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53 Cards in this Set
- Front
- Back
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degree of heat effects - tissue temp change
mild |
<40 degrees C (104 degrees F)
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degree of heat effects - tissue temp change
danger |
>45 degrees C (113 degrees F)
*note - at 50 C you will get tissue damage no matter what. your blood cannot keep up with the heat dissipation of the heat applied to the skin |
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therapeutic range of heat
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40-45 deg. C
"hot" to "very hot" creates hyperemia - inc blood flow to the area |
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normal range of resting body temp
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36-37 deg C
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intensity of heat
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a fine balance between speed of heating tissue and blood dissipation of heat
The volume of heated area also matters |
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physical principles of heat - tissue temp rise
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skin heats, muscles gets limited heat rise
-the best way to insure the muscle heats is through exercise depth of tissue matters time of exposure -first 10 min = heat rise, then temp will dec/plateau. so after 20 min of heat application you aren't doing any good. rise =first 10 minutes plateau = next 10 minutes fall = after that |
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general effects of heat (7)
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warmth
well-being (promotes sense of well-being) promotes relaxation inc blood flow promotes healing tissue prep - for whatever treatment you are going to do provides pain relief dec muscle spasms |
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metabolic effects of heat (3)
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metabolic rate inc 2-3 times baseline for each 10 deg C elevation in temp
--inc metabolism in area, however not enough of a difference for weight loss inc oxygen uptake --to circulate blood inc nutrients to support healing --however you don't want to apply heat right away in acute phase of injury - want to dec swelling in the area, not promote blood supply |
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vascular effects of heat (3 factors create vascular effect)
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1) axon reflex - stim thermo receptors in skin. send signal to vasodialate cells in area, does not necessarily go through spinal cord
2) local spinal cord reflex 3) rel of chem mediators secondary to temp elevation -histamine -bradykinin -prostaglandins (these inc permeability of blood vessels) |
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vascular effect - chemical mediators
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histamine
bradykinin prostaglandins mild inflammatory reaction -sweat secretion -rel of histamine and prostaglandins (which in permeability of blood vessels) |
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vascular effect - spinal cord relfex
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dec in post glanglionic nerve receptors - this can cause an inc blood flow to the whole system.
apply heat to core - can inc blood flow to extremities more proximal, larger area = larger systemic effect |
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vascular effect summary
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**all create vasodilation and improved local vascular perfusion to the skin/intramuscular/intracapsular structures
**min to no change in muscle blood flow related to heat application -- dilates in response to metabolic (exercise demands) |
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neuromusclar effects of heat
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-temp reduction in volitional strength
(effects relaibility of muscle testing) they think that this is caused by the thermo regulators firing and thus blocking other neurons - gate theory -relaxation dim. muscle spindle firing rates dim sensitivity of golgi tendon organ dec firing of alpha motor neurons dec muscle guarding dec DOMS (delayed onset muscle soreness) - can dec by 50% when they exercise and apply heat dec pain -most change in first 1.5-2 deg C |
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connective tissue effects of heat
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extensibility in - effects of stretch last longer
joint stiffness dec muscle flexibility inc (muscles aren't directly effected - it is the tendons/etc) combining heat and stretch |
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psychological effects of heat
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feelings of relaxation and well-being
-activates thalamus and posterior insula -supports sense of well-being and pain control |
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specific heat
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amount of energy req to elev. temp of a material a given number of degrees of C
materials with high specific heat (water) hold more energy than those with low specific heat (air) and feel much warmer to the touch at the same temp |
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conduction
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heat transfer by direct contact
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convection
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heat transfers by liquid or gas
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radiation
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conversion of heat energy
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thermal conductivity
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rate of transfer of heat energy - materials with higher thermal conductivity (metal) transfer heat much more rapidly than those with low thermal conductivity (air) ... and can cause burns
*this is why we make sure pt does not have jewelry on when you are heating them...to avoid burns |
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thermal conductivity other factors
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area of exposure (hot pack vs hot tub)
tissue depth (thickness) - more superficial tissues heated more effectively use materials with lower conductivity next to skin to prevent burns (towel) |
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convection
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heat transfer via circulation of a moving medium
ex-whirlpool, air currents, blood circulation not going to use a lot of this |
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radiation
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heat transfer using electromagnetic radiation - body part close enough to radiant source, heat will be absorbed
ex - heat lamp (air) not going to use a lot of this |
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evaporation (cooling)
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absorption of energy as a result of conversion of a liquid to a gas
sweating alcohol evap vapocoolant sprays |
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superficial heating agents
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hot packs (moist, electric)
heat wraps paraffin wax fluidotherapy heat lamps hydrotherapy |
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hot packs
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silica get 70-75 deg C
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application of hot packs
how many towels? when do you check? any rules? |
6 layers of towels - some clinics say 8
if you do less you run the risk of burning rate of rise - freq monitoring for initial 10 minutes, then less flux as max heat dissipates (when you get the plateau) don't lie with full body weight on top of heat packs --cannot control the rate of absorption due to body size (this is best practice - use clinical judgement) |
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hot pack advantages
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get heat to specific area
ease of prep/application variety of shapes and sizes available moist and comfortable rel. inexpensive to purchase and replace |
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hot pack disadvantages
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you can't control temp once applied
doesn't conform to all body parts difficult to secure in place at times doesn't retain heat longer than 20 min cannot apply during exercise |
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frozen shoulder with heat packs
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heat pack w/ stretch vs stretch alone
conc-heat elevates pain threshold allowing for more ROM, improved ADL and red pain scores |
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DOMS w/ heat packs
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heat/cold/neutral pack or no treatment x 20 min for delayed onset muscle soreness -- DOMS in biceps brachii 48 hours after induced DOMS
heat pack only modality to provide sig. red. in pain scores 30 min after treatment it helps everything around the muscle, but not the muscle itself (too deep for heat to penetrate) |
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paraffin wax
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low melting point - 54 deg C
low specific heat heat transfers slowly *very unlikely to burn pt can add mineral oil to paraffin for a more sensitive pt - lowers specific heat even more conforms to uneven surfaces - typically used on hands - arthritic pt normally seen in outpt |
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application of paraffin
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dip and wrap
dip and immerse painted on don't do with contagious skin conditions |
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paraffin advantages
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forms to odd surfaces
pt really like it |
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paraffin disadvantages
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can't treat large areas
can't treat pt with cont. skin cond heating lasts 20 min can't control temp once applied pt can't exercise with it on |
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paraffin RA study
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no definitive evidence to support or refute efficacy
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paraffin RA treatment paraffin + post exercise
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sig in regards to imp. in stiffness, ROB, grip function when followed by exercise
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electric heating pads
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home - convenient
dry heat sensation can cause burns *don't perscibe b/c pt get burned but many pt use them at home |
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electric heating pads adv/disadv
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adv - many have them at home
dis - not well controlled many pt fall asleep with them on and end up burned |
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air activated heat wraps
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home/personal use
one time use- lasts up to 8 hours won't cause burn due to max temp - 104F can be active with them on can get expensive since one time use |
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heat wrap vs NSAIDS for lower back pain
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imp. flexibility, red pain and less muscle stiffness with heat wraps over ibprophen and acetaminophen
try to avoid NSAIDS if it can be helped to not impair body's chemical response to injury |
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heat wrap vs NSAIDS for wrist pain
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heat wrap efficacious for red of wrist pain (similar to the lower back pain study outcomes)
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fluidotherapy
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dry whirlpool - dry corn cob is pushed around machine.
39-48 deg C allows active and assisted exercise provides mild resistance desenitization adv - feels good hand clinic use them a lot works well for people with paraffin aversion can control the heat dis - expensive can't treat whole body |
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clinical decision making for using heat or col
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don't use an agent just to use an agent - use in combo with something else
wet v dry -- moist has higher specific heat superficial vs deep- area of body to be treated 1-3 cm deep use superficial heating modality options 1-5 cm use ultrasound or diathermy know stages of injury medical status what pt likes |
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basic heat adv/disadv
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adv-
dec pain inc tissue extensibility dec stiffness disadv - may inc swelling |
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basic cold adv/disadv
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adv-
may prevent further swelling dec pain disadv- inc stiffness dec tissue extensibility |
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when to use superficial vs deep heating modality
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strained muscle belly of quads-- ultrasound/diathermy
arthritic right fingers - paraffin, fluidotherapy |
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indications for superficial heat
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pain control
enhanced circulation tissue healing neuromuscular relaxation improved joint ROM |
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contradictions for superficial heat (7)
*memorize |
lack of thermal sensation
vascular insufficiency, thrombophlebitis - not enough vascular in area, poor capillary refill recent or potential hemorrhage known malignancy (may be a precaution) - ex. cancer acute inflammation - don't want to make it worse infection - don't want to spread it to whole body impaired mentation - pt can't tell you if it is too hot or too cold |
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precautions for superficial heat (7)
*memorize |
known malignancy (may be contradicition)
areas exposed to liniments or rubs - must be cleaned thoroughly unreliable situations (pt cognition, comm impaired) - superivision pregnancy - don't put hotpack over fetus cardiac insufficiency - remove superficial metal (jewelry) localized edema - don't want to inc. edema |
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mottling
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precursor to burn
white blotches in reddened area due to rebound vasoconstriction and paralysis of blood vessels - they cannot express the heat fast enough if found when checking... discontinue use of heat document |
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clinical decision making with heat
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mild v vigorous heating
volume pain red inc extensibility muscle relaxation improved ROM figure out why you are doing what you are doing |
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documentation with heating
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selection of modality with rational
location duration intensity position frequency precaution outcome, client response, modification |
