THERMOTHERAPY – HOT PACKS
7/1/2016
LOGANATHAN CHANDRASEKAR, MPT.,
LECTURER
COLLEGE OF APPLIED MEDICAL SCIENCES
MAJMAAH UNIVERSITY
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Lecture Outline
• Introduction – Thermotherapy & Hot packs
• Unit description
• Physiological effects
• Therapeutic benefits
• Indications & Contraindications
• Application Technique / Lab Activity procedure
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Learning Objectives
• At the end of this lecture, the students will be able to
• Describe the equipment, operation of apparatus, physiological & therapeutic
effects, indication , contraindication, advantages, dis-advantages, precaution &
dangers of Hydrocollator / Hot packs
• Evaluate the rehabilitation if necessary of each individual patient according to the
follow up.
• Demonstrate safely the knowledge and skills in planning, designing,
implementing, and evaluating effective hydrocollator treatments in the
management of orthopedic, rheumatologic, and some basic neurological and
pediatric conditions.
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INTRODUCTION - THERMOTHERAPY
The therapeutic application of heat is called
thermotherapy.
Within rehabilitation, thermotherapy is used primarily to
control pain, increase soft tissue extensibility &
circulation, & accelerate healing.
Heat has these therapeutic effects because of its influence
on hemodynamic, neuromuscular, & metabolic processes.
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EFFECTS OF HEAT
 Hemodynamic effects
a. Vasodilation

a.
b.
c.
Neuromuscular effects
Changes in nerve conduction velocity & firing rate
Increased pain threshold
Changes in muscle strength
 Metabolic effects
a. Increased metabolic rate
 Altered tissue extensibility
a. Increased collagen extensibility
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USES OF SUPERFICIAL HEAT
Pain control
Increased range of motion & Decreased
joint stiffness
Accelerated healing
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CONTRAINDICATIONS FOR THE USE OF
THERMOTHERAPY
Recent or potential hemorrhage
Thrombophlebitis
Impaired sensation
Impaired mentation
Malignant tumor
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PRECAUTIONS FOR THE USE OF
THERMOTHERAPY
 Acute injury or inflammation – (First 48 – 72 hrs – Heat should not
be applied)
 Pregnancy
 Impaired circulation
 Poor thermal regulation
 Edema
 Cardiac Insufficiency
 Metal in the area
 Over an open wound
 Over areas where topical counterirritants have recently been
applied
 Demyelinated nerves
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ADVERSE EFFECTS OF THERMOTHERAPY
Burns
Fainting
Bleeding
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INTRODUCTION • The use of moist heat as a therapeutic agent is one
of the oldest forms of medicine.
• Commercial hot packs is one of the most common
ways to deliver superficial moist heat.
• The heating unit is called a HYDROCOLLATOR UNIT
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Hydrocollator unit –
Different sizes
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Hydrocollator unit –
inside view
Wire Racks / Shelf
with Hot packs
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THE HYDROCOLLATOR UNIT
• The hydro-collator unit is a stainless steel tank in which
hydrophilic silica gel or BENTONITE crystal covered with
canvas are heated.
• The capacities of the machines vary, and all units have
insulated bases, the larger machines being insulated with
fiberglass.
• The units contain a wire rack which acts as divider for the
packs and prevents contact of packs with the bottom of
the tank.
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• These packs are stored in thermostatically
controlled water cabinet and maintains water in
the unit at a temperature between 70°C and 75°C
(158˚ to 167˚ F).
• Initially it takes 2 hours to heat & 30 minutes to
reheat between each use.
• It can be left on continuously as long as there is
enough water in the tank.
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A Hydro collator Pack
• A hydrocollator pack is good in any situation that requires
penetrating heat. It provide therapeutic warming of
superficial tissues up to 1cm. (Therapeutic temperature
range is 30 – 40 ˚ C)
• A hydro collator pack is a fabric envelope containing silica
gel / Bentonite crystals.
• The main property of the gel is its capability to absorb
many times its own volume of water, provides a
considerable store of heat energy.
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• These packs are heated in a hydro-collator unit.
• It give moist heat for 20 to 30 minutes
Packs come in various sizes and shapes. (Regular
size – 12’’ x 12’’ for most body segments, Double
size – 24’’ x 24’’ for back, low back & buttocks, 6’’ x
18’’ for cervical spine.)
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Hydrocollator packs
Hydrocollator packs
Hydrocollator packs
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• The packs are wrapped in:
– Regular bath towels – 6- 8 layers of toweling or Commercial
double pad towels. The commercial double pad toweling has a
pouch for pack placement & 1’’ thick toweling to be placed in
cross fashion. 6 layers of toweling equal to 1’’ of toweling.
– Large packs may be wrapped in bath blankets .
– The packs last about six months.
– When they begin to wear out the filler leaks out and
makes the water cloudy; they should then be replaced.
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• The pack is applied to the body
after being wrapped adequately
in toweling or blankets. (This
provides THERMAL INSULATION,
So that the pack is at above 71˚C
& the skin temperature does not
rise above 42˚C or so).
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• Care must be taken to have a layer of toweling and to
avoid excessive pressure by weight being placed on bony
points.
• The part selected to be treated must be able to tolerate
the pressure of the pack (approximately 500 to 800
grams) and to tolerate a 7° C to 10°C rise in temperature.
• But after 10 min of the treatment the patient may regard
the pack as cool & comfortable.
• Nevertheless the rise in temperature of the region under
the pack averages 5˚C.
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PHYSIOLOGICAL EFFECTS OF HOT PACKS
 Heat – an erythemal response with localized sweating
 Vasodilation
 Increase in metabolic rate
 Increase in core temperature with higher heat intensities
 Increase in heart rate lead to decrease in blood pressure
 Regulate fluid & electrolyte balance
 Decrease in GI activity, relaxation of gut muscles & a decreased peristalsis. With
increased internal temperature, results in increased metabolic by product & an
increased renal response.
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PHYSIOLOGICAL EFFECTS OF HOT PACKS
 Increase in subcutaneous tissue temperature
 Extensibility of collagen tissue is increased
 Free nerve endings are stimulated
 Increased nutrients, cell permeability & capillary pressure
 Phagocytic & leukocytic activity increases
 Local blood circulation increases – increased capillary flow – more
nutrients, oxygen & antibodies
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THERAPEUTIC BENEFITS OF HOT PACKS
Analgesic effect resulting in reduction in pain
Muscle relaxation
Decrease in joint stiffness by decreasing tension in the
periarticular structure
Accelerate healing
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Indications for Hot Packs
1.PAIN & MUSCLE SPASM & Menstrual
cramps
2. Sub acute & chronic Inflammation.
3. Sub acute & Chronic regional Edema.
4. Adhesions.
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Contra-indications for Hydrocollator
Packs:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Impaired Skin Sensation
Circulatory dysfunction
Analgesic drugs
Infections and open wounds
Cancer and Tuberculosis
Gross Oedema
Lack of Comprehension
Deep X-Ray Therapy
Liniment
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Advantages:
1. A hydro-collator pack is easy to apply
2. The packs are of various sizes which fit most
clinical needs & used to cover moderate to large
areas.
3. Moist heat has a more sedative effect than dry
heat.
4. low cost, minimal maintenance, long life
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5. Maximal temperatures are more
uniform than in electrically-heated pads.
6. The patient does not need much
handling.
7. The pads can be laid out ready for the
patient to place on the affected part.
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Disadvantages:
1. A hydro-collator pack is not easily applied around
shoulders and hips.
2. It is somewhat heavy and should not be used on
extremely sensitive patients, since it can create
discomfort.
3. Sometimes moist packs have a tendency to cause
a skin rash.
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DANGERS & PRECAUTION
• 1. BURNS – May occur due to;
a)Insufficient toweling
b)The temperature of the pack could be too
high
c)Impaired circulation
• 2. DEHYDRATION – Excessive sweating may
produce dehydration
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CARE OF THE HYDROCOLLATOR UNIT
• 1. The water level should be kept up
to 3/4th full of water or slightly over
the top of the packs at all times
• 2. The unit should be cleaned
periodically
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APPLICATION
• Remove the pack from the unit & place it on the
towel.
• Fold another towel into 4 – 6 layers & place it over
the pack.
• Wrap the whole pack up with the bottom towel.
• The temperature of the wrapped pack should not
exceed the 44˚C
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• Monitor the initial response from the patient to
treatment during the first 5 to 10 min by asking the
patient for feedback & by visually inspecting the
skin.
• If necessary, adjust the layers of toweling.
• During the treatment maintain the position of hot
pack & ensure that it does not exacerbate pain,
produce discomfort or occlude circulation.
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Back treatment
Different sizes
Neck treatment
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