DR Isha Tajane - Superficial Heat (2021-2022) - 014122 - 230222 - 110118

Biophysics of Heat &
Superficial Heat Therapy
Dr. Isha Akulwar-Tajane (PT)

MPTh Neurosciences
PhD Scholar
Associate Professor
Dr. Isha Akulwar - Tajane
Thermotherapy
• Use of heat (or cold) for therapy

• Non-pharmacologic approach
• Very frequently used
• Induce physiological effects for therapeutic benefits
• Mainly for pain relief
• Preparatory treatment methods

Superficial heating agents/modalities
Superficial Main layers of the human skin
• only on the surface, not deep

• few millimeters within the skin
• the subcutaneous layer of fat
beneath the skin surface acts
as a thermal insulator and
inhibits heat transfer.

Heating • Heat applied externally to human body

• Increase the skin temperature within
the therapeutic range of 1040F to 1130F.

Agents / Modalities • Physical devices used to deliver

therapeutic heat

Learning objectives
1. Basic biophysics related to physical properties of matter
2. Basic biophysics related to heat
3. Physiology of temperature regulation
4. Physiological effects of superficial heat
5. Therapeutic effects of superficial heat
6. Indications of superficial heat therapy
7. Contraindications of superficial heat therapy
8. Enlist various superficial heat modalities
9. Describe every modality (with diagrams) and its application
10. Describe home remedies for application of superficial heat
Questions
1. Specific heat
2. Latent heat
3. Thermal regulation
4. Physiological effects of superficial heat
5. Indications /therapeutic uses of superficial heat
6. Contraindications of superficial heat
7. Dangers of superficial heat
8. Hydrocollator packs
9. Paraffin wax bath
10. Home remedies for superficial heat therapy

Biophysics of heat
1. Atom and molecules

2. States of matter
3. Latent heat
4. Specific heat
5. Transmission of heat
6. Physical effects of heat

• All matter is composed of atoms
• The Atom
- Has a central nucleus surrounded
by a cloud of electrons revolving in
definite orbits
- Electrically neutral

• The nucleus
- Central part of the atom
- Positively charged
- Made up of particles held
together by immensely strong
nuclear forces
- Most important particles –
Proton and Neutron

• The Proton
- A nuclear particle- comparatively large
- Positively charged
- Number of protons in the nucleus = Atomic number
• The Neutron
- A nuclear particle – mass almost equal to that of a proton
- Electrically neutral
- Number affects weight of an atom (atomic mass = protons + neutrons)
Isotopes (differing atomic masses)

-An atom of an element which contains the standard number of protons but non-
standard number of neutrons
• The Electron
- Particles revolving around the nucleus
- Arranged in definite energy shells or
orbits around the nucleus, called
principle quantum shells (seven)
- Negatively charged
- Very small – 1/1837of a proton’s mass
- Determine the chemical and physical
activity of the atom

States of Matter
 Three – Solid, Liquid and Gaseous
 Molecules of a substance are influenced by two forces
a) Cohesive force – attract the molecule to one another
b) Kinetic force (energy) – the force of movement of the molecule
 Solid State
- Cohesive force – strong, holds molecules in a rigid lattice
formation, shape of the mass remains constant
- Kinetic energy – only vibration of the molecules about a mean
position
• More energy (e.g. heat) added to the solid – kinetic energy
increases – movement of the molecules increases – collapse of the
rigid structure – Liquid state is reached
• Liquid state
- The molecules are in contact but can move freely past one another
- The liquid maintains its volume but takes the shape of its container

Even more heat is applied – kinetic energy > cohesive force,
molecules fly apart to form a Gas
• Gaseous state
- Molecule continually collide with one another and with the
wall of the container so that gas exerts pressure
(pressure increases with any further rise in temperature)

Specific heat Substance Specific heat
1 Water 4.185
• Amount of heat needed to raise the
temperature of 1 gm of water through 10C 2 Air 1.01
• Unit : kJ/kg/0C 3 Paraffin wax 2.7
4 Whole human 3.56
body
• Water much greater specific heat =
hot water stores much heat/unit mass 5 Skin 3.77
6 Muscle 3.75
• Determines the thermal conductivity 7 Whole blood 3.64
(how much heat is transferred to patient’s
8 Fat 2.3
skin, how quickly heat is lost)
9 Bone 1.59
Latent Heat
“The specific amount of energy required for (or released by) a change of state”
As matter changes from

A state of low kinetic energy a state of high kinetic energy
Heat is absorbed
A state of high kinetic energy a state of low kinetic energy
Heat is released
e.g. 1 gm of ice at 00 C 1 gm of water at 00 C

336 joules of energy (latent heat of fusion)
1 gm of water at 1000 C 1 gm of steam at 1000 C
2268 joules of energy (latent heat of vaporization)
Transmission of Heat
• Heat flow occurs when two objects at different temperatures

are in contact with each other.
• According to the second law of thermodynamics,

the heat transfer always takes place from high temperature
to low temperature spontaneously.
• Heat flows from the warmer to the cooler object until they
are both at the same temperature.

Transmission of Heat
3 modes of heat transfer

1. Conduction (thermal conductivity)
• In a solid (since the molecules are closer together)

• One end of a solid metal rod is heated – added energy causes an
increased vibration of molecules – vibration transmitted to adjacent
molecules – heat is conducted from the areas of high temperature to
areas of lower temperature
Good conductors = metals
Non-conductors = wood, some plastics

2. Convection (forced or thermal)
• In a liquid or a gas
• One part of a fluid is heated – kinetic energy of the
molecules in that part is increased – these molecules move
further apart – this part becomes less dense – this part rises
displacing the more dense fluid above, which descends to
take its place
• The currents so produced – convection currents

3. Radiation
• The emission of electromagnetic waves from all matter that

has a temperature greater than absolute zero.
• Heating of certain atoms causes an electron to move to a
higher – energy shell; as it returns to its normal shell, energy
is released as a pulse of infra-red electromagnetic energy
• Conversion of heat energy into an electromagnetic radiation

Examples
Mode of heat transfer Superficial heat modality

(primary mode)
Conduction Hot pack, paraffin wax bath
Convection Fluidotherapy, hydrotherapy, moist air
Radiation Infra red, UVR

Insulation
Heat transfer can be controlled and prevented by insulation

so that it doesn't transfer to the environment.
The purpose of insulation is to prevent heat transfer from a higher
temperature to a lower temperature.
All the ways of heat transfer should be taken into account when
designing the insulation.

Physical Effects of Heat (Effects on matter)
1. Rise in temperature (specific heat)
2. Expansion – increase in volume
molecules move apart as a result of increased kinetic energy
producing a greater vibration of molecules
3. Increase in pressure – if the volume is restricted
4. Change of physical state (solid- liquid- gas, latent heat)
5. Acceleration of chemical reaction – any chemical reaction
capable of being accelerated is accelerated by a rise in
temperature (van’t Hoff law)

6. Reduced viscosity of fluids
- Heating increases kinetic motion of the molecules
- reduces cohesive mutual attraction
7. Production of a potential difference (Seebeck effect)
If the junction of two dissimilar metals, e.g. bismuth and
antimony, is heated, a potential difference is produced
between their free ends (the thermocouple principle)
8. Production of electromagnetic radiation = Heating of certain

atoms causes an electron to move to a higher – energy shell; as
it returns to its normal shell, energy is released as a pulse of
infra-red electromagnetic energy
9. Thermionic emission
Heating of molecules of some materials, e.g. tungsten
Molecular agitation – some electrons leave their atoms &
break free of the surface of the metal
Leaves a positive charge which tends to attract the negative
electrons back
Rate of loss of electrons = rate of return
A cloud of electrons exists as a space charge around the object
This process = thermionic emission
Principle of electric valves

Physiological effects of heat
= effects on the human body

Body temperature
• Humans are homeothermic with respect to their core

temperature.
• Core temperature = temperature of the deeply placed structures,

dependent on a balance b/w heat loss & gain
• Body surface- skin & subcutaneous tissue temperature are
variable, heat exchange with the environment
• Temperature gradient= temperature reduces from the core

towards periphery, low thermal conductivity of the tissues
(subcutaneous fat acting as a thermal barrier)
Thermal regulation
• Purpose = To protect the body from thermal damage

(and the physical and chemical damage associated with it)
• Body temperature
• Cutaneous receptors
• Temperature regulating centers in the brain
• Mechanisms

Cutaneous thermoreceptors
• Receptors in the skin

• Heat receptors < (eight times more) cold receptors
• Signal temperature sensation and contribute to the
control of body temperature

Temperature-regulating center in the brain
• Heat sensitive neurons in anterior hypothalamus are

affected by blood temperature.
• Posterior hypothalamus receives signals from peripheral
receptors.
Thermal regulation
Physiological Behavioral
Controlled by Controlled by higher

Hypothalamus centers in the brain
Different Behavior of the

physiological person
systems
Physiological
• Metabolic control
• Vasomotor control - blood flow to the skin is varied
• Sweating - evaporation from the skin is varied
Behavioral
• Avoidance of metabolic activity, muscle activity; inactivity
• Insulation of body surface varied - clothes, shelter
• Avoiding environmental heat
Causes of heat gain Causes of heat loss
1 Basal metabolism Evaporation of sweat from the skin, water
vapor carried away by perspiration
2 Metabolism of muscle contraction Excretion of urine, feces & other fluids
3 Metabolism of other tissues Exhaled warm air-forced convection

e.g. digestion
4 Conduction from hotter objects Conduction to cooler objects, air
5 Absorption of radiation from the Radiation to the environment

environment

Dr. Isha Akulwar -
Tajane
Core temperature depends on the heat balance
Heat gain
Heat loss

Physiological effects
Local, General or Remote effects
Extent depends on:

a. Size of the area (body part) heated
b. Temperature applied
c. Duration of heating
d. Method of application

• Local effects take place in the same region which is directly heated
• Remote effects are seen in that region which is not directly heated.
e.g. effects seen in left upper limb after application of heat to right
upper limb

Generalized effects are
those physiological effects which are produced on the whole body
(though the heat application could have been only to limited body region)
Usually occur due to application of heat to -

1) larger body areas;
2) central body regions such as trunk or shoulder or hip;
3) for a longer time;
4) at higher temperatures
e.g. = generalized vasodilation, fall in blood pressure, generalized sweating, etc.
The purpose is *thermoregulation* = to maintain the core temperature constant

and to *protect the body from thermal damage*
Physiological change
1. What’s the change?

2. How is it assessed?
3. Good or not good
a) If Good- how’s it used therapeutically?
Therapeutic Effect and Indications
b) If not good- can it be avoided (precautions)?
or is it a contraindication?
What’s the underlying Physiological change responsible for

producing a therapeutic effect?

• What’s the change? = Increased metabolic rate
• Good/Bad?
√ Good for non-healing or slowly healing injuries, wounds, etc.

How? By improving healing, repair mechanisms (also by improving
circulation, thus supplying more oxygen, nutrients, etc.)
X Bad for cancerous tissues, infection, during fever, acute injuries,

etc.

Physiological effects of heat (effects on body)
Heating the tissues results in rise in temperature

a. Temperature dependent physical & chemical changes
– as in metabolic rate, viscosity, collagen tissue
extensibility
b. Changes related to physiological regulation ,

developed to protect the body from damage- as in
vascular & nervous systems = circulatory & neural
effects
Physical and Chemical changes
• Rise in tissue temperatures
• Metabolic rate – increased (van’t Hoff’s law)
• Fluids- viscosity is reduced, circulation is increased
• Collagen tissue structures - increased extensibility
• Sweat glands- increased sweating
Circulatory changes
• Blood vessels- Vasodilation- cutaneous, generalized
• Lymph vessels= other tissue fluids
Neural changes Effect on receptors, nerves, brain

• Thermoregulatory mechanism- generalized, local
• Analgesic effect= pain-gate mechanism and endorphin release mechanism

a.1. Rise in temperature –
- Marked and rapid rise in skin temperature followed by slight and slow
rise in deep tissue (subcutaneous tissue and muscle) temperature
- Amount of increase = balance between heat input and dispersion
- Local – body part treated

- Generalized- only with treatment involving whole body, heating is
extensive and prolonged
- Normally, no rise in core temperature

a.2. Metabolic activity-
In accordance with Van’t Hoff’s Law,

metabolic rate raised by heating (about 13% per 10C)
- Increased demand for oxygen and food stuffs

- Increased output of waste products

a.3. Lowers the viscosity of fluids
In blood & lymph vessels; and in tissue spaces

Increases blood flow and fluid movement

a.4. Effect on Collagenous tissue
- Increased extensibility of collagen tissue

- Reduces joint stiffness

b.1. Blood vessel changes
- Cutaneous vasodilation – erythema of the skin

- In capillaries, arterioles and venules
- Immediate
- Direct and reflex
- Also generalized vasodilatation
- To distribute additional heat around the body & to protect the
heated skin
- Increased flow of blood supplying oxygen & nutritive material;
and removing waste products
b.2. Blood and tissue fluid-
- Reduced viscosity of blood

- Rise in capillary blood pressure and flow
- Increase in fluid exchange across capillary walls & cell membranes
- Acidity of blood rises (pH falls), (due to increased metabolism-

release of CO2 & lactic acid)
- Increase in paO2 and paCO2
- Increase in lymph formation
- Increase in blood leucocytes count
Changes in the capillary circulation-
vasodilatation,
increased in capillary blood pressure,
increased rate of fluid exchange across
Dr. Ishathe capillary
Akulwar - Tajane walls & cell membranes
c.1. Effect on nerves –
Stimulation of sensory receptors (thermal receptors) & afferent

nerves
1. Heat regulating centers –control of body temperature
2. Analgesic effect by acting on the pain gate control
mechanism as a counterirritant or through the action of
endorphins
3. Reduction of muscle spasm – secondary afferent
muscle spindle nerve endings and Golgi tendon endings

c. 2. Increased activity of sweat glands
• Sensory nerve endings - Reflex stimulation of the

sweat glands in the area exposed to heat
• Thermoregulatory centres- generalized sweating

• b.6. Fall in blood pressure –
due to generalized vasodilatation (peripheral

resistance is reduced),
also due to reduction in viscosity of the blood

Therapeutic uses of heat (Indications)
1. Pain relief & sedation
2. Reduction of muscle spasm
3. Increase of range of motion
4. Reduction of joint stiffness
5. Lengthening scar tissue or contractures
6. Reduction of edema of the extremities
7. Acceleration of healing
8. Control of infection
9. Prevention of pressure sores
10. As a precursor of other treatment
Pain relief for various musculoskeletal • Vascular
conditions, relief from muscle spasm • Nervous
As an adjunct to Stretching, • Physical and Chemical

ROM exercises • Pain relief (Vascular + Nervous)
Reduction in edema of the • Vascular (blood flow, lymphatic flow,

extremities venous return)
Acceleration of healing of tissue injuries, • Chemical

wounds in chronic stage • Vascular

Therapeutic effect - 1.Relief of pain
Physiological effects responsible for this effect:
• Sensory nerve stimulation:

- pain gate mechanism,
- increased levels of endorphins
• Vascular changes
- increased blood flow ‘wash out’ pain provoking metabolites
(prostaglandins and bradykinin) and brings more nutrients
Nervous Vascular Pain
system system relief
Sensory receptors Pain gate mechanism (SC);

(skin, muscles), nerves, Endorphins & encephalin Pain relief
spinal cord, brain release (MB)
Vasodilatation Wash out of chemical Bring more

Pain relief
metabolites nutrients

Pain gate mechanism
• Afferent input via the posterior root of the spinal cord

• Through synapses in the substantia gelatinosa and nucleus
proprius of the posterior horn
• This level – gate
• Pain gate = closed or open for pain
• Small diameter fibers – get stimulated by pain stimulus
• Large diameter fibers – get stimulated by thermal or mechanical
stimulus
• Preference to impulses from large diameter fibres
• Stimulation of large diameter fibres – results in pain suppression

Pain suppression through endogenous opiates
• Spinal cord – brainstem – cerebral cortex

• Periaqueductal grey matter & raphe nucleus in the midbrain- descending
pain suppression system
• Their neurons release an endogenous opiate substance into the substantia
gelatinosa at the spinal cord level
• Endogenous opiate- beta endorphin or enkephalin
• Causes inhibition of transmission of the pain impulses
• Counterirritant effect- (cryotherapy)

Therapeutic effect 2. Reduction of muscle spasm
1. Stimulation of secondary afferent muscle spindle

nerve endings & Golgi tendon organs
2. Increased blood flow bring more nutrients; and
wash out pain provoking metabolites
3. Reduction in pain

Therapeutic effects –
3. Increase in range of motion
4. Reducing joint stiffness
5. Lengthening scar tissue or contractures
As an adjunct to stretching and ROM exercises
Physiological effects responsible for these effects:
Collagen tissue Viscosity of

fluids Pain relief
• Increased • Relief of spasm &

• Reduced
extensibility tissue pain
• Better • Greater tolerance
stretching to stretching

Scar Contracture

Therapeutic effect- 6. Reduction of edema of the extremities
• Vasodilation allows increased rates of fluid exchange, increased

absorption of the exudate
• Precaution- part should be treated in elevation

• To be more effective, heat therapy should be coupled with
active exercises, and should encompass the whole swollen
region

Therapeutic effect- 7. Acceleration of healing
• Physiological effects responsible for this effect:
1. Increased metabolic rate

2. Increased cellular activity
3. Increased local blood flow
4. Increased phagocytosis
• Conditions- chronic and post-traumatic conditions-

arthroses, soft tissue lesions, post-surgical healing

Therapeutic effect - 8. Control of infection
1. Heat enhances natural defense mechanisms e.g.

surface drying diminishes bacterial colonization
• Precautions- dry form of heat is used, not moist

heat, non-contact (with modality)
• Conditions- surface infections e.g. chronic
paronychia, fungal infection

Therapeutic effect - 9. Prevention of pressure sores
1. Increased blood flow decreases the risk of skin

breakdown
NB: Heat therapy is given prior to

development of pressure sores
not once it develops

Therapeutic effect -10. As a precursor of other treatment
1. Pain relief
2. Muscle relaxation
3. Muscle warm-up
• Prior to muscle stretching, joint mobilization, massage,

traction, exercises

Contraindications x
1. Defective arterial blood supply, such as peripheral vascular disorders, cardiac

conditions, etc.
2. Defective venous blood circulation, e.g. deep vein thrombosis, varicose veins
3. Impaired skin sensation such as in neurological conditions, e.g. diabetic
neuropathy
4. Hemorrhage, acute injuries
5. Open wounds
6. Allergic rash
7. Skin conditions, e.g. acute dermatitis
8. Fever
9. Infections
10. Tumors
Dangers
1. Tissue damage – (thermal) burns

Permanent skin damage or loss
due to permanent damage to proteins in the skin cells –
protein denaturation
- Relationship between time, temperature and resulting damage

- Temperature above 450C
2. Fall in blood pressure - faintness

Basic guidelines for Application
• Safe - Avoid adverse effects and dangers
• Effective - in achieving the desired therapeutic effects
Basic tools • Test tubes

required for • Thermometer
application • Apparatus

Basic guidelines
1. Assessment of the patient

2. Preparation of the apparatus
3. Preparation of the patient
4. Instructions and warnings before treatment commences
5. Monitoring the treatment
6. Re-assessment of the patient at the termination of
treatment, instructions to the patient

❑ Assessment of the patient
• Specific examination of the body part to be treated
1. for possible dangers & contraindications

(test for normal circulation, thermal sensation,
presence of wounds, metal implants, etc.)
2. to decide about the therapy- which modality, which

method of application, any modifications required, etc.

Assessment of the patient
1. History- medical conditions, addictions, allergy, etc.

2. Medical reports
3. Clinical Examination
I. Observation- wounds, pale skin, varicose veins, edema, etc.
II. Palpation- temperature of the skin, peripheral pulsations, edema
III. Testing thermal sensation
IV. Musculoskeletal examination-
Pain =location/type/severity/duration; spasm, range of motion

❑Testing thermal sensation
1. Necessary in the safe application of heat treatment

2. Two test tubes of water
3. Temperature of hot water is 40-450C &
cold water is at 15-200C
4. Apply randomly to the part to be treated, compare with
other body parts having normal sensation
5. Ask the patient to identify which is which, with the eyes shut
# Temperatures above 450C or below 150C are not used because

they may test PAIN sensation rather than thermal sensation
Peripheral pulsations

Varicose veins = contraindication
to heat therapy
-Tortuous, swollen, twisted veins that lie just under the

skin; and usually occur in the legs.
- Caused by weak or damaged vein walls & valves.
- Ineffective in draining blood back to the main circulation
- Results in edema, especially in dependent positioning
Observation
• Open wounds
• Skin condition: color- pale; fragile; any
signs of infection

• Explanation to the patient
1) Treatment (type, duration, effects)
2) Appropriate clothing- expose, if no then cotton clothes;

remove/loosen any restrictive/tight clothing (as this will affect
the circulation)
3) Type of sensation to be experienced (mild warmth)
4) Patient is warned of any effects to be reported during and after

the treatment (e.g. excessive heat or less than adequate heat)
• Preparation of the part to be treated
1) Part to be treated is suitably exposed

2) Remove metal accessories (e.g. rings, bangles, wrist watch, necklace, waist belt, coins from
pocket/wallet, anklet, toe rings, etc.)
3) Part is washed, cleaned and thoroughly dried
4) Position the part comfortably & appropriately, so that patient is relaxed &
unnecessary movement is avoided
5) Position the part in elevation in cases of edema
One purpose of exposing is to have optimum heat transfer from the modality to patient’s skin
(layer of clothing will reduce the heat transfer).
Another important reason why we should expose the part is to observe the effects of heat
directly. If the part remains covered with the clothes, then therapist can not observe the skin
color change or burns etc.
❑Preparation of the apparatus
1. All the apparatus & equipment needed are assembled & suitably positioned
2. Visual checks are made of switches, controls, dials, indicator lights, cables,
plugs, power outlets
3. Any necessary testing prior to the application & setting up the apparatus to
ensure optimum therapeutic effects & safety
4. Strict check & control of temperature

❑Precautions to be taken by the therapist for himself/herself
• The therapist should minimize his/her own exposure to the effects of

modality being used.
e.g. use tongs to remove hot packs from the tank,

use of rubber gloves during PWB application

❑ Instructions & warnings before the treatment commences
1) Instruct what the patient must & must not do,

e.g. keep still & not to touch the apparatus, do not fall asleep,
do not use mobile phone during treatment
2) Instruct if any exercise needs to be performed during application,

e.g. hand exercises in fluidotherapy, contrast bath
3) Give essential warnings,

e.g. ‘if this becomes more than a comfortable warmth, it can burn’

❑Monitoring the treatment
• The patient must be observed throughout to ensure that

treatment is progressing satisfactorily & without adverse
effects
• Effectiveness of the therapy should be ensured by checking the

modality, e.g. hot packs for temperature, change in placement
on patient’s body, etc.

❑At the termination of treatment
• The part treated is examined to ensure that the desired effects

have occurred & there are no adverse & unwanted effects
• Instruct the patient in what he/she must & must not do
• An accurate record of all the parameters of the treatment is

documented including region treated, technique, duration,
resultant effect, etc.

• Temperature tolerance varies with individual; and according to
the site and area covered
• In case of adverse events (dangers)
1. Burns- the damaged area should be cooled as quickly as

possible - ice/cold water, ointment
2. Fall in blood pressure- patient should be made to lie down,
check vital parameters- BP, pulse rate, etc., adequate water to
drink
3. Edema- part has to be elevated, exercises in elevation to drain
the fluid
Superficial heat
• Superficial heating = Heat from outside transferred to the skin
by conduction, convection (or radiation as in IR)
1. Heat applied to the skin, does not pass the thermal barrier (fat)
2. Effects= depends on thermal conductivity of body tissues

a) Superficial to fat layer-heating by conduction
b) Deep soft tissue heating= by blood flow (carrying hot blood)
• Heat transfer in the tissues occur by conduction and convection

1. Conduction- from source of heat to the patient’s skin
2. Main way of transfer of heat in the tissues is by forced
convection in the blood and lymph Dr. Isha Akulwar - Tajane
• Hot water Compare
• Heated sand a) Moist heat versus Dry heat
• Heated air b) Physical properties, especially specific
heat, thermal conductivity
• Molten wax c) Mode of heat transfer- e.g. direct
contact=conduction
e.g. Moist heat

1) moisture left on the skin-causes evaporation
2) steam- increases temperature of the hot packs, more heating effect
For every modality, describe (with

1. Design and construction
2. Application
3. Physiological effects (common to every heat modality +
specific to this particular modality)
4. Therapeutic uses and indications
5. Contraindications Dr. Isha Akulwar - Tajane
Basic components of the apparatus
1. Controls
2. Thermostat = thermo (heat) + stat (constant)
Maintains the temperature at the set level
Most important component
3. Indicators

Electric heating pads
• Heating is by conduction
• Electric resistance wire connected in suitable fabric & a set of resistances
provided in a controlled unit, so that pad can operate at various
temperatures
• Available in various sizes, varying from 30 x 30 cm to electric blankets
• Used for achieving muscle relaxation or for reducing muscle spasm prior
to other treatments
• Advantages :
1. Any body part can be treated
2. Easy & comfortable for the patient, can be used at home
3. Easily available in market
4. Portable, reusable

Hydro collator packs
• Heating is by conduction
• Hot moist packs (moist heat)
• Consists of silicate gel, such as bentonite, enclosed in a cotton fabric
container
• Property of silicate gel-
1) Hydrophilic= absorbs a large quantity of water which, if it is hot,
provides a considerable source of heat energy
2) Low thermal conductivity as compared to water-thus provides
prolonged heating
• Gel contained in a set of separated fabric pockets, like a duvet, so that
the whole pack is made flexible & the gel confined
• Available in various sizes to fit different body areas
Available in various sizes and shapes to suit different body regions

Advantage of duvets
Duvets make the hot pack flexible so that

the hot pack can be adjusted as per the
body contours.
This is required for good contact of the hot

pack with the patient’s body.
Difference in the quality of hot packs
(repeated use, wear & tear)
Left Right
Torn, content may leak Content are more and
from it, not safe to use, well packed,
may lead to burns Dr. Isha Akulwar - Tajane
Quality of hot pack affects effectiveness of the therapy

Application
1. Preparation of patient
2. Preparation of apparatus
3. Hot packs are wrapped in toweling (terry towels) before
applying
4. 4-8 layers (depending on towel thickness) intervene
between the pack & the skin
5. Toweling provides thermal insulation – although the pack is
at about 750C, skin temperature < 420C

Heated by being
placed in a special tank
(Hydrocollator tank)
of water warmed to
75-800C
Water heated by an
electric heater,
controlled by a
thermostat

Dr. Isha
Akulwar -
Tajane Electric
supply
Lid
Tap
(Outlet)
75-800 C
Hot packs and accessories (macintosh, terry
towel, bedsheet) are assembled in advance.
A tong is used to remove hot pack from the

container. It has a wooden handle (non-
conductor of heat). Dr. Isha Akulwar - Tajane
Temperature of the hot water &
packs is checked.
Appropriate size & shape is

selected.
Pack is removed with a tong.
Hot pack is wrapped in a towel

(ideal =terry towel)
Ideal= 4 to 8 layers
Appropriate as per -
temperature of hot pack &
patient tolerance
Specific heat Substance Specific
heat
• Amount of heat needed to 1 Water 4.185
raise the temperature of
1 gm of water through 10C 2 Air 1.01
• Unit : kJ/kg/0C 3 Paraffin wax 2.7
4 Whole human 3.56
• Determines the thermal body
conductivity
5 Skin 3.77
• Water much greater
specific heat = hot water 6 Muscle 3.75
stores much heat/unit
7 Whole blood 3.64
mass
8 Fat 2.3
9 Bone 1.59
Importance of insulation, with towels
• Temperature of water- 75-800C

• Water – specific heat= high, good thermal conductivity, risk of
burns (scalds)
• The hot packs are at a high temperature and their *direct*

application can result in thermal burns
• Insulation- achieved with towels

• Terry towels- space in fibers, trap air,
air = less thermal conductivity,
thus insulation

Hot pack is
covered from
above with
macintosh (bad
conductor of
heat)
Hot pack is Purpose: To prevent heat loss from the

exposed hot packs to the environment, thus the
same hot pack retains the heat for a
longer time.

1. Duration of therapy= Packs are applied to the body part for
20-30 minutes, change the hot pack after 10 min.
2. It takes about 8 minutes for the skin temperature to reach its
maximum.
❖ Special considerations:
I. Check for thermal sensitivity
II. Packs take about 2 hours to become fully heated

Application for low back region Dr. Isha Akulwar - Tajane
Preferred – Prone Feet out of the plinth, Pillow under the abdomen
Arms comfortably placed, neck rotated to one side
Advantages:
• Ease of application,
• Uniform application
Disadvantages:
• Position uncomfortable
• Breathing difficulty (e.g. in
elderly)
Alternate - Supine Pillow under the knees, under the neck (thin, optional)
Advantage:
• Heat loss to the environment is
less < Prone
Disadvantages:
• Improper contact
• Inconvenient for the therapist
to apply & monitor
Hot pack for the entire back region
Appropriate hot pack (size and shape)
NB: The hot pack is always wrapped in towel.

It’s uncovered in the images for the purpose of
your understanding of its exact placement.
Hot pack for low back region

Hot pack for Hip region- anterolateral aspect 1
Hot pack for Hip region- anterolateral aspect 2

Application for upper back region
Preferred position = Prone
Alternate - Supine Pillow under the knees , under the neck (thin, optional)
Advantage:
• Heat loss to the environment
is less < Prone
Disadvantages:
• Improper contact
• Inconvenient for the therapist
to apply & monitor
Hot pack for cervical region (different shape)

Application for the cervical region
Preferred
position =
Sitting in a
chair
with forehead
resting on
hands with a
pillow in front
on a table

Application for the shoulder
Preferred – Supine
If edema is present- Hand is placed in

elevation with forearm supported

Supine lying
Hot pack for forearm & elbow region- anterior,

medial & lateral aspects
• Entire upper limb is

well supported
• Forearm & hand are
elevated
Application
forearm &
wrist
Supine lying
• Entire upper limb is

well supported
• Forearm & hand are
elevated
Application for the thigh
Application for the Anterior aspect

Supine lying – positioning similar to that for hip region, hot pack
is placed on the anterior aspect of thigh
Application for the Posterior aspect

Application for the knee
Preferred – Supine for antero-lateral aspect
Alternate - long sitting with back support
Preferred – Prone for posterior aspect

Hot pack for
knee –
anterior, medial
& lateral aspects
Supine lying
or
Long sitting with
back support A soft cushion to
Dr. Isha Akulwar - Tajane support the knee
Supine lying
or
Long sitting with
back support
Hot pack for ankle & foot region-

anterior, medial & lateral aspects

Hot pack for ankle & foot region – anterior, medial & lateral
aspects
Entire lower limb is elevated and well supported

Other packs used for heat therapy
1) Chemical heating packs
• Commercially prepared, disposable hot packs, supply dry
form of heat (warm dry heat)
• Striking or squeezing the pack releases chemicals that
create the heat
• These packs are designed to maintain a constant
temperature between 40.6-460C for 30 min to 1 hour
2) Kenny packs – a piece of absorbent lint or woolen material
soaked in almost boiling water, wrung out (using gloves) &
then applied to the skin at about 600C
3) Mud packs (peloids) – kaolin & peat
Inconvenient, used in past,
now replaced by cleaner & more convenient packs
Paraffin Wax Bath (PWB)
• Application of the molten paraffin wax directly on the body parts
• Mode of heat transfer = conduction
(after application to patient’s body, heat is released by molten
wax during its conversion to solid wax)

Special properties of wax
• The specific heat of paraffin wax =2.72 kJ/kg/0C, less than that
of water=4.2 kJ/kg/0C
• Low thermal conductivity – provides prolonged low heating
• The wax transmits heat energy to the tissues by giving up

energy as it solidifies – the latent heat of fusion- without any
temperature change
Net effect : remarkably effective low temperature heating

Water versus Wax
Sr. Substance Specific heat Temperature

No. (kJ/kg/0C)
1 Water 4.185 75-800C

*covered with towels
2 Paraffin wax 2.7 40-440C
Low specific heat of wax enhances the patient’s ability to tolerate

heat from the wax better than that from the water at the same
temperature.

PWB versus Hot water
• Water much greater specific heat = hot water stores much

heat/unit mass
• Paraffin wax and hot air store less heat than hot water
• Thus, advantages of PWB over hot water

1. Higher temperature can be used with wax
2. ‘Prolonged’ (as heat is released slowly by wax) low heating
can be achieved with wax
3. ‘Dip n leave in’ method can be used with wax but not with
water
4. Heat is not easily lost to the environment with wax

Self insulation
• There is a layer between the skin and the wax producing

sweating which does not evaporate.
• Thus, it gives moist heat.
• This can happen for all the methods of wax application except
‘dip and leave in’
(After removal the heated part cools quickly by evaporation)

Composition of the wax
• Wax: Paraffin: Mineral oil = 7:3:1

or
• Wax: Paraffin or mineral oil = 7:1
Addition of impurity [paraffin (liquid) or mineral oil] :
1) Melting point of wax is 540C (51-550C),

may cause burn
2) + To lower the melting point to 40-440C,

for safe application
3) This combination has low specific heat

• Wax is maintained molten in stainless steel or enameled baths which
are electrically heated
• Melted wax is at a temperature of 40-440C, maintained by a
thermostat
• Baths available in various sizes & shapes, can be adjusted for height
• Apparatus:
1. Stainless steel container heated by electric means
2. Heated by 3 electric coils
3. Controls for temperature and heat
4. Lid cover container
5. Casters allow the container to be moved from place to place

Solid wax is electrically heated Heat gained by the solid wax for
at 40-440C the conversion into liquid state =
Latent heat of fusion

Solid wax is
converted
into
liquid state

Arrangements to be made prior
to moving the patient to the
treatment area
Electric mains is switched off
Temperature of the wax is checked
The wax bath container is kept closed

with the lid till the patient is settled
for the treatment.
Suitable sitting arrangement is done

with appropriate height chair or stool
A non-skiddy disposable material is

placed on the floor (wax may fall on
the floor and make the floor slippery)
Accessories to apply wax: brush, tumbler, gauze bandage
Accessories to cover: plastic sheet, towel

Thermal Insulation
to prevent heat loss to the
environment
Wrapping in wax paper or
plastic, which is covered by
towels or insulated mitts.
Dr. Isha Akulwar -

Tajane
NB: Ideally body part is always covered with plastic sheet.
It’s shown exposed in this picture for your understanding.
PWB – mesh method, appearance some time after application
Disadvantage: During the therapy, as the wax solidifies, bandage

looses close contact with the patient’s skin and thus, effective
heat transfer does not take place, also the moisture is not
retained on patient’s skin.
Application time
• 20-30 minutes or till wax is solidified.

• Part is well supported, preferably in elevated position
• No movement is allowed
• If required, re-application of wax can be done after removal of
the first application, the entire procedure can be repeated.

Application of paraffin wax
• Heating is by conduction (direct contact method)
• Various methods of application depending on the body part to
be treated:
1. Dip and wrap
2. Dip and leave in
3. Brush (painting)
4. Direct pouring or Ladling
5. Bandaging (and brush)

1. ‘Dip and wrap’ method
• The part is immersed in the wax for a second or so (briefly,

otherwise outer coating is melted off and thickness of the wax
does not built up)
• Withdrawn
• Re-immersed after 2-3 seconds (allowed to cool)
• Repeated 6-12 times to produce a coating of wax 2-3 mm thick
over the part
• The part is then put into a plastic bag or paper cover and wrapped
in a blanket or towel – to limit the rate of loss of heat to the air
• The part is elevated above the level of the heart- to reduce edema
• Wax left in place for 15-20 minutes (wax –completely solid),

removed in 1 piece
• Advantages
Most widely used method because of
1. Ease of application
2. Uniform application
• Disadvantage:
1. Can only be used for the distal parts of extremities – hands,
wrists, feet and ankles
Can not be used for proximal parts
• Higher range of temperature for hand, lower for feet

2. ‘Dip and leave in’ method
• After a few succession of dips, the part is left in the wax bath for
15-20 minutes
• To achieve higher skin temperatures for longer periods
• Much greater increase in tissue temperature
• However, dependent positioning, can increase edema

Other methods- when part can not be immersed
3. Brushing the wax on using a large brush
4. Ladling- ladling wax over the part with a suitably large bowl placed
beneath, this method suitable for knees
• For immersion, patient could be apprehensive for application.

• More heat is felt in this technique & may not be tolerable at times.
• So for immersion technique, temperature could be kept in the
lower range (40,41 degree C )
• For bandaging method, higher side of the range (43,44C)
• Temperature of wax is in the range of 40-44 degree C. This range is
therapeutic range. Temperature in this range will produce the
therapeutic effects.

3. Brushing (painting) method
Coats of wax are applied

with a paint brush
using even and rapid
strokes
Suitable for the proximal body parts which can not be immersed,
or if patient is not comfortable for immersion method
5. Bandaging method
• Bandages of suitable size and mesh soaked in the hot wax
are wrapped around the limb
• Several layers can be made and/or additional wax is then
brushed over the bandage
• Preferably used for treating proximal body parts (which can
not be immersed)

PWB wrist/hand
positioning
• Sitting with feet supported on the ground

• Entire upper limb is supported
• Distalmost part in the same horizontal plane or elevated
• Back is supported Dr. Isha Akulwar - Tajane
PWB
ankle/foot
positioning
• Sitting in a chair
• Entire lower limb is well supported
• Distal most part in the same horizontal plane or elevated
• Other foot supported on the ground/foot stool Dr. Isha Akulwar - Tajane
Skill of application
• Uniform layers
• Properly cover from all the sides
• Should come out as a single piece
Care should be taken while removal

of the wax

Some wax sticking to the skin post-application
but the patient is not supposed to wash the part with water

❖ Precautions to be taken :
1. Prior to wax application, the part is washed and thoroughly
dried to prevent water being introduced into the wax bath.
2. Water should not be allowed to enter into the wax bath-
since water at this temperature can lead to burns
3. Wax should not be allowed to drop on the floor- since it
renders the floor slippery, any spillage must be promptly
dealt with
4. After use wax is cleaned in a purifier and reused
❖ Precautions for the therapist

• Use of gloves
• Hands not wet

❖ Dangers of PWB
1. Wax is highly inflammable, avoid overheating

• Precaution- fire blanket, carbon dioxide or foam extinguisher
should be available handy in the treatment area
• Container should be open while heating the wax (no lid)
2. Some patients may develop allergy to wax
3. Wax itself is sterile, however needs to be cleaned regularly or

replaced.

Bandage after removal (post treatment)
Disadvantages of bandage method-

1) Heat is absorbed by the bandage
(not entire heat gets transferred to the patient’s skin)
2) Some quantity of the wax is wasted Dr. Isha Akulwar - Tajane
Physiological effects of PWB
• Marked increase in the temperature of the skin

• Circulatory effects – stimulation of superficial capillaries &
arterioles, causing local hyperaemia & reflex vasodilatation
• Sensory nerves – sedative effect, (reduces pain and muscle spasm)
• Skin- moist and pliable, (soften adhesions & scars in the skin prior
to mobilizing & stretching procedures)

Special indication for PWB for its marked effect
on skin and other soft tissues and tissue
extensibility
Wax is a natural emollient, helping make skin

supple and soft. When applied, it adds moisture
and continues to boost the moisture levels of the
skin after the treatment is complete.
During application, due to rise in skin

Image of rheumatoid
temperature, a layer of sweat is produced on the
arthritis hand
skin. However, this sweat is not allowed to
evaporate (to the external environment) due to
the overlying wax layer, thus moisture is retained
making the skin pliable and soft

Home remedies
Purpose- to have therapeutic benefits of heat therapy at home with
application of simple and suitable methods by the patients themselves or
their caregivers after proper training
1. Preparation of the part (similar to as mentioned in basic guidelines)

2. Proper instructions – temperature, duration of application, frequency
of application, possible dangers due to inappropriate application
3. Proper positioning of the body part and proper application must be
taught to the patient & ensure that he/she has learnt the correct
technique of application
4. Inspection of the part prior to & after the application
5. Drink adequate amount of water before application as a precaution to
avoid fall in blood pressure, also how to get up after treatment if
treatment is taken in lying (supine/prone) position
6. Patient/caregiver education is an important part of home
remedies.
7. Suitability of the patients in terms of understanding the
purpose; proper method and dosage of application; risks;
dangers, etc. should be assured by the therapist prior to
prescribing home remedies.
8. Also, after training its should be assured that the patient has
learnt the correct method of application by making the
patient/caregiver practice in front of the therapist.
9. Immediate care in case of dangers should be carefully taught
to the patient/caregiver.

Home remedies
❖ Modalities (commercially available/prepared at home):
1) Electric heating pads

2) Hot water bottle
3) Hot water bag
4) Hot water bath
5) Hot mud
6) Hair dryer (dry heat)
7) For contrast bath- two containers- buckets
or Heating pad/hot wet towel and cold packs

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Biophysics of Heat &

Superficial Heat Therapy

Dr. Isha Akulwar-Tajane (PT)

• Use of heat (or cold) for therapy

Dr. Isha Akulwar - Tajane

Superficial Main layers of the human skin

• only on the surface, not deep

Dr. Isha Akulwar - Tajane

Heating • Heat applied externally to human body

Dr. Isha Akulwar - Tajane

Agents / Modalities • Physical devices used to deliver

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

1. Atom and molecules

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

Isotopes (differing atomic masses)

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

As matter changes from

e.g. 1 gm of ice at 00 C 1 gm of water at 00 C

• Heat flow occurs when two objects at different temperatures

• According to the second law of thermodynamics,

Dr. Isha Akulwar - Tajane

3 modes of heat transfer

Dr. Isha Akulwar - Tajane

• In a solid (since the molecules are closer together)

Good conductors = metals

Non-conductors = wood, some plastics

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

• The emission of electromagnetic waves from all matter that

Dr. Isha Akulwar - Tajane

Mode of heat transfer Superficial heat modality

Dr. Isha Akulwar - Tajane

Heat transfer can be controlled and prevented by insulation

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

8. Production of electromagnetic radiation = Heating of certain

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

• Humans are homeothermic with respect to their core

• Core temperature = temperature of the deeply placed structures,

• Temperature gradient= temperature reduces from the core

• Purpose = To protect the body from thermal damage

Dr. Isha Akulwar - Tajane

• Receptors in the skin

Dr. Isha Akulwar - Tajane

• Heat sensitive neurons in anterior hypothalamus are

Controlled by Controlled by higher

Different Behavior of the

3 Metabolism of other tissues Exhaled warm air-forced convection

5 Absorption of radiation from the Radiation to the environment

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

Local, General or Remote effects

Extent depends on:

Dr. Isha Akulwar - Tajane

Dr. Isha Akulwar - Tajane

Usually occur due to application of heat to -

e.g. = generalized vasodilation, fall in blood pressure, generalized sweating, etc.

The purpose is thermoregulation = to maintain the core temperature constant