Superficial Heating Modalities

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Superficial Heating Modalities
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Superficial vs Deep Heating Agents

• Superficial
• Primarily causes increases in skin temp and
  superficial subcutaneous tissue
• Depths of penetration lt2 cm
• Deep
• Heat deeper tissues
• Depth of penetration 3-5 cm

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Biophysical Effects of Superficial Heat

• Magnitude of tissue temperature changes depends
  on
• The extent of tissue temp rise
• Therapuetic levels 104-113 skin temp
• Above or below?
• The rate energy is added to tissue
• Too fast or too slow
• The volume of tissue exposed
• Larger volume more chances for systemic changes

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Physiological Responses to Tissue Heating

• Metabolic Reactions
• 2xs metabolic rate 106o F
• Enzymatic activity increases 102o F
• gt122 rapid decrease
• Oxygen uptake?
• Vascular Effects
• Vasodilation
• Importance of Skin BF during Heating
• Local and reflexive mechanisms

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Physiological Responses to Heating

• Vascular cont.
• Axon Reflex
• Cutaneous receptors
• Some afferents go to SC
• Others go directly to vessel receptors

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Physiological Responses to Heating

• Vascular cont.
• Local Spinal Reflex
• Activated via cutaneous receptors
• Decreases nerve activity of smooth muscle tissue
• Importance of Skeletal Muscle BF during Heating

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Physiological Responses to Tissue Heating

• Neuromuscular Effects
• Provides analgesia to assist with pain relief
  and muscle guarding
• Heat can
• Elevate pain threshold
• Alter nerve conduction velocity
• Change muscle spindle firing rates?
• Temporarily change tension producing
  characteristics in muscle

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Physiological Responses to Tissue Heating

• Connective Tissue Effects
• Superficial heat alone will NOT alter
  viscoelastic properties of tissue
• Heat and stretch together
• Result plastic elongation of deeper tissue
• Two factors important determining treatment
  strategies
• Temperature elevation
• Stretch

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Heating Agents
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Conductive Heating Agents

• Hot packs
• Superficial moist heat
• Placement considerations
• Depth of Penetration
• Tx time
• Advantages and disadvantages
• Precautions

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Conductive Heating Agents

• Paraffin Wax Bath Treatment
• Low Melting Point
• Low Specific Heat
• Rationale for Use
• Application Techniques
• Dip and Wrap
• Dip and Immerse
• Tx Time
• Advantage Disadvantages
• Precautions

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Convective Heating Agents

• Fluidotherapy
• Dry heating agent
• Viscosity low
• Provide high heat fluxes and strong massaging
  action
• Heat Control
• Fluidotherapy vs Paraffin Wax
• Advantages Disadvantages

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Radiating Heating Agents

• Infrared Heat Lamps
• Not commonly used
• Very superficial
• 1-10 mm DOP
• Two types
• Luminous
• Non-luminous
• Setup
• Inverse Square Law
• Cosine Law
• Tx Time

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Clinical Implications for Superficial Heat

• Trunk, shoulder, hip or knee considered mild
  heating
• Mild vs Vigorous

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Mild vs Vigorous Heat
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Surface Temperature Ranges and Subjective Feelings
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Clinical Implications for Superficial Heat

• Trunk, shoulder, hip or knee considered mild
  heating
• Mild vs Vigorous
• Pain and Muscle Spasm
• Improving ROM
• Tissue Healing
• Subacute and Chronic Conditions
• Hematoma resolution
• Joint contractures

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Contraindications to Superficial Heating

• Poor or reduced sensation
• Vascular insufficiency
• Vascular Disease
• Acute injuries
• Malignancy
• Application over where liniments have been applied

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Heat vs Cold therapy

• Factors to consider
• Stage of healing
• Heat
• Advantages
• Decr pain, incr tissue extensibility, decr
  stiffness
• Disadvantages
• May incr swelling
• Cold
• Advantages
• Prevent further swelling, decr pain
• Disadvantage
• Incr stiffness, decr tissue extensibility
• Areas of body treated
• Medical status
• Patient preference