Euro Mediterranean Rehabilitation Summer School

Haim Ring
Year 12 November 2016 - Physical Agents
Siracusa

The Heat : ( breaf ) clinical applications of

exogenous thermal therapy with
reference to Thermalism .
Alessandro Giustini

The world context Always for All

I C F WHO Health Condition

(disorder/disease)

Body
function&structure
(Impairment))
(Impairment

Activities
(Limitation)

Environmental
Factors

Participation
(Restriction)

Personal
Factors

WHO action plan 20142021: Better

health for persons with disabilities

Rehabilitation is the health strategy which, based on

integrative ICF model of functioning, disability and health
Applies and Integrates :
every biomedical and engineering approaches focused to optimize a
person's capacity
approaches which build on and strengthen the resources of the person
approaches which provide a facilitating environment
and approaches which develop a person's performance in the interaction
with the environment
Over the course of a health condition,along and across the continuum of cares,
ranging from the acute hospital to rehabilitation facilities ,to the community
and home
and across sectors including health, education, labor and social affairs
with the goal to enable people with health conditions, experiencing or likely to
experience disability, to achieve and maintain optimal life functioning in
interaction with the environment

For

All

In a synergetic global and holistic approach

based on PRM medical knowledges ,
competences and experiences taking care
of any kind of impairments and disabilities.

So Contents , Tasks,
Roles , Responsibilities
are growing for PRM !

Or Robot ?

Innovation and technologies cannot cover any

aspects : many old treatments are up-to-date ,
still effective and relevant for Health .

Firstly it is foundamental
to maintain well
known/ updated the
main scientific and
clinical roots of PMR !

The Heath and its applications are the

most widespread, utilized, known care tool
in the human health history ( for animal
behaviour too) .
Surely it is a main source ( or the first
together exercise ) in our clinical activity
regarding PRM history , growth and
common acceptance !
Both ancient and new advanced aspects .

Tissues can be warmed by

Conduction ( different objects in
physical contact )
Convection ( medium in liquid or fluid
state, in motion )
Conversion ( heath tranfert by
radiant or sound energies )

Main Effects :
-

Blood flow ( pression )

Collagen extensibility
Cell metabolic activity
Beta-endorphin (?)
Muscle tone ( force )
Proprioception (?)

General Indications :
Muscle Spasm
Contracture
Tension Myalgia
Borsitis
Tenosynovitis
Fibromiositis
Fibromialgia ?

PAIN

Exogen Cooling Tools and Modalities :

37 C - 42 C

Hot Packs ( Wraps, Bottle, Compress )

Heath Lamps ( Sun Bath )
Ovens ( Sauna - Baths)
Sand
Paraffin
Muds
Water Balneo - Hydroterapy

Petrofsky ; Laymon ; Alshammari ; Haneul Lee

Department of Physical Therapy, Loma Linda University, Loma Linda, CA, USA
Schools of Physical Therapy, Touro University, Henderson, NV, USA
Departments of Physical Therapy, Gachon University, Incheon, South Korea
Use of low level of continues heat as an adjunct to physical therapy improves
knee pain recovery and the compliance for home exercise in patients with
chronic knee pain: a randomized controlled trial

Keywords: Knee pain, Heat.

This study examined if the use of low level continuous heat (LLCH) wraps at
home between physical therapy sessions at a clinic resulted in better
therapy outcomes in patients with chronic knee pain.
These results indicated that the use of LLCH as an adjunct to conventional
physical therapy for chronic knee pain significantly improved pain
attenuation and recovery of strength and movement in patients with
chronic knee pain.

Treatment for low back pain

F. Ervolino and R. Gazze
1051-9815/16/$35.00 2016 IOS Press and the authors.

. One common and effective modality for the treatment of chronic pain is heat .
chronic back pain of at least six months duration, had sought out a previous medical
opinion on their pain and were not candidates for imminent surgery
Among many modalities tissue heating , as conventional heating pads , .Thermotex FIR
pad provides by infrared radiation for heating and could potentially be implemented
in a manner that does not interfere in a workflow. IR is commonly applied in mid-range
wavelengths of 1.5 to 5.6 microns, however far infrared radiation (FIR) in the range of 5.6
to 1000 microns provides heating in tissues where injuries to muscles commonly occur and
thus may be more effective

.this study corroborates prior research that shows infrared therapy to be

useful in the reduction of low back pain .

Only a few recent references focused on many aspects

regarding Heath :
Lewis SE, Holmes PS, Woby SR, Hindle J, and Fowler NE.- Short-term effect of
superficial heat treatment on paraspinal muscle activity, stature recovery,
and psychological factors in patients with chronic low back pain. Arch Phys
Med Rehabil 93: 367-372, 2012.
Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, and
Leggett S.- Continuous low-level heat wrap therapy for the prevention and
early phase treatment of delayed-onset muscle soreness of the low back:
a randomized controlled trial. Arch Phys Med Rehabil 87: 1310-1317,
2006.
Kim H, Suzuki T, Saito K, Kim M, and Yoshida H.-Effectiveness of exercise with
or without thermal therapy for community-dwelling elderly Japanese
women with non-specific knee pain: a randomized controlled trial. Arch
Gerontol Geriatr 57: 352-359, 2013.

Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Hinkle RT, Beth Goodale 1
M, Abeln SB, and Weingand KW. - Continuous low-level heat wrap therapy
provides more efficacy than Ibuprofen and acetaminophen for acute low
back pain. Spine 27: 1012-1017, 2002.
Ochiai S, Watanabe A, Oda H, and Ikeda H. Effectiveness of thermotherapy
using a heat and steam generating sheet for cartilage in knee
osteoarthritis. Journal of physical therapy science 26: 281-284, 2014.
Stark J, Petrofsky J, Berk L, Bains G, Chen S, and Doyle G.- Continuous lowlevel heatwrap therapy relieves low back pain and reduces muscle
stiffness. The Physician and sportsmedicine 42: 39-48,2014
Petrofsky J, Batt J, Bollinger JN, Jensen MC, Maru EH, and Al-Nakhli HH. Comparison of different heat modalities for treating delayed-onset muscle
soreness in people with diabetes. Diabetes technology & therapeutics 13:
645-655, 2011.

Balneotherapy
Hydrotherapy/Shower
Crenotheraphy /TermalTherapy

Reduction of Edema ( skin , joint )

Skin relief (vascular, sensorial )
Weight relief ( posture and movement )
Properties of mineral waters and gases

PAIN

Hidrotherapy (Pool ) is actually a needed aspect to qualify any

Rehabilitation Department .
Heath is a main part, in water and not only .

Water and Heath :

Synergistic therapeutic actions .
Massage ( by hands, mechanical, water)
Manipulation ( stetching )
Physical activity
Exercises ( joint, muscles )
(during heath or immediately after )
Positive location and context to promote
active healthy personal behaviour .

Heath, Water , Movement

and why not music ,
rhythm, pleasure at
Thermal Bath .

21/10/14

THANK YOU
Alessandro
Giustini