Thermotherapy in Physiotherapy - Types, Indications, Benefits, and Contraindications

What Is Thermotherapy?

Thermotherapy involves the application of heat to the affected area using deep and superficial heating methods. It helps relieve symptoms like pain and stiffness and also helps improve blood circulation. It can also be used as a home tool for rehabilitation from soft tissue injuries. Thermotherapy can be achieved through various modes of heat such as hot packs, towels, wax baths, heat wraps, steam baths, saunas, and sunlight. The heat application can relieve symptoms of various musculoskeletal and neurological problems. In addition, continuous heat production helps improve circulation, accelerate healing, and reduce swelling if any is present.

What Are the Types of Thermotherapy in Physiotherapy?

Superficial Heating Methods: These only penetrate a few millimeters, produce localized analgesia, and increase circulation in the area applied. Types of superficial heat include moist hot packs, dry heating pads, paraffin, hydrotherapy, and lamps. It is ideal for stiff and painful joints. It helps improve circulation and nutrition, relieves superficial pain, relaxes joints and muscles, and softens the superficial tissues treated.

1. Hot Packs: These are conventional hot water bags wrapped in a folded wet towel and applied directly to the skin for 15 to 20 minutes.

2. Infrared Lamps: This involves directly applying dry heat by infrared rays for about 18 to 20 minutes.

3. Hydrotherapy: Hydrotherapy is similar to aquatic therapy in combining heat with exercise, but it is an expensive method.

4. Paraffin Wax Bath: It is a mixture of liquid paraffin and petroleum jelly, which are melted together. Ten dips forming ten layers of wax maintain heat and soothe the skin. Paraffin is mainly used for irregularly shaped joints in delivering superficial heat and patients who cannot tolerate the weight of a moist pack. They are contraindicated in acute injuries, epiphyseal areas, and neoplasia.

Deep Heating Methods: Deep heating methods such as ultrasound can affect the viscoelastic properties of collagen and increase the ligament stretch, thereby improving function and pain reduction in osteoarthritis patients. This therapy is ideal for deeper chronic joint pain and helps improve the concentration of white blood cells and antibodies. This therapy helps reduce deeper pain due to neuromuscular problems and improves membrane permeability, thereby promoting collagen synthesis, pain threshold, scar tissue resolution, relieving joint adhesions, and remodeling scars.

1. Short Wave Diathermy: It involves deep tissue heating for up to 30 to 50-millimeter depth through high-frequency currents. These should never be used in acute injuries.

2. Ultrasound: Ultrasound uses high-frequency sound waves with deep thermal effects on the tissue. It brings back molecular rearrangement, reducing adhesions and hematoma, and is safe in some acute conditions. It cannot be used in neoplasia, pregnancy, myositis, and patients having metallic implants. Myositis is an inflammatory condition causing prolonged muscle weakness.

What Are the Indications for Thermotherapy?

• Pain Management: Thermotherapy produces an analgesic and a mild sedative effect, which will help numb the pain.

• Strains and Sprains: Muscle strains and sprains are injuries caused due to ligament stretching or tear. This can produce extreme pain and bruising. The application of heat provides symptomatic relief.

• Tendonitis: Inflammation of tendons (tissue connecting bone to muscle) is called tendonitis and can be managed through thermotherapy.

• Osteoarthritis: It is one type of arthritis and is considered a degenerative joint disease in which multiple joints are affected. Thermotherapy can be applied directly to the affected joints.

• Muscle Stiffness: Muscle stiffness can be reduced by applying heat therapy.

• Warm-up: Warming up before the activity and using heat modalities before sports or an athletic event will help improve blood circulation and enhance muscle performance.

• Spasm Relief: Muscle spasms are relieved by inhibiting muscle excitation through heating. Pain and spasm are dependent on each other. Therefore reducing pain will also help reduce cramps.

• Headaches and Migraines: In headaches and migraines, thermotherapy has been effective in relieving symptoms.

• Preheating: Preheating before using other modes of physiotherapy is done by using heat therapy.

• Sciatica and Lumbago: Lower back pain occurring from sciatica and lumbago can be treated through thermotherapy. Sciatica is a condition in which pain is produced along the course of the sciatic nerve, and lumbago is simply low back pain that does not occur due to a specific cause.

What Are the Benefits?

1. Hemodynamic Effect: Thermotherapy promotes vasodilation, thereby improving blood flow. There will be a release of chemical mediators responsible for inflammation locally. This, in turn, will activate the cutaneous receptors and the smooth muscle. Thus there will be relaxation of the smooth muscle.

2. Reduced Blood Pressure: Vasodilation will reduce blood pressure and viscosity.

3. Pain Reduction: The activation of cutaneous receptors on applying heat will help reduce pain. Thermotherapy accelerates healing by improving the blood flow to that area bringing in nutrients and chemical mediators.

4. Toxin Removal: Thermotherapy deeply cleanses the body by eliminating toxins. It helps in reducing aging.

5. Muscle Performance: When used in athletic training, it helps improve performance and soothes muscle aches and pains. It also helps in improving breathing and aids in body remineralization.

6. Improved Health: Promotes enhanced physical health and encourages better sleep. Stimulates the immune system by helping improve the circulation of white blood cells and mediators of inflammation.

7. Metabolic Rate: After thermotherapy, the metabolic rate has proven to be improved. The oxygen uptake is increased, thereby promoting faster healing.

8. Tissue Extensibility: The elastic properties of collagen are enhanced on heat application. It also acts by relieving tight muscles and improving the range of motion.

9. Edema Reduction: Vasodilation by thermotherapy helps allow fluid exchange, thereby reducing the edema in the extremities.

10. Skin Disease: Some fungal infections are treated using infrared therapy. The heat application kills a variety of microorganisms thriving on the skin surface.

What Are the Contraindications?

The contraindications include:

• It cannot be used in new injuries that have occurred recently.

• It is absolutely contraindicated to be used in open wounds.

• It cannot be used in patients having acute inflammatory conditions.

• Patients having a fever or high temperature cannot undergo this procedure.

• It cannot be used in areas of active bleeding and metastasis of malignancies.

• Patients with cardiac insufficiency and peripheral vascular disease are contraindicated for this treatment.

• Patients who are receiving radiation therapy are contraindicated.

• If the area to be treated is hot, red, inflamed, or numb, this treatment should not proceed.

• Patients having reduced sensation of heat cannot undergo this treatment.

• Diabetic nephropathy and myositis-affected patients are contraindicated from this procedure.

• Pregnant women and patients who have metallic implants cannot undergo this therapy.

Conclusion

Thermotherapy alters the tissue temperature in the applied area. It provides desirable biological effects such as pain reduction, increased blood flow because of vasodilatation, metabolic rate acceleration, and improved tissue extensibility. Thermotherapy has various therapeutic effects, and the advantages outnumber the disadvantages. Choosing the correct mode of thermotherapy can help improve healing and prevent complications caused due to heat.