superficial heating modalities discusstion with all examples.with indications , contraindications, advantages, disadvamntages

3. Paraffin wax bath is the
example of superficial
heating modality . In this
case we generally use
paraffin wax for treatment
purpose . Hare in a metal
cabinert t, the wax is
stroed . In the metal
cabinet , the wax is
maintained in which are
electrically heated and the
temperature is controlled
by the thermostate.
The paraffin wax is melts
at around 54 degree but
if we add mineral oil like
liquid paraffin it needs low
temperature .
most wax baths are kept
at temperature below 42
to 52degree .
 Paraffin wax is a simple , convenient , resonally
efficient method of applying conducted heat to the
extremities.
 It is a combined immersion technique with paraffin
wax and mineral oil for conductive heat gains .
 For treatment purpose we generally use the 7 units
of wax and 1 unit of mineral oil.
 The paraffin wax is then kept at low temperature
and remains warm for a longer time then water.
 Use higher range of temperature for hand
treatment and lower for feet.
Method of application :-
the most widly used method of application is ‘Dip
and Wrape’ method . This can only be used for
extremities like hands , wrist, feet and ankle .
But there are several methods of paraffin wax bath
treatment , are as follows -1/ Dip & leave .2/
brushing . 3/ bandaging .4/ pouring.

4. Indication :-
1. Increase circulatory effect
.
2. Rheumatoid arthritis.
3. effects on skin .
4. Ischemia.
Contraindication :-
I. Open wound .
II. Allergic rash.
III. Defective skin sensation
.
IV. Defective arterial blood
supply .
V. Impaired skin sensation .
VI. Large piceses of dirt in
the wax bath may
harbour organisms but it
is extremely unlikely that
these would lesd to
infection .
VII. acute dermatities may
be made worse by wax ,
or indeed any form of
heat on the skin.
VIII. Some individuals may
become allergic to the
wax with extended and
prolonged treatment nut
this is wrap.
IX. Malignency.
X. Acute trauma or
inflammation.
 Physiological effects :-
 Tharmal energy provide pain relief .
 Increase in local blood flow.
 Metabolism .
 Elasticity of connective tissue.
Advantage:-
o Usefull for Pt with poor heat tolarence , dry scaly
skins, after plaster of paris removal.
o Can be followed by theraputic exercise .
o Can be carried out at time .
o Wax can used around the bony contours of feet and
hands .
o heat is applied evenly by conduction.
Disadvantage :-
o Effective only for distal extremities in the terms in
case of application .
o No method of temperature controls once applied.

5. The composition of the
wax : paraffin : mineral
oil =7:3:1 or wax :
paraffin or mineral oil is
7:1.
The combination of the
wax and the mineral oil
has low specific heat.
Paraffin has slow
tharmal conductivity .
 slow the diffision .( 6
time lower than water)

6. Dipping & wrap:-
 It is the most common method.
 involves placing the body part to be
treated in a paraffin bath , followed by
removing it and allowing to cool and
harden.
 Approximately 7 to 12 dips are done.
 Followed by wrapping in wax paper
or plastic , which is covered by towels
.
 Application time is 20 to 30 minutes
or till wax cools.

7. .pouring:-
 The molten wax is directly poured by
a mug or utensil on the part to be
treated .
 Wrapped around by a towel or a
plastic for prevent heat loss.
 The wax is allowed to solidify for
about 10 -20 mins.
 Several (4-6) layers can be made
over the body tissue.

8. Bandaging method:-
 It is a less commonly used
method for paraffin wax
application.
 A towel or aroll of bandage is
immersed in molten oaraffin wax
.
 Wrapped around the body part.
 Several layers can be made over
the body part.
 This method is perfectly used for
treating proximal parts of the
body.

9. Brushing method:-
 If the part can’t be immersed in
wax , it is possible to coat the
part by using the paint brush.
 This method is used for areas
like hip , knee , elbow, shoulder &
many other parts.
 8 to 10 coats of wax are applied
to the area with a brush .
 the area is then wrapped with
towel for 10-20 minutes and after
this time , paraffin wax is
removed and discarded.

10.  Precausions :-
i. Wax is highly inflammable if it
becomes overheated so should
only used when a fire blanket
and suitable carbon dioxide or
foam extinguisher are
available.
ii. Wax split on the floor makes it
slippery so always be careful.
iii. Acute dermatitis may be made
worse by wax or indeed any
from of heat on the skin .

11. A hydro collator pack is a
fabric envelope containing silica
gel.
Silica gel such as bentonite us
used for this treatment purpose
.the gel will absorbed large
quantity of water which if it is
hot, provides a considerable
store of heat energy.
The packs are made in various
sizes to fit different body parts.
The packs are heated by an
electric heater which is controlled
by a tharmostat.
It need about 2 hrs to become
fully heated from cold but rather
less when being reheated.
The hot packs are wrapped in
toweling before being applied to
the part so that some 4 -8 layers
, depending on the towel
thickness.
 if the pack is at about
75degree C, the skin
temperature does not rise above
42 degree .
The toweling can be separated
from the wet pack by a plastic
sheet which prevents wetting of
the towel and thus enhans the
insulating effect.
If there is less tharmal sensitivity in the treating area of
the body or there is sensaton it could cause tissue
damage if the insulation is not adequate.
The procedure takes about 20- 30 minutes for each
seasion .
If lower temperature packs (eg-65degree)are used then
less thickness of toweling is needed.
There are other various packs like-
1. kenney packs.
2. mud packs.
The kenney packs are piece of absorbent lint or
woolen material socked in almost boiling water and
then wrong out can be applied to the skin when the
temperature has fallen to about 60degree. After
about 5 mins the pack will have fallen to skin
temperature at which point is replaced .
The mud packs are also known as koolin packs , have
been used as hot moist packs because it was
considered that their chemical composition give
then specific theraputic properties.

12. Indication:-
•Pain & muscle spasm.
•Inflammation.
•Edema.
•Adhesions.
Contraindication:-
Impaired skin sensation
.
Circulatory dystruction .
Analgesic drugs.
Infections & open
wound.
Cancer and
tuberculosis .
Gross edema.
Deep x- Ray therapy.

13. Fluidotherapy is
a dry heating
agent that
provides
mechanical as
well as thermal
stimuli to
produce
theraputic effect.
 This method is consist of a cabinet
containing warm air which is
thermostatically controlled &is blown
through a mass of tiny cellulose particles.
 This combination is produce a fluid like
mixture into which the distal aprt of limb
can be immersed through a hole in the
wax .
 The velocity of the mixture is relatively
low so that the Pt can move the limb or
performs exercise.
 This treatment is generally performed in
between 38-45degree C but according
to the Rx purpose we may use higher
temperature.
 It takes about 20 minutes for each
seasion.

14. Pt should be
prepared in the
same way like hot
pack application i.e.
the part is
undressed , jewelry
etc is removed .
Skin sensation for
heat and cold
should checked .
If there is any
open wound on the
part to be treated it
should be covered
with a plastic
sheet.
 Indication :-
I. Decrease pain .
II. Increase range of motion .
III. Decrease swelling .
IV. Decrease spasm.
V. Inflammation.
VI. Post operative rehabilitation.
VII. Sub- acute condition,
Contraindication:-
I. Fever .
II. Anesthetic area.
III. Severe circulatory disorder.
IV. Hemorrhage .
V. Heat sensitive patient .

15. Advantage:-
1. Easy to use .
2. Agitation can be controlled .
3. Most body areas can be treated .
4. Allows for some active exercise .
5. Provides some dry and comfortable
heat.
Disadvantage :-
1. Expensive to purchase .
2. Some Pt don’t like the closed in feeling
3. Some Pt are intolerant to the particles
present inside.

16. Whirlpool baths are
stainless steel trunks or
baths of various sizes.
The smaller ones are
made to accommodate the
limbs .
The larger refers to
turbulence produced by an
electric pump. Or
compressed air which
mixes air & water into a
jetstream.
In that treatment process
generally about 36 -41
degree C is usually
employed.
The whirlpool effects
serves to stimulate the
skin surface.
The stimulation of large
–diameter mechano
receptors &
thermoreceptors may
account for analgesic
effects.
 The principle of whirlpool therapy is to combine the
effects of temperature with the mechanical effects of
water.
 The whirlpool bath is used for treatment of limb or
whole body.
 The whirlpool bath combines the values of conductive
heat and gentle massage.
 It is useful for relaxation of muscle spasm.
 Get relief of pain by stimuli which act through the pain
–gait mechanism.
(the pain gait mechanism asserts that non-painful closes the
nerve ‘gates’ painful input which prevents pain
sensation from travelling to the central nervous system)
Type of whirlpool bath:-
A. Low boy tank
B. High boy tank.
C. Hubbard tank or full body tank .
D. Extremity tank.

17.  Low boy tank:-
The low boy tank can be
used to allow an adult to
sit in the tank .
It can range in capacity from
75 to 105 gallons of water

18.  High boy tank:-
Sometimes referred to as hip or
leg tank can allow for the
immersion of bath lower
extremities.
Capacity can range from 60 to
105 gallons .

19.  Hubbard tank or full
body tank:-
The Hubbard tank has a greater
potential for exercise during
treatment due to its size and
can accommodate a full
body treatment .
Capacity can range range from
200 to more than 400 gallons .

20.  Extremity tank:-
The extremity tank is usually
used for the upper or
lower extremities .
Capacity can range from 10
to 45 gallons of water.

21.  Indication:-
I. Poor circulation .
II. Chronic edema .
III. Separate dead tissues.
IV. Pain relief in amputations .
V. After removal of plaster cast.
VI. Stiff joint .
VII. Infected wounds.
VIII. Weak and painful feet.
 Contraindication:-
I. Fever .
II. Recent skin grafts.
III. Circulatory impairment.
IV. Active bleeding .
V. Open wound .
VI. Heammorhage .
VII. Skin allergy .

22. contrast bath is a
convenient , easy
to apply thermal
modality in the
treatment of
peripheral areas .
It is a method of
application which
involves soaking
the area to be
treated in
alternating baths
of hot and cold
water.
Contrast baths
combines
alternating hot
and cold water
applications to
increase blood
flow and to
decrease joint
stiffness.
 For this the containers are
partially filled , one with ice
and other with normal
water.(33.9-36.7 degree C.)
 The procedure is continued for
15- 20 minutes.
 In case of fatigue and
overwound lesion of skin ,
excellent results are achieves
of and started and end with
hot immersion .
 The ratio of hot and cold
recommended is 4:1 . If the
part can’t be immersed then
alternate towels or packs are
used .

23.  Indication:-
i. infection, sprains , strains,
brusis and arthritis are some
of the more common
conditions that greatly
benefited by this bath.
ii. Contrast bath are used to
treat the hands, wrists, feet ,
ankles and can also be used
for the elbows and knees if
the container is large.
 Contraindication:-
I. Pregnency.
II. Undressed or infected
wounds.
III. Pacemaker .
IV. Metastesis.
V. Fever.

25.  Electric heating is a process in which the electric energy is
converted into hest energy .
 Electric heating is works on the principle of ‘joule heating’ which
state that if a material with ‘R’ resistance and current ‘I’ low through
it during ‘t’ second then the heat ‘H’ is produced in the material is
H=I^2Rt.
 These vary from small pads about 30/30 cm.
 Electric resistance wire is contained in a suitable fabric and a set of
resistance provided in a control unit so that the pad can operate
various temperature.
 The resistance wire is heated and warmed the fabric which then
placed against the skin gives conduction heating .

26.  Advantage:-
 Clean atmosphere / free from
dirt .
 Bo pollution .
 response quickly.
 Localized application.
 Uniform heating.
 Highest efficiency of utilization
.

27. Cryotherapy is the
treating method In which
cold therapy used for
treatment .
’cryo’ means cols as the
name is suggested the
cryotherapy is the
application to the tissues
resulting in cooling of part
by transfer of heat from
the portion to cooling
medium.
The media used are ice ,
cold packs , chilled water,.
the ice is used more
frequently then cold water
because it forms cool the
injoured part faster by
taking latent heat for its
melting from the body.
 Methods of application:-
There are various type methods to
administration of application :
i. Ice massage .
ii. Immersion.
iii. Ice packs .
iv. Ice towel.
v. cold compression units.
vi. Cold spray.
Ice massage:-
in this method ice is filled in a poly bag
and then rubbed on the skin . The
pressure applied is kept minimal an the
movement of the bag should be to and
fro or circulation . The ice is applied for
5-10 minutes .

28. Immersion :-
in this method , either
water kept at 0- 10 degree
C or a 50%ice and 50%
water is taken . The part
of the body is then then
immersed for 10 minutes .

29. Ice pack:-
In this polythene which is
double layerd or towel
bag is used but ice is
used after crushing it. The
treatment is usually given
for 20 minutes in one
sitting and repeted many
times a day.

30. ice towel:-
This method can be placed over
quite a large area .the ice
towel will need to be replaced
y another one after few
minutes to give adequate
cooling . it is particularly a
useful technique foe treatment
of muscle and allows
movement . For exercise to
performed while cold therapy
is being applied.

31. Cold compression
unit:-
Cold therapy combined with
compression devices to a limb
segment are available . Cold
water is circulate in a sleeve
which is put over limb and part
of it is inflated at intervals .

32. Cold spray:-
This therapy is called spray
therapy . This method is used
in sports injuries .in that ethyl
chloride is used. It is of
definate use in atheletic
injuries specially when
immediate response is
required during a match in
field.

33.  Reduction in inflammation.
 Reduction in pain.
 Reduction in muscle spasm is atributed to
the pain reduction .
 Limiting the extent of initial injury.

34.  Indication:-
a. Soft tissue injury.
b. Ligament screen s
c. Strain of muscle.
d. Pain relief.
e. Reduced muscle spasm .
f. Prevent edema.
g. Produced temporary
anesthetic effect.
 Contraindication:-
a. Circulatory disorder.
b. Coronary heart disease.
c. External hemorrhage .
d. Patient with allergy to cold.
e. Cryoglobinemia(if abnormal
protein is present in blood)