Heat Treatments
Heat treatments are applied to body areas that are injured or functioning in an abnormal way.
The general purposes of a heat treatment are to improve the flexibility of soft tissues, remove toxic substances, enhance blood flow, increase function of tissue cells, encourage muscle relaxation, and help relieve pain. There are two types of heat treatments: superficial and deep. Superficial treatments apply heat to the outside of the body. Deep heat treatments direct it toward specific inner tissues through ultrasound or electric current. Heat treatments are beneficial prior to exercise, providing a warm-up effect.
Hot packs are a very common form of heat treatment. Moist heat packs are readily available in most hospitals, physical therapy centers, and athletic training rooms. Treatment temperature should not exceed 131°F (55°C). The pack is used over multiple layers of toweling to achieve a comfortable warming effect for approximately 30 minutes.
Hot-water bottles are another form of superficial heat treatment. The bottles are filled half-way with hot water between 115-125°F (46.1-52°C). Covered by a protective toweling, the bottle is placed on the treatment area and left until the water has cooled.
Electrical heating pads continue to be used, however because of the need for an electrical outlet, safety and convenience become issues.
Paraffin is often used for heating uneven surfaces of the body such as the hands. It consists of melted paraffin wax and mineral oil. While solid at room temperature, parrafin is used as a liquid heat treatment when heated to 126-127.4°F (52-53°C). The most common form of paraffin application is called the dip-and-wax method. In this technique, the patient will dip 8-12 times and then the extremity will be covered with a plastic bag and a towel for insulation. Most treatment sessions are about 20 minutes.
Hydrotherapy tanks or pools are used to treat many musculoskeletal disorders. The water is generally set at warm temperatures, never exceeding 150°F (65.6°C). Because the patient often performs resistance exercises while in the water, higher temperatures become a concern as the treatment becomes more physically draining. Because of this, many hydrotherapy baths are now set at 95-110°F (35-43.3°C). There are also units available with moveable turbine jets, which provide a light massage effect.
Fluidotherapy is a form of heat treatment developed in the 1970s. It uses dry heat in the form of cellulose particles suspended in air. Temperatures in this treatment range from 110-123°F (43.3-50.5°C). Fluidotherapy allows the patient to exercise the limb during the treatment, and also provides massage, increasing blood flow.
Ultrasound heat treatments penetrate the body, providing relief to inner tissue. Ultrasound energy comes from the acoustic or sound spectrum, but is not detected by the human ear. Using conducting agents such as gel or mineral oil, the ultrasound transducer warms muscle tissue and other connective tissue such as ligaments and tendons. Fat, however, absorbs the energy to a much lesser degree. Ultrasound has a relatively longlasting effect, continuing up to one hour.
Diathermy is another deep-heat treatment. An electrode drum is used to apply heat to an affected area. It consists of a wire coil surrounded by an insulating plastic housing. Plenty of toweling must be layered between the unit and the patient. This device is helpful with chronic low back pain and muscle spasms. Prior to ultrasound technology, diathermy was a popular heat therapy of the 1940s-1960s.
Once heat treatment has been completed, any symptoms of dizziness and nausea should be noted and documented along with any skin irritations or discoloring not previously present. A one-hour interval between treatments is needed to avoid restriction of blood flow.
Supervision should be present during any form of heat treatment, especially hydrotherapy. All heat treatments can potentially damage tissue, if temperatures are excessive. In all cases, proper insulation and length of treatment should be carefully administered. Overexposure during a superficial heat treatment may result in redness, blisters, burns, or reduced blood circulation. During ultrasound therapy, excessive treatment over bony areas with little soft tissue (such as hand, feet, and elbow) can cause excessive heat resulting in pain and possible tissue damage. Exposure to the electrode drum during diathermy may produce hot spots.
Heat treatments should not be used on individuals with circulation problems, heat intolerance, or lack of sensation in the affected area. Low blood circulation may contribute to heat-related injuries. Heat treatments also should not be used on individuals afflicted with heart, lung, or kidney diseases. Deep heat treatments should not be used on areas above the eye, heart, or on a pregnant patient. Deep heat treatments over areas with metal surgical implants should be avoided in case of rapid temperature increase and subsequent injury.
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