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 WAX:
 Paraffin wax approx: 54c contained with mineral oil
such as liquid paraffin to produce temperature
controlled bath at a temp b/w 42 to 50c.
 These temperature are higher slightly than would
be tolerated if placed in hot water.
 Specific heat of paraffin wax is less than of water
(2.72kj/per degree for wax and 4.2 kj/per k for
 DIP AND WRAP METHOD:  Precaution
 Repeated 6-12mins develop wax  Cardiac insufficiency
gloove. The technique increase
greater temprature.
 Metal in the area


 Use for provide heat to small
 Temprature 40-42c.
 Moist Pads ,packs immersed in
hot water approx:36-
41c.APPROX 5mins.
 Provide prolong heating.

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

• It is a combined immersion technique with
Paraffin wax + mineral oil for conductive heat gains.
• For therapeutic use:
– 7 units of wax ---------1unit mineraloil.

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

 Gives of heat very slowly – no rapid loss of heat.

 Temperature is maintained at 47 - 55°c.

 Melting point of wax is 55˚C.

 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.
 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
• 3. Analgesic effect:

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

3. Adhesions and Scars:

Wax softens the adhesion and scar in the skin
and thus facilitates the mobilization and stretching
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

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.
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). 15
 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 &
 Heat is applied evenly by conduction.
1.Effective only for distal extremities in the terms of ease of

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


5.The bath must be cleaned regularly & emptied at least twice a

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
 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
 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.
 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.
 Along with the use of hydrotherapy, the use of paraffin
wax therapy can be traced all the way back to Roman
 In those ancient times, the Roman would pour hot waxes
on the body in preparation for message therapy.
 Later the French embraced paraffin therapy by melting
paraffin wax and spreading it on wounds to accelerate
 In world War I, the British used paraffin wax therapy as
a protocol to treat orthopedic disorders in military
 In modern times, paraffin therapy is quite common and widely used to aid
in the treatment of conditions such as the following:

 Arthritis
 Bursitis
 Eczema
 Fibromyalgia
 Inflammation
 Muscle spasms
 Overworked/fatigued muscles
 Psoriasis
 Scar Tissue
 Stiff Joints
 Tendonitis
 Tennis Elbow
 Can moist heat therapy help my pain and stiffness?
How about my dry weary skin?

 Paraffin therapy is one of the most effective method of

applying deep heat to relieve pain and stiffness. The
warm paraffin also moisturizes for healthier looking
softer skin.
 Therabath warm paraffin wax treatment are fast
acting, drug-free and versatile, providing heat
therapy for many different applications from
arthritis joint pain relieve.
 Paraffin wax is known as retaining a great amount of
heat as it has a good absorbing power
 When one uses paraffin wax bath the wax goes
through a phase change and starts melting and
becomes the paraffin then takes the shape of s coating
on the dipped part of the hands or feet
 This way the heat present in the paraffin bath is
transferred to the affected are where you experiencing
 The heat from a paraffin wax bath helps in the
opening the pores of the skin which, in turn
increases blood circulation in that specific area.
 This not only revitalizes the skin but also rejuvenates
it, making the skin look smooth and radiant a
paraffin wax bath is drug free painless and
fast acting therapy that can help in getting rid of
the pain in no time
Paraffin Wax:
 The melted wax needs to be maintained at a temperature
of 40°C - 45°C for treatment purposes.
 The temperature of the wax must be checked
before treatment is given.
 This method of heating the tissue has the advantage that it
is the most convenient way of applying conducted heat to
the extremities.
 As the wax solidifies from its molten state it releases its
energy of latent heat and this heat energy is
conducted into the tissue.
 The composition of solid wax , liquid paraffin , petroleum
jelly 7:3:1.

 The part to be treated must be clean and free

from cuts, rashes or infection.
 Fingers apart, dip hand and remove.
 Wait, harden and opaque
 Redip 6 to 10 times.
 Wrap in plastic bags, wax paper then towel.
 Don't move hand during dipping or rest which
prevent to crack coating and allow air to
penetrate and cool rapidly..
 Elevate extremity
 Treatment
time=20 minutes.
 After this remove the
towel and the wax.
 Inspect and dry
the part.
 The discarded wax is
finally remelted strained
and place back in the
bath at the end of the

 Paint a layer of paraffin onto

treatment area with a brush.
 Wait for opaque and harden.
 Paint another layer. (not larger
than 1st layer)
 Repeat 6 to 10 times.
 Cover with plastic bags then
towel and don't move the area.
 Wait for 20 minutes or until cool.
 Peel off, replace or Discard.

 Finger apart, dip and remove.

 Wait 5 to 15 seconds, harden and opaque.
 Remain in it for upto 20 minutes.
 Remove, when temperature should be at lower

 When treatment completed for all above

 Inspect the area
 Any sign of adverse effects
 Sterilized the wax by heating it to 80°C(176°F)
then allow it to cool overnight.
 Its temperature should be allowed to return to
b/w 45°C to 50°C

 The molten wax is directly

poured by a mug or utensil
on the part to be treated
and wrapped around a
 The wax is allowed to
solidify for about 10-12

 A towel or roll of
bandage is immersed in
in molten paraffin wax
and then wrapped
around body part.
 This method usually used
for treating proximal
parts of the body.
Physiological effects

 Increase metabolic activity

 Increase blood supply
 Increase tissue fluid exchange
 Nerve stimulation
 Decrease viscosity
 Increase extensibility of collagen
Therapeutic uses

 Encourage healing
 Decrease edema
 Decrease pain
 Decrease muscle spasm
 Increase joint range
 Precursor to stretching

 Maintain good contact with highly contoured areas

 Easy to use
 Inexpensive
 Body part can be elevated.
 Oil lubricate and conditions the skin
 Can be used by the patient at home

 Messy and time consuming to apply

 Cannot be used an open skin lesions as it may
contaminate the lesion
 Risk of cross contamination if paraffin is reused.
 Part in depended position for dip immersion
 Open wound:
 Wax shouldn't enter in open wound because it will set in tissue acting as an
inert foreign body and delay healing.
 Skin condition
 Acute dermatitis may be worse by wax or any other form of heat on skin.
 Skin infections are not usually treated as heat may increase the
inflammation activity.
 Defective arterial blood supply including DVT and vericose vein.
 Impaired skin sensations, defective thermal sensation couple with deficient
cutaneous circulation as occur with recently skin graft do not treat.
 Impaired skin sensation, defective thermal sensation couple with deficient
cutaneous circulation as occur with recently skin graft do not treat. Defective
arterial supply.

 Inflammable, if it becomes overheated for

precaution have Fire blanket, Suitable CO2
or Foam extinguisher.
 Marked increase in the temperature of skin
 Less increase in other superficial tissue.

 Stimulating of Superficial capillaries and arterioles
causing local hyperemia and reflex vasodilation.
 Neurogenic vasodilation due to the action of
vasodilator formed as a result of sweat gland activity.
 Skin become moist and soft after wax application which
helps to soften adhesions and scars in the skin prior to
mobilizing and stretching procedures.


 Mild heating appears to have a sedative effect on
sensory nerve endings.
 In RA or degenerative joint diseases, decrease pain and
muscle spasm.
Paraffin wax, with a melting point of approximately 54 C, is combined with a mineral oil such as
liquid paraffin to produce a temperature-controlled bath at a temperature between 42'C and
50C. These temperatures are slightly higher than would be tolerated if the body part were
placed in hot water. This is because the specific heat of paraffin wax is less than that of water
(2.72 kJ/kg per degree centigrade for Wax and 4.2 kJ/kg per degree centigrade for
water). Wax therefore releases less energy than water when cooling. Selkins and Emery
(1990) note that the amount of heat imparted to the tissue due the solidification of the wax -
the latent heat of fusion - is small. At the same time, heat loss is prevented owing to the
insulating nature of the material. The net result is a well-insulated, low-temperature method of
heating tissue. Slightly higher temperatures may be used for the upper extremities than for the
lower extremities and newly healed tissue (Bums & Conin 1987, Head & Helms 1977).
Efficacy of Paraffin Wax Baths for Rheumatoid Arthritic

• 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
 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).
 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).
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).
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.
To investigate the effects of treatment with paraffin bath
in patients with systemic sclerosis (scleroderma).
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.
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.
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.

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.
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.
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.
Case study:
 A 65 year old woman with a history of moderate
RA physical examination reveals painful walking,
bilateral ankle joint and toe stiffness, light toe
deformity and chapped dry skin on the feet and
ankles.examination of the upper limb reveals
adequate wrist and hand function .she is concerned
about her reduced and declining ability to walk
and perform activities of daily living ( ADL's) ?
Intervention parameters:

 Thermal agent = paraffin bath.

 Application method = dipping with
continous immersion.
 Dosage: (T∞ag-s) 20° ± 2° C (68° ± 2F)
 Treatment frequency = daily, 7 days a
week .
 Intervention period = 21 days.
Case study:
 MP is a 75 years old woman referred for physical
therapy with a diagnosis of osteoarthritis of the
hands. MP complains of stiffness and aching in all
her finger joints, causing difficulty in gripping
cooking utensils and performing other household
tasks and resulting in pain with writing.
 Thermal agent: Paraffin bath
 Temperature of Paraffin: 50'C (106F)
 Application method used: 10 min, dip-wrap, seven
 Dosage ( T∞ ag -s) 20'C + - 2'C ( 88+- 2F)
 Treatment frequency: daily, 7 times a week
 Intervention period : 21 days