Thermal Physiology and Modalities

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Thermal Physiology and Modalities

• Veronica Southard PT MS GCS

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Thermotherapy

• Indications
• Subacute/chronic conditions
• Pain
• Decreased ROM
• Resolution of edema
• MTP
• Muscular conditions

• Contraindications
• Acute MS conditions
• Impaired circulation
• PVD
• Skin anesthesia
• Open wounds or skin conditions
• Acute DVT

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Physiological Effects of Local Superficial
Heating on Tissue

• Dilatation ? increased circulation
• Reduction of sympathetic impulses? increased
  blood flow to venous plexuses
• Increased metabolic rate

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Consensual heat vasodilatation

• Remote vasodilatation in response to heating

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Physiologic effects of cold

• Decreased local temperature
• Decreased metabolic rate
• Local vasoconstriction
• Decreased nerve conduction velocity
• Depressed excitability of free nerve endings and
  peripheral nerve fibers

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Extent of cooling

• Type
• Duration
• Thickness
• Body part

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Cold Physiology

• Initial response to cold is vasoconstriction.
• Huntings response prevents local tissue damage
  secondary to vasoconstriction.
• Hypothalamus induces shivering
• Arterial vasoconstriction results in increased bp
  and hr.

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Indications for cold

• Acute subacute it is
• Acute pain, edema
• MTP
• M guarding and spasm

• Acute m strain
• bursitis
• tendonitis
• DOMS
• spasticity

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Contraindications for cold

• Impaired circulation
• PVD
• Hypersensitivity to cold
• Skin anesthesia
• Open wounds or skin conditions
• Infection

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Cutaneous circulation

• Purpose
• Nutrition
• Temperature regulation

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Cutaneous bl vessel types

• Subcutaneous venous plexus conduct heat to the
  skin surface.
• Arteriovenous anastomoses Maximal constriction
  at 59 F, below this point, dilatation caused by
  local effect of cold on the vessels, producing
  paralysis of the contractile mechanism of the
  vessel wall or blockage of n impulses into
  internal vessels.

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Sensory receptors

• Cold, warm and pain receptors are found
  subendothelially.
• Pain and temperature receptors are transmitted
  via the Lat Spinothalamic tract.
• At extreme, pain receptors transmit in response
  to possible tissue damage.
• Warm and cold receptors readily adapt.
• When larger surface areas are treated, vasomotor
  centers and the hypothalamus are activated

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Goals of Penetration

• Increase tissue temperature with increased bl fl
  to deeper tissues Use diathermy or US
• Decrease temperature and bl fl use Ice

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Summary of effects of heat
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Summary Effects of Cold
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Hydrotherapy

• Water healing
• Application of water for physical or
  psychological dysfunction

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Types and Indications of Hydrotherapy

• Types
• WP
• HT
• Contrast baths
• Pool
• Non immersion irrigation devices

• Indications
• Wound treatment
• Enhanced environments for ther ex
• Pain control/reduction
• Edema
• Health maintenance

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Properties of water

• High specific heat
• Thermal conductivity
• Buoyancy
• Resistance
• Hydrostatic pressure

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Specific heat

• Waters specific heat is 4x that of the air.
  That means that water holds 4x as much thermal
  energy as an equivalent amount of air at the same
  temperature

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Thermal conductivity

• The thermal conductivity of water is 25x greater
  than air. This means that it transfers thermal
  energy 25x more rapidly than air at the same
  temperature.
• Modes of heat transfer
• 1. Conduction
• 2. Convection
• 3. Radiation

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Buoyancy

• Upward thrust on the body opposite to the force
  of gravity

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Archimedes Principle

• A body immersed or partially immersed in a fluid
  at rest experiences an upward thrust to the wt.
  of the fluid it displaces.
• Specific gravity is a measure of the density of
  an object when compared to water.
• Different bodily tissues have different specific
  gravity values.

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Resistance

• The resistance to motion in water is secondary to
  the viscosity.
• Resistance occurs against the direction of motion
  in proportion to the speed of the bodys motion
  and frontal area of the body in contact with the
  water.
• Therefore resistance is variable

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Hydrostatic Pressure

• Pressure exerted by a fluid on a body immersed in
  the fluid.
• Pascals law fluid exerts equal pressure on all
  body surfaces at rest at a given depth and this
  pressure increases in proportion to the depth of
  immersion.

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Uses of hydrotherapy

• 1. Superficial heating/cooling
• 2. Wound care
• 3. Pain control
• 4. Edema control

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Contraindications for Hydrotherapy

• 1. Superficial heat and cold anesthesia
• 2. Maceration around wound
• 3. Bleeding

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Precautions Specific to Hydrotherapy

• Impaired thermal sensation
• Infection in area to be immersed
• Impaired cognition/confusion
• Areas of recent skin grafts

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Full Body Immersion

• Precautions
• 1.Confusion/disorientation
• 2. Alcohol ingest. Recently
• 3. Meds
• 4. Urinary incont
• 5. Fear
• 6. Respiratory problems

• Contraindications
• 1. Cardiac instability
• 2. Possible spread of infection
• 3. Bowel incontinence
• 4. Severe epilepsy
• 5. Suicidal

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WP

• Equipment Tank, agitator, stainless steel, many
  body part sizes.

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Cold WP

• Indicated when exercise during icing is desired.
• Equipment Ice, toweling, WP, bench, total
  immersion in 65-80F, 5-15 minutes
• Caution gravity dependent positions may inc.
  swelling. A wet compressive wrap should be put
  on part prior to tx. Cover toes for comfort.
  Most intense application of cold. Stay with pt.

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WP Temperature Range
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Hubbard Tank

• 8by6 kidney shaped 425 gallons water.
• Used at temeratures of 97-100F

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Contrast Baths

• Used for subacute swelling, and
  pain,desensitization creates a vasodilatation/vaso
  constriction response.
• Equipment two large containers, thermometer,
  towels, ice chips.
• Hot 80-104F
• Cold 55-67F
• Start with warm3-4 minutes, end warm5 minutes.
• Upon completion check girth again

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Ice Massage

• Apply ice continuously until numb. Watch for
  dripping water. Position carefully.
• Equipment Cup with frozen water, towels
• Application circular pattern, each stroke covers
  50 of the previous stroke.
• Physiologic response cold, stinging, pain,
  numbness

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Cold hydrocollator Packs

• Equipment cold pack in freezer 10-25F,
  protective toweling.
• Treatment requires pt to be still. 20 minutes
• Position part in elevated position in the acute
  and subacute phase.
• Left on fro prolonged periods can decrease tone.

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Ice packs

• Acute injury and to prevent additional swelling
  following exercise.
• Equipment Sm plastic bags, ice flakes, moist
  towels, ace wrap, slat solution.
• Treatment position pt. secure pack, cover with
  towel to prevent heat loss, up to 20 minutes

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Paraffin

• Uniot should be at 126F. Provides 6x the amt of
  heat as compared to water.
• Equip unit, towels, plastic bags
• Methods Dipping, painting, submersion
• Apply 6-10 layers
• Duration 20minutes
• Part should be thoroughly cleansed prior to tx
  and dried. Reuse paraffin

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IR lamps

• Equipment Lamp, dry toweling, moist toweling
• Standard formula 20 for 20 minutes.

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Hot packs

• Unit set between 1660-175 F, HP, towels
  thermostat.
• Use 6-12 layers of toweling for 15-20 minutes
• Avoid having the pt. lie on HP

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Summary on IR modalities penetration

• lt/ 1 cm.
• Superficial, direct effect on cutaneous bl
  vessels and cutaneous receptors
• Absorbed IR energy inc/dec circ at the fat and
  superficial m layers
• If maintained long enough to inc. temp of the
  blood, hypothalamus will respond

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Documentation

• Type of modality,
• pt.position, and
• or activity,
• temp of water/ dips/towels/distance etc.
• Duration
• Outcome or response to tx