3 1.Paraffin Wax / Paraffin Bath Paraffin wax is a simple, convenient, reasonably efficient method of applying conducted heat to the extremities.It is a combined immersion technique withParaffin wax + mineral oil for conductive heat gains.For therapeutic use:7 units of wax unit mineral oil.The paraffin wax is then kept at low temperature and remains warm for a longer time than water.
4 Heat exchange by conduction In the case of parraffin, it provides superficial heat with a depth of 1 cm.
5 Characteristics of Paraffin Wax Paraffin has a slow thermal conductivity→ Slow heat diffusion (6 times lower than water).Paraffine wax has a low melting point (55°).When the oil is added, the paraffin will remain at a temperature of 40° to 44°C.This low specific heat will enhance the patient to tolerate heat from the paraffine better than from water of the same temperature.better tolerance to heat for the patient.
6 Characteristics of Paraffin Wax 2.Self insulator: It gives moist heat :there is a layer between the skin and the wax producing heat and sweating which does not evaporate.After removal the heated part cools quickly ( by evaporation).3. It is analgesic: This insulating layer keeps the heat and is effective in relief of pain.
7 Equipment used for paraffin wax applications Wax is placed in a parrafin bath:Small sizes for home use exist.2 stainless steel containers + wooden or bakelite insulator + heating wire.The water melts the wax. Thermometer reading should also be taken. The wax has to be melted in advance and it takes 3 to 4 hours or heated constantly.Paraffin + petrolatum oilWater at 72°CThermostat at 44° C Maximum
9 Operation of the Apparatus Normally, parrafin wax has a melting point of 55°C.Large bath have a capacity of 25 kg of paraffin.You will then add 5 liters of light petrolaneum oil to lower the melting point and prevent burns.To melt the paraffin turn the switch on to heat the coil, the water for 1 hour prior to treatment.Always check the temperature with thermometer before ttt.For busy clinics, the bath can be plugged in day & night to be ready for use.
10 Care of the Paraffin Bath Apparatus The patient’s body part should be cleaned before ttt.Bath is to be cleaned regularly (every 6 months) while the paraffin is liquid. Disconnect the unit from electrical outlet & dip the parraffin out of the bath with a small pan in another container.Remove & clean the slats , remaining paraffin can be removed and sediments removed with paper towels.Replace then the parrafin back in the bath and add new paraffin as needed.
11 Physiological Responses to Paraffin Wax Therapy Heat production:in the first 2 min a marked increase in skin temperature: 12°C to 13°C.While wax wrapping the temprature drops.Then after 30 min. at the end of the treatment to:8°C at skin level.5°C at subcutaneous fascia.2°C -3°C in superficial muscles.
12 Physiological Responses to Paraffin Wax 2. Circulatory effects:Stimulation of superficial capillaries & arterioles → local hyperemia → reflex vasodilatation of capillaries in the skin ( pink).→ reflex heating of the joints.→ skin t° drops quickly after min.→ reduces then vasodilatation.N.B : Exercises after wax is important to ↑ ROM and muscle strength.
13 Physiological Responses to Paraffin Wax Analgesic effects:Most important effect as sedative effect on tissue.Moist heat gives a soothing effect.Very good prior to the exercise for superficial joints.Stretching effects: wax leaves the skin moist, soft and pliable. It is useful for stretching scars and adhesions.
14 Indications1. Pain and musle spasm especially in the distal extremities ( toes and fingers).2. Oedema and inflammation: gentle heat reduces:Post-traumatic swelling of the hands and feetSwelling of the hands in rheumatoid arthritis.Swelling of the hands in degenerative joints disease.Especially in sub-acute and early chronic stages or inflammation.! Caution is needed in acute phase of arthritic pain and swelling.3. Adhesions and scars : wax softens and facilitates the mobilization and stretching procedures.
15 ContraindicationsImpaired skin sensation (hot/cold sensation test): anaesthesia, hypostasia, hyperesthesia, parastesia.Some dermatological conditions: eczema,dermatis. (report any reactions after ttt).Circulatory dysfunction ( varicose veins, DVT, arterial disease)Analgesic drugs as pain tolerance to heat is impaired.Infections and open wounds ( as it increases the infective activity) such as in blood born infections.
16 Contraindications (cont) Cancer, tumors or tuberculosis ( TB) in the area to be treated as it ↑ the metabolic activity & rate of growth.Gross oedema with a very thin and delicate skin covering the area .Lack of comprehension ( children, senile , head injuries, confused, agitated,…)Deep X~ray therapy within three months prior to treatment ↓ bloodflow thus impaired sensation.10. External or internal metal fixators, implants (metal plates in orthopedics).
17 Advantages 2 or 3 patients can be treated in the same time. Useful for pt. with poor heat tolerance, dry scaly skins, after Plaster of Paris removal.Can be followed by therapeutic exercises.Can be carried out at home.Wax can mold around the bony contours of feet & hands.Heat is applied evenly by conduction.
18 Disadvantages Not sterile or not very desinfected procedure. Messy technique, floor should be protected.Sedimentation occurs in bottom of the bath → should be regularly cleaned (daily or every 2 days).Contamination by air unless covered by lid.Water collects at bottom of bath.
19 Techniques of Application Technique I by Dipping: Create paraffine glove by 10 repeated dippings. Fingers are in Abduction. Dont tip above the level of the previous glove.Technique II by Immersion:dip once for having a glove then and immerse for 15 to 20 min.Never immerse at first for a long time without making a « glove » dry before to have insulation.
20 Techniques of Application Technique III( Parrafin wax with infrared cabinet):same as technique I &II+ place in heat cabinet at 70°Cor under infrared lamp at 0.5 m distance.
21 Techniques of Application Technique IV ( Tray technique):Dip twice then immerse for 15 minutes. Remove the hand and place in a tray containing semi-liquid paraffin.Ask patient to move hand and make shapes out of the solidifying wax.
22 Application Techniques. 5.Technique V( Parraffin with elevation): Same technique as I then place the hand in elevation under a hot air cabinet.Alternatively the hand can be placed in elevation with a towel or blanket wrapped around hand for 20 min.6. Technique VI ( Bandaging): Wax can be also applied to the knees and elbow by applying elasto-crepe bandages which have been immersed in wax.Then brushing more wax on the bandages using a paint brush.
23 Analysis of the Techniques Technique I (Dipping): query need for wrapping in towel as there is a strong rise in temperature initially.Technique II( by immersion) will maintain a more constant temperature as the extremity remains in the bath.Technique V ( Elevation) is useful for the oedematous hands, with dry scaly skin.Technique VI ( with bandaging) has limited use only for home technique.