Thermotherapy – Dennis M., Occupational Therapist
Thermotherapy is the number one modality used by practicing Occupational therapists, according to a survey by American Occupational Therapy Association. The mechanisms of heating tissue are classified as being superficial (1 cm) or deep (greater than 1 cm) of penetration to the underlying tissue. Hot packs, contrast bath; fluidotherapy and paraffin baths are considered superficial heating agents. Therapeutic Ultrasound is considered a deep heating agent. In this article we will discuss superficial heating only. Heat can be transferred by conduction or convection. Conduction involves an exchange of energy between two materials that have two different temperatures. Convection is the conveyance of heat by the movement of heated particles over an extremity, such as fluidotherapy and whirlpool baths. Conditions that benefit from Thermotherapy included: stiff joints; subcutaneous adhesions; contractures; chronic arthritis; subacute/chronic inflammation; trauma/wounds; neuromas and muscle spasms. Superficial heating agents should not be used with the following conditions: impaired sensation; tumors/cancer; deep vein thrombophlebitis; pregnancy; advance cardiac disease; primary repair of tendon or ligament. Clinical applications: Hotpacks: transfer heat through conduction to depths of 1 cm and are considered a passive form of treatment, since patients are not actively involved during the application. However a sustained positional stretch of the tissue being treated can be accomplished during the heating process. The Hot pack should be wrapped in several layers of towels, with treatment length around 10-20 minutes, checking patient every five minutes. Contrast Bath: involves alternating placement of an extremity in warm water (100-110 degrees) and cool tap water facilitate a pumping type action to decrease edema and improve superficial blood flow. Fluidotherapy: provides heat & sensory effect useful for desensitization and pressure oscillations to decrease edema by having the patient engaging in hand pumping motion(s), during the treatment period. Paraffin Bath: It allows for an even distribution of heat to the treatment surface, which is very effective in reducing stiffness and pain as in Arthritis. All of these clinical applications listed previously there is a degree of risk burning the patient. Monitoring both the therapeutic temperature of the intervention(s) before applying them and monitoring the patient’s skin should be the primary concern for the therapist. For further information and specifics for using Thermotherapy the following resources are recommended: “Physical Agent Modalities by Dr. Alfred G. Bracciano and Physical Agents in Rehabilitation by Dr. Michelle Cameron.