Some Key Points in this Unit

Heat is a form of energy. Heat is transferred from a body of higher temperature to

a body or environment at a lower temperature.
The quantity of heat needed to raise the temperature of 1 gram of water by
1°C, say 14.5° to 15.5°C, is 4.2 joules (1 calorie).
The heat capacity (C) of a body is the ratio of the quantity of heat (Q) supplied to
a body to its corresponding temperature rise (T).
C=4
The heat capacity of a body is numerically equal to the quantity of heat needed to
raise its temperature by one degree Celsius.
Specific heat capacity of a material is the quantity of heat in joules that must be
supplied to one gram of material to raise its temperature by one degree Celsius.
The units are J/g/°C.
Temperature is measured on the Celsius temperature scale, formerly called
centigrade.
Electromagnetic waves are forms of energy. They consist of a transverse electric
field together with a transverse magnetic field, and were first described by James
Maxwell in 1861. Light waves, radio waves, microwaves and X-rays are all
electromagnetic waves with different frequencies but the same velocity. The
velocity of electromagnetic waves is denoted by c and its value is 3 x 108 m.s..

Photon and Quanta.

According to Planck in 1900, energy is emitted in discrete
packets of quanta. The quantum of electromagnetic radiation is the photon. The
energy of a photon is calculated from the frequency of the wave.
E = hv
where E = energy of photon; v = frequency: h is Planck's constant, which has the
value of 6.63 x 10" J.Hz.
Hyperaemia is an increased content of blood in a part with distention of blood
vessels. It may be active from the active dilatation of blood vessels, or it may be
passive hyperaemia from hindered drainage when veins and lymphatics are
occluded, or in congestive heart failure.
Vasodilatation is the increase of the lumen of blood vessels, that is, the blood
vessels are dilated.
Denaturation is the alteration of the characteristics of an organic substance,
especially a protein, by chemical or physical action.

1.1 Some Ideas on Heat and the Electromagnetic

Spectrum
Every living organism produces heat. The heat is either lost to the environment or
stored in the body. In man's natural environment the predominant form of
radiation is thermal, and it is with this radiation that we are most familiar. The
reason is partly that our senses are adapted to receive this form of radiant energy,
thereby giving us the sensations of sight, warmth, cold and pain, and partly that the
atmosphere around us is suited to transmit thermal radiation.
Heat is continually produced in the body as a by-product of metabolism. It is lost
from the body by radiation, conduction and evaporation. In respect to heat
transfer between man and his environment, the sun is by far the most important
source of radiant heat, and radiation from our skin to the environment is an
important source of cooling. As much as 70% of body heat production may be lost
by radiation exchange with the cold surfaces in our environment.
An understanding of the kinds of electromagnetic radiation that produce heat,
the physics of heat, and a knowledge of the structure of the skin are essential to
enable the physician and the therapist to produce maximum benefit from the use
of therapeutic heat. Knowledge of the physiological responses of the body to heat
and the effects of thermal radiations on any pathophysiological states of the body
help in the use of heat in the treatment of patients.
Heat is a form of energy. Thermal energy can be thought of as vibrations of the
molecules of the substance. This motion of the molecules and their electrons
causes the emission of electromagnetic waves. Waves are emitted in discrete
packets called photons. Both the average energy of the photons and their rate of
emission increase as the temperature of the source is increased. Photons of a
particular energy have a characteristic wavelength or frequency. Absorption of
photons by a body leads to an increase in its heat energy.

Heat and the Electromagnetic Spectrum

Some derived SI units

UNIT SYMBOL
QUANTITY
DEFINITION
Hz
frequency
force
hertz
newton
pressure
pascal
One cycle per second
The force which when
applied to a mass of 1 kg
causes an acceleration of 1
metre per second per second
in the direction of the force
The pressure which arises
when a force of 1 Nis
applied uniformly over an
area of 1 m
The work done, or energy
expended, when a force of 1
newton moves through a
distance of 1 metre
(°C) = T(K)-273.15
work, energy
joule
temperature
degree
Celsius
volt
electric potential
The poiential difference
between two points on a
conductor carrying a current
of 1 ampere when the power
dissipated between the
points is 1 watt

THE ELECTROMAGNETIC SPECTRUM

Vibrations at a nuclear and electronic level give rise to photons of a wide range of
frequencies. The electromagnetic spectrum is an array of the various electro-
magnetic waves in order of length or frequency.
One wavelength is the horizontal distance between the crests of any two
adjacent waves. Electromagnetic wavelengths are measured in nanometres (nm).
One nanometre equals one thousand millionth of a metre, 10m. One cycle is the
complete sequence of events that takes place during the passage of one wave.
Frequency is the number of cycles which pass a point in unit time.

Electromagnetic waves travel in straight lines at the velocity of about 300 000.00
metres per second. The velocity is the same for all electromagnetic waves.
frequency varies inversely with the wavelength

PHYSICAL PRINCIPLES OF HEAT

Heat flow through matter (tissues) varies with the nature of the material (type of
tissue) and is called thermal conductivity. Changes in surface tissue tempera
from superficial heating agents depend on the intensity of the heat applied, the time of
heat exposure, and the thermal medium (product of thermal conductivity, density, and
specific heat) for surface heat. The greatest degree of temperature elevation with su-
perficial heating agents occurs in the skin and the subcutaneous tissues within 0.5 cm
from the skin surface. In areas of adequate blood supply, temperature will increase to a
maximum within 6 to 8 minutes of exposure. 12. Muscle temperature at depths of 1 to
2 cm will increase to a lesser degree and will require a longer duration of exposure (15
to 30 minutes) to reach peak values. 5,16,39 At a depth of 3 cm, using clinically tolerable
intensities, muscle temperature elevation can be expected to be about 1°C (31.8°F) or
less.
In joints of the hand and wrist, or foot and ankle, with relatively little soft tissue
covering, superficial heating agents can raise intra-articular temperatures.3.58,9 In fact,
a 20-minute exposure of the foot to dry heat at 47.8°C (118°F) was shown to increase
joint capsule temperature in the foot. Even though there can be a reflex vasodilatory
response on the unheated opposite extremity, no reflex temperature changes would be
expected to occurs
After the peak temperature is reached, there is a plateauing effect, or slight de-
crease in skin temperature, over the remainder of the heat exposure 8,12,16,33 Typical
temperature responses of areas with intact circulation are diagrammed in Table 5-1.
Fat provides an insulation against heat; it has a low thermal conductivity (see
Table 4-1). Therefore, tissues under adipose tissue are likely to be minimally affected
by superficial heating agents. In order to elevate deep tissues to therapeutically de-
sired levels without burning the skin and subcutaneous tissue, a deep-heating agent
such as continuous wave ultrasound or shortwave diathermy would be selected.

Metabolic Reactions
Chemical reactions in cells of the body are influenced by temperature. Generally
speaking, chemical activity in cells and metabolic rate will increase twofold to three-
fold for each 10°C (50°F) rise in temperature. 12.15 Therefore energy expenditure will in-
crease with increasing temperature. As temperature rises past a certain point, usually
45°C to 50°C (113°F to 122°F), human tissues will burn because the metabolic activity
required to repair tissue is not capable of keeping up with thermally induced protein
denaturation
An increase in chemical reaction rate can also have positive effects on human
function. Oxygen uptake by tissues will increase. Theoretically, therefore, more nutri-
ents will be available to promote tissue healing.

Vascular Effects
Increasing tissue temperature is usually associated with vasodilation, and thus
with an increase in blood flow to the area. 28-19,10,17 This blanket statement, however
can be misleading. It is important to know which regions have increased blood flow.
The control mechanisms are different for blood flow to different structures--for exam-
ple, skin compared with skeletal muscle. Therefore, responses to temperature change
will not always be the same; or if a response is in the same direction, it may not be of
the same magnitude.
Skin blood flow has an important role both in nutrition and in the maintenance of
constant core body temperature of 37°C (98.6°F), and is primarily under the control of
sympathetic adrenergic nerves,18,19 Vasodilation of resistance vessels of the skin will
occur as a means of losing heat through local or reflex mechanisms. The skin is unique
in that it has specialized vessels, arteriovenous (AV) anastomoses, which have an im-
portant role in heat loss. 19 These shunt vessels go from arterioles to venules to venous
plexuses, thus bypassing the capillary bed. The blood flow through these anastomoses
is under neural control. Activation occurs in response to reflex activation of tempera-
ture receptors or stimulation of heat-loss mechanisms triggered in part by the circula-
tion of warmed blood through the preoptic region of the anterior hypothalamus. These
AV shunt vessels are found in the hands (palms and fingertips), feet (toes and soles),
and face (ears, nose, and lips).
Blood flow changes in the skin, as mentioned previously, can be caused by lo-
cal10,18,29 or reflex" mechanisms. Vasodilation of the heat-exposed skin can be pro-
posed to occur owing to three factors: (1) an axon reflex; (2) release of chemical media-
tors secondary to temperature elevation; and (3) local spinal cord reflexes. Heat
applied to the skin stimulates cutaneous thermoreceptors. These sensory afferents
carry impulses to the spinal cord. Some of these afferent impulses are carried through
branches antidromically toward skin blood vessels, and a vasoactive mediator is re
leased. This results in vasodilation through an axon reflex (hig. 3-1).
Heat produces a mild inflammatory reaction. Chemical mediators of inflamma
tion, including histamine and prostaglandins, are released in the area and act on resis
tance vessels to cause vasodilation. In addition, temperature elevation cause
Vasodilation. In addition, temperature elevation causes sweat secretion and the enzyme
kallikren is released from sweat glands. This enzyme acts on a
globulin, kininogen, to release bradykinin Vasodilation of resistance vessels and an
increase in capillary and postcapillary venule permeability occur because of the action
of these chemical mediators on smooth-muscle tone and endothelial-cell contractility,
respectively. Because of an increase in capillary hydrostatic pressure and permeability,
outward fluid filtration from vascular to extravascular space is favored. Therefore,
heat within the therapeutic range can potentially increase interstitial fluid and cause
mild inflammation.
A local spinal cord reflex is elicited through heat-activated cutaneous afferent
stimulation. This reflex results in a decrease in postganglionic sympathetic adrenergic
nerve activity to the smooth muscles of blood vessels. A schematic of the reflex is dia-
grammed in Figure 5-2.
Vasodilatory effects of this reflex response are not only limited to the area heated,
but there will be a consensual (reflex) response in areas remote from the site of applica-
tion. When one area of the body (e.g., the low back) is heated, increases in skin blood
flow occur in distal extremities in areas of the body that are not directly heated.23-35
This principle of reflex vasodilation is felt to be safe to use with patients with periph-
eral vascular disease. For example, cutaneous blood flow to the feet could be in-creased by the
application of heat to the low back
Skeletal muscle blood flow is primarily under metabolic regulation and demon-
strates the greatest response to increases or decreases in levels of exercise. When su-
perficial heating agents are given, minimal to no change in skeletal muscle blood flow
is expected. This notion is supported by two reports on heat lamp (infrared) applica-
tion. Crockford and Hellonº measured venous oxygen content following 20-to 30-
minute exposures of the forearm. Superficial venous oxygen content increased, but
there was no change in muscle blood flow. Wyper and McNiven reported no change
in muscle blood flow following heat (infrared) treatment

Heat Transfer
The primary methods of heat transfer for superficial heating agents are conduce
convection, and radiation. Conduction is a method of heat transfer where the ki-
tis motion of atoms and molecules of one object is passed on to another object. This
netic motion, often described as "atoms jostling one another," 18 is increased when
biect is heated more than another, and occurs more effectively if the objects are
solids, 18
Convection is the bulk movement of moving molecules, either in liquid or
gaseous form, such that this bulk movement of liquid or gas transfers heat from one
place to another. The fluid movement can be pumped, such as the blood within the
body being pumped by the heart, and warming all the parts to which it travels; or, it!
moves because a heated liquid or gas, being less dense, floats upward.
Radiation is the conversion of heat energy into electromagnetic radiation. All ob-
jects at temperatures above absolute zero (273°C) both emit and absorb radiant energy.
Any heated object or element, such as an infrared heat lamp, gives off radiant heat. If an
object or body part is brought close enough to the radiant energy source, heat will be ab
sorbed. Radiant heat application using infrared lamps is rarely, if ever, used today in reha
bilitation as a form of superficial heating, and therefore will not be discussed further.

Conductive Heating Agents: Hot Packs and Paraffin Wax

The two most commonly used superficial heating agents are hot packs and paraf-
fin wax. Both transfer heat to the body via conduction because they are in contact with
the skin, and both the hot pack and the paraffin are at a much higher temperature than
the skin surface to which they are applied. Therefore, thermal energy is lost from the
agent and gained by the tissues. The quantity of heat gained and the subsequent phys-
iologic responses to that heat gain are dependent upon several factors, including but
not limited to: (1) thermal conductivity of the tissues; (2) body volume exposed; and
(3) time of exposure

HOT PACKS
Hot packs provide a superficial, moist heat. Commercial hot packs consist of can-
vas or nylon cases, filled with a hydrophilic silicate or some other hydrophilic sub-
stance, or sand (Fig. 5-4). Hot packs are stored in a thermostatically controlled cabinet
in water at a temperature between 70°C and 75°C (158°F and 167°F).1,16,18 Hot packs
come in a variety of shapes and sizes, and should be chosen on the basis of the size
and contour of the body part(s) to be treated
The packs should totally cover the treatment area and should be secured in place
(Figs. 5-5 and 5-6). The pack should not be secured so tightly that the patient cannot
remove it if it becomes too hot. The pack should be covered with layers of terry towel-
ing or commercial hot pack covers. While there appears to be no definite number of
layers of toweling for wrapping hot packs, the consensus is about six to eight layers,
depending on towel thickness. Commercial hot-pack covers often need another laver
or two of toweling to ensure adequate insulation from the hot pack.

As with all forms of heating agents, the patient should only feel a mild to moder-
te sensation of heat during application; the old adage "the hotter the better" could re
sult in skin burns. The therapist should monitor the patient during hot pack applica
tion, and it is advisable to check under the hot pack after about 5 minutes to detect the
skin color and patient's subjective feelings about the amount of heat being perceived
A significant early change in skin color may suggest overheating. Fair skinned individ
uals may turn bright pink/red to or blotchy red and white, while darker-skinned indi
viduals may exhibit areas of darker and lighter color. Fyfe' suggests frequent monitor
ing of the patient until about the 9 to 10-minute mark after warmth is first perceived,
when the maximum heating begins to dissipate. If the pack feels too hot to the patient,
or the therapist detects distinct skin color change, more toweling should be added, or
the hot pack should be removed. Patients should be advised not to be with full body
weight directly on top of hot packs, particularly when the intended treatment area is
on the trunk. Body weight will squeeze water from the pack and may accelerate the
rate of heat transfer. In addition, local circulation could be reduced through compres-
sion of vessels, thus reducing circulatory convective cooling (dissipation of the heat).
Both factors could cause overheating of the skin.
If hot packs are recommended for use at home (by caregivers or reliable patients),
adequate instructions should be provided. There are a variety of methods of using
moist heat at home by patients or care givers, including commercial hot packs (hy-
drophilic silicate) and small water tanks for storage; sand packs, which can be heated
either in water or in a microwave oven; and gel packs, which can also be heated in wa-
ter or in a microwave oven. A common rubber hot-water bottle covered with moist
toweling will also suffice.
All forms of hot packs should be inspected regularly for leaks and should be dis-
carded if leaking occurs. When hydrophilic silicate hot packs become old and worn,
they leak the pastelike material within them, and they should be discarded, along with
gel packs that leak. Hot packs containing sand can be repaired by re-sewing the seams
of the pack.
Clinically, hot packs appear to be used most often to help reduce pain and muscle
spasm, and to help improve tissue extensibility. -17.7832/12/48 The moist superficial
heat they provide appears to rate quite highly among patients relative to their comfort
heating ability, and effectiveness.
When compared with other heating modalities, or other modalities used to treat
pain, hot packs fare well, although not significantly better. Several studies 42,47,55 indir
cated that while the hot packs decreased pain and muscle spasm and improved ranea
of motion, they were not significantly better than other modalities. Williams and asse
ciates 42 found that hot packs did improve range of motion at the shoulder more than
ice, although not significantly. Interestingly, however, most of the patients in the
treatment group asked if they could be treated with heat instead of ice once the study
was completed.

Advantages of Using Hot Packs

1. Ease of preparation and application.
2. Variety of shapes and sizes available.
3. Moist, comfortable heat.
4. Relatively inexpensive to purchase and replace (assuming a tank already owned).
Disadvantages of Using Hot Packs
1. No method of temperature control once applied to patient.
2. Do not readily conform to all body parts.
3. Sometimes awkward to secure in place on a patient.
4. Do not retain heat for longer than about 20 minutes,
5. It is a passive treatment, not requiring active patient participation
6. Leaking hydrophilic or gel packs must be discarded.

PARAFFIN WAX
Paraffin wax has several physical characteristics that make it an efficient source of
superficial heat. First, it has a low melting point, around 54°C (129°F). This can be low-
ered more by adding more paraffin oil or mineral oil, so that the wax remains molten
at temperatures between about 45°C and 54°C (113°F and 129°F). This molten state al-
lows for more even distribution of the wax around the part to be treated (usually distal
extremities). Second, paraffin has a low specific heat, which means that it does not feel
as hot water of the same temperature; therefore, there is much less risk of a burn.
Third, it conducts heat more slowly than water at the same temperature, thus allowing
the tissues to heat up more slowly, also decreasing the risk of a burn. This is particu-
larly important when treating patients with sensitive skin or diminished skin sensa-
tion, for example, following burns..,
The paraffin mixture of a paraffin wax (six or seven parts) to oil (1 part) is com-
mercially available (Fig. 5-7) and is melted and stored for use in thermostatically con-
trolled stainless steel or plastic containers. These wax baths come in a variety of sizes;
the smaller ones are ideal for patient use at home (Fig. 5-8).
Paraffin is most commonly used for the distal extremities, including the fingers,
hand, wrist, and perhaps elbow in the upper limb, and the toes, foot, and ankle in the
lower limb. There are two principal techniques of application: (1) dip and wrap; and
(2) dip and reimmerse. For both methods, the extremity to be treated should be
washed and dried, and all jewelry should be removed from the part. When treating the
hand and wrist for example the fingers should be slightly spread apart, the wrist re-
laxed, and the hand and wrist dipped into the wax to a few centimeters above the
wrist joint. The hand is then removed from the wax and held above the bath until the
wax has stopped dripping-then the hand is dipped again. The patient should be re-
minded not to move the hand and fingers so not to break the seal of the glove being
formed. This procedure is repeated about 6 to 10 times until a solid wax glove has
formed around the fingers, hand, and wrist. The hand is then placed in a plastic bag
and wrapped with a towel to help retain the heat. If there is a potential for edema to
increase secondary to the heat, the part should be elevated above level of the heart un-
til the treatment time is over.
With the dip-and-reimmerse technique, after the wax glove has formed, the area
covered by the glove is put back into the wax bath and kept there for the duration of
the heat treatment (about 10 to 20 minutes). The most vigorous responses with respect
to temperature elevation and blood flow changes will occur with the dip-and-reim-
merse technique. This technique would not be well suited for most patients who are
predisposed to edema, or if they cannot sit comfortably in the position required for
treatment. This technique also precludes other patients from using the wax bath dur-
ing that time period. If there are potential treatment areas that are not amenable to ei-
ther of these methods, the wax can be painted on using a paint brush, applying up to
10 coats of wax.
When using paraffin to improve skin pliability over healed burn areas, à tem-
perature of 47°C (116.6°F) has been suggested." Paraffin also lubricates and condi
tions the skin, because of the mineral oil content.62 This can be particularly useful
when treating a scarred skin area. Using wax and stretching, Head and Helms
demonstrated a maintainable average increase in range of motion of 7 to 10 degrees
in joints of patients with burn scars. If wax is applied over a skin-grafted area, the
eraft should be stable, nonfragile, and at least 10 days postgraft.40 Treatment is daily
for 2 to 3 weeks.
Paraffin baths are often used as part of a treatment program in patients with
rheumatoid arthritis. Wax is used in the nonflare phases to decrease pain and increase
tissue extensibility. Dellhag and associates found wax baths to be an effective treat-
ment for this population. Although they found no significant therapeutic effects with
wax-bath treatments alone, there was a significant improvement in stiffness, range of
motion, and grip function when the wax treatment was followed by active exercise.
Relative to other heat modalities, paraffin wax is not significantly better at de-
creasing pain or increasing joint range of motion. Hoyrup and Kjorvelº compared
whirlpool and wax treatments for hand therapy. They measured hand volume, range
of motion, and level of pain immediately prior to and following 3 weeks of treatment.
While all subjects showed significant improvements in range of motion as well as de-
creased pain levels, no significant differences were found between the modalities.
Hawkes and associates compared wax baths with both ultrasound alone and ultra-
sound followed by an electrical stimulation hand bath in patients with rheumatoid
arthritis of the hands. All treatment groups demonstrated significant improvements in
the seven measurements taken (grip strength, joint size, articular index, range of mo-
tion, timed task, functional activities, and pain, measured using a VAS), although they
found no significant differences among treatment groups.
Paraffin should not be applied over open wounds because of the risk of burning
the tissues. Patients with infected skin lesions should not use wax for fear of exacerbat-
ing the lesion. When contagious skin conditions or warts are present, prior to immer-
sion in the wax bath, the area is covered with a bandage or some form of plastic skin
film, as the wax bath could become contaminated.

Advantages of Paraffin Wax

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 fingers 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 tool.
7. Comfortable, moist heat.
8. Relatively inexpensive to replace wax (assuming bath is already owned).
Disadvantages of Paraffin Wax
1. Effective only for distal extremities in terms of ease of application
2. Most effective method of application is the bath method, which limits accessibility
for other body parts to be treated effectively.
3. No method of temperature control once applied.
4. Heating lasts only about 20 minutes.
5. It is a passive treatment; exercise may not be performed simultaneously.

To understand the amount of heat or cold the patient receives and the resulting
therapeutic effects, the physical therapist must become acquainted with
basic physical concepts concerning thermal energy and with biophysics, the
physical relationship to the body and the physiological effects produced. Integrat-
ing this information helps the therapist determine which thermal effects are thera-
peutically beneficial or detrimental. This chapter begins the process by discussing
the aspects of thermal physics that are relevant to thermal physical agents.

HEAT AND THE FIRST LAW OF THERMODYNAMICS

Kinetic energy--the movement of molecules or their constituents (atoms, nuclei,
and electrons)-is related to the temperature of a substance. Thus, kinetic energy,
the internal energy of the substance, is thermal energy. As the temperature of a sub-
stance increases, the motion of its molecules increases. Movement of the entire
molecule is termed translational, and movement of the constituents within the
molecule can be either rotational or vibrational. Molecular motion ceases only if
the temperature of a substance is absolute zero: ie, it contains no heat.
Assuming that the sun is the initial source of energy, no molecular motion of
any substance would occur without solar energy. As long as a substance has some
energy, some random molecular motion is present. Thus, the substance contains
some heat. With increased input of energy, kinetic energy increases. The increased
molecular motion produces more heat and the temperature rises. Because an in-
crease in molecular motion correlates with an increase in heat of a substance, a
simple definition of heat could be that heat is molecular motion

.
The words hot and cold are relative terms. One can say that no such thing as
cold exists because as long as any molecular motion is present, there is some near
However, the terms are used for the sake of comparison. If one places an
viously warmed to 104° F (40° C) in water that is 90°F (32.2°C), the water
cold, but if a chilled hand is placed in the same water, the water might
different perception is the result of a different reference point. Thus,
cold is not an absolute entity; it is a term used to describe an entity that has
heat, or gives the sensation of less heat, than does another entity. However, in day
to-day terms, we have become accustomed to calling certain temperatures
cold for practical purposes. Toa snow skier, 50°F (10° C) weather is hot; to a water
skier, it is cold. Table 7-1 indicates how various temperatures of water are gener
ally perceived when a person in a temperate ambient temperature immerses a
body part in water.

First Law of Thermodynamics

The first law of thermodynamics tells us that, with the exception of nuclear effects,
energy cannot be created or destroyed but can be transformed from one form to
another. Whenever this transformation occurs, some energy is released as heat and
thus is considered to be thermal energy. Any activity of chemical, mechanical, or
electromagnetic systems always produces some heat. Through such processes, dia-
thermy and ultrasound modalities convert high-frequency electromagnetic or
sound energies to heat in the tissue where the original energy is absorbed.

Temperature and Temperature Scales

Temperature is not heat per se, it is a means of measuring or describing heat more
specifically than is possible using the relative terms hot and cold. This description
is not completely accurate either because two substances (eg, water and melted
paraffin) at equal temperatures may not necessarily contain equal amounts of her
energy or feel equally hot
Temperature can be measured with four different scales. Table 7-2.com
the four scales and notes the temperatures that have special meaning to theran
Clinically, we use both Fahrenheit (F) and Celsius (C) (centigrade) scales, there
therapists should be able to quickly convert any information given in either
to the other. One commonly used conversion formula is
F = (9/5 °C) + 32 or C - 5/9 (F-32)
The Kelein and Rankin temperature scales are used for scientific research. the size of the
degree is the same for the Celsius and Kelvin (K) scales and for the Fahrenheit and Rankin
scales.
HEAT TRANSFER
Heat is always transferred from higher to lower temperature molecules until a
state of equilibrium is achieved. This heat transfer can occur through radiation, con-
duction, and convection. Devices using each of these means of heat transfer are
available to clinicians. Fig. 7-1 illustrates three thermal modalities that transfer
heat by the different mechanisms: heat lamps, hot packs, and fluidotherapy. There-
fore, the physical therapist can select the modality with the means of heat transfer
that is most appropriate for a particular situation.

Radiation
All objects can give off or take on thermal energy through the process of radiation.
Energy emitted at infrared frequencies will travel from a warmer substance and be
absorbed in a cooler substance. The increase in infrared energy causes the molecu-
lar motion in the cooler object to increase, thus increasing its heat. Because infrared
rays are synonymous with heat waves, all the physical laws of radiation apply (see
Chapter 5).If you stand in a room and the temperature of your exposed skin is 87° F (30.6 )
and the walls of the room are 65° F (18.3°C), you will radiate infrared energy. That
energy will travel from you to the walls, where it will be absorbed; this transfer
will continue until you have cooled and the walls have heated so that temperatures
both are equal. Basically, infrared waves are transmitted throus do not heat air. However, some
waves are absorbe that may be in the air. Advertisements for some smallean heaters explain
the concept of infrared heating. These advertisents stress that these heaters are "people
heaters," not "space heaters.. But infrared rays transmitted through space are absorbed into
objects and people.
this is just as true for the heated filament units commonly the heated filament units commonly
called "space heaters Both types emit infrared rays; thus, they heat obiects rather than the air.
space heater implies that the heater is effective only within a limited area of space
from the heater. Both quartz and filament infrared lamps are used in physical ther-
ару.ransmitted through space and thus
absorbed in dust and other substances
ents for some small-area heaters called quartz
eating. These advertisements stress that
not space heaters."

Conduction
Conduction is a method of heat transfer from one place to another by successive
molecular collisions. Heat transfer by conduction is a slow process. When two ob
jects of different temperatures come in contact--for example, when your warm
hand touches a cooler object--the more rapidly moving molecules of the warmer
object (your hand) collide with the more slowly moving molecules of the cooler
object. The collision causes the more slowly moving molecules to move faster, thus
increasing the temperature of that object. But because the warmer object (your
hand) gave up some of its energy, its molecules move more slowly after the coll:
sion, causing your hand to become cooler.
Paraffin, hot packs, and cold packs use the conduction transfer method. Hot
paraffin transfer heat from the modality to the body. In the case packs and melted paraffin
transfer heat from the modality
of a cold pack, however, the rapidly moving, warmer molecules of the body trans
fer heat to the pack. Consequently, the body cools and the pack becomes warmer.

Convection

is a method of heat transfer in which the heated molecules move from

one place to another. This method of heat transfer is more rapid than
and occurs in liquids and gases. Increased input of energy into a systen
e energy of some molecules, which produces more forceful collisions and causes
molecules to travel greater distances after colliding. Thus, as the temperature
reases, the space between fluid or gas molecules increases, resulting in a less
ise heated region. A region of lower density is lighter, but it demands more
space, replacing the region of higher density. For example, warm air rises and cool
air sinks. Circulation of the air or water takes place as the heated, more buoyant
gas or fluid rises.
Fig. 7-2A and B illustrate convection. If the air in a room is initially 50° F (10° C)
and a baseboard heater heats the air adjacent to it to 90° F (32.2° C), the warmer air

will expand and the molecules will begin to rise, causing the cooler air nearer the
ceungbecause of its greater density--to circulate down toward the baseboard,
where it will be heated. However, as rising hot-air molecules pass the descending
cool-air molecules, they collide (touch). As a result, some heat is conducted (trans-
ferred to the cooler molecules). Thus, the "cool" molecules will be warmer than the
initial temperature of the air in the room (50° F) as they near the floor (see Fig.
7-2C).
Nonetheless, as this cooler air, which is now near the floor is heated, it in turn
will rise. The circulatory process will continue until all molecules reach the same
temperature. This is analogous to the body's major means of heat transfer between
core and surface. As heat is convected in blood flowing through the vascular sys-
tem some heat is transferred by conduction to adjacent tissues or blood vessels.
The same principles of convection apply to water. With a temperature gradi-
ent, water will circulate without any stirring or agitation until all of it reaches ap-
proximately the same temperature. For example, suppose you fill one-third of a
whirlpool tank with extremely hot water, then add the same amount of cool water.
In a few minutes, all the water will be the same temperature via convection even
without stirring the water. Of course, agitation hastens this circulating process tre-
mendously.

THERMAL PROPERTIES OF SUBSTANCES

Many properties of substances depend on and vary with changes in temperature
and atmospheric pressure. Such properties include (1) the state of the substance
(solid, liquid, or gas) (2) its density and thermal expansion, (3) its specific heat ca-
pacity (c), and (4) its thermal conductivity (k). Because each substance has a unique
molecular structure, no specific temperature or pressure affects the properties of
all substances in the same way.

State of the Substance

Heat taken in or given up by a substance does not always change its temperature.
Some energy is used in the process of changing a substance from one state to an-
other. The heat required to change a substance from a liquid to a solid is called the
heat of fusion, and the heat required to change a substance from a solid to a gas is
called the heat of vaporization.

Heat of Fusion
When water gives up enough heat so that its temperature drops to the freezing
point, the next 80 calories per gram of heat (c/g) (336i/g) it gives up wi not lower
its temperature, they will solidify it into ice. Conversely, as the solid becomes fluid
its temperature will not rise until all the solid has melted, although heat is contin-
ually added to the substance. Thus, at approximately the melting point, all sub-
stances remain at the same temperature until they have melted completely, al-
though heat continues to be added.
The melting and solidifying temperature points of substances vary. Although
the exact temperature at which a substance changes from a fluid to a solid depends
on the atmospheric pressure, we usually say that water solidifies at 32° F (0° C),
whereas melted paraffin solidifies at approximately 131°F (55° C). Adding mineral
oil to paraffin lowers the melting point of the mixture. The exact temperature at
which the mixture changes from solid to fluid depends on the amount of mineral
oil added. As used clinically, this melting point is approximately 126°F (52° C) (see
Table 7-2).

Agents in
Elecna
Physiothera
70
THERMAL AGENTS
its temperature will not rise until all the solid has melted, although heat is contin-
ually added to the substance. Thus, at approximately the melting point, all sub-
stances remain at the same temperature until they have melted completely, al-
though heat continues to be added.
The melting and solidifying temperature points of substances vary. Although
the exact temperature at which a substance changes from a fluid to a solid depends
on the atmospheric pressure, we usually say that water solidifies at 32° F (0° C),
whereas melted paraffin solidifies at approximately 131°F (55° C). Adding mineral
oil to paraffin lowers the melting point of the mixture. The exact temperature at
which the mixture changes from solid to fluid depends on the amount of mineral
oil added. As used clinically, this melting point is approximately 126°F (52° C) (see
Table 7-2).

Heat of Vaporization
Water is changed into its gaseous state (steam) at the boiling point. This state re-
quires 540 cal/g (2268 /g). Thus, at 212° F (100° C) the next 540 c/g (2268 j/g)
input of heat into the water does not raise the temperature but converts the water
into steam
The same process occurs with vaporization of sweat-an essential mechanism
for cooling the body (see Chapter 8). Fluids do evaporate below 212° F (100° C),
growing colder as they do. For example, water left in a dish gradually disappears;
the rate of vaporization depends on the humidity of the ambient air. The faster the
evaporation of any substance, the more pronounced the cooling effect. Using alco-
hol, water, or vapor coolant sprays to cool the skin quickly is a clinical example of
this phenomenon.