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Electrophysical Agents PART II Electrophysical Agents BBelanger_Ch06_R2.inddelanger_Ch06_R2.indd 8989 22/24/09/24/09 77:11:18:11:18 PPMM 6 CHAPTER Hot Pack and Paraffin Bath Therapy Chapter Outline I. RATIONALE FOR USE B. Paraffin Bath A. Definition and Description C. Quantitave Dosimetry B. Hot Packs and Paraffin Baths VI. EVIDENCE FOR INDICATIONS C. Infrared Lamps A. Guided by Evidence D. Microwaveable Packs and Heat Wraps B. Evidence From Human Research E. Rationale for Use C. Strength of Evidence and Justification II. HISTORICAL PERSPECTIVE of Usage of Hot Pack Therapy D. Strength of Evidence and Justification A. Hot Packs of usage of Paraffin Bath Therapy B. Paraffin Baths E. Contrasting Facts C. Body of Literature VII. CONTRAINDICATIONS III. BIOPHYSICAL CHARACTERISTICS A. Heat Transfer via Conduction VIII. RISKS, PRECAUTIONS, AND B. Heat versus Temperature RECOMMENDATIONS C. Specific Heat Capacity and Thermal IX. CONSIDERATIONS FOR APPLICATION AND Conductivity DOCUMENTATION IV. PHYSIOLOGICAL AND THERAPEUTIC EFFECTS A. Basic Considerations A. Thermal Effects on Healthy Subjects B. Procedures B. Thermophysiological Effects C. Documentation V. DOSIMETRY CASE STUDY 6-1 A. Hot Pack CASE STUDY 6-2 Learning Objectives Knowledge: List the basic considerations associated Analysis: Explain how to establish objective or quan- with the application of hot pack and paraffin bath titative dosimetry with regard to the application of therapy. hot pack and paraffin therapy. Comprehension: Summarize the physiological and Synthesis: Explain the difference between heat and therapeutic effects of hot pack and paraffin bath temperature. therapy. Evaluation: Discuss the concepts of specific heat capacity and thermal conductivity and their rel- Application: Demonstrate paraffin bath therapy appli- evance to the use of hot pack and paraffin bath cation methods. therapy. 90 BBelanger_Ch06_R2.inddelanger_Ch06_R2.indd 9090 22/24/09/24/09 77:11:19:11:19 PPMM CHAPTER 6 Hot Pack and Paraffi n Bath Therapy 91 I. RATIONALE FOR USE 3. Potential Confusion It follows from the above evidence that the use of superfi - cial thermal agents, such as hot packs and paraffi n baths, A. DEFINITION AND DESCRIPTION can lead, in some cases, to the therapeutic heating of This chapter discusses the use of two therapeutic agents, deeply located soft tissues. When applied over the upper namely, hot packs and paraffi n baths. These agents fall and lower extremities, particularly over the hands, feet, under the fi eld of thermotherapy, which is defi ned as the and joint areas (wrist, elbow, ankle, knee) where the fat application of heat sources, called thermal agents, over tissue layer is thinner, it is quite likely that these super- skin surface areas for the purpose of heating soft tissues. fi cial thermal agents can increase the temperature of the Hot packs and paraffi n baths deliver moist heat, as op- deeper soft tissues. Readers should keep in mind, there- posed to the dry heat delivered by other thermal electro- fore, that hot pack and paraffi n bath therapies can induce physical agents (EPAs) such as fl uidotherapy (Chapter 7), superfi cial as well as deep soft-tissue heating. shortwave diathermy (Chapter 10), and ultrasound ther- apy (Chapter 20). The rationale for integrating the discus- sion of these two agents into a single chapter, therefore, B. HOT PACKS AND PARAFFIN BATHS is based on the fact that both deliver moist heat to soft Figure 6-1A shows a typical commercial hot pack; (B) tissues. shows a paraffi n bath fi lled with a paraffi n mixture. Hot packs are manufactured in different sizes and shapes to 1. Superficial Versus Deep Thermotherapy accommodate different parts of the human body. Paraf- Historically, thermotherapy has been classifi ed as either fi n baths are also manufactured in different sizes and superfi cial or deep in nature. There is a consensus in the are used to treat the distal parts of the upper and lower EPA literature to defi ne superfi cial thermotherapy as the extremities. heating of soft tissues located within 1 cm from the skin surface (Bell et al., 2002; Knight et al., 2008a,b). There- fore, deep thermotherapy can be logically defi ned as the 1. Extent of Hot Pack Use heating of soft tissues deeper than 1 cm from the skin sur- Lindsay et al. (1995) surveyed Canadian private physi- face. Current EPA textbooks classify hot packs and paraf- otherapy clinics and found hot packs were available in fi n baths as superfi cial thermal agents. all facilities (100%), with an overall frequency of use of 95.1%. Three year later, Robertson et al. (1998) surveyed 2. Superficial Versus Deep Soft Tissues more than 200 clinical physiotherapy facilities in Australia Research has shown that the application of paraffi n baths and found that hot packs were available in 88% of facilities and fl uidotherapy (Chapter 7), which are classifi ed as su- and were used daily by 73% of all respondents. In 2007, perfi cial thermal agents, to the hands and feet of human Nussbaum et al. (2007) surveyed 125 Canadian physi- subjects can induce signifi cant temperature increases not otherapists and showed that superfi cial thermal agents only in the most superfi cially located tissues (i.e., skin), were available to 96% and used by 54% of the respond- but also in the deeply located soft tissues (muscles and ents. No published survey could be found on the use of joint capsules). hot packs in the United States. A B FIGURE 6-1 Typical hot pack with hydrocollator unit (A) and paraffin bath filled with a paraffin mixture (B). (Courtesy of Chattanooga Group.) BBelanger_Ch06_R2.inddelanger_Ch06_R2.indd 9191 22/24/09/24/09 77:11:19:11:19 PPMM 92 PART II Electrophysical Agents 2. Extent of Paraffin Bath Use 20). It is also to provide practitioners with thermal agents The Australian survey by Robertson et al. (1998) revealed capable of heating large body surface areas (hot packs) that paraffi n baths were available in 64% of facilities and and diffi cult-to-reach body areas such as fi ngers and toes were used daily by 28% of the respondents. The Canadian (paraffi n bath). survey by Lindsay et al. (1995) showed this agent to be present in 57.4% of private clinics, with a frequency of use of 11.1%. No literature on the use of hot packs in the II. HISTORICAL PERSPECTIVE United States could be found. A. HOT PACKS 3. Current Use No literature is available to indicate whether the use of The literature suggests that the therapeutic use of hot these two thermal agents has increased, decreased, or re- packs was introduced during the mid-1950s by Hollander mained steady. Judging from the fact that these two agents et al. (1949), Horvath et al. (1949), and Erdman et al. are still covered today in several EPA textbooks (see Refer- (1956). ences) and listed in several brochures published by EPA manufacturers, it is fair to say that their clinical use is still B. PARAFFIN BATHS common and widespread. This view is further substantiated by the fact that today, the teaching of hot pack and paraffi n The literature also indicates that paraffi n bath therapy was bath therapy is still mandatory in the physical therapy aca- fi rst introduced in the early part of the 20th century by De demic EPA curricula of many countries, such as Canada Sanfort (1915), Humphris (1920), Portmann, (1926), and (NPAG, 2001), Australia and New Zealand (Chipchase et Zeiter (1939). al., 2005), and the United States (APTA, 2001). C. BODY OF LITERATURE C. INFRARED LAMPS Despite their routine clinical use over the past 70 or 80 The popular and routine use of hot packs and paraffi n years, the topic of hot pack and paraffi n bath therapy has baths stands in clear contrast to the signifi cantly declin- been the subject of a limited number of articles (see Ref- ing use of another classic superfi cial thermal agent, infra- erences), review articles (Hardy et al., 1998; Ayling et al., red lamps. In Australia (Robertson et al., 1995), infrared 2000; Brosseau et al., 2006; Robinson et al., 2006), and lamps, which generate dry heat, were found in only 39% of several chapters of textbooks (Jackins et al., 1990; Lehmann the facilities surveyed and were used only 35% of the time. et al., 1990; Sekins et al., 1990; Basford, 1998; Hayes, In Canada, Lindsay et al. (1995) found infrared lamps in 2000; Bell et al., 2002; Cameron, 2003; Starkey, 2004; only 2.2% of the clinics surveyed, with a 0% frequency of Michlovitz et al., 2005; Hecox et al., 2006; Michlovitz et use. These results are in keeping with those of Pope et al. al., 2006; Knight et al., 2008a,b). (1995) in England, who reported a very low rate of use. Therefore, infrared lamps are not covered in this chapter. III. BIOPHYSICAL CHARACTERISTICS D. MICROWAVEABLE PACKS AND HEAT WRAPS A. HEAT TRANSFER VIA CONDUCTION The declining use of infrared lamps may also be explained by the recent emergence of safe, over-the-counter, easy- The use of hot pack and paraffi n bath therapy is based to-use, reusable microwaveable packs and disposable heat on the biophysical principle of thermal energy transfer, wraps (Nadler et al., 2002; 2003a,b; Trowbridge et al., via conduction, between the agents and the exposed soft 2004). These packs and wraps, sold in various sizes and tissues. Conduction is defi ned as the process of internal shapes, are capable of delivering superfi cial dry or moist thermal energy exchange between areas of different tem- heat to localized body areas. There is recent evidence to peratures, whereby the exchange of kinetic energy from suggest that a particular dry heat wrap may have benefi cial particle to particle is accomplished by direct molecular therapeutic effects on acute nonspecifi c low-back pain collisions (Sekins et al., 1990).
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