Electrotherapy for MSP

Paraffin wax bath therapy is an application of molten paraffin wax over the body parts. The combination of paraffin and mineral oil has low specific heat which enhances the patient’s ability to tolerate heat from paraffin better than that from the water of the same temperature. The composition of solid wax: liquid paraffin, mineral oil and petroleum jelly.

Paraffin wax bath

Methods of application of wax:

Patient preparation:

· Check the sensitivity of patient

· Dry the skin if wet

· The treatment part should be in relax position

Preparation of paraffin wax:

· Heat the paraffin wax up to therapeutic temperature (50 – 52°C).

· Paraffin liquid and petroleum jelly should be added.

There are four methods of application of paraffin wax therapy and the treatment is given for about 10 – 20 minutes.

1. Dipping method (Direct immersion)

2. Wrapping method (bandaging)

3. Brushing method

4. Pouring method

1 Dipping method (Direct immersion):

In this method, the body part to be treated is directly immersed into the container of paraffin wax for 2 – 3 seconds and taken out. After 2 – 3 seconds the part is again immersed to make another layer of paraffin wax. This process is repeated 6 – 12 times until 3 – 4 mm layer is formed, and then wrapped around by plastic sheet and towel. This method is preferably used for treating distal parts of the body.

2 Wrapping method (bandaging):

A roll of bandage is immersed in molten paraffin wax and then wrapped around the body part. This method is preferably used for treating proximal parts of the body.

3 Brushing method:

A brush of various sizes is used for the application of molten wax over the body tissues. This method is used for proximal joints i.e. shoulder, elbow and knee joints etc.

4 Pouring method:

The molten wax is directly poured by a utensil on the part to be treated and then wrapped around by a towel.

Therapeutic effects:

Arthritic conditions:

In arthritis conditions like RA, particularly for the stiff and painful joint and the distal part of the body such as hands, feet, paraffin wax is helpful before mobilization exercises. The heat produce by the paraffin wax reduces the pain and soften the joint.

Painful conditions:

In painful condition affecting the joints due to trauma or disease paraffin wax is of value to decrease pain and enhancing function e.g. sprain, strain.

Stiff joints:

Paraffin wax therapy decreases pain, soften the joint and also increases the mobility.

Chronic inflammation:

In chronic inflammatory condition with oedema and stiffness affecting joints, paraffin wax is of value important to decrease oedema and increase softening of joint.

Contra indications:

· Open wound

· Skin infection

· Defective skin sensation

· Ischemic conditions

· Skin allergy

Dangers:

· Burns

· Aggravation of inflammation

Effects of heat on body:

Cellular effects:

Metabolic activities are increase by the rise in temperature i.e. 13 % of metabolic activities is increased by 1°C rise in temperature. When the metabolic activities increase the demand for O2, nutrients also increases and more waste products are produced. Accelerated cellular metabolism can produce many beneficial therapeutic effects to treat injury or infection.

Effects on blood flow:

When the skin is heated the surface become reddens and the blood vessel dilated increasing the blood flow. For the healing if there is infection a good blood supply that beings more WBCs kill bacteria can assist n the process. Increase in metabolism leads to release to CO2 and lactic acid leading to greater acidity of the tissues which causes dilatation of the vessels. Histamine and tissue dilators substances such as bradykinin are also released by the greater heating of the tissues. They also help in the dilatation of vessel.

Effects on collagen tissues:

Some specific tissues in the body such as collagen tissues are sensitive to heat. It has been shown from previous study that above 50°C temperature (40 - 45°C) the extensibility of collagen tissues has been increased. This only occurs if the tissue is simultaneously stretched and requires temperature near the therapeutic limit.

Neurological effects of heat:

↓ muscle tone:

Heating of the tissues to therapeutic range (40 – 45°C) results in the reduction of the muscle spasm. Ia afferent of the muscle spindle have been shown to increase their firing rates with raise in temperature while most secondary to pathological changes afferent decreases firing rate with the rise in temperature.

Heating will stimulate the Golgi tendon organ. ↑firing of Golgi tendon organ resulting in increase inhibition. All these factors will reduce the muscle tone.

Relieve of pain:

Pain is relieved by the application of heat due to decreased nerve conduction velocity or elevated pain threshold. It may be due to sedative or counter irritation effect of heat. Pain relieve is associated with relieve of muscular spasm and increase in joint range of motion.