Superficial Heating Modalities

1. Superficial Heating Modalities

2. Superficial vs Deep Heating Agents Superficial Primarily causes increases in skin temp and superficial subcutaneous tissue Depths of penetration <2 cm Deep Heat deeper tissues Depth of penetration 3-5 cm

3. 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

4. Physiological Responses to Tissue Heating Metabolic Reactions 2x�s metabolic rate =106o F Enzymatic activity increases = 102o F >122 = rapid decrease Oxygen uptake? Vascular Effects Vasodilation Importance of Skin BF during Heating Local and reflexive mechanisms

5. Physiological Responses to Heating Vascular cont. Axon Reflex Cutaneous receptors Some afferents go to SC Others go directly to vessel receptors

6. 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

7. 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

8. 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

9. Heating Agents

10. Conductive Heating Agents Hot packs Superficial moist heat Placement considerations Depth of Penetration Tx time Advantages and disadvantages Precautions

11. 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

12. 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

13. 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

14. Clinical Implications for Superficial Heat Trunk, shoulder, hip or knee considered mild heating Mild vs Vigorous

15. Mild vs Vigorous Heat

16. Surface Temperature Ranges and Subjective Feelings

17. 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

18. Contraindications to Superficial Heating Poor or reduced sensation Vascular insufficiency Vascular Disease Acute injuries Malignancy Application over where liniments have been applied

19. 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