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Heat, Cold & Paraffin

Use of Heat, Cold, Contrast Baths, Paraffin

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.



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