Heat Modalities

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Heat Modalities

• Heat is the increase in molecular vibration and
  cellular metabolic rate
• Commonly classified into 3 categories
• Chemical action associated with cell metabolism
• Electrical or magnetic currents as those found in
  diathermy devices
• Mechanical action as found with ultrasound

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Heat Modalities

• Methods of thermotherapy can be classified as
  superficial or deep
• Superficial
• Infrared lamps
• Moist heat packs
• Paraffin baths
• Warm whirlpool or immersion
• Deep
• Microwave diathermy
• Shortwave diathermy
• Ultrasound

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Heat Modalities

• Superficial agents must be able to ? skin
  temperature to 104º to 113ºF to produce
  therapeutic effects
• Superficial agents are limited to depths of less
  than 2 cm
• Effects of heat are essentially opposite of cold,
  thus treatment indications will be different

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Heat Modalities Local Effects of Heat

• Local Effects of Heat Application
• Vasodilation
• Increased rate of cell metabolism
• Increased delivery of leukocytes
• Increased capillary permeability
• Increased venous and lymphatic draining
• Edema formation
• Removal of metabolic wastes
• Increased elasticity of ligaments, capsules and
  muscle

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Heat Modalities Local Effects of Heat

• Local Effects of Heat Continued
• Analgesia and sedation of nerves
• Decreased muscle tone
• Decreased muscle spasm
• Perspiration
• Increased nerve conduction velocity

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Heat Modalities Systemic Effects of Heat

• Systemic Effects of Heat
• Increased body temperature
• Increased pulse rate
• Increased respiratory rate
• Decreased blood pressure
• These effects occur primarily when entire body is
  exposed to warm temps

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Heat Modalities Indications

• General Indications
• Subacute or chronic inflammatory conditions
• Reduction of subacute or chronic pain
• Subacute or chronic muscle spasm
• Decreased ROM
• Hematoma resolution
• Reduction of joint contractures

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Heat Modalities Contraindications

• Contraindications
• Acute injuries
• Impaired circulation
• Poor thermal regulation
• Anesthetic areas
• Neoplasms
• Thrombophlebitis

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Heat Modalities Magnitude and Duration of Temp
Increase

• Maximum therapeutic benefits occur when the skin
  temperature rapidly increases
• Most be careful too much injury too little
  limited therapeutic effect
• During the first 5 to 6 minutes of treatment, the
  body absorbs heat faster than it can be
  dissipated
• At 7-9 minutes the temp begins to plateau

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Heat Modalities Magnitude and Duration of Temp
Increase

• When maximum vasodilation occurs and the
  intensity of the treatment stays constant, the
  vessels will begin to constrict Rebound
  Vasoconstriction
• This occurs approx. 20 minutes into the tx
• Mottling
• Warning sign of skin white areas with red
  splotches

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Heat Modalities Tissue Cooling

• Tissue cools faster after a heat treatment then
  it re-warms after a cold treatment
• Superficial intramuscular temperatures remain
  elevated for approximately 30 minutes after the
  removal of the modality

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Heat Modalities Dissipation of Heat in the
Treatment Area
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Heat Modalities Therapeutic Temperature
Benchmarks

• Increased temp causes blood hemoglobin to release
  oxygen, providing more oxygen for the healing
  process
• At 106F the release of O2 is doubled
• Enzymatic activity increases at 102 and
  continues until 122
• From 104 to 113 tissue has a greater ability to
  be stretched

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Heat Modalities Effects on the Injury Response
Process

• Timing is important in determining when heat
  should be applied
• If applied to early it will ? cell metabolism and
  the rate of inflammation

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Heat Modalities Cellular Response - Blood and
Fluid Dynamics

• For each increase of 18ºF in skin temp, the
  cells metabolic rate increases two to three
  times (Q10 Effect) ? need for oxygen
• Rise in temp vasodilation of blood vessels,
  which will result in ? edema to the area, but,
  also an ? in removal
• This ? in removal is necessary in order for edema
  not to return

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Heat Modalities Effect on Inflammation

• Heat accelerates inflammation
• Soft tissue repair is facilitated through an
  increase in metabolic rate and increased blood
  supply
• Increase in nutrients delivered to the cell and
  there is an increase in the delivery of
  leukocytes, encouraging phagocytosis

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Heat Modalities Muscle Spasm and Tissue
Elasticity

• Increased temp reduces the muscle spindles
  sensitivity to stretch, decreasing the amount of
  muscle spasm
• There is also an increase in extensibility of the
  collagen and other tissues
• Heat alone will not increase ROM, must also
  include gentle passive stretching

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Heat Modalities Pain Control

• In chronic conditions pain is caused by chemical
  (lack of oxygen) pain and mechanical (pressure)
  pain
• Heat increases oxygen delivery to limit chemical
  pain
• Heat increases circulation to and away from the
  injury, removing edema and irritants

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Heat Modalities Exercise as a Form of Heat

• Moderate to intense exercise increases
  intramuscular temps 4 at a depth of 5 cm in the
  involved muscles
• Does not result in vigorous heating, but can be
  considered more functional than the use of a
  standard heating modality

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Heat Modalities Moist Heat Pack

• Superficial heat modality
• Water in unit is 160º to 170ºF
• Capable of maintaining temp for 30 to 45 minutes

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Heat Modalities Moist Heat Pack

• Application
• Cover with towel or commercial covering
• Duration
• 20 to 30 minutes
• Frequency
• As necessary, with sufficient time between
  treatments

• Indications
• Subacute or chronic conditions
• reduction of subacute or chronic pain
• Decreased ROM
• Hematoma resolution
• Reduction of joint contractures
• Infection

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Heat Modalities Moist Heat Packs

• Contraindications
• Acute conditions
• Peripheral vascular disease
• Impaired circulation
• Poor thermal regulation

• Precautions
• Do not let heat pack come in direct contact with
  skin
• Infected areas need to be covered with sterile
  gauze

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Heat Modalities Moist Heat Packs

• Other thoughts and concerns
• Place pack on athlete in a comfortable manner
• Athlete should not sit or lay on hot pack
• Check athlete after first 5 minutes to look for
  mottling
• Clean all towels or covers if used over open wound

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Heat Modalities Paraffin Bath

• Contains mixture of wax and mineral oil (71)
• Superficial agent used to deliver heat to small,
  irregular shaped areas
• Used in chronic conditions of the hands and feet

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Heat Modalities Paraffin Bath

• May increase intra-articular temps as much as
  6.3F
• Paraffin is kept at a constant temp between 118
  and 126
• Can provide 6 times the heat as compared to water

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Heat Modalities Paraffin Bath

• Application
• Immersion Bath
• Glove Method
• Duration
• 15-20 minutes
• Frequency
• Can be applied several times daily

• Indications
• Subacute or chronic conditions
• Limitations of motion after immobilization
• Contraindications
• Open wounds
• Skin infections
• Sensory loss
• Peripheral vascular disease

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Heat Modalities Fluidotherapy

• Dry heat modality that uses a suspended air
  stream, which has the properties of a liquid
• Applies heat, massage, sensory stimulation for
  desensitization and pressure
• Good success in treatment of pain, decreased ROM,
  wounds, swelling and blood flow
• Treatment of the hand at 115 results in a 6 fold
  increase in blood flow and a 4 fold increase in
  metabolic rates

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Heat Modalities Fluidotherapy

• Applied at 118 fluidotherapy can increase joint
  capsule temps by 16.2 and superficial muscle by
  9.5
• Commonly used for the wrist, hand and fingers
  and the ankle and toes

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Heat Modalities Fluidotherapy

• Temp Range
• 110 to 125F
• Duration
• 20 minutes
• Frequency
• Can be applied several times daily

• Indications
• Pain reduction
• Prior to or during joint mobilization
• ROM exercises
• Non-rheumatoid arthritis
• Contraindications
• Open wounds
• Sensory loss
• Peripheral vascular disease
• Cancerous lesions

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Heat Modalities Warm Whirlpool

• Effective for irregularly shaped areas
• Allows for ROM exercises
• Turbine provides massage effect
• Temp at 90º to 110ºF (Lower if whole body
  treatment

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Heat Modalities Warm Whirlpool

• Duration
• 20-30 minutes
• Frequency
• Treatments can be once or twice per day

• Indications
• Decreased ROM
• Subacute or chronic inflam. Conditions
• Perphiral vascular disease or nerve injuries
• Contraindications
• Acute conditions
• Patients requiring postural support
• Fever
• Skin conditions

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Heat Modalities Warm Whirlpool

• Other thoughts and concerns
• Never turn on or off WP while in water
• Plugged into GFI
• Use disinfectant as necessary
• Completely drain and clean if used by athlete
  with open wound
• Do not use with acute injury

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Heat Modalities Contrast Bath

• Most commonly used in subacute or chronic
  conditions
• Try to create a pumping action to stimulate
  blood flow
• May start or finish in either hot or cold

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Heat Modalities Contrast Bath

• Duration
• 20-30 minutes
• Frequency
• May be repeated as necessary
• Same temps and concerns as with the cold or warm
  whirlpool application

• Indications
• Ecchymosis removal
• Edema removal
• Subacute or chronic conditions
• Pain reduction
• Increasing ROM
• Contraindications
• Acute injuries
• Any contraindication to heat or cold applications

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Heat Modalities Counterirritants

• Not an infrared modality, but commonly referred
  to in this area due to the sensation produced.
• Topical ointments containing
• Menthol and methyl salicylate (found in
  peppermint and wintergreen oils)
• Camphor
• Capsaicin

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Heat Modalities Counterirritants

• Exact mechanism of pain relief is not known
• Most likely due to the stimulation of the A-beta
  nerves
• No evidence of temp increases, however, some
  studies have shown a decrease in pain and an
  increase in range of motion

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Heat Modalities Counterirritants

• Apply to skin in a massaging motion
• May also apply a pad or wrap to the area after
  application of the ointment
• Use with caution, but do not underestimate the
  psychological effects

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Comparison of Heat Cold
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Use of Heat vs. Cold

• Not a real clear cut answer when to switch from
  heat to cold
• Remember that each athlete is different
• Always use cold after exercise
• Try to answer the following questions?

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Use of Heat vs. Cold

• Does the body area feel warm to the touch?
• Is the injured area still sensitive to light or
  moderate touch?
• Does the amount of swelling continue to increase
  over time?
• Does swelling increase during activity?
• Does pain limit the joints ROM?
• Would you consider the acute inflammation process
  to still be active?
• Does the athlete continue to show improvement
  with the use of cold modalities?