Ultrasound

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Physical Agent Modalities

• Superficial Heat
• T. Ahadi MD
• Physiatrist

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• Modalities are physical agents that are utilized
  to produce a therapeutic response in tissue
• Heat
• Cold
• Sound
• Water
• Electricity
• Electromagnetic waves

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• Heat
• Superficial
• Hot pack (HP)
• Infra red (IR)
• Electrical pad
• Fluidotherapy
• Paraffin bath
• Contrast bath
• Hydrotherapy
• Deep (Diathermies)
• short wave
• Micro wave
• Ultrasound (U/S)

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Physiological effect of superficial heat

• Homodynamic
• Increase in Blood flow
• Decrease Chronic Inflammation (increase nutrient
  ,leukocytes ,Ab and increase egress of metabolic
  products and tissue debris)
• Increase Acute Inflammation
• Increase Edema
• Increase Bleeding

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Physiological effect of superficial heat

• Joint and connective tissue
• Increase tendon Extensibility
• Increase Collagenase Activity
• Decrease Joint Stiffness
• Decrease muscle spasm

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Physiological effect of superficial heat

• Analgesia by Heat and General Relaxation
• - Vasodilatation Resulting in Decreased Ischemic
  Pain
• - Vasodilatation Resulting in Washout of Pain
  Mediators
• - Endorphin Mediated Response
• - Alteration of Nerve Conduction
• - Alteration of Cell Membrane Permeability

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Superficial Heat

• Often used for
• pain control
• increase tissue extensibility
• Done prior to or in conjunction with other
  treatments.

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Heat
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GENERAL PRECAUTIONS

• Acute trauma
• Impaired Circulation
• Bleeding Diatheses
• Edema
• Large Scars
• Impaired Sensation
• Malignancy
• Cognitive or Communication Problem

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• Hot Packs
• Equipment
• Canvas Pouch with Silica Gel .Pack is kept
  in a water- filled heating unit maintained
  between 74.5 ºC
• Maintains heat for 20-30 minutes
• Indications
• Used for general muscle relaxation and reduction
  of pain-spasm
• Limitation - unable to heat deeper tissues
  effectively
• Application
• Pack removed from water covered w/ 6 layers of
  toweling which are removed as cooling occurs
  area treated for 15-20 minutes

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Hot packs
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Precautions

• General heat precaution
• The patient should not lie on the pack
• -water squeezing
• -Increased heating over bony prominences
• Hot packs are the most
• common cause of burns in PT

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Paraffin Bath

• A mixture of wax an mineral oil in a ration of 7
  parts wax to 1 part oil
• Temperature of 52.2º C to 54.4 ºC
• Paraffin can provide approx.. 6x the amount of
  heat as water due to low heat conductivity

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Paraffin Bath

• Application techniques
• Dipping
• Immersion
• Brushing

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Paraffin Bath Contraindications

• General heat precautions
• Open wounds
• Infection
• Skin conditions (e.g. acute dermatitis, eczema)
• Unstable, fragile or early stage skin grafts

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• Fluidotherapy
• Equipment
• Unit which contains cellulose particles and
  forced hot air
• This Gas-Solid system behaves like a low vicosity
  fluid
• Used to treat distal extremities in effort to
  decrease pain, increase ROM and decrease swelling
  and spasm
• Application
• Temperature ranges from 100-113o F
• Treatment time 15-20 minute

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Fluidotherapy

• Advantages
• Provide high heat
• massaging action
• Perform ROM EX
• Heat Control
• Precautions
• - General heat precaution
• - Risk of cross contamination

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Infrared Heat Lamps

• Intensity
• Distance (Inverse Square Law)
• 30-60cm
• Angle of delivery
• (Cosine Law)

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Infrared Lamp

• Advantages
• -It is preferable in patients who cannot tolerate
  the weight of hot packs
• -Minimal cross contamination risk
• Precautions
• -General heat precautions
• -light sensitivity
• -dry skin

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• Whirlpool Bath, Hubbard tanks
• Equipment
• A portion of body or whole body is
  immersed
• Varying sizes used to treat a variety of body
  parts
• Greater extremes of temperature can be tolerated
  in whirlpool bath
• Antigravity effect in hubbard tank
• Agitation (amount of movement) is controlled by
  air emitted
• Indications
• Combination of massage and water immersion
• Swelling, muscle spasm and pain

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Whirlpool Bath, Hubbard tanks
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• Special Considerations
• Must be careful with full-body immersion
• Proper maintenance is necessary to avoid
  infection
• Safety is a major concern
• Electrical outlet

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Contrast bath

• used as a transition between cold and heat
• may use water or ice packs/hot packs etc..
• The effect is believed to be related to cyclic
  vasoconstriction and vasodilatation( vascular
  pumping )
• 30 min sessions are typical
• Beginning with 10 min immersion in hot, followed
  by alternating immersions of 1min cold and 4 min
  hot ending session with cold
• May vary the length of time in cold vs.. heat
  depending on effects desired

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Contrast bath
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Contrast Bath

• Indications of use
• -Rheumatologic Dis.
• -Neuropathic pain
• -CRPS

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Prescription of Heat

• Indication/Diagnosis
• Location
• Size
• Irregular/ regular surface
• Intensity(mostly rely on patient perception of
  thermal intensity)
• Duration(in superficial heat,20-30 min per site)
• Frequency
• Severity
• Clinical Judgment

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Which Modality

• Target Tissue
• Depth of the heating Desired
• Intensity of Heating Desired
• Body Habitus (Subcutaneous Adipose tissue)
• Co morbid Conditions (Cancer, Vascular Disease,
  Neuropathy)
• Age (epiphysial plate)
• Sex( Pregnancy)

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Clinical Implications for Superficial Heat

• Trunk, shoulder, hip or knee musculoskeletal
  problems( Tendinitis, Tenosynovitis, Bursitis,
  Capsulitis)
• Pain(low back,neck,myofascial,) and Muscle Spasm
• Joint contractures Improving ROM
• Tissue Healing
• Subacute and Chronic Conditions
• General Relaxation

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