Superficial and Deep Heating

Modalities
Jeffrey Arboleda
Department of Rehabilitation Medicine
First Year Resident
What?
  Superficial heat - less than 1 cm deep
 Hot Moist Pack (HMP)
 Paraffin Wax Bath (PWB)
 Hydrotherapy
 Ultraviolet Radiation (UVR)
 Infrared Radiation (IRR)
What?  Laser Therapy

 Deep heat/ diathermy - as deep as 3 to 5 cm without heating

superficial tissues
 Ultrasound (UTZ)
 Shortwave Diathermy (SWD)
 Microwave Diathermy (MWD)
  increases local blood flow and circulation
Superficial Heat  analgesic effect
 relaxes skeletal muscles
Why?
 reduces pain
 reduce inflammation
 facilitate tissue healing
Superficial Heat

Who?
Superficial Heat

What?
When?
How?
HMP
most commonly used superficial
heat in institutions
15 to 20 minutes
not be allowed to lie on the packs
PWB
most commonly used in RA and OA
20 to 30 minutes
first layer is the highest on the body
segment and each successive layer
lower than the previous one
Hydrotherapy
excellent treatment for RA and OA
15 to 20 minutes
drain and clean immediately after a
patient with open or infected lesion
IRR
the only superficial heating choice
when the patient has skin defects
20 inches (50 cm) distance equals
20 minutes treatment time
-avoid touching the reflector
>warm moist towel on treated area
>clothing or dry towels on not
treated area.
-check every few minutes for
mottling
  Deep heat/ diathermy - as deep as 3 to 5 cm without heating
Deep Heat
superficial tissues
 Ultrasound (UTZ)
What?  Shortwave Diathermy (SWD)
 Microwave Diathermy (MWD)
UTZ

Why?
  the only type of diathermy that can be used in areas with surgical
metallic implants

UTZ

Who?
When?
How?

 5 to 10 minutes, continuous or pulsed, over area of approximately 25 cm2 (4

square inches) slowly in a circular or longitudinal manner for

 0.8 and 3 MHz (Low-frequency ultrasound has better penetration, and high-
frequency ultrasound generates more heat in the superficial area)

 duty cycle around 20% to 25% is a preferred form of ultrasound energy

  Pulsed SWD
 Heat reinforces acute inflammation, promoting further edema with
exacerbation of pain

 Continuous SWD
 Relieve pain and muscle spasm
SWD/MWD
 Resolve inflammation
 Reduce swelling
Why?
 Promote vasodilation
 Increase soft tissue extensibility and joint range of motion

 MWD
 Does not penetrate tissue as deeply as shortwave or ultra- sound,
and its penetration decreases with the increase of microwave
frequency
 Focusing ability becomes more difficult for low-frequency MWD,
resulting from a longer wavelength
  SWD: technique of choice when uniform elevation of temperature is
required in the deep tissues and inside joints.
 MWD: best for use in the area covered with low subcutaneous fat
content; thus tendons, muscles, and joints can be effectively heated.

SWD/MWD

Who?
When?
How?

 SWD: 20 to 30 minutes, 13.56 MHz (wavelength, 22 m), 27.12 MHz

(wavelength, 11 m), and 40.68 MHz (wavelength, 7.5 m)