Deep Thermal Treatment

It is a way to heat the local area by applying a heating

agent (electrotherapy) from outside.
Effects of deep thermal agent
 Physiologic effects occur local and systemic
 Local effect is an increase on the function of the cells
via heating agent
 General effects are reflex vasodilatation and relief of
muscle spasm via relaxation of skeletal muscles.
Appliance of deep thermal
treatment

 High frequency currents (Short wave diathermy)

 Electromagnetic radiation (Microwave diathermy)
 High frequency sound waves (Ultrasound)
Diathermy
 It is term of applying a high frequency electromagnetic
enery to heat body tissues.
 Shortwave Diathermy
 Microwave Diathermy
 Longwave Diathermy
Short Wave Diathermy
 It is an electromagnetic currents
 Frequency: 27.12 MHz, Wave length: 11 meter
 It heats large areas.
 It can be continuous or pulsed (Pulsed application is
often preferred).
Short Wave Diathermy
 Continuous short wave diathermy effects via kinetic
energy
 Pulsed short wave diathermy shows the benefits via
nonthermal changes
 The application of shortwave diathermy increases the
subcutaneous fat tissue to 15 ° C, 4-5 ° C to 4-6 ° C in
muscle tissue.
Short Wave Diathermy
Thermal effects include
 Changes in blood flow due to increased temperature
 Increased cell metabolism
 Increased tissue flexibility
 Muscle relaxation
 Changes in enzyme reactions (Continuous SWD)
Shortwave Diathermy
The non-thermal effects include
 Healing of superficial wounds
 Decrease of edema and lymphedema
 Decrease of venous stasis ulcers
 (Pulsed SWD)
 Heals cell dysfunction.
 It provides the normal balance of the ions of the cells.
Physiological Effects
Increase of metabolism
 According to Van't Hoff's law, a chemical that has the
ability to accelerate is accelerated by increase of
temperature.
As a result of the increase in metabolism,
 Oxygen will be destroyed
 Nutrients coming into the muscles will increase
Physiological Effects
 It is sedative.
 It relaxes the mucles.
 Reduce spasm and pain transmission.
 Reduce the excitability of nerves
 Increase the body temperature
 Increases of sweating
 Sweating under the electrodes is more.
 Generates antibodies (it can be used acne and abscess
Application
 The tool has to be tested.
 The treatment should be explained to the patient.
 The treatment table has to be insulator.
 The diathermy tool is disturbing the instruments
about two meters away.
 The patient must undergo a warm-cold sensory test.
 The patient should be in a comfortable position.
Application
 The patient should not have any metals.
 The extremity to be treated must be open.
 The skin has to be dry
 The distances of the electrodes should be 1.5 - 5 cm.
 The cords should not touch the patient and each other.
 The patient should be observed.
Application
 Application time is 20-30 minutes.
 There are no definite recommendations for what the
appropriate dose is.
 The patient should never say "too hot" during application.
 The patient should not go outside shorthly after SWD.
 If the patient goes out immediately after applying SWD, he
will start to chill.
 The patient should wait 10-20 minutes after application.
 SWD can be used comfortably in subacute and chronic
periods.
Dose of treatment
 The treatment dose cannot be fully controlled.
 The amount of warming cannot be determined exactly.
 The amount of warming can not be measured.
Warming=present intensity 2X resistance
 The patient should feel warm. Power output: Watt(W)
 The duration of treatment; 20-30 minutes. 20 minutes
is quite ideal.
 The treatment should be given three times per week.
 If there is no contraindication, treatment can be done
every day
Dose of treatment
 Increases metabolism: 1C increase with 100 ms and
800 beats.
 2 C increase with 200 ms 800 beats : Pain reduces
muscle spasm. It increases blood flow.
 4C increase with 400 msec 800 beats : Increases
flexibility.
Dose of treatment
 Dose I (lowest): No heat sensation, Subthermal (5W-
10W)
 Dose II (low): Light warm feeling (12w)
 Dose III (Medium): Medium warming sensation (24w)
 Dose IV (Heavy): Until the pain level. (48W)
Indications
 Musculoskeletal pain  Contracture
 Inflammation  Fibromyalgia
 Pain  Fibrosis
 Spasm  Bursitis
 Sprains  RA
 Tendinitis, tenosynovitis  Capsulitis
Contraindications
 Metal implants  The tendency to
 Cardiac pacemaker bleeding
 Ischemic areas  Sensory loss
 Peripheral vascular  Cancer
diseases  No application to the
 Pregnancy abdomen and lumbar
 Fever
region during
menstruation
 Acute inflammation
Tool Features
 Power outputs: 100 watts in continuous mode, 200
watts pulsed mode or 400 watts in continuous mode,
1000 watts in pulsed mode
 For SWD application, capacitor and induction field
methods are used
Capacitor (capacitor) field method
 It is used more often.
 The patient is in the resonator circuit of the tool
(constitutes part of the circuit).
 Electrical force passes between the two electrodes.
 The aim of treatment is to increase the temperature
equally in deep and superficial tissues.
 The skin and subcutaneous tissue are overheated.
 Reciprocal aplication is often preffered.
 Disc and pad electrodes.
Capacitor (capacitor) field method
 The diameters of capacitor electrode range between 4
to 17 cm.
 Electrode should be choosen according to the body
area to be treated.
 They do not need to be connected directly to the body.
 Capacitors are made up of metal coils embedded
-The patient is in the
resonator circuit of the
tool (constitutes part
of the circuit).
-Electrical force passes
between the two
electrodes.
Electrodes
 Glass electrodes

 Rubber electrodes

 Cable electrodes
Glass electrodes
 These electrodes are usually circular, but they can be
varied (such as a triangular electrode) for non-uniform
regions such as the axilla.
 The electrodes are attached to the fixed arm.
 In practice, a gap should be left between the glass and
the skin to ensure both a good evaporation and a deep
relaxation.
 Instead of glass, there are electrodes that are either
bakelite or plastic.
 Rubber electrodes
 These are bendable metal
electrodes covered with rubber.
 The advantage is to adjust to body
curvatures.
 Also plate electrode can be used.
Rubber electrodes include metal
coils.
 The felt plates (1-2 cm) should be
located between the body and the
electrodes to prevent sweating.
 Should be aware of overheating.
 The metal parts of electrodes is
breakable
Properties of electrodes
 Size of electrodes
 The distance of the electrodes to the skin
 Positions of electrodes
Size of Electrodes
 Electrodes should be slightly larger
than the area to be treated. Thus,
equal temperature can be applied
to the deep and superficial tissues.
 If it is smaller than the area to be
treated, the skin will be overheated.
 If it is larger than the area to be
treated, the energy will be lost.
 If the one is large and the other is
small, the electrical force lines will
pass through to the small one.
 The distance of the electrodes to
the skin
 In general, the distance between
the electrodes is 1.5 - 5 cm.
 If the electrodes is to close, the
electrical force lines become more
concentrated at the skin.
 If it is too far away, some of the
electrical force lines will lose their
energy until reaching the surface,
and the desired temperature will
not be obtained in the deep tissues.
 If one is nearer to the skin, and the
other is farther away, the energy
will be more at the nearer side.
Positions of electrodes
 Electrodes should be parallel to skin, not to each other
Distance between electrodes
 In practice, the distance
between the electrodes
must be greater than the
sum of the distances of
the electrodes to the skin
(A >a + b).
 If the treatment area is
not smooth, the
electrodes should be at a
long distance from the
skin
Application techniques
 Reciprocal
 Coplanar method
 Cross application
 Monopolar application
Application techniques
Reciprocal
The part to be treated is between the
two electrodes.
Coplanar Method
Place the electrodes on the same
surface of the part to be treated. The
temperature is superficial.
Cross Application
Electrodes are held in a mediolateral
position in the first half of the
treatment and in a anteroposterior
position in the second half of the
treatment.
Monopolar Application
One of the electrodes can be placed on
the treated side and the other side can
be placed or not used.
Induction field method
 The high frequency current passes through the
induction coil and creates a magnetic field.
 Provides more warmth in muscle and connective
tissue. There is no danger of overheating when the
body is covered.
 They are pot-like drum electrodes or cable electrodes
 Easy to use, penetration of the heat into the tissues is
high.
 Drum or cable electrodes.
Cable Application
 2 m length and 1.5 cm
thickness
 Induction cables should
be wrapped around the
body (protected with
towel)
 In practice, there should
be a distance of at least
1.5cm between the skin
and the cable.
Cable Application
 There is an electromagnetic field between the cable.
 Cable electrodes connect to resonator part of tool.
Cable Application
 It is usually used for the
treatments of arms an
legs
 Cable ends have to be
parallel to each other.
Shunt Technique
Shunt Technique
 It is used when more than one limb is treated at the
same time.
 For example; Two condenser electrodes are applied to
the lateral surface of both ankles, as in the case of the
two ankle joints.
 Two flat rubber electrodes are placed on the medial
parts of both ankles and the ends are connected
together.
Two different electrodes methods
Two different electrodes methods
 It is used when the upper and lower surfaces need to
be treated at the same time in the body parts which are
not too thick like the forearm.
Hazards
 Burn
 Scalding
 Electric shock
 Gangrene
 Hypotension
 Dizziness