Heat treatments are applications of therapeutic thermal agents to specific body areas experiencing injury or dysfunction.
The general purpose of a heat treatment is to increase the extensibility of soft tissues, remove toxins from cells, enhance blood flow, increase function of the tissue cells, encourage muscle relaxation, and help relieve pain. There are two types of heat treatments: superficial and deep. Superficial heat treatments apply heat to the outside of the body. Deep heat treatments direct heat toward specific inner tissues through ultrasound or by electric current. Heat treatments are beneficial prior to exercise, providing a warm-up effect to the soft tissues involved.
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.
There are four different ways to convey heat:
- Conduction is the transfer of heat between two objects in direct contact with each other.
- Conversion is the transition of one form of energy to heat.
- Radiation involves the transmission and absorption of electromagnetic waves to produce a heating effect.
- Convection occurs when a liquid or gas moves past a body part creating heat.
Hot packs, water bottles, and heating pads
Hot packs are a very common form of heat treatment utilizing conduction as a form of heat transfer. 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. More recently, several manufacturers have developed packs that may be warmed in a microwave over a specified amount of time prior to use.
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 hot-water bottle is placed on the treatment area and left until the water has cooled off.
Electrical heating pads continue to be used, however because of the need for an electrical outlet, safety and convenience become an issue.
Paraffin, a conductive form of superficial heat, is often used for heating uneven surfaces of the body such as the hands. It consists of melted paraffin wax and mineral oil. Paraffin placed in a small bath unit becomes solid at room temperature and is used as a liquid heat treatment when heated at 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 eight to 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 is used in a form of heat treatment for many musculoskeletal disorders. The hydrotherapy tanks and pools are all generally set at warm temperatures, never exceeding 150°F (65.6°C). Because the patient often performs resistance exercises while in the water, higher water temperatures become a concern as the treatment becomes more physically draining. Because of this, many hydrotherapy baths are now being set at 95-110°F (35-43.3°C). There are also units available with moveable turbine jets, which provide a light massage effect. Hydrotherapy is helpful as a warm-up prior to exercise.
Fluidotherapy is a form of heat treatment developed in the 1970s. It is a dry heat modality consisting of cellulose particles suspended in air. Units come in different sizes and some are restricted to only treating a hand or foot. The turbulence of the gas-solid mixture provides thermal contact with objects that are immersed in the medium. Temperatures of 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 massages the limb, increasing blood flow.
Ultrasound heat treatments penetrate the body to provide relief to inner tissue. Ultrasound energy comes from the acoustic or sound spectrum and is undetectable to the human ear. By using conducting agents such as gel or mineral oil, the ultrasound transducer warms areas of the musculoskeletal system Some areas of the musculoskeletal system absorb ultrasound better that others. Muscle tissue and other connective tissue such as ligaments and tendons absorb this form of energy very well, however fat absorbs 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 dead space and other insulators such as a plastic housing. Plenty of toweling must be layered between the unit and the patient. This device is unique in that it utilizes the basis of a magnetic field on connective tissues. One advantage of diathermy over various other heat treatments is that fat does resist an electrical field, which is not the case with a magnetic field. It is found to be helpful with those experiencing chronic low back pain and muscle spasms. Prior to ultrasound technology, diathermy was a popular heat therapy of the 1940s–1960s.
Before administering any form of heat treatment, heat sensitivity is accessed and the skin over the affected area is cleansed. When a patient is undergoing any form of heat treatment, supervision should always be present especially in the treatment of hydrotherapy.
Once the heat treatment has been completed, any symptoms of dizziness and nausea should be noted and documented along with any skin irritations or discoloring not present prior to the heat treatment. A one hour interval between treatments should be adhered to in order to avoid restriction of blood flow.
All heat treatments have the potential of tissue damage resulting from excessive temperatures. Proper insulation and treatment duration should be carefully administered for each method. 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.
American Physical Therapy Association. 1111 North Fairfax St., Alexandria, Virginia 22314. (800) 999-2782. 〈https://www.apta.org〉.