PHYSICAL

AGENTS &
HYDROTHERAPY
Heat and the Skin
EPIDERMIS
➢outermost layer of the skin
➢it is avascular
5 LAYERS OF THE EPIDERMIS
1. Stratum Corneum - waterproof characteristic of the skin and
serves to protect the body against infection
2. Stratum Granulosum - responsible for water retention and heat
regulation
3. Stratum Spinosum - adds a protective layer for the underlying
Basale
4. Stratum Basale - site where epidermis regenerates
- contains melanocytes which determine your skin color

CO LU Go Sa BAtok
DERMIS
• > 20-30x thicker than the epidermis
• > considered as the “true” skin
• > contains blood vessel, lymphatics, nerves,
collagen and elastic fibers
• > encloses appendages (sweat and
sebaceous gland)
• > provides tensile strength and elasticity to
avoid deformation
• > divides into the papillary layer and the
reticular layer
 Corium
• Reticular Layer – Consists of dense connective tissue.
• Papillary Layer – A collagen and elastic fibres are fewer
and form a continuous fine network in the papillae
beneath the epidermis.
 LOCATION OF THE NERVES IN THE SKIN
STRUCTURE LOCATION FUNCTION
Free nerve endings Epidermis Pain, Itch

Free nerve endings Dermis Pain, Itch

Merkel’s disk Stratum Spinosum Touch

Meissner’s corpuscles Papillary Dermis Touch

Ruffini’s corpuscle Papillary Dermis Warm

Krause’s end bulb Papillary Dermis Cold

Pacinian corpuscle Reticular Dermis Pressure and Vibration

Appendages of the skin:
1. Hair
2. Nails
3. Sebaceous glands
4. Sweat glands
a. Eccrine
b. Apocrine
Biophysical Properties of the Skin

• Electrical Properties: Moist skin conducts

electricity and dry skin resists it.

• Surface Electrical Resistance: inversely

proportional to temperature
Factors Increasing Skin Resistance

• Dry skin
• Ischemia
• Vasoconstriction
• Edema
 Factors Decreasing Skin
Resistance

• Moist skin
• Exercise
• Vasodilation
• Application of LFC
 Skin Temperature
is affected by:

• Thermal conductivity of the skin

• Density
• Specific heat of the living skin
(Quantity of heat in Joules that must be supplied to 1g
of material to raise its temperature by 1 degC)
• Circulation architecture
TEMPERATURE
Balance between heat
produced or acquired
by the body, and the
amount lost.
 Thermoregulatory System
 Thermoreceptors
- provide input to the regulating center
(a) peripheral
(b) central
 Regulating Center
- Hypothalamus
- coordinates the heat production and loss processes
 Effector Organs
- responds to both increases and decreases in temperature
- vasomotor, shivering, piloerection, alteration of metabolic
rate, muscle activity, and sweating.
 Conservation & Production
of Body Heat
• Vasoconstriction
• Decrease in sweat gland activity
• Cutis anserina
• Shivering
• Hormonal regulation
- epinephrine
- thyroxine
Loss of Heat

• Radiation
• Conduction
• Convection
• Evaporation
Abnormalities in Body Temperature

 Pyrexia: elevation of normal body temperature

Hyperpyrexia/Hyperthermia
- Extremely high fever above 106 degF (41.1 decC)

Pyrogens –fever producing substance

secreted from toxic bacteria or are released
from degenerating body tissues
 3 Stages

• Invasion (Onset)
- until maximum temperature is reached
• Fastigium or Stadium (Course)
- point of highest elevation of the fever
• Difervescence (Termination)
- fever subsides and temperature move towards normal
• Hypothermia
- lowered body temperature
- decreased activity of thermoregulatory
system at 34.4 degC (94 degF)
- completely lost at 29.4 degC (85 degF)
 Factors Influencing Body
Temperature
• Time of day: Circadian Rhythm
• Age
• Emotions
• Exercise
• Menstrual cycle
• Pregnancy
• External environment
• Location of measurement
 CIRCADIAN RHYTHM

▪ Circadian rhythm is the 24-hour internal clock in our

brain that regulates cycles of alertness and
sleepiness by responding to light changes in our
environment. Our physiology and behavior are
shaped by the Earth's rotation around its axis.
 PHYSIOLOGICAL EFFECTS OF
HEAT AND COLD

Parameters determining the extent of physiological

response:
1. Size of area exposed
2. Intensity of radiation
3. Relative depths of absorption of specific radiation
3 MAIN EFFECTS OF HEAT ON THE
TISSUES

• Local and remote increased in blood flow due to

temperature rise and fall
• Stimulation of the neural receptors on the skin or tissues
• Increase or decrease of metabolic activity
 Reactive Hyperemia

• An increase in the amount of blood in a region

when its circulation is re-established after a
period of occlusion
• Blood flowing into the dilated vessels makes the
skin fiery red.
• Arterial dilatation is due to hypoxia and is
affected by the release of chemical substances
Heat in Physiotherapy
 THERMOTHERAPY

• Heat is form of energy. It is continually produced in the body

as a by-product of metabolism.
• Thermal energy can be thought of as vibrations of the
molecules of the substance whose motions causes emission
of electromagnetic waves.
 The ELECTROMAGNETIC WAVE

• WAVELENGTH: horizontal distance between the

crests of any two adjacent waves.
• CYCLE: The complete sequence of events that takes
place during the passage of one wave.
The ELECTROMAGNETIC
SPECTRUM
An array of the various electromagnetic
waves in order of length or frequency.
Methods of
Heat Transfer
➢ Radiation
➢ Conduction
➢ Convection
➢ Evaporation
Classification of Various Heating Modalities

• Depth of penetration
• Method of heat transfer
 Modality Depth of Method of
penetration heat transfer

• Hot packs / heating Superficial Conduction

pack
• Paraffin baths Superficial
• Fluidotherapy Superficial Convection
• Whirlpool bath Superficial
• Hubbard tank Superficial
• Infra Red Radiation Superficial Radiation
• Ultrasound Deep Conversion
• SWD Deep
• MWD Deep
Body Responses to Local Heat Application
• Physiologic changes caused by superficial heat
application to a small area of the body (e.g.,
Quadriceps, shoulder)

• Physiologic Response of the Body System

Physiologic Response of the Body System

Vasodilation
Blood flow
Capillary permeability
Edema
Metabolism
 Elasticity of non elastic tissues
Physiologic Response of the Body
System

 Joint stiffness
Muscle spasm
 Pain
 Thermotherapy
Body Responses to General Heat Application
Thermotherapy
Body Responses to General Heat Application

 Metabolic rate
 Pulse rate
 Cardiac output
 Respiratory rate
 Vasodilation
 Metabolic Effects
• Increase by an average of 13% for a rise of
1degC
• Heating beyond 45degC causes irreversible
tissue damage
 Thermotherapy
Goals & Indication of Sup. Thermotherapy

1. Modulate pain
2.  connective tissue extensibility
3.  or eliminate soft tissue inflammation &
swelling
4.  rate of tissue healing
5.  soft tissue & jt. Restriction
6.  muscle spasm
 Thermotherapy
Precautions :
1. Cardiac insufficiency
2. Edema
3. Impaired circulation
4. Impaired thermal regulation
5. Metal in treatment area
6. Open wound
 Thermotherapy
Contraindication:

1. Acute & early subacute traumatic &

inflammatory conditions
2.  circulation,  sensation
3. DVT, impaired cognitive function
4. Malignant tumor
5. Tendency towards hemorrhage or edema
6. Very young & very old px.
 DOSIMETRY

• Intensity: guided by the feeling of warmth on the part of the

patient
a) threshold value, gentle comforting warmth: minimal
b) distinct feeing of agreeable warmth: medium
c) intense feeling of heat, maximunm heat tolerance is
exercised: maximum
d) intolerable heat, burning sensation: danger level
• Duration
- average of 15 to 30 minutes
• Frequency
- advisable is to give treatment daily for the first course
of 10 treatments.
End of Lecture
HEAT AND THE SKIN