS HOT BATHS. HOT AIR BATHS SAUNA (dry air) STEAM BATHS (moisture-filled air) 32 SAUNA/FINNISH BATH Temperatures range from 80-100ºC. 6-8% humidity due to intake and outlet vents Very dry air implies body can tolerate high temperatures. Traditional sauna: ladles of water may be pored over stones to produce steam. 33 STEAM / WET HOT AIR BATHS Temperature 38-45ºC. Humidity 100%. It is a lower temperature since the skin is already wet. Air as hot as sauna harder to tolerate. 34 INSTRUCTIONS BEFORE ENTERING Do not eat for 1 hour beforehand. After vigorous exercise, wait a few minutes. Drink a glass of water before and 2 more during and after. Stay in for 10-15 minutes. If feeling dizzy, lightheaded, fatigued or too hot leave the sauna immediately. Finish with a cold shower and drink a glass of water. 35 INDICATIONS General relaxation. Warming of tissue. Pain and joinf stiffness Stimulation of circulation. Preparation for cold treatments. Muscle spasm. Detoxification, Musculoskeletal pain Onset of common cold 36 CAUTIONS Intense itching Asthma (moist air) Hypothyroid conditions. People at risk of lymphedema 37 CONTRAINDICATIONS Systemic or chronic conditions Cardiovascular problems Diabetes Hepatitis Lymphedema Multiple sclerosis Seizure disorders. 38 CONTRAINDICATIONS Loss of sensation. Morbid obesity. Pregnancy. Recent meal. Inability to tolerate heat. Patient under the influence of alcohol or drugs. 39 OTHERS Hot hydromassage. Hot showers. Hot baths. Hot jets. Fluidotherapy 40 FLUIDOTHERAPY Dry heating agent which transfers heat by CONVECTION. It consists of a cabinet containing finely ground cellulose particles made from corn cobs. When heated air circulated through these particles they act as a liquid. 41 FLUIDOTHERAPY Pacient places a body part into the cabinet where it floats. Portals that allow therapist to access the patient’s body while being heated. Temperature and particle agitation can be controlled. 42 CONVERSION METHODS Ultrasound therapy Short-wave diathermy Microwave diathermy Tecartherapy 43 RADIATION METHODS INFRARED RADIATION ULTRAVIOLET RADIATION 44 BIBLIOGRAPHY Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. Elsevier, 2012. Bélanger AY. Evidence-Based Guide to Therapetic Physical Agents. Elsevier Churchill Livingstone 2.002. Watson T. Electrotherapy: Evidence-Based Practice. Elsevier, Churchill Livinstone, 2008. Bélanger AY. Therapeutic Electrophysical Agents. Evidence Behind Practice. Lippincott Willians & Wilkins, 2014. 45