Infra-red Therapy
SHEILA S KITCHEN MSC MCSP DipTP
Senior Lecturer
CECILY J PARTRIDGE P ~ F C S P
Reader in Physiotherapy
Centre for Physiotherapy Research, King’s College London
Authors’ note: The purpose of this article is to review the current state
of knowledge about this method of electrotherapy. It has, however, been found
necessary to provide background information to familiarise the reader with
the terms used and the concepts developed and reviewed in the latter part
of the paper.
. .
This review will be updated by Ms A O’Ryan, District Physiotherapist,
Pavilion 6, Whiston Hospital, Prescot L35 5DR.
Key words: Review, infra-red, physiological effects, hazards
Summary: Infra-red therapy has been used in clinical practice for a con-
siderable period of time; there are, however, a limited number of studies
which evaluate the efficacy of this modality in the management of clinical
conditions. This review considers the physical behaviour, physiological effects,
the efficacy and hazards of infra-red therapy.
Biography: Sheila Kitchen qualified as a physiotherapist at Guy’s Hospital
in 1971. Since then she has practised clinically and then taught for the last
14 years. She is now senior lecturer at King’s College London and is course
co-ordinator for the new MSc degree for remedial therapists being run at
London University. She has undertaken the review of literature in the
field of electrotherapy as part of the research programme of the Centre for
Physiotherapy Research.
Cecily Partridge is director of the Physiotherapy Research Unit, King’s
College London. She worked in clinical practice for many years, but has
been in full-time research since 1975. Her research interests include
community physiotherapy, recovery from physical disability, and the
measurement and evaluation of practice in physiotherapy.
Introduction
THE use of heat for the treatment of a variety of medical
conditions has a long history; hot baths and poultices have
been used for very many years and are mentioned in classical
literature. Infra-red therapy has a history which reaches back
to the beginning of the century and it seems that physio-
therapists still make considerable use of this heating method,
Ide and Partridge reporting an excess of 6,000 machines in
service in Britain in 1988.
Some work was carried out early in the second half of this
century into the efficacy of infra-red in therapy (Fleck, 1952)
but interest appears t o have waned more recently, there
being a dearth of published research in recent years. It is
important to remember that early work must be viewed with
caution as the consistency of output from machines and
the accuracy of measuring equipment was limited by the
prevailing technological knowledge.
This review is concerned with the physiological effects
of infra-red, its therapeutic efficacy and its associated
hazards.
Physiotherapy, April 1991, vol 77,no 4
Background
Infra-red (IR) radiations lie within that part of the electro-
magnetic spectrum which give rise t o heating when
absorbed by matter. IR radiations display wavelengths of
between 0.78-1,000 micrometers (pm), lying between
microwaves and visible light on the spectrum (Wells et a/,
1988; Moss e t a / , 1989). Many sources which emit either
visible or ultraviolet radiation will also emit IR (Moss et a/,
1989). The International Commission on Illumination (CIE)
describes three biologically significant bands - IR-A from
0.78-1.4 pm, IR-B from 1.4-3.0 pm and IR-C from
3.0 pm-1.0 mm. Wavelengths used clinically are mainly of
between 0.7 and 1.5 pm (Ward, 1986) and are therefore
mainly concentrated in the IR-A band.
IR radiations can be reflected, absorbed, transmitted,
refracted and diffracted by matter. All of these parameters
are of importance when measuring IR radiations but only
refraction, absorption and transmission are of biological
significance (Moss e t a / , 1989).
IR sources can be either natural, the most common source
being the sun, or artificial. Sources used by therapists in the
clinical setting are of the latter type and can be either
luminous or non-luminous generators. Luminous generators
produce radiations of a peak wavelength of 1 p;they also
produce visible light. Non-luminous generators produce
radiations which peak at a wavelength of 4 pm (Wells etal,
1988). Filters may be used t o limit the output t o a particular
wavelength band (Moss e t a / , 1989). A period should be
allowed for the lamp t o heat up as it has been shown that
the heat emitted by the source increases over a period of
time (Orenberg et a/, 1986); the time required will vary
according t o the type of lamp. Non-luminous lamps will take
longer than luminous lamps t o reach a stable, peak level of
heat emission as the molecular oscillation causing heating
spreads through the body of the heater (Ward, 1986).
Penetration of energy into a medium is dependent on the
intensity of the source of IR, the wavelength and consequent
frequency of the wave, the angle at which the ray hits the
surface and the coefficient of absorption of the material
(Lehmann et a/, 1982; Ward, 1986; Kahn, 1987). Skin is a
complex material and consequently its reflective and
absorption characteristics are not uniform; these depend
primarily on the blood supply t o the area and skin pigmenta-
tion (Moss et a/, 1989). Jacques et a/ (1955) determined
reflection curves for human skin and noted that maximum
reflectivity occurs between 0.7 and 1.2 pm, the range of
many therapeutic lamps.
The depth of penetration of IR into the skin varies with
its structure. Hardy (1956) points out that short wavelengths
are scattered more than long and that the differences are
minimised as the thickness of the skin increases. Penetration
therefore depends on both the absorption properties of the
constituents of the skin and the degree of scattering brought
about by the skin microstructure. Maximum penetration
occurs with wavelengths of 1.2 pm; the skin is virtually
opaque t o wavelengths of 2 pm and more (Moss etal, 1989).
Hardy (1956) showed that at least 5 0 % of radiations of 1.2
pm penetrated t o a depth of 0.8 mm, allowing interaction
249
w i t h capillaries and nerve endings. As the energy absorbed
decreases exponentially with depth (Ward, 1986) most
heating will occur superficially, though some will penetrate
t o a greater depth. IR was treated as a surface heating
modality by Selkins and Emery (1982) w h o found that
almost all energy was absorbed at a depth of 2.5 mm.
Harlen (1980) differentiated between different IR wavelengths,
demonstrating penetration depths of 0.1 m m for long wave-
lengths and up t o 3 mm for the shorter wavelengths.
It is possible t o calculate mathematically the amount
of heat received by a patient (Selkins and Emery, 1982;
Orenberg e t a / , 1986) or t o measure the heat developed in
the tissues using heat sensors of varying types (Westerhof
e t a / , 1987; Kramer, 1984; Moss eta/, 1989). It is however
normal clinical practice t o gauge the heat striking the surface
by the sensory report of the patient (Hyland and Kirkland,
1980; Ward, 1986). Both temperature and pain are sensed
in the skin and are not dependent on the rate of heating or
the internal thermal gradient (Moss et a/, 1989). Thermal
sensitivity t o IR radiation is a complex subject which was
further discussed by Stevens (1983).
The amount of energy received by the patient will be
governed by the intensity of the output of the lamp,
measured in watts, the distance of the lamp from the patient,
and the duration of the treatment (Michlovitz, 1986; Ward,
1986). Penetration is governed by the factors already
discussed.
Biological Effects of Infra-red
Lehmann and de Lateur (1982) claimed that 'skin and
subcutaneous tissues are selectively heated by infra-red' and
provided an extensive discussion and bibliography of much
of the literature prior t o 1980, on the biological effects of
the most commonly used forms of therapeutic heating. They
indicated a need for a temperature of between 40-45OC,
maintained for at least five minutes, t o achieve therapeutic
effects.
Moss e t a / (1989) stated that 'it is generally assumed' that
IR photons do not give rise t o photochemical effects. The
main physiological effects claimed for IR are therefore the
result of tissue heating, and are listed as altered metabolic
and circulatory effects, increased extensibility of collagen,
reduced pain and a reduction in muscle spasm (Lehmann and
de Lateur, 1982; Wells e t a/, 1988; Low and Reed, 1990).
Metabolic Changes
A n increase in temperature will result in an increase in the
metabolic activities in the superficial tissues due to the direct
effect of heat on chemical processes. These effects are well
documented in physiological texts (Ganong, 1989).
Circulatory Changes
Direct heating of skin tissue, such as that produced by IR,
results in increased circulation which is due t o vasodilation
of the skin vessels; this may be mediated through the
direct effect of heat on the vessels themselves or via
their vasomotor nerve supply (Clark and Edholm, 1985;
Ganong, 1989). Increased levels of certain metabolites in
the blood, the result of increased metabolic activity arising
from the increased temperatures, have a direct effect on
vessel walls, stimulating vasodilation (Ganong, 1989; Ward,
1986; Wells e t a / , 1988). Body core temperature and blood
pressure do not, however, rise significantly, even when
exposing the whole of one aspect of the body t o a source
of IR (Westerhof e t a / , 1987; Moss e t a / , 1989).
IR radiation has been shown t o cause an increase in blood
2 50
flow in the cutaneous circulation but not in the underlying
muscles (Crockford and Hellon, 1959; Millard, 1961; Wyper
and McNiven, 1976). Crockford and Hellon (1959)
demonstrated a gradual rise in temperature which occurred
during the first ten minutes of irradiation, the return to normal
taking an average of 3 5 minutes..
Both Crockford and Hellon (1959) and Kaidbey e t a / (1982)
reported a change in cutaneous blood flow in adjacent
tissues despite screening from irradiation. Kaidbey et a/
(1982) irradiated one half of the back w i t h IR, raising the
skin temperature by approximately 7 OC; the other side,
covered during exposure, exhibited a rise in temperature of
only 1.5-2.0°C. A n irregular flare extended for a distance
of 2-4 c m beyond the irradiated area.
Clark and Edholm (1985) found that heating the feet in
hot water resulted in an increase in blood flow at a distant
point, namely the forearm; Crockford and Hellon (1959)
looked for such a reflex dilation following irradiation of
the hand and arm w i t h IR rays but were unable to report a
similar response. All these writers together suggest that
the effects of IR are local; increased circulation, though
not totally limited to the irradiated area, does not extend
far in terms either of depth or of lateral spread.
Extensibility of Collagen
Much work has been carried out in the field of rheology,
or the study of the deformation and flow of materials, on
the behaviour of collagen under stress (van Brocklin and Ellis,
1965; Yamada, 1970; Shah e t a / , 1977; Woo e t a / , 1980;
Zernicke e t a / , 1984; Viidik, 1990a and many others). Most
work, including these papers, dealt w i t h the extensibility
of collagen in vitro and the loads leading to permanent
deformation and disruption; collagen from a variety of
different sites, b o t h animal and human, has been
investigated.
Both Lehmann and de Lateur (1982) and Low and Reed
(1990) stated that heat alters the behaviour of collagen and
may therefore be used prior t o applying passive stretch or
active exercise in order to facilitate the lengthening of scars
or contractures. A few papers describe the effect of an
increase in temperature on the behaviour of collagenous
materials under stress but this is a technically difficult area
t o investigate. Gersten (1955) showed an increase in the
extensibility of frog Achilles tendon as the result of heating
by ultrasound, using intensities of 1; 2 and 3 watts/cm2
respectively. Lehmann et a/ (1970) heated rat tail tendon
t o a temperature of 41-45OC, using a hot water bath. A t
these higher temperatures the viscous properties of tendon
appeared, leading t o a reduction in tensile strength. The
stress-strain relationship was altered; residual elongation
occurred following the application of a designated force at
temperatures of 45OC whereas no residual elongation
occurred at normal body temperatures. Warren et a/ (1971,
1976) also described alterations in the strength of rat tail
collagen associated w i t h heating, again using a water bath.
Rupture, following loading, occurred at similar levels of
stress in collagen'heated t o 45OC and in material tested
at normal body temperatures. A t 39OC, however, rupture
occurred at loads of 3 0 - 5 0 % of normal. This temperature
relates t o the transition phase of collagen.
All this information should be considered w i t h great care
by therapists evaluating the effects of stretch by either
passive or active means in vivo. It is important t o remember
that caution must be used when attempting t o extrapolate
from the experimental to clinical environments. The pressure
a therapist exerts on a joint will probably be in the region
Physiotherapy, April 1991, vol77, no 4
of about one-third of the force used in vitro t o produce
deformation (Viidik, 1990b). The stresses applied by the use
of active exercise will vary widely but are unlikely t o reach
experimental levels. The role played by reflexes, especially
when pain is present, and the behaviour of muscle under
stretch, must also be taken into account.
Therapists should therefore be very cautious in their claims
about the effects of heating on the extensibility of
collagenous tissues in vivo.
Neurological Effects
Melzack and Wall (1982) stated that 'despite widespread
use of heat t o relieve pain, we do not know why it works'.
They suggested t w o possible mechanisms of pain relief.
First, vasodilation 'must' bring cells and chemicals to the
area to assist healing and remove the breakdown products
of injury. Second, the pain gate control theory might indicate
that the transmission of thermal sensations may take
precedence over nociceptive impulses (Melzack and Wall,
1982). Heating of tissue generates impulses which could
have an inhibitory effect and close the pain gate. This
hypothesis would explain why heat at a distance from the
site may relieve pain but it should be noted that this view
is constantly being modified by new work.
Lehmann e t a / (1958) reported that when IR was applied
to the ulnar nerve region at the elbow, an analgesic effect
was noted distal to the point of application. Kramer (1984)
utilised IR as a control when evaluating the heating effect
of ultrasound in nerve conduction tests on normal subjects.
IR was applied to the distal humeral segment of the ulnar
nerve for long enough t o generate a rise in tissue temperature
of 0.8OC, the same temperature as produced by the
ultrasound. An increase in the post-treatment ulnar nerve
conduction velocity was found which was comparable w i t h
that produced by the ultrasound. The workers attributed this
velocity change t o the increase in temperature.
The studies of Halle e t a / (1981) and Currier and Kramer
(19821, again on human subjects, supported this work.
Though used as a control for work on ultrasound by these
workers, it seems that IR can cause an increase in the
conduction velocity of normal nerves in man. This could have
implications both in terms of motor and sensory conduction;
and increase in motor conduction can result in an increase
in speed of a reflex response and possibly the speed of
muscle contraction. Current theories suggest that an
increase in sensory conduction might influence sensory
responses via an increase in endorphins which could affect
the pain gate mechanism. There is however no firm evidence
for this view at present.
Most work involving the effects of heat on tissue describes
the pain produced by the increase in temperature rather than
the analgesic effects which may be produced at a slightly
lower temperature. One of the few papers in this area by
Kanui (1987) notes that the mechanisms involved in the
analgesic effect of heat are obscure; he evaluated the effect
of an undefined type of heat on chemically induced pain in
rats and found that temperatures of between 38-42OC
caused 'substantial analgesia'. In contrast, Kumazawa et a/
(1987) showed that the application of heat, resulting in a
temperature of between 34OC and 43OC, could cause heat
sensitisation and a corresponding hyperalgesia. These
contrary views are extremely important t o physiotherapy
practice and need further investigation. The present lack
of information makes it difficult to interpret the material
which is available.
Information about the physiological basis for the clinical
Physiotherapy, April 1991, vol 77, no 4
Ibservation that heat relieves muscle spasm is limited.
-ehmann and de Lateur (1982) indicated that heating tissue
:o therapeutic temperatures of between 4OoC and 45OC
.esulted in a reduction of spasm and suggested that this was
Jue t o a selective reduction in the firing of muscle spindle
secondary endings, backed by increased inhibition of Golgi
:endon organs. They also showed that stimulation of skin
n the neck region could result in increased muscle relaxation,
2ossibly through decreased gamma fibre activity, leading
to decreased spindle excitability. They suggested that this
atter mechanism could be the way in which IR acts, as it
ieats only superficial tissue. Both observations made by
the researchers may be correct but it is unlikely, in the
ight of more recent work in the area of neurology, that
the mechanisms suggested are acceptable.
Barbour e t a / (1986) conducted a subjective evaluation of
the efficacy of any form of 'heat' in the relief of pain and
interviewed 5 8 patients suffering from cancer. They found
that 6 8 % used heat in some form t o help control pain.
Despite the difficulties in establishing mechanisms it is
interesting t o note that patients regard heating as an
effective method of pain relief.
Cellular Effects
Kligman (1982) demonstrated in guinea pigs that
prolonged exposure (15 minutes, three times a week over
4 5 weeks) t o IR at an intensity of 12.45 J/cm2 giving rise
t o a skin temperature of about 4OoC, can result in an
increase in elastic fibres in the upper dermis and a large
increase in ground substance. This effect is increased when
the IR is combined w i t h ultraviolet light.
IR radiation may cause an alteration in the amino acid
composition of proteins which then appear t o become more
resistant t o heat. This effect means that thermal tolerance
develops and results in a reduction in the efficacy of
subsequent doses (Westerhof e t a / , 1987). This effect can
be overcome by allowing a gap of between 36 and 7 2 hours
t o elapse between treatments.
While normal cells are unaffected, the effects of mild
hyperthermia (41-45OC) on cancer cells can include the
inhibition of the synthesis of RNA, DNA and proteins
(Westerhof et a/, 1987). This can cause irreversible
structural damage t o cell membranes and the disruption
of organelles.
Efficacy
A number of authors have suggested that IR radiation can
be effective in a variety of clinical settings. Low and Reed
(1990), Kahn (1987) and Forster and Palastanga (1985)
suggested the use of IR for the reduction of pain and muscle
spasm, the acceleration of healing, the improvement of the
circulation and the reduction of oedema. Forster and
Palastange (1985) added t o this list the possible use of IR
as a counter t o excessive dosages of ultraviolet rays and Low
and Reed (1990) noted that IR can be used in the treatment
of certain skin conditions. Little evidence was provided by
the earlier of these writers in support of these suggestions;
Low and Reed (1990) attempted t o back their suggestions
from reported work but had difficulty as there is such a
scarcity of information.
Joint Stiffness
Joint stiffness encompasses a number of parameters such
as the behaviour of ligaments, which tend t o degenerate
w i t h immobilisation, and joint capsule and periarticular
251
structures, which tend t o stiffen with immobilisation and
fluid pressure. Very few papers report the results of heating
a stiff, living joint. Wright and Johns (1961) applied IR t o a
normal hand joint in vivo, producing a surface temperature
of 45OC. They measured a 2 0 % drop in joint stiffness at
45OC when compared with stiffness at a temperature of
33OC. This work was performed with only t w o subjects
and has not been replicated. They also demonstrated
that people suffering from rheumatoid arthritis and chronic
tophaceous gout exhibited increased stiffness, and
suggested that the work on the effects of heat on stiffness
in normal subjects would apply t o those with pathological
stiffening. It is, however, not possible t o extrapolate
from these results t o the general use of IR t o reduce joint
stiffness.
Psoriasis
Psoriatic lesions, though of uncertain origin, may result
from the activity of either epidermal keratinocytes or dermal
fibroblasts or both. Trials involving the use of hyperthermia
t o control psoriasis (Westerhof etal, 1987) were suggested
by work on thermal effects o n cancer cells. Twelve patients
w i t h psoriasis underwent total body exposure, 30 minutes
t o each side of the body for one month. A skin temperature
of 42OC was achieved and the vasomotor erythema resulting
persisted for half an hour. The authors claimed that 8 0 %
of these patients experienced remission, 3 0 % experiencing
a dramatic improvement.
Orenberg e t a / (1986) compared heat delivery systems for
the hyperthermic treatment of psoriasis. Ultrasound, hot
water and IR were examined. IR, with a centre wave length
of 10 pn, was positioned in order t o give a maximum surface
temperature of 44OC, decreasing t o 40.5OC at a depth of
3 mm. Peak temperatures were reached during the early
phase of treatment; this was followed by a slight fall. Heating
is required in the region of the plaque tissue, this being the
epidermis and upper dermis. Orenberg etal (1986) concluded
that 'IR systems provide adequate heating within a millimetre
of the skin surface . . . at deeper tissue levels high thermal
impedence plus heat loss . . . prevent achievement of
significant temperature elevations'. IR seems adequate t o
heat the desired tissues. This was borne out by Westerhof
e t a l (19871, whose work suggested that IR may be a useful
measure t o combat psoriasis, possibly in association w i t h
other treatment methods. Further work in this area needs
t o be done.
Skin Ulcers
Again this area is not well documented: Hyland and
Kirkland (1980) applied IR t o ulcers with the objective of
improving healing by dehydration, increasing the circulation
and the retardation of bacterial growth. The ulcers were
treated for 3 0 minutes, four times a day. Infra-red therapy
was most successful in ulcers of 5 m m or less in depth.
No use was made of a control group of patients in order t o
make a comparison and no indication is given of the time
for which the ulcers had been present in the patients prior
to irradiation. This work indicated that it might be possible
t o treat ulcers with IR radiation; further research in this
area should be undertaken t o establish its value both
inherently and in relation t o the many other methods
of treatment currently in use.
Infra-red Radiation and Ultraviolet Irradiation
Therapists have held a number of beliefs concerning the
interrelationship between IR and ultraviolet radiation (UVR).
Early, poorly quantified work by Hill and Eidenow (1923) and
252
Shattock and Waller (1929) appears to have given rise to the
Delief that the application of IR radiation prior t o UVR could
ncrease the absorption of the latter. Everett e t a / (1963) and
Montgomery (1973) mentioned a second belief held by
therapists, which is that the effects of UVR are diminished
DY the application of IR following the UVR treatment. There
s however little evidence t o support either of these beliefs,
though work such as that by Kligman (1982) on guinea pigs
did suggest that the t w o together might modify cellular
xtivity. Both Bain e t a / (1943) and Freeman and Knox (1964)
,eported that heat increased the incidence and development
>f UVR-induced tumours in mice, thus showing that IR
,rradiation does accelerate this effect of UVR.
Montgomery (1973), building on the earlier work of Everett
O t a/ (1963) and Freeman and Knox (19641, measured the
length of time required to produce a minimal erythema using
a number of conditions. These were UVR alone, either
preceding or following the UVR w i t h 2 5 minutes of IR or
Following the UVR treatment w i t h four minutes of IR. They
Found that the application of IR both before and after UVR
treatment could enhance the erythema. When applied before
the UVR treatment an increase in erythema always resulted;
when given after the UVR, IR enhanced as often as
diminished the erythema. Kaidbey etal (1982) also evaluated
the effect of applying IR t o the skin before, during and after
the use of UVR. They also noted the effect IR had on the
action of the phototoxic and photosensitising activities of
certain drugs. Results indicated that heating neither
enhanced the UVR erythema when given prior to or reduced
it when given after ultraviolet radiation. Heat had differing
effects on the activity of drugs depending on their nature.
Kaidbey e t a / (1982) drew attention to the large number of
variables involved in such a trial and pointed out that these
results may not hold if the variables are altered. These
authors gave full details of the parameters used.
Summary
These few papers on the effects of IR radiation in differing
situations span many years and cover a very varied spectrum
of interest, from ulcers and psoriasis t o effects upon other
radiations. Few trials into the clinical efficacy of IR appear
to have been conducted in the last twenty years.
The reports vary in the detail provided about dosage
parameters and methodology and it is not clear from any
of these trials h o w measured temperatures relate t o the
normal clinical practice of judging temperature by the
patients' verbal report and possibly the skin erythema,
though the theory behind this issue was touched upon by
Stevens (1983). Patient numbers varied from t w o (Wright
and Johns, 1961) t o 2 4 (Kaidbey e t a / , 1982); Everett e t a /
(1963) giving no figures. Lamps vary in their output and
the descriptions given often include only manufacturers'
descriptions of the machine, rarely including further details
of wavelength and output. No trials indicated that they used
randomised allocation of patients or the blind assessment
of the results, so that it is impossible to generalise from the
information given.
Doses were stated clearly in some trials (Kligman, 1982;
Orenberg et a/, 1986; Kaidbey et a/, 1987; Westerhof e t a / ,
19871, though not all. Most workers established tissue
temperatures using thermal sensors; some measured surface
skin temperature (Wright and Johns, 1961; !-!\$and and
Kirkland, 1980; Orenberg eta/, 1986; Westerhof eta/, 1987)
and others measured the subcutaneous temperatures
(Kramer, 1984; Orenberg eta/, 1986; Westerhof eta/, 1987).
Everett et a/ (1963) and Montgomery (1973) gave no
indication of temperatures achieved. Exposure times varied
physiotherapy, April 1991,vol 77,no 4
from a few minutes (Everett et a/, 1963) t o half an hour
(Hyland and Kirkland, 1980; Westerhof eta/, 1987) and the
distances between lamp and skin also varied considerably.
The trial by Kligman (1982) was performed on an animal
model and caution should therefore be exercised when
extrapolating to human subjects as the heating patterns
in a small animal may be very different from those in a
human body.
More studies and investigations are required which
employ rigorous experimental methods in order t o examine
the effect IR has on differing clinical conditions and the
stage at which any therapeutic intervention may be most
effective.
Hazards
Hyland and Kirkland (1980) described the effects of
excessive exposure to IR as being permanent pigmentation,
wheal formation, blistering and oedema. Moss et a/ (19891,
in their review, considered optical damage t o be the most
likely hazard, corneal burns resulting from far-IR and retinal
and lenticular injury from near-IR. These latter injuries are
normally associated with long-term irradiation. Skin damage
can occur at temperatures of 46-47OC; pain is usually
elicited at a temperature of 44.5 -t 1.3OC and should
therefore provide protection by evoking a response prior t o
burning (Hardy, 1951; Stevens, 1983).
Kligman (1982) demonstrated and discussed the damage
caused by prolonged exposure to IR, especially when
combined with ultraviolet. Epidermal hyperplasia and a large
increase in ground substance occurred in guinea pigs when
subjected t o prolonged irradiation ( 4 5 weeks, three times
a week) with IR alone. The writer suggested that space
heaters, IR reflector lamps in beauty salons and sunbathing
can all have these effects. Therapists might wish t o add t o
this list those patients having their o w n IR lamps for
self-treatment.
The Chartered Society of Physiotherapy has available a
document which provides information on the safe use of IR
therapy in the clinical environment which is based on the
knowledge available t o date.
Discussion and Conclusion
There are few recent papers which have evaluated the
clinical effects of IR, though IR lamps are still widely available
in physiotherapy departments and are still being bought (Ide
and Partridge, 1988; Ide 1989). It is essential that an
evaluation of this modality should take place, reflecting the
conditions and purposes for which it is at present used.
IR radiation has been shown t o increase the temperature
of superficial tissues, primarily the skin; it may facilitate reflex
relaxation of muscle, increase the extensibility of collagen,
relieve pain and increase cutaneous circulation. These
aspects need to be further examined t o evaluate their effects
on varying pathologies at differing stages in the disease
process. The underlying physiology must be considered
seriously and deductions made in the light of modern
theories. IR needs t o be compared with other methods of
heating tissues such as continuous and pulsed shortwave
diathermy, microwave, wax, hot packs and hot water soaks
in order t o find the most efficacious method in each
situation.
A number of questions need t o be addressed. Do the
physiological effects of heating occur more efficiently when
forms of heating other than IR are used? What are the
advantages and disadvantages of IR when compared w i t h
Physiotherapy, April 1991, vol 77, no 4
)ther types of heating? Does IR cause beneficial thermal
:hanges in collagen when applied to large joints? What effect
joes superficial vasodilitation have on different conditions?
Does IR cause reflex relaxation of muscle?
All these questions - and others - must be addressed
:o establish a sound physiological basis for the active choice
i f IR as the preferred treatment in identified conditions.
ACKNOWLEDGMENTS
We would like to thank the Department of Health for funding this
nork. Particular thanks also go to Dr C Gabriel, Department of
'hysics, King's College London, and Dr R Smith, Department of
'hysics, St Bartholomew's Hospital, London, for their invaluable
:omments along the way.
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Barbour, L A , McGuire, D B and Kirchhoff, K T (1986). 'Nonanalgesic
methods of pain control used by cancer patients', Oncology
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Clark, R P and Edholm, 0 G (1985). Man and his Thermal
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