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• Paraffin wax bath therapy is an application of the molten paraffin wax on the body part. • The temperature of the paraffin wax is maintaining at 40-44°c, where as its melting point is 51-55°c. • If the molten wax at 51-55°c is poured on the body part, it may cause burn over the body tissue, which is why some impurity is added to lower down its melting point such as liquid paraffin or mineral oil. • The wax is maintained molted in stainless steel or enamel bath which are electrically heated; temperature is kept constant by a thermostat. • There may be a fixed thermometer to check the temperature and a means of adjusting the thermostat setting to the temperature. • Paraffin wax bath therapy provide about the 6 times the amount of heat available in water because the mineral oil in the paraffin lowers its melting point.
The combination of the paraffin and the mineral oil has low specific heat which enhances the patient’s ability to tolerate heat from the paraffin better then from the water of the same temperature. The composition of the wax: paraffin: petroleum jelly is 7:3:1 or wax: paraffin: or mineral oil is 7:1. The mode of the transmission of heat from paraffin to the patient skin is by means conduction.
Parts of a typical paraffin wax bath unit are container, mains, thermostat, thermostat pilot lamp, power pilot lamp, lid, and caster. • Container is made-up of enamelled baths or stainless steel bowl and outer fiberglass shell. • Initially heating is quicker with this type because there is no water jacket to be heated.
• Container contains wax and paraffin oil. Main function is to switch on or off the heating element, which is located in the casing of paraffin wax bath unit. • Thermostat keeps the temperature fix or static in the range which is adjusted with knob thermostat pilot’s lamp indicates whether thermostat is on or off. • Power pilot’s lamp function is to show whether power is on or off. • Lid cover container and caster allow the paraffin wax bath container to be move from 1 place to another.
• The nature of wax treatment is explained and the area to be treated is inspected for contraindication.
• Look for any wound, skin infection, rashes etc. on the part to be treated. • Cleaned the skin using tissue paper or cotton. • Tell the patient in brief about temperature of the wax and benefits • Drip down few drops of molten wax on the dorsal surface of your hand to check the temperature. • This is done before; the patient so that he/she can prepare psychologically and fear of heat is minimized. • After the above step the patient is always found to cooperate and fear of molten wax and heat is remove from the mind.
• The part is immersed for a second or so in the wax, withdraw and
allow to cool for 2 to 3 sec. and then re-immersed It is important to immerse the part briefly other wise the outer most coating is melted off and the thickness of wax does not build. The procedure is repeated 6-12 times to produce a coating of wax 2 or 3 mm thick over the body part. The part is then put into a plastic bag or paper cover and raped in a blanket or towel to limit the rate of heat loss to the air. For any condition in which there is a proclivity for edema the part should be elevated. Adequate elevation in which the part is kept above the level of the heart is of almost importance since other wise the heating effect will tend to exacerbate swelling of the extremities.
• The glove of wax is normally left in a place for some 15 minute by which time the wax is completely solid although still malleable, so that it can be remove in a 1 piece. • After use the wax is cleaned in a purified and reuse.
• Despite of the fact that skin temperature above 45°c can lead to damage, it is possible to put the hand comfortably in bath of wax at some 50°c. • Water at the same temperature would be uncomfortably hot and ultimately cause damage. • This is bcozs the specific heat of paraffin wax is about 2.72 kj/kg/°c or less with added mineral oil and therefore much lower than that of water at 4.2 kj/kg/°c.
Thus, the amount of energy released by the wax cooling 1°c is less than that of water. kj/kg/°c Perhaps more importantly, when the part is immersed in wax the cool skin causes a thin layer of wax to solidify on the surface. Due to the relatively low thermal conductivity of the wax this static layer act as to insulate the skin from the hotter surrounding the wax: some air may be trapped between this solidify layer and the skin, adding to the insulating effects. The wax transmits the heat energy to the tissue by giving up energy as it solidifies the latent heat of the fusion without any temperature changes. This amount of energy is quite small therefore about 35 kj/kg. Although the temperature of a thin layer of wax on the tissue falls quite quickly on its outside surface the low thermal conductivity
prevents much heat loss from the skin surface. The net effect is to provide remarkably effective low temperature heating of the part. Certainly there is widespread approbation amongst patient who suffers with painful and stiff joints for this form of heat. As a consequence of preventing water loss from the surface of skin the wax treatment tends to leave the skin with more moisture hence feeling soft and pliable. This may be therapeutically valuable if the skin is dry. It is also claimed to soften adhesion and scar in the skin.
The part to be treated must be cleaned by soap and moisture to be soaked by towel. Position of the patient should be such that the part to be treated comes closer to the wax bath container. Before application one must ensure that there should be no moisture on the body tissues otherwise burn could occur. The warm wax is placed on the body tissues by various techniques and the treatment is given for about 10-20 minutes.
Various techniques used for the application of paraffin wax are as fallows:
1. Direct pouring method:
The molten Wax is directly poured by a mug or utensil on the part to be treated and then wrapped around by a towel. The wax is allowed to solidify for about 10-20 minutes. Several (46) layers can be made over the body tissues.
2. Brushing method:
• It is a less commonly used method of paraffin wax application. • in this method, 8-10 coats of wax are applied to the area with a paint brush using even and rapid strokes • The area is then wrapped with towel for 10-20 minutes and after this time, paraffin wax is removed and discarded
3. Immersion method:
• This method of application provides some what vigorous heating.
• The body part to be treated dipped 3-4 time to form a thin coat and then left immersed in paraffin wax for 20-30 minutes • A thin glove of solid paraffin wax formed slows the heat conduction • Use of immersion method required co-operation and tolerance by the patient in a dependent position • Care should be taken to ensure that the patient is in comfortable position during the treatment • With immersion method, the temperature elevation of body tissue is 2°c higher then dipping method
4. Dipping method:
It provides mild heating. The patient should wash and dry the part to be treated. The therapists instruct the patient to dip the body part in a bath and then removed it until the paraffin solidifies and thin layer of adherent
• • •
solid paraffin is formed which covers the skin. Dipping is repeated until a thick coat is formed. In other words, at least 8-12 times until thick glow on a part. Once thick glow of wax is formed the treated area should be wrapped 1st in a plastic and then wrapped with a towel. If edema is concerned then area may be elevated. The effective duration of this treatment is 10-15 minutes. At the end of this treatment time the glow of solid of peeled off or removed by slipping the finger beneath the glow and sliding the wax off and into the plastic sack, which cover it during the treatment The sack is then discarded or the wax is emptied in the bath unit.
5. Toweling or bandaging method:
• A towel or a roll of bandage is immersed in molten paraffin wax and then wrapped around the body part. • Several layers can be made over the body part. • This method is preferably used for treating proximal parts of the body. Once the treatment is given by paraffin wax, it can be reused for the next session. Regular cleaning or changing of the wax is necessary to ensure good hygiene.
1. Heat production:
• There is a marked increase in skin temperature in the 1st two minute, up to 12-13°c. • This drop, while in the wax wrapping to an increase of
about 8°c at the end of 30 minutes. • In the subcutaneous fascia, there is an increase of 5°c at the end of the treatment. • In the superficial muscles, then in only about 2-3°c rise in temperature at the end of the treatment
• Stimulation of superficial capillaries an arterioles cause local hyperemia and reflex vasodilatation. • This is marked only in the region of the skin. • The hyperemia is due to response of the skin to its function of heat regulation. • The effects of vasodilatation in the muscle are negligible, but then may be some reflex heating in the joints. • Skin and subcutaneous tissue temperature drop after 15-20
minute, reducing the vasodilatation • Exercise after the wax is essential to increase the muscle circulation and sedative effect of heat to obtain more range of movement and muscle strength.
• The most important effect of wax its marked sedative effect on the tissue. • The moist heat is remarkable soothing to the patient. • It is this effect that is used prior to the exercise, in the treatment of superficially placed joints. • It is very comfortable to the patient.
• Wax leaves the skin moist, soft and pliable.
• This is useful for stretching scar and adhesion before applying mobilization techniques.
Pain and Muscle Spasm: Wax
reduces the pain and muscle spasm seen in hands and feet, as the moist heat encircles each finger and toe, and relieves pain.
Edema and Inflammation:
The gentle heat reduces posttraumatic swelling of the hands and feet and also swelling in hands affected by rheumatoid arthritis or degenerative joint disease, particularly in the sub-acute and early chronic stages of inflammation.
Adhesions and Scars: Wax
softens the adhesion and scar in the skin and thus facilitates the
mobilization and stretching procedures.
1.Impaired skin sensation: This
will be determined by a hot/cold skin test.
2.Some Dermatological conditions are exacerbated by
moist heat, such as eczema, athlete’s foot and dermatitis. Any dermatological condition, which appears after treatment, must be reported.
Patients with varicose veins, deep vein thrombosis and arterial disease must not have any heat applied directly over the affected part.
4.Analgesic Drugs: If patients are
taking strong narcotics for pain, the
time and dosage of the drugs must be ascertained. Heat is not administered immediately after intake of drugs, since pain tolerance to heat is impaired.
5.Infections and open wounds: Heat will increase the
6.Cancer or tuberculosis: In the
area to be treated, heat, by increasing the metabolic rate, may increase the rate of growth and spread the disease.
7.Gross edema: With a very thin
and delicate skin covering the area, the skin may be damaged and the heat may tend to increase the edema.
8.Lack of comprehension:
patients who cannot understand the nature of the treatment and comprehend the potential danger,
for example, children, very old patients, other nationalities.
9.Deep X-ray Therapy: Within
three months prior to treatment decrease blood flow in the area and may cause impaired skin sensation.
1.Low specific heat allows for application at a higher temperature than water without the risk of a burn. 2.Low thermal conductivity allows for heating of tissues to occur more
slowly, thus reducing the risk of overheating the tissues. 3.Molten state allows for even distribution of heat to areas like finger and toes. 4.First dip traps air and moisture to create more even heat distribution. 5.Oils used in the wax add moisture to the skin. 6.Wax remains malleable, after removal, allowing for use as an exercise tools. 7.Comfortable, moist heat. 8.Relative inexpensive to replace wax.
only for distal extremities
in the terms of ease of application.
effective method of application
is the bath method, which limit accessibility for other body part to be treated effectively.
No method of temperature controls once applied. Heating last only about 20 minutes. It is a passive treatment: exercise may not be performed simultaneously.
Sterile the paraffin wax bath by heating it to 212° Fahrenheit. For reuse sterilization should be done frequently. Drain the melted paraffin wax, filter it out and replace it back for reuse. Change the wax at least once in 6 month.
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