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Thermotherapy. By Ren Peterson, Laurel Petersen, Jason Neilsen, Angela Perkins. Objectives 11. Educate on the physiologic effects of different thermotherapy agents. Inform on the indications, contraindications, precautions, and recommendations for a variety of thermotherapy agents.

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By Ren Peterson, Laurel Petersen, Jason Neilsen,

Angela Perkins

objectives 11
Objectives 11
  • Educate on the physiologic effects of different thermotherapy agents.
  • Inform on the indications, contraindications, precautions, and recommendations for a variety of thermotherapy agents.
  • Identify and demonstrate how various thermotherapy agents are applied to biological tissues.
  • Have fun while learning.
  • Click to learn more about that topic
  • Click to move to next slide
  • Click to move to previous slide
  • Click to go to Main Menu
  • Click to see the last slide viewed
  • Click to hear audio
  • Click to end program

main menu
  • History Perspective
  • General Information on Thermotherapy
  • Moist Heat Packs
  • Paraffin Baths
  • Fluidotherapy
  • Infrared Lamp
  • Warm whirlpool/Immersion

historical perspective of thermotherapy 8
Historical Perspective of Thermotherapy 8
  • Heat has always been used in various form for therapeutic benefits.
  • The first sources of heat that provided an effective treatment for ailments and pain included sunlight, heated sand, and heated water.
  • Early users of thermotherapy also obtained heat form hot stones and coals, open fire, and irons.
  • The earliest hot water containers consisted of hollow dried fruits and bladder or skin of animals.
  • The first scientific inquiries into the use of thermotherapy were conducted in the early 19th century.
considerations 1
  • Pre treatment considerations
    • Adipose tissue thickness
    • Stage of healing
    • Contraindications
  • During treatment Considerations
    • Patient comfort/Safety
  • Post Treatment Considerations
    • Treatment efficacy
moist heat packs 10
Moist Heat Packs 10
  • Biophysical Characteristics
  • Application
  • Recommendations
  • Evidence-Based Research
biophysical characteristics 1 moist heat packs
Biophysical Characteristics 1Moist Heat Packs
  • Increased blood flow/vasodilatation.
  • Increased cell metabolism.
  • Muscular relaxation secondary to reducing muscle spindle sensitivity.
application 10 moist heat packs
Application 10Moist Heat Packs
  • Indications
  • Contraindications
  • Dangers/Precautions
  • Demonstration of set-up
  • Proper Application
indications 1 moist heat packs
Indications 1Moist Heat Packs
  • Subacute or chronic inflammatory conditions
  • Reduction of subacute or chronic pain
  • Subacute or chronic muscle spasm
  • Decreased ROM
  • Hematoma resolution
  • Reduction of joint contractures
  • Infection
contraindications 1 moist heat packs
Contraindications 1Moist Heat Packs
  • Acute conditions- because of increase of inflammation
  • Peripheral vascular disease (PVD)
  • Impaired circulation
  • Poor thermal regulation
dangers precautions 1 moist heat packs
Dangers/Precautions 1Moist Heat Packs
  • Do not allow the moist heat pack to come into direct contact with the skin because burns may result.
  • If the packs are changed during the course of the treatment, additional care must be taken to prevent buns.
  • Infected areas must be covered with sterile gauze or another type of material to collect seepage.
  • Do not allow the patient to lay on the pack. If you must, increase space between by adding extra layers.
proper application 1 9 moist heat packs
Proper Application 1,9Moist Heat Packs
  • Moist heat packs should be stored in hydrocollator at 160°F to 170°F.
  • Use 6 layers of toweling or insulation to protect patient.
  • Recheck patient after 5 minutes for comfort and mottling.
  • Treatment time should be between 20 to 30 minutes.
  • Treatments may be repeated as needed, but allow skin to cool before next treatment is given
recommendations 1 moist heat packs
Recommendations 1Moist Heat Packs
  • Localized superficial heating
  • Pain
  • Muscle spasm
  • Chronic inflammatory conditions
  • Increasing muscle, tendon, and fascial elasticity.
evidence based research 2 12 moist heat packs
Evidence-Based Research 2,12Moist Heat Packs
  • STUDY 1: 30 healthy subjects compared the efficacy of a 30 second static stretch to a 20 minutes moist heat pack application on hamstring flexibility.

The study found that applying a moist heat pack increased hamstring flexibility significantly more than using a static stretch (p<0.03).

  • STUDY 2: 30 subjects (9 men and 21 women) with frozen shoulder used a single-blinded randomized controlled study comparing shortwave diathermy & stretching, hot pack & stretching, and stretching alone one pain, function, and ROM.

The study found that There was not a significant difference found in pain or function between groups, all improved. However, shortwave diathermy and hot pack administration both improved ROM, with diathermy showing greatest improvement (p<0.05)

paraffin baths
Paraffin Baths
  • Biophysical Characteristics
  • Application
  • Recommendations
  • Evidence-Based Research
biophysical characteristics 1 paraffin baths
Biophysical Characteristics 1Paraffin Baths
  • Increases perspiration
  • Increases blood flow/vasodilation
  • Increased cell metabolism
applications paraffin baths
ApplicationsParaffin Baths
  • Indications
  • Contraindications
  • Dangers/Precautions
  • Demonstration of set-up
  • Proper Application
indications 1 paraffin baths
Indications 1Paraffin Baths
  • Subacute and chronic inflammatory conditions
  • Limitation of motion after immobilization
contraindications 1 paraffin baths
Contraindications 1Paraffin Baths
  • Open wounds: Wax and oil would irritate the tissues.
  • Skin infections: The warm, dark environment is excellent for breeding bacteria
  • Sensory loss
  • Peripheral vascular disease
dangers precautions 1 paraffin baths
Dangers/Precautions 1Paraffin Baths
  • General Population
    • Do not allow the patient to touch the bottom or sides of the paraffin tank as burns may result.
  • Elderly
    • The sensation of the paraffin is misleading as to the actual temperature of the treatment. The temperature of the paraffin is sufficient to cause burns, but its specific heat requires more time to transfer the energy
dangers precautions 1 paraffin baths1
Dangers/Precautions1Paraffin Baths
  • Athletes
    • Avoid using paraffin with athletes who are required to catch or throw a ball or workers who are required to maintain good grip after the treatment. The mineral oil in the paraffin mixture tends to make the hands slippery, making the task of catching a ball or holding onto a hammer difficult.
proper application 1 9 paraffin baths
Proper Application 1,9Paraffin Baths

Glove Method

  • The extremity should be dipped into the paraffin for a couple of seconds, then remove to allow wax to harden.
  • Repeat process 7 to 12 times.
  • The paraffin-coated extremity should be wrapped in a plastic bag with several layers of toweling around it to act as insulation.
  • Treatment time is 15 to 20 minutes.
  • Treatment may be repeated several times a day.
recommendations 1 paraffin baths
Recommendations 1Paraffin Baths
  • Paraffin is used for delivering superficial heat to small, irregularly shaped areas.
  • The treatment of chronic inflammatory conditions
  • Softening of the skin
evidence based research 4 paraffin baths
Evidence-Based Research 4Paraffin Baths 
  • A study of 17 patients with Sclerosis compared two treatment methods. One group received a paraffin bath treatment followed by hand exercises. The other group only performed hand exercises.
  • Improvements in function were significantly greater in the hand which was treated with paraffin bath exercise than in hand treated with exercise only.
  • Improvements were increased finger flexion and extension, thumb abduction, volar flexion in the wrist, and perceived stiffness and skin elasticity.
  • Biophysical Characteristics
  • Application
  • Recommendations
  • Evidence-Based Research
biophysical characteristics 1 fluidotherapy
Biophysical Characteristics1Fluidotherapy
  • Increased blood flow/vasodilation
  • Increased cell metabolism
  • Muscular relaxation secondary to reducing muscle spindle sensitivity.
application fluidotherapy
  • Indications
  • Contraindications
  • Dangers/Precautions
  • Proper Application
indications 1 fluidotherapy
Indications 1Fluidotherapy
  • Pain reduction
  • Aid in joint mobilization
  • ROM exercises while doing treatment
  • Non-rheumatoid arthritis
contraindictions 1 fluidotherapy
Contraindictions 1Fluidotherapy
  • Uncovered open wounds
  • Sensory Loss
  • Peripheral vascular disease
  • Over cancerous lesions
  • Decreased tolerance to heat.
dangers precautions 1 fluidotherapy
Dangers/Precautions 1Fluidotherapy
  • Cover open wounds prior to treatment.
  • Be aware that some patients are sensitive to allergic reactions caused by dust or pollen.
proper application 1 fluidotherapy
Ensure that the patient is free of contraindications.

Preheat the fluidotherapy unit.

Remove jewlery from body part being treated.

Wash and dry patients extremity using an antimicrobial soap.

Prevent medium from entering open wounds by a nonpermiable covering.

Proper Application1Fluidotherapy
recommendations 1 fluidotherapy
  • Superficial heating of the skin of the upper or lower extremities.
  • Decreases pain.
  • Increase ROM.
evidence based research 10 fluidotherapy
Evidence-Based Research10Fluidotherapy
  • In a study by Borrell it was found that fluidotherapy produced a greater increase of joint capsule and intramuscular temperatures than that of hydrotherapy and paraffin wax.
  • Joint capsule and intramuscular temperatures were as follows: fluidotherapy +16.2, +9.5; paraffin wax +13.5, + 8.1; and hydrotherapy +10.8, 7.7 degrees Fahrenheit respectively.
infrared lamp
Infrared Lamp
  • Biophysical Characteristics
  • Application
  • Recommendations
biophysical characteristics 1 infrared lamp
Biophysical Characteristics 1Infrared Lamp
  • Increased blood flow/vasodilation
  • Increased cell metabolism
  • Muscular relaxation secondary to reducing muscle spindle sensitivity.
application infrared lamp
ApplicationInfrared Lamp
  • Indications
  • Contraindications
  • Dangers/Precautions
  • Proper Application
indications 1 infrared lamp
Indications1Infrared Lamp
  • Subacute or chronic inflammatory conditions.
  • Skin infections.
  • Peripheral nerve injuries before electrical stimulation: Another modality should be considered if the patient lacks temperature perception.
contradications 1 infrared lamp
Contradications 1Infrared Lamp
  • Acute inflammatory conditions.
  • Peripheral vascular disease.
  • Areas with sensory loss.
  • Over areas of scars.
  • Sunburns.
dangers precautions 1 infrared lamp
Dangers/Precautions 1Infrared Lamp
  • The infrared heating element does not cool during the treatment, thus providing a constant level of energy. The unchanging temperature source increases the risk of burns. Check with the patient regularly.
  • Do not use on a sleeping or unconscious patient.
proper application 1 infrared lamp
Proper Application 1Infrared Lamp
  • Check for any contraindications.
  • Clean area to be treated.
  • Position patient so that the lamp is perpendicular to the targeted tissue.
  • Position the lamp 24 inches from target tissue.
  • Instruct patient to not move.
  • Check the patient often.
  • Instruct the patient to tell the clinician of any burning sensation.
recommendations 1 infrared lamps
Recommendations 1Infrared Lamps
  • Often used as a superficial heating agent.
  • Drying superficial tissues.
  • Sedating sensory nerves.
warm whirlpool immersion
Warm whirlpool/Immersion
  • Biophysical Characteristics
  • Application
  • Recommendations
  • Evidence-Based Research
biophysical characteristics 1 warm whirlpool immersion
Biophysical Characteristics 1Warm whirlpool/immersion 
  • Provides a good supportive medium for active ROM exercises
    • Due to the physical characteristics of water, buoyancy, resistance, and hydrostatic pressure.
  • Promotes muscular relaxation
  • Decreases pain & muscle spasms
    • Due to the agitation & aeration of the water causing sedation, analgesia, and increased blood flow.
application warm whirlpool immersion
ApplicationWarm whirlpool/immersion 
  • Indications
  • Contraindications
  • Dangers/Precautions
  • Demonstration of set-up
  • Proper Application
indications 1 warm whirlpool immersion
Indications 1Warm Whirlpool/Immersion
  • Decreased ROM
  • Subacute or chornic inflammatory conditions
  • Peripheral vascular disease (neutral temp)
  • Peripheral nerve injuries
contraindications 1 warm whirlpool immersion
Contraindications 1Warm Whirlpool/Immersion
  • Acute conditions in which water turbulence would further irritate the injured area or in which the limb is placed in a gravity-dependent position.
  • Fever
  • Patients requiring postural support during treatment
  • Certain skin conditions speared by water
  • General contraindications for thermotherapy
dangers precautions 1 warm whirlpool immersion
Dangers/Precautions 1Warm Whirlpool/Immersion
  • Heat loss can only take place in two forms: evaporation & respiration. Therefore, a patient’s core temperature can be increased too much and cause hyperthermia.
  • The pressure associated with full-body immersion may impair breathing in individuals suffering from advance respiratory disease
more dangers precautions 1 warm whirlpool immersion
More Dangers/Precautions 1Warm Whirlpool/Immersion
  • Temperature must be decreased as the total body area immersed increases
  • Moderate to strenuous workouts while immersed will further increase body core temperature
  • Must be connected to a ground-fault circuit interrupter
  • Instruct patient not to turn the motor on or off while in the water
more dangers precautions 1 warm whirlpool immersion1
More Dangers/Precautions 1Warm Whirlpool/Immersion
  • Patients must be supervised by a staff member at all times
  • The flowing water may nauseate some patients, especially those prone to motion sickness.
  • Patients under the influence of drugs, alcohol, or those who have seizure disorders or heart disease are at risk of losing consciousness during treatment.
proper application 1 warm whirlpool immersion
Proper Application1Warm Whirlpool/Immersion
  • Water temperature of 90°F to 110°F
  • Initial treatments are given for 5-10 mins
    • The duration of treatments may increase to 20-30 mins as patient processes in their individual program.
  • When treating deep structures, duration of treatment should increase as the amount of adipose tissue increases
  • Treatments may be given once or twice a day
recommendations 1 warm whirlpool immersion
Recommendations 1Warm Whirlpool/Immersion 
  • Large irregular shaped areas
  • Possible to do ROM activities/exercise while receiving thermal treatment
evidence based research 3 warm whirlpool immersion
Evidence-Based Research 3Warm Whirlpool/Immersion 
  • A study using 56 subjects was conducted to compared the efficacy of warm whirlpool, cold whirlpool, and constrast therapy in the treatment of delayed-onset muscle soreness.
  • The study found that contrast therapy & was found to decrease perceived soreness significantly more than warm whirlpool or no treatment. (P<.01). In addition, warm whirlpool was more effective than no treatment.
more evidence based research 3 warm whirlpool immersion
More Evidence-Based Research3Warm Whirlpool/Immersion 
  • A study using 21 subjects was conducted to determine if cold whirlpool treatment decreases the functional performance equally regardless of gender.
  • The tests used to determined functional performance were: counter movement vertical jump, T-test, 40-yard dash, and active range of motion of the ankle. Participants were treated with a 20 minute, 10 degree Celsius cold whirlpool following the pre-test of a given functional performance measure.
  • The study found that the participants demonstrated significant decreases in counter movement vertical jump, T-test, and 40-yard dash performance immediately following treatment. Vertical jump performance remained impaired for at least 32 minutes. While both the T-test and 40-yard dash were affected for 7 and 22 minutes post- treatment, respectively. Participants also demonstrated significant decreases in peak power and average power immediately after and for 32 minutes post-treatment. Dorsiflexion was significantly decreased 7 and 12 minutes following treatment
  • This suggest functional performance was affected immediately following and for up to 32 minutes after cold whirlpool treatment. It was also evident that there is a gradual performance increase for each measure of functional performance across time. Therefore, the consequences should be carefully considered before returning athletes to activity following cold whirlpool treatment.
A paraffin bath contains a mixture of wax and mineral oil. What is the ratio between the two?

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Melted paraffin is kept at a constant temperature that ranges from ____ to ____ for upper extremity treatments.

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T/F You should allow the moist heat pack to directly contact the skin for adequate treatment?

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T/F It is recommended to proceed to treat a patient with thermal modalities if they have impaired circulation.

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Which thermotherapy treatment provides a good supportive medium for active ROM exercises?

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T/F Temperature of a warm whirlpool must increase has the total body area immersed increases?

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T/f Borrell found that fluidotherapy produced a greater increas in joint capsule & Intramuscular temperatures than that of hydrotherapy

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Because of paraffin bath’s low specific heat, it can provide approximately __ times the amount of heat as water

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Temperatures for whirlpool treatments given to the lower extremity are decreased to ____ to ___ .

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  • 1. Starkey, C. (2004). Therapeutic Modalities (3rd ed.). Philadelphia: F.A. Davis Company
  • 2. Funk D, Swank AM, Adams KJ, Treolo D. Efficacy of moist heat pack application over static stretching on hamstring flexibility. Journal of Strength and Conditioning Research. 2001;15(1):123-126.
  • 3. Kuligowski, L.A, Lephart, S.M., Giannantonio, F. P., & Blanc R. O. (1998). The Effects of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. Journal of Athletic Training 33(3):222-228.
  • 4. Gunnel, S., Anita, A., & Eklund, M. (2004). Evaluation of paraffin bath treatment in patients with systemic sclerosis. Disability & Rehabilitation. 26 (16): 981-987.
  • 5. Sherry, E., & Wilson, S. F. (1998) Oxford handbook of sports medicine. New York: Oxford University Press Inc.
  • 6. Prentice, W.E. (1999). Rehabilitaion Techniques in Sports Medicine (3rd ed.). Boston: WCB/McGraw-Hill Companies.
  • 7. Fu, F. H., & Stone, D. A. ( 2001). Sports injuries: Mechanisms, prevention, and treatment (2nd ed.). Philadelphia: Lippincott Williams and Wilkins
  • 8. Snyder, M., & Lindquist, R. (1998). Complementary Alternative Thearpies in Nursing (3rd ed.). New York: Springer Publishing Company.
  • 9. Patterson, S. M., Udermann, B. E., Doberstein S. T., and Reineke, D. M. (2008). The effects of cold whirlpool on power, speed, agility, and range of motion. Journal of Sports Science and Medicine. 7: 387-394.
  • 10. Borrell, RM., Parker, R., Henley, EJ., Masley, D., Repinecz, M., Comparison of in vivo temperatures produced by hydrotherapy, paraffin wax treatment, and fluidotherapy. Physical Therapy (1980); 60: 1273-6
  • 11. Berry D. (2008). Power point presentation for Chapthers 5 & 6. Therapeutic Modalities. Ogden: HPHP copier.
  • 12. Leung M.S., & Cheing G.L. (2008). Effects of deep and superficial heating in the management of frozen shoulder. Journal of Reabilitative Medicine. 40: 145-150.
general indications 1 5
  • More commonly used for chronic inflammation and muscle spasm.
  • Subacute inflammation
  • Analgesic Effect
  • Decreased ROM
  • Hematoma resolution
  • Reduction of joint contractures
  • Psychologically, heat can be better tolerated than cold
general contraindications 1 7
General Contraindications 1,7
  • Early stages of acute injuries
  • Impaired circulation
  • Advanced arthritis (vigorous heating)
  • Poor thermal regulation
  • Anesthetic areas
  • Neoplasms
  • Thrombophelbitis
  • Neurovascular deficits
  • Elevated core temperature due to infection
  • Malignant Tumors
thermotherapy affects 1 5 6 7
Thermotherapy Affects 1,5,6,7
  • Smooth muscle of blood vessels
    • Vasodilation
      • Increases blood supply/flow
        • Increase volume of injured limb
    • Increase Cellular metabolism
      • Subsequent resolution of inflammation infiltration, edema, and exudate.
      • Increases the delivery of oxygen & nutrients
        • Decrease ischemia
  • Blood and synovial fluid viscosity
    • Decreased viscosity as temperature increases
thermotherapy affects cont
Thermotherapy affects cont
  • Peripheral nerve activity
    • Increases firing threshold of peripheral nerves producing an analgesia proximal to the application
    • Causes a counterirritation, closing the gate to small pain fibers
  • Muscle spindle response
    • Skin stimulation by superficial heat may decrease gamma motor neuron activity and muscle spindle response with a subsequent reduction in striated muscle spasms.
      • Same effect of cryotherapy, but thermotherapy has a greater effect
  • Extensibility of collagen
    • There is an increase in the tissue’s elasticity and plasticity due to the altered structure
    • When combined with stretching or exercise leads to increased ROM