Heat – Thermotherapy.

The therapeutic application of heat is known as thermotherapy. Tissue is heated at diredt

contact with heat-bearer (the substance, which is heated.)
Thermotherapy is one of the ancient and widespread methods of physiotherapy. First of
all they use a great amount of heart-bearer, offered by both traditional and nontraditional
medicine.
Thermotherapy leads to changes in metabolism. Metabolic rate increases by
approximately 10% for every 1°C increase in temperature of tissue. To attain medical efec it is
enough to increase tissue temperature on 4-5°C, but heat must be prolonged and heat-stream
must be stable and proportional. That is why heat-bearer must have specific physical affinities.
The best heating agents are with high specific heat. Specific heat is the amount of energy
required to raise the temperature of a given weight of a material (1 g) by a given number of
degrees (1°C). The higher the specific heat of material, the greater amount of heat will be given
to tissues. Another important characteristic of heating agent is heat-conduction, which influences
on the material ability to pass on the heat. Contract with heating agent leads to appearance of
heat stream in the tissue, its intensivity is measured in amount of heat going per time unit
through the square unit. The higher the heat-conduction is the more intensive the heat stream.
Because of medical effect doesn’t require a great heating of tissue the heating agent is closely
connected with heat-conduction. The less the heat-conduction is the longer the heat stream in
time. Convection is a heat transfer by circulation of a medium of a different temperature. For
example, heat transfer of water is achieved mainly by convection. In the physiotherapeutical
heating agent’s convective stream are very small or absent. When this heating contacts with
tissues it’s thin lay above the skin becomes cool. The main mass of heating agent passes on it’s
warmth through this cooling lay by means of heat-conduction. Because of low heat-conduction
of heating agent, the patient undergoes easily high temperature of heating agent.
So, the best heating agent is the substance with high specific heat, low heat-conduction
with minimal convection or its absence.
The main physiological reactions and medical effects of heat, the main indications and
contraindications were discussed in previous chapters. It should be mentioned, that the mains
effects of heat are the following: antispastic, analgetic, hemodynamic, metabolic. The
intensification of blood- and lymphocirculation leads to best regeneration, for example at
inflammative processes.
Thermotherapy is used mainly in local actions – applications. The procedure is dosed by
the temperature of heating agent and duration of action (30-60 min). The procedures may be
every day or about day. The amount of procedures is from 12 to 20 per treatment course.
The main indication for thermotherapy is:
1. Inflammative process (without purulence) in resolution stage.
2. Degenerative-dystrophic and inflammative diseases of musculo-sceletal system
3. Periferal nervous system diseases and traumas
4. Consequences of traumas (contusions, tendon strains) with aim of analgetic effect
5. Hypermotoric dyskynesias of internal organs
6. Spastic muscular contraction (before medical gymnastics).
The main contraindications:
1. Acute and subacute stages of inflammative processes, purulence, acute stages of
chronic diseases
2. Impaired thermal sensation of skin.
Therapeutical application of paraffin and ozokerite.
The paraffin is a mixture of hard high-molecular carbohydrogenes of methan line, and
has microcristallic structure. The paraffin is got by means of cultivation of some sorts of
petroleum. According to the degree of purification of paraffin there are three types of it: high
purificated, purificated and nonpurificated. The high-purificated and purificated paraffins are
used in treatment. They are mass of white color. The smelting temperature of different types of
the paraffin ranges in wide borders. In medicine the paraffins with smelting temperature 52-55°C
are used.
The paraffin has high specific heat, low heat-conduction and the convection is practically
absent.the main significance has its occult warmth of smelting – the amount of heat required to
transformation of paraffin from hard condition to fluid condition. During paraffin transformation
from fluid to hard condition the occult warmth of harding allots (it is equal to occult warmth of
smelting). During this transformation the temperature of applicated paraffin stays constant,
which gives stable heat stream for a long time.
The temperature of paraffin before medical procedure is about 95°C. The paraffinoheater
with electroheating device is used for this process.
The following methodics of paraffinotherapy are used:
1) Cuvet–applicative method. It is used enamel cuvet, which size is equal to the square
of applicated paraffin. Smelted paraffin is filled up cuvet with medical oilcloth. Still soft paraffin
is got out from the cuvet together with oilcloth, after that it is applicated on the appropriate body
region and is covered with blanket. This method is the simplest, and ma be used at home. The
cuvet may be need to the ward, so the procedure may be carried out outside of physiotherapeutic
cabinet.
2) Napkin-applicative method: smelted paraffin is applicated on the skin by means of
brush to the thickness of about 0,5 cm. After that on this layer of paraffin the gauze napkin is
applicated (this napkin is moistened in smelted paraffin). The gauze napkin is covered with
oilcloth, than with blanket.
3) Method of stratification. The smelted paraffin is applicated on the skin by means of
brush to the layer’s thickness of about 1-2 cm, than is covered with oilcloth and blanket.
4) Method of paraffin-bath is used to act on the wrist of foot, which are covered with
paraffin by means of method of stratification. Then wrist or foot is let down in special bath or
oilcloth packet with smelted paraffin, which is heated up to 60-65°C.
To prevent the burns it is necessary to watch for dryness of skin under the paraffin
application. Hair must be shaved or appropriate skin region, must be oiled with vaselin to avoid
their adhesion to got cool paraffin.
The mass of the paraffin is increases in volume on 10-15% during smelting. According
by the volume of paraffin is decreases during harding. Using circulation application of the
paraffin leads to excessive compression of the tissues. During compression it is transferred a
great amount of warmth, but at the same time this warmth is transported by blood to other organs
and tissues in smaller degree.
The same paraffin may be used for thermotherapy several times. Before the next using
the paraffin is sterilized by heating it to 110°C, and then the heating is stopped. Decreasing its
temperature to 100°C requires time, which is enough for its sterilization in room’s conditions.
For keeping an elastic ability of again used paraffin should be added. This procedure may be
repeated 3-4 times. After that the paraffin loses its elasticity, is hashed during cooling and must
not be used again.
Ozokerite. This term is translated as a mountain wax. It is a product of petroleum
extraction and mainly consists of a mixture of hard high-smelting carbohydrogenes of paraffin
line with fluid and gaseous carbohydrogenes of the same line. Ozokerite is a natural mountain
species. Its different birthplaces are differed from each other according to their chemical
composition, their color: light-green, yellow, brown, black. The ozokerite becomes darker during
prolonged keeping on the open air. To get the ozokerite it is necessary to vaporize the species or
to extract by means of organic substances. Then partial dispersion of mineral oils is carried out,
so the ozokerite becomes free from water, mechanic admixtures completely. After those
processes the ozokerite looks like a bee wax.
The smelting temperature of the ozokerite is from 52 to 68°C. Its specific heat is higher
and heat conduction is lower then those of the paraffin. The heat-keeping ability is greater thn it
of the paraffin. The heat convection is practically absent.
 The medical effect of ozokerite depends on not only its heat-bearer abilities, but also the
presence of bioactive substances in its composition, which can penetrate through the undamaged
skin. They have an acetylcholyneous effect, so increase the parasympathic tonus. It was said
about more active regeneration of peripheral nerves at their diseases and traumas treated by
ozokerite (in comparison to paraffin). It was referred to presence of folliculin-like substances in
ozokerite, which may be used in treatment of female sterility, connected with ovarian
hypoplasia.
Generally the methods of ozokerite treatment, the indications and contraindications are
the same as for paraffinotherapy.
Fangotherapy (mudtherapy, pelotherapy).
Medical mud or peloids are a natural substances, which consist of a water mineral and
organic substances and ointment-like consistency. According to their origin there six types of
mud:
1. Silt mud are a silt deflections of salt cisterns.
2. Sapropeles are a silt deflections of fresh cisterns.
3. Peat mud are an peat formations of the marshes
4. Clay silt are a mineralized sediments of cisterns with low presens of organic
substances and absens of ferrum sulfides.
5. Hill mud are a hemifluid clay formations, generated by means of destruction of
mountain species in gaso-petroleum regions.
6. Hydrothermal mud are a hemifluid clay formations, generated in regions of
volcanous activity.
There are three types of mud, which are most widespread in physiotherapy: silt mud,
sapropeles mud, peat mud. Each type of medical mud consists of three parts: a crystallic
skeleton, a colloid fraction and a mud solution.
Crystallic skeleton – is nonorganic rough0dispersive part of mud. It consists of smallest
particles of gravel, clay, magnium and calcium carbonates, phosphates, not soluble in the water.
It may have small amount of animal and plant remainders. The particles diameter is not more
than 0,25 mm. The large part of crystallic skeleton in medical mud explains it granularity,
crumblity, low plasticity, which is sometimes increased with water addition.
Colloid fraction – is a thin dispersive part of mud, which connect separate parts of
crystallic skeleton and fills all its interspaces. Colloid fraction consists of complex nonorganic
and organomineral substances, organic substances. Its main part is a colloid ferrum hydrosulfide.
It also has hydrates of oxide and acid of ferrum, hydrate of aluminum oxide, silicate acid and
other substances. The organic colloids are a plant and animal remainders; their main part consists
of guminic substances, nitrogenous substances, and organic acids. The important medical
significance is characteristically for antibiotics, biogenic stimulators, enzyme-like and hormone-
like substances. The colloid fraction influences on mud plasticity, on close application of mud to
skin, on bad washability by water. The physical affinities of mud like heating agent depend on a
colloid fraction.
Mud solution – is a fluid part of mud consisting of water, solved their mineral salts,
organic substances, gases. First of all it has natrium chloride and phosphate, magnium chloride,
phosphate, sulfate, H2S, methan, CO2. There are several microelements there: Fe, Zn, Co. The
quote of mud solution in medical mud depends on contents of colloids with hydrophilic
affinities. The mud solution mainly fits to chemical composition of water layer, covering mud
deflections. But the composition of this water layer is changeable; the composition of mud
solution is constant. The soluble bioactive substances present not only in the colloid fraction, but
also in the mud solution.
The separate elements of mud solution, extracted from medical mud, are used for
injections like a biogenes stimulators: FiBS, peloidodistillate, hummisolum, torfot.
The microflora plays the main role in destruction of the dead plants, and animals, which
take part in medical mud formation. The microorganisms compose about 2-6% of mud organic
mass. The putrefaction aerobes and anaerobes, sulfate reducing and butyro-acidic bacteria,
different types of fungi present here. The sulfate-reducing bacteria, which generate H2S, are of
great importance. H2S is connected with ferrum, generating hydrotroillitum – the mainest
component of silt mud. The pathogenic for human microflora is absent in the medical mud. The
microflora takes part in mud regeneration, i.e. in restoration its physico-chemical,
microbiological, sanitarian-biological indexis after medical application. Each type of mud can
regenerate in the appropriate conditions, but the durations of this process are different. For
example, the silt mud regenerates during 3-4 months, after that it may be used again.
The silt muds are formed in the bottom of open salt cisterns with the absence of streams.
According to localization of this cistern mud are divided on continental mud, lake-stream mud
(are generated in the cisterns, which are feed by underground mineral waters), seaside mud, sea
mud (bottom deflections in the sea bay, estuaries).
The natural evaporation of water leads to accumulation of nonorganic salt in the mud
solution. The amount of organic substances in this mud is not significant because of small
biomass of these cisterns. The silt mud has a great amount of ferrum sulfides, which make it dark
in color. It has a slight odor of H2S and NH3.This mud is very plastic because of great amount of
colloids.
Sapropeles muds are generated on the bottom of open fresh cisterns because of
decomposition of lowest animal a plant organisms. That is why the sapropeles consist of great
amount of organic colloids, which have a large hydrophility. These muds are differing from
others by a great amount of mud solution, and also have fluid consistency, what requires
sometimes their sedimentation before using. Because of the great amount of organic substances
in the sapropeles, a significant amount of bioactive components are generated there.
Peat muds are generated in marshes, where highest plants are decomposited at excessive
humidity and anaerobic conditions. The content of peat mud depends on water regime’s
character and peat-generating plant. The type of the peat mud depends on the degree of
mineralization of mud solution and sulfides presence. The most widespread peat is a fresh water
peat without sulfides. The rarest type is a mineralized strong acidic peat with a great amount of
ferrum salt and H2SO4 (sulfuric acid) and has an astringent and cauterizing effects. One of its
birthplaces is located near Sapozhok of Ryazan region. The peat mud has much cristallic fraction
and the little colloid fraction, so it has granularity and crumblity. Peats have many organic
substances, including huminic substances, which have a high biological activity.
Medical effect of mud therapy.
The action of medical mud on the body consists of thermal and chemical factors. Using a
general mud baths adds also a mechanic factor. The mud procedure shows local and general
reactions. The medical mud has high specific heat, low heat conduction, and heat convection is
practically absent. These affinities allow using the mud of a relative high temperature. But it is
demonstrated, that mud temperature about 30-40°C leads to most favorable changes in the
organism. The chemical and biologically active substances have a particular role in the medical
effect of mud. They penetrate through the undamaged skin and show their local and general
action. The application of heated mud improves they penetration through the skin.
The medical mud due to its adsorptive affinity cleans the skin, adsorbing products of
metabolism and bacteria. This improves an excretion and absorption of skin. The local skin
reactions are morphologically characterized by proliferation of malpighian layer and by
thickening of horny layer, by increasing of fibroblasts’ amount, of histiocytes and lymphocytes
increases in the skin. The excitability of skin receptors diminishes greatly after short increasing.
The degree of these changes is different on application of different types of mud. For example,
an acidic peat leads to more significant reactions than weakly alkaline silt mud.
The general effect is realized due to neuro-reflective and humoral mechanisms. The
chemical and thermal irritation of skin receptors leads to responsive reactions both in zone of an
appropriate segment and in other body’s parts and in central nervous system due to excitement’s
irradiation. The influence of the procedure on the hypothalamus activates a hormonal part of
reflective-humoral tract. The neurohormones of hypothalamus stimulate the hypophysis’ activity,
and hormones of hypophysis activate adrenal cortex and other endocrine glands. The absorbed
chemical and bioactive substances transfer into blood-stream and show a general effect. They
have the most prominent influence on inflammative processes. An activation of cellular
reactions, a stimulation of fibroblast’s activity help to damaged tissue reparation. The inhibition
of free-radicalis oxidation is observed.
That is why an antiinflamative effect may be observed after possible exacerbation. The
application of mud therapy is most expedient in stage of decreasing of inflammation and in
reparative period. The favorable effect of mud application is observed at dystrophic processes
with more active and less active phases.
So, the mud therapy shows antiinflammative, regenerative, analgetic actions. It increases
effect of anti-inflammatory drugs.
The reaction of organism on mudtherapy depends on its functional condition. The
different types of mud may be effective in different patients with the same diseases. The choice
of mud type and its optimal dosage for different diseases is actually today.
The technique and methods of mud therapy.
The medical mud is heated on the water bath or vapor-water bath before using. The
blankout is lied on the cough than it is covered by medical oilcloth, than – linen sheet. The mud
mass of appropriate temperature is laid on the sheet. The patient lies down on the mud
application. An appropriate part of body is covered with mud and after that – with three layers of
tissue. The nurse looks after the patient during the procedure, registrates his pulse and breathing.
After procedure the patient is discovered, the mud is removed by means of hands and he is
washed with shower-bath of temperature 36-37°C without soap. The patient dresses himself and
has a rest in special room during 30-40 min.
The procedure duration is 15-20 min, may be 30 min.
The procedures may be every day or about day, with two active day and one day of rest.
The treatment course consists of 12-18 procedures.
The mud application may be general and local. General applications are rare used
nowadays; they are indicated at much generalized processes. In such case the mud is laid on the
whole body, except head and heart area with the thickness of layer is about 2-3 cm.
The local applications is applicated on the part of the body: on wrist area – “gloves”, feet
and shin area – “sock”, “boot”, pelvic area and superior parts of hips – “shorts”, pelvis and lower
extremities – “trousers”, pelvis and one leg – “hemitrousers”, thoracic cage and arms – “jacket”,
thoracic café and one arm – “hemijacked”, abdomen region or internal organs projection –gaster,
liver, intestine; on cervico-collar region.
There are following methods of action on certain part of the body:
- Local (focal) – an application is laid on damaged region;
- Parafocal – they act on the neighbor region to avoid a deterioration of the
pathological process;
- Segmento-reflective – an application is laid on the zone of appropriate
spinocerebral segment projection (for example, the action on the cervical-collar region at
encephalitis, arachnoiditis);
- Repercussive action depends on methameric reflex, which includes
reflective changes in one segment’s region on the contralateral side. For example, the
application is laid on the left leg at the right leg pathological process;
- Combinative action on the pathological region and segmentary reflex
zone. For example, to treat the gaster the mud applications are laid on the epigastric region
and back near 7-10th thoracic vertebrae.
At local applications the thickness of mud layer is about 4-6 cm for silt mud and 6-8 cm
for peat mud. The intracavitary mudtherapy is also used as vaginal and rectal mud tampons. In
these cases the mud is cleaned from mechanic admixtures due to the fraction through the sieve or
gauze.
 The main indications and contraindications are the same that for using other
thermotherapeutic procedures. The effectivity of mudtherapy connects with combination of
thermal and chemical factors. In some cases the action of chemical and bioactive substances is
more significant. This affinity is special for medical mud among other heating agents. The
mudtherapy is a type of thermotherapy traditionally, but at the same time it is a special type of
physiotherapy.
It is necessary to add some other indications to usual indications for using thermal agents:
- Diseases and traumas consequences of central nervous system (consequences of
injuies, contusions, of encephalitis and myelitis, arachnoiditis, poliomyelitis, disseminated
sclerosis), action on the cervico-collar zone;
- Causalgia – the pain in extremities as a consequences of wounds;
- Vibration disease (using of mud “gloves”, “collars”);
- Sclerodermia in nonactive stage;
- Diseases of gastrointestinal tract in subacute and chronic stages: gastric and duodenal
ulcers, chronic gastritis, chronic colitis, chronic cholecystitis and others;
- Cronic nonspecific pulmonary diseases;
- Diseases of male and female genital system;
- Urological diseases.