MOIST HEAT THERAPIES                                                        
 by ROBYN WILSON, LMT,  ATC

(Although this is an article toward a professional, the applications are still things that we should know and utilize on our own , in our own homes, Teresa)

The purpose of this article is to review the psychological effects of superficial heat and the appropriate use of two infrared heating modalities, moist heat packs and whirlpool baths.  

Of the  therapeutic modalities  in use today, perhaps none are more commonly used than those that are classified as infrared modalities. The term infrared typically conjures up visions of infrared lamps and bakers; however, most of the more common heat and cold therapies, such as hydrocollator packs, paraffin baths, hot and cold whirlpools and ice packs also fall under the the classification of infrared modalities. Each of these therapies radiate energy with wavelengths and frequencies that fall into the classification of the infrared region of the electromagnetic spectrum are therefore infrared modalities.

Infrared modalities have a depth of  penetrations less than 1 cm, thus the physiological effects are primarily superficial and directly effect the cutaneous vessels and nerve receptors. Heat applied superficially to the skin will directly increase the subcutaneous tissue temperature. The primary effect of local heating is vasodilation of capillaries with increased local blood flow, increased local metabolic activity and relaxation of muscle spasm. Superficial heat, when applied to a sufficient volume of tissue for the appropriate duration, may indirectly spread to deeper tissues. The temperature rise of muscle tissue occurs through a reflexive effect on the circulatory system and through conduction, not as a direct effect of the superficial heat. Direct deep heating (3-5 cm) can only be achieved through the use of diathermies and ultrasound

In the last issue of Florida News,an article by Laurel Freeman outlined the application of ice, often termed cryotherapy. Cryotherapy, is most effective immediately following injury or during the acute inflammatory cycle of healing. In contrast, heat will aggravate acute inflammatory conditions.

The acute inflammation cycle lasts no longer than two weeks. Beyond that inflammation is considered subacute and beyond one month is chronic. Heat is typically applied to conditions such as postacute sprains, strains and articular (joint) problems and  chronic inflammation. The desirable therapeutic effects of heat include;

(1) reducing pain,
(2) increasing blood flow
(3) relieving muscle spasm
(4) decreasing joint stiffness
(5) increasing the extensibility of collagen tissue
(6) reducing inflammation, edema, and exudates in the postacute phase of healing
(7) producing a relaxation response with decreased muscle guarding.

In general, moist heating of the skin is safe therapeutic medium, assuming the heat is kept at the appropriate temperature and  the duration of treatment is not too long. As with any of the heating modalities it is important to consider these contraindications and precautions;
1) Never apply heat when there is a loss of sensation.
2) Never apply heat immediately after an injury.
3) Never apply heat when there is decreased circulation.
4) Never apply heat directly to  the eyes or genitals.
5) Never heat the abdomen during pregnancy.
6) Never apply heat to a body part that exhibits signs of acute inflammation.

Moist heat causes a greater indirect increase in the deep tissue temperature than does dry heat. Therefore, we will highlight two moist heat therapies, moist heat packs and whirlpool baths.

Moist Heat Packs

Commercial moist heat packs, otherwise known as hydrocollator packs, heat by conduction. The major value of hydrocollator packs results in general relaxation and reduction of pain. The hydrocollator pack consists of a cotton pad  filled with collagen gel. This pack is immersed into a hydrocollator, a tank which holds thermostatically controlled water at a temperature of 160 degrees F.. Once removed and wrapped properly in the terry cloth toweling the hydrocollator pack will maintain a constant heat level for up to 20 minutes. Place the towels between the client and the pads to accommodate their level of tolerance and remove the layers as the pads cool. Treat the area for 15 to 20 minutes. Be sure your client is comfortable at all times.

Whirlpool Bath                                                                                                                                           
Whirlpool bath is a combination of massage and water immersion. It provides heat through both conduction (skins contact with water) and conduction (water swirls around skin surface). Whirlpool baths assists the body part in reducing swelling, muscle spasm  and pain. Buoyancy in the water also aids in the movement of the body part to improve range of motion. The whirlpool is essentially a tank and a turbine motor which regulates the movement of water and air. Water temperature may vary depending on desired results. In general, 96-104 degrees F is considered warm to hot. Once the tank is filled with water at the desired temperature the client can submerge the part to be treated. Keep in mind, as you increase the surface area being heated, you will achieve a more rapid and drastic rise in tissue temperature. A duration of 20 minutes is recommended for chronic injuries  but you may have to work up to the desired duration as the client becomes more tolerant. Monitor the client for comfort and any signs of lightheadedness, especially in the case of whole body submergence.

Moist heat modalities such as the two mentioned are relatively simple, efficient and inexpensive.

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