PARAFFIN -WAX THERAPY:

PRESENTED BY:

• SARA IBRAHIM

WAX THERAPY:

• Wax therapy, which uses a bath of molten paraffin wax, is one of the most effective ways of applying heat to improve mobility by warming the connective tissues. Wax

therapy is mainly used on your hands along with an exercise program.

• The temperature of the paraffin wax is maintained at 47 - 55°c.

• In the case of parraffin, it provides superficial heat with a depth of 1 cm.

COMPOSITION:• It is a combined immersion technique with

Paraffin wax + mineral oil for conductive heat gains.• For therapeutic use:

– 7 units of wax ---------1unit mineral oil.

– The paraffin wax is then kept at low temperature and remains warm for a longer time than water.

Principal of wax therapy:

•The mode of the transmission of heat (heat exchange) from paraffin to the patient skin is by conduction method.

Characteristics of wax:

1.Low thermal conductivity , provides superficial heat with a depth of 1 cm.

2.Gives of heat very slowly – no rapid loss of heat.3.Temperature is maintained at 47 - 55°c.

4.Melting point of wax is 55˚C.

5. It is self insulating. (The first layer creates a thin layer of air next to the skin which acts as an insulator)

Parts of Paraffin Bath unit:

• Container, • Mains,• Thermostat, • Thermostat pilot

lamp, • Power pilot lamp,• Lid, and • Caster.

Care of apparatus:

•Clean part before immersion.•Clean unit regularly.•Remove wax from unit.•Remove slat from bottom and clean.•Remove residual wax with paper towel.•The complete wax & oil should be changed every six months.

PHYSIOLOGICAL EFFECTS :

1.Heat production:•There is a marked increase in skin temperature in the 1st two minute, up to 12-13°c. This drop, while in the wax wrapping to an increase of about 8°c at the end of 30 minutes.•In the subcutaneous fascia, there is an increase of 5°c at the end of the treatment.•In the superficial muscles, is only about 2-3°c rise in temperature at the end of the treatment.•2. Circulating effect:•Stimulation of superficial capillaries and arterioles cause local hyperaemia and reflex vasodilatation. This is marked only in the region of the skin.

• The hyperaemia is due to response of the skin to its function of heat regulation.

• The effects of vasodilatation in the muscle are negligible, but then may be some reflex heating in the joints.

• Skin and subcutaneous tissue temperature drop after15-20 minute, reducing the vasodilatation.

• Exercise after the wax is essential to increase the muscle circulation and sedative effect of heat to obtain more range of movement and muscle strength.

• 3. Analgesic effect:

• The most important effect of wax its marked sedative effect on the tissue.

• The moist heat is remarkable soothing to the patient.• It is this effect that is used prior to the exercise, in the

treatment of superficially placed joints.• It is very comfortable to the patient.

• 4. Stretching effect:

• Wax leaves the skin moist, soft and pliable.

• This is useful for stretching scar and adhesion before applying mobilization techniques.

Indications:1. Pain and Muscle Spasm:

Wax reduces the pain and muscle spasm.

2. Oedema and Inflammation: The gentle heat reduces post-traumatic swelling,

rheumatoid arthritis or degenerative joint disease, of the hands and feet and also swelling in hands particularly in the sub-acute and early chronic stages of inflammation.

3. Adhesions and Scars: Wax softens the adhesion and scar in the skin

and thus facilitates the mobilization and stretching procedures.

Contrindications:1. Impaire skin sensation (hot/cold sensation test):

anaesthesia, hypostasia, hyperesthesia, parastesia.

2. Some dermatological conditions: eczema,dermatis. (report any reactions after ttt).

3. Circulatory dysfunction ( varicose veins, DVT, arterial disease)

4. Analgesic drugs as pain tolerance to heat is impaired.

5. Infections and open wounds ( as it increases the infective activity) such as in blood born infections.

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Cont…6. Cancer, tumors or tuberculosis ( TB) in the area to be

treated as it ↑ the metabolic activity & rate of growth.

7. Gross oedema with a very thin and delicate skin covering the area .

8. Lack of comprehension ( children, senile , head injuries, confused, agitated,…)

9. 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).

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PRECAUTIONS:

1. Cardiac insufficiency

2. Metal in the area

Advantages:i. 2 or 3 patients can be treated in the same time.ii. Useful for pt. with poor heat tolerance, dry scaly

skins, after Plaster of Paris removal.iii. Can be followed by therapeutic exercises.iv. Can be carried out at home.v. Wax can mold around the bony contours of feet

& hands. vi. Heat is applied evenly by conduction.

Disadvantages:1. Effective only for distal extremities in the terms of ease of application.

2. No method of temperature controls once applied.3. Sedimentation occurs at the bottom.

4. It is a passive treatment: exercise may not be performed simultaneously.

5. The bath must be cleaned regularly & emptied at least twice a year.6. Contamination of oil by atmospheric dust.7. It also poses environmental concerns regarding its disposal.

Preparation of patient: The nature of wax treatment is explained and the area to be

treated is inspected for contraindication. Look for any wound, skin infection, rashes etc. on the part to be

treated. Wash the area thoroughly & dry by using tissue paper or cotton. Tell the patient in brief about temperature of the wax and

benefits.so that he/she can prepare psychologically and fear of heat is minimized.

The patient is instructed to remove any jewelry or metal in the area.

Position of the patient should be such that the part to be treated comes closer to the wax bath container.

Instruct the patient to avoid touching the sides and bottom of the heating unit because burns may result.

Instruct the patient who is receiving an immersion method not to move the joints that are in the liquid. The cracking of the wax will allow fresh paraffin to touch the skin, increasing the risk of burns.

Treatment:• Dip the client’s hand into the paraffin up to the wrist,

making sure the hand is relaxed, for a few seconds, then remove. Repeat this dip 4 or 5 times until hand is fully coated. 

i. When the dipping process is done, put hands in a plastic liner, or wrap in warm towels.

ii. Place a mitt over the plastic liner, or just leave the hands sitting in the towels.

iii. Allow the wax to stiffen for five to 10 minutes, then remove the mitts, liner, or towels.

iv. Remove the paraffin and throw away the used wax.

Techniques/Methods of application:

2. Brushing / Painting method:

3. Dip & Immerse / Dip & Leave in method:

4. Dip & Wrap / Glove method:

5. Towelling/Bandaging method:

• A lint cloth / towel is immersed in molten paraffin wax and then wrapped around the body part.

• Several layers can be made over the body part.• This method is preferably used for treating proximal

parts of the body.

Efficacy of Paraffin Wax Baths for Rheumatoid Arthritic Hands.

ABSTRACT:•Objective: To provide an overview on the therapeutic application of paraffin wax to the hands of people with rheumatoid arthritis and to examine critically whether paraffin wax is efficacious for this condition in light of this information.

•Methods: A systematic database search using the MeSH heading ‘rheumatoid arthritis' combined with the terms: ‘therapeutic use of heat' and ‘therapeutic use of cold' was implemented. All relevant basic studies, clinical trials examining the effect paraffin wax has on hand tissue temperature, and randomised controlled clinical trials specifically examining the use of paraffin wax for treating rheumatoid arthritis, and their methodological quality were rigorously assessed according to standardised criteria.

• Results:Of the four randomised trials identified concerning the outcome of

paraffin wax applications to rheumatoid arthritic hands, one yielded equivocal results, while three reported that after three to four weeks, paraffin wax applications were accompanied by significant improvements in rheumatoid arthritic hand function when followed by exercise. The modality also relieves pain and stiffness immediately after its application with no documented detrimental effects on the disease process, even though paraffin wax temporarily raises joint temperature

• Conclusions:As a whole our data suggest there may be some benefit with few side-

effects in the application of paraffin wax to the hands of people with non-acute rheumatoid arthritis prior to exercise. However, the data are insufficient and preclude any definitive conclusions concerning the efficacy of paraffin wax for treating painful hand arthritis.

Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand

osteoarthritis.ABSTRACT:

•PURPOSE: To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA).

•METHODS: Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreiser's index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA).

• RESULTS:Both groups had a significant reduction in their 'current' pain 15

min after the first and twelfth treatments compared to pre-treatment but there was no difference between groups (t = 0.10, p > 0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t = 2.92, p < 0.05) and with movement (t = 4.73, p < 0.05) than the PO group. The PTA group also showed greater improvement in their FIHOA following 12 treatments than the PO group (t = 3.52, p < 0.05).

• CONCLUSION: Our results indicate that the addition of a topical analgesic to

paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.

• Evaluation of paraffin bath treatment in patients with systemic sclerosis.

ABSTRACT:OBJECTIVE: To investigate the effects of treatment with paraffin bath

in patients with systemic sclerosis (scleroderma).METHODS: In 17 patients with scleroderma one hand was treated

daily with paraffin bath in combination with hand exercise. The other hand was treated with exercise only and was considered a control. Hand function was estimated before treatment and after 1 month of treatment, concerning hand mobility and grip force, and perceived pain, stiffness and skin elasticity.

• RESULTS: At the follow-up, finger flexion and extension, thumb abduction,

volar flexion in the wrist, and perceived stiffness and skin elasticity had improved significantly in the paraffin-treated hand compared with the baseline values. The improved hand function was independent of skin score and disease duration. Improvements in function were significantly greater in the hand which was treated with paraffin bath and exercise than in the hand treated with exercise only concerning extension deficit, perceived stiffness and skin elasticity.

• CONCLUSIONS: In this pilot study hand exercise in combination with paraffin bath

seemed to improve mobility, perceived stiffness and skin elasticity. However, further studies with larger sample size are needed to attain more reliable results of the effect of paraffin bath treatment in patients with scleroderma.

Efficacy of Paraffin Wax Bath with and without Joint Mobilization Techniques in Rehabilitation of post-Traumatic stiff hand.

Abstract•Objective:Post-traumatic stiff hand is common a condition which causes pain and disability, the paraffin wax bath and joint mobilizations have the key role in its rehabilitation. We conducted the present study to determine the efficacy of paraffin wax bath with mobilization techniques compared with joint mobilization alone.

Methodology: This single blind randomized control trial was conducted on 71 patients in department of physical therapy and rehabilitation, Riphah International University Islamabad, and patients with post-traumatic stiff hand after distal upper extremity fractures, were included.

The patients were randomized into two groups: the joint mobilization techniques with paraffin wax bath were included in group A, and joint mobilization techniques without paraffin wax bath in group B. The study variables were pain score on visual analogue scale (VAS) 0/10, thumb function score (TFS) and passive range of motion (PROM) of wrist flexion, extension, radial and ulnar deviation, and were compared at baseline and at completion on plan-of-care after six weeks.

•Results: Seventy one patients with post-traumatic stiff hand were enrolled and placed randomly into two groups. The baseline characteristics were similar in both groups. Six week after intervention, patients in group A had more improvement in pain score (p=0.001), TFS (p=0.003), and PROM of wrist flexion (p=0.002), extension (p=0.003), radial deviation (p=0.013), and ulnar deviation (p=.004), as compared to group B. However, in group B the improvement was less in pain score (p=0.104), TFS (p=0.520), and PROM of wrist flexion (p=0.193), extension (p=0.1081), radial deviation (p=0.051), and ulnar deviation (p=.168), as compared to group A.

• Conclusion: Paraffin wax bath with joint mobilization

techniques are more effective than mobilization techniques without paraffin wax bath in the rehabilitation of post traumatic stiff hand.

Thank you: