Physical agent modalities (PAMs), such as use of heat and cold, are used in hand & upper extremity therapy to prepare tissues to receive the best benefit of the therapeutic activities that follow (mobility, strengthening, manual therapy techniques). PAMs help
Reduce swelling and inflammation
Reduce pain and muscle spasm
Decrease joint stiffness
Improve scar mobility
Enhance joint mobility and muscle performance
Promote tissue healing.
Heat & Paraffin
Heat & Paraffin application are often used in hand therapy to:
Warm-up tissues prior to exercise and activity
Reduce pain
Reduce stiffness
Increase circulation
Reduce muscle guarding
Use heat with great caution if you have sensation loss. Areas with loss of nerve function will burn easily and heal slowly.
How to Apply:
Hot packs
Use an electric hot pack or a gel packs that can be heated in a microwave
Apply for 10-15 minutes
Best for larger areas or bigger muscles
Paraffin
Paraffin machines can be purchased for home use
Dip the hand 3-10 times creating a "glove"
To lower the melting temperature of the paraffin, mineral oil is added to the wax. The oil is good for the scar as well as for dry hands.
Paraffin creates a deeper heat. It is best for use:
on scars
to coat joints that are stiff or sore due to injury or arthritis
Why it Works: Heat application creates an increase of temperature in the skin and underlying tissue causing vasodilation and increasing circulation as well as tissue elasticity. Heat can also elevate the pain threshhold (the lowest point at which the body recognized the pain stimulus) helping to control acute pain and muscle guarding.
Cold
Cold packs and ice massage are often used in hand therapy to:
Reduce swelling and inflammation
Reduce pain from:
Exercise
Activity
Re-injury
Use cold with great caution if you have sensation loss. You can cause a cold burn or frostbite easily in areas without normal nerve functioning.
How to Apply:
Cold packs
Use frozen gel packs
Apply for 10-15 minutes
Best for larger areas or bigger muscles
Ice Massage
Use an ice cube or freeze water in a paper or styrofoam cup and tear off the lip so the ice is exposed
Massage in circular motions
Massage for 4-5 minutes until the area goes numb
Best for smaller areas and more superficial injuries such as a tendinitis
Why it Works: Cold application creates a reduction of temperature in the skin and underlying tissue causing vasoconstriction and reducing metabolism resulting in a reduction of swelling. Cold can also elevate the pain threshhold (the lowest point at which the body recognized the pain stimulus) helping to control acute pain and muscle guarding.
Contrast Baths
Contrast baths use alternating hot and cold water soaks to:
Reduce pain
Reduce stiffness
Increase circulation
How to Apply: Contrast Baths
Fill one basin or tub with hot water and a second one with cold water
Soak the injured hand/arm in the warm water for 2 minutes, then switch to the cold water for 1 minute
Repeat for 4-5 cycles
Tends to work well for those recovering from wrist fractures who have stiffness and swelling
Why it Works: The cold water causes vasoconstriction while the hot water causes vasodilation. Alternating between the two creates a pumping action that reduces inflammation and swelling.