Therapeutic Application of Paraffin

Paraffin is a a great way to deliver a heat treatment to a body area.  It is most useful for the distal extremities although it has been used for elbows in a therapy setting and has even been used as a facial application, although this latter feature is more for cosmetic purposes rather than therapy purposes.

Paraffin is considered a superficial heat treatment but due to the increase in temperature of superficial tissues heat conduction to deeper, subcutaneous tissues and therefore structures surrounding superficial joints can be reached.

There are several components involved in delivering a proper paraffin treatment, below is a list of the equipment and supplies needed and the settings involved:

  • The paraffin tank - Should have a built in heating unit and a thermostat
  • Plastic or paper bags or plastic wrap
  • Thermometer
  • Timer and bell
  • Rubber bands or tape
  • Chair or treatment table
  • Pillows and/or footstool
  • Towels
  • Proper mixture of paraffin - Usually comes already mixed from manufacturer but the proper ratio for wax and mineral oil is 5:1 - 5 parts wax (1 part = 1 pound) and 1 part mineral oil (1 part = 1 pint)
  • Additional paraffin to be added when needed
  • If the mixture is reused it should be replaced at least every 6-8 months or as needed.  If it is not reused make sure to prep the mixture far enough in advance of a treatment so the mixture can be at the proper temperature.
  • Proper temperature of the mixture should be in the range of 125o to 130o F.

As already mentioned above a paraffin treatment is very useful for distal extremities, it's warm, moisting effects are also a plus for this treatment as it not only delivers the therapeutic effects of heat but it also softens the skin and gives an overall relaxing feeling to the patient.

Care should be taken for people who are sensative to temperature extremes, one of the few disadvantages to paraffin.  Another draw back to this treatment is the inability do perform any kind of ROM exercises during the treatment since this will cause the wax to break apart or seperate from the skin causing a decrease in the effectivness of the treatment.  Aside from these reasons the only other disadvantage is cleaning up the tank and paraffin since the liquid wax can get quite messy.

Indications for a Paraffin Treatment:

  • Joint stiffness - follwing sprains, strains, or fractures
  • Arthritis - OA and RA
  • Old scar tissue limiting motion
  • Subacute and chronic conditions, traumatic and inflammatory conditions, bursitis, tenosynovitis

Contraindications for a Paraffin Treatment:

  • Diminished or absent sensation
  • Open wounds
  • Infections or contagious diseases
  • Recent, thin scars
  • Rashes
  • May promote accelerated destruction of articular cartilage in acute, inflammatory, joint pathologies
  • Peripheral Vascular Disease
  • Debilitating conditions
  • Peripheral nerve injuries

When delivering a Paraffin Treatment we need to be aware of the positive or negative reactions we may see.  The patient should feel a hot, tingly sensation and maybe a "drawing" sensation during the session. 

Responses we want to be aware of that would cause us to stop treatment immediately would be dizziness, throbbing, breathing difficulty, nauseau, any increase in pain, or a burning sensation.

Administer a Paraffin Bath Treatment

Some quick steps for giving a Paraffin Treatment:

  • Review patient's tx card to determine the correct body part to be treated, duration of treatment, and technique to be used ie. Immersion, dip and wrap.
  • Get all you materials ready and make sure the bath is at the proper temperature - 125o to 130o F.
  • Be sure to explain the procedure to the patient informing them of the following:
    • They will be dipping the affected body part in the mixture in order to -
      • Increase circulation
      • Help the skin become moist, soft, and pliable
      • Stimulate local sweating
    • They may feel a hot, tingling, or drawing sensation in the area being treated and that these are normal responses to the treatment.
    • Try to avoid the sides of the unit
  • Inspect the area to be treated and make sure there are no contraindications in the area.  If any contraindications are noted do not administer the treatment.
  • Prepare the client for the treatment.
    • Make sure all jewelry has been removed from the area being treated - if an item of jewelry cannot be removed do not adminster the treatment and notify the Physical Therapist.
    • Make sure the clothing does not restrict circulation
    • Have the patient wash the area to be treated with soap and water and dry thoroughly.
  • Position the client so they will be comfortable during the treatment.
  • Position body part to be treated
    • Fingers or toes should be relaxed
    • If treating the hand the wrist should be kept at 0o flexion or in the anatomical position if possible
  • Check the temperature if the bath to make sure it is still in the proper temperature range, if not postpone treatment until the temperature is correct.
  • Begin the Paraffin treatment
    • Dip the part to be treated into the bath so it is fully covered, wait several seconds and then remove the part.  If the immersion method is to be used make sure the first dip is as deep as possible.
    • Hold the part over the bath to allow excess paraffin to drip off.  If cracks, holes or bubbles are noted apply small amounts of paraffin to the areas with your finger
    • Once the paraffin has solidified and lost its shiny appearance you can dip it again.  Repeat dipping the area 10 to 12 times having dipping just below the level of the previous dip if possible.  This helps counting the layers if you lose track of how many times you have dipped.
  • Use the prescribed method - Immersion or Dip and Wrap
    • Immersion
      •  After the last dip tell the patient to dip the area into the bath and leave it there until the treatment time has completed. 
      • Position the client comfortably using pillows or towels for support and provide a footstool if necessary.  A tall chair or the edge of the treatment table works well for lower extremity treatments.  Make sure client is secured properly, especially if in a chair, using a safety belt or litter strap.
    • Dip and Wrap
      • After the dipping is complete carefully place the gloved area (paraffin glove) in a plastic or paper bag and then wrap with a towel.  Secure towel with rubber bands or tape.
      • Position client comfortably, allowing them to sit or lie down for the treatment session.  Minimal movement of treated area should occur.
  • Set a timer for the prescribed treatment time according to instructions for the patient.  Treatment time is 20 minutes unless otherwise prescribed.
  • Provide a bell for the patient to ring if any adverse reaction occur during the treatment or tell the patient to call you if a bell is not available or both hands are being treated.
    • Tell the patient to let you know immediately if any pain or discomfort is felt. 
    • If treatment must be stopped remove the wrap and the paraffin glove, visually inspect the area and inform the Physical Therapist.
  • Monitor the patient during the treatment
    • Check patient's facial expressions
    • Observe resperation
    • Ask how treatment is being tolerated
  • Discontinue treatment after timer goes off.
    • Immersion
      • Slowly remove treated part from the bath
      • Peel off paraffin from body part
      • Carefully place paraffin back in bath or dispose of it
      • Replace lid on Paraffin Bath
    • Dip and Wrap
      • If necessary aassist client up from treatment position,
      • Remove towel wrapping
      • Peel off paraffin from body part
      • Carefully place paraffin back in bath or dispose of it
      • Replace lid on Paraffin Bath
  • Visually inspect the treated area.  A light to moderate erythema should be noted where the paraffin was in contact with the patient.
  • Don't forget to have a towel available for the patient to use to clean up the treated area.  Most patients will enjoy the nice, warm, smooth feeling of the paraffin and will want to rub their hands together.  If they would prefer not to use a towel that is fine.  Just be sure to ask them if they "Wanna Towel??"
  • Check treatment instructions for additional care
  • Document treatment appropriately