Thermotherapy For Wound Healing

  • Asha Moalin Master’s degree in Healthcare Technology, University of Birmingham, UK
  • Saira Loane Master's of Toxicology, Institute of Biomedical Research, University of Birmingham, UK

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Introduction

Thermotherapy also known as heat therapy is the use of heat as a treatment to injured parts of the body. When heat is used, blood circulation increases around the body, alleviating pain and reducing stiffness in joints and muscles.1 Thermotherapy has been used to treat medical conditions such as:2

  • Muscle aches and pain,
  • Strains and sprains,
  • Stiffness in muscles and joints,
  • Muscles spasms,
  • Osteoarthritis,
  • Wound healing.

Wound healing

Wound healing is an important biological process that is needed to close our outermost layer which acts as a barrier. Skin is the largest organ in the body and its main function is to be a barrier and protect the body from injury, infection and UV light (from the sun). Without wound healing, we would be exposed to outside dangers like infections or we would lose fluids that are required for normal physiological function3. If a wound does not heal, there is an infection risk, trauma risk to the injury, blood loss and impaired function and as such wound healing is vital for us to be healthy.3 

Heat therapy has been used to improve wound healing as it increases blood flow to the site of injury.4 Increase in blood flow also means an increase in oxygen available for the tissues to repair it self and more immune cells like macrophages in the injured site which decreases the chance of wound infection.4 This article will be focused on thermotherapy for wound healing.

Physiology of wound healing

Wound healing is a four-phase process consisting of:5

  1. Hemostasis
  2. Inflammatory phase
  3. Proliferation phase
  4. Tissue remodelling phase

Wound healing is very specific and for a wound to heal correctly, it will need to go through these phases correctly at the right time. 

Hemostasis: is the first stage of wound healing and this phase is activated when there is bleeding at the site of the injury.6 The main role of hemostasis is to stop the bleeding and it works by vasoconstricting the walls of blood vessels, effectively making the blood vessels narrower.6 Vasoconstricting is important as it stops the bleeding, which prevents important fluids from leaving the body. Once the bleeding is stopped, platelets are recruited to the site of injury which will form a blood clot, preventing blood loss.7 However it is more important as the platelets contain important growth factors and cytokines and these signal and recruit immune cells like macrophages and neutrophils which are needed to fight pathogens and prevent infection occurring at the wound site.7

Inflammatory phase: this is the next phase in wound healing. The immune cells like neutrophils recruited by the platelets are now at the site of injury and these cells initiate inflammation. When inflammation is initiated, it recruits more neutrophils and macrophages to the site of injury from the blood circulation, which will then feed into causing more inflammation.7 This is important as inflammation provides immune cells to the site of injury which will prevent pathogens from infecting and colonizing the wound and will also remove any tissue debris, and this essentially cleans the wound area.

The proliferation phase only begins when the levels of neutrophils and macrophages in the wound site is nonexistent7. The proliferation phase is when the platelet clot is replaced by granulation tissues that will then be used to make skin tissue. Granulation tissue is a mixture of collagen, fibroblasts and other important proteins and this acts as a foundation for the tissue remodelling phase where new tissue is formed.6 Another important role of the proliferation phase is the formation of new blood vessels (angiogenesis) and this is important in wound healing as it allows for increase in oxygen and nutrient availability for tissue regeneration at the site of injury.7

Tissue remodeling is the final stage of wound healing and this is when the granulation tissue is transformed into a scar. The main function of this phase is to reform the layers of the skin and to form a scar, which will close the wound up.7 Within this phase, all the cells within the granulation tissue will be killed off in a process called apoptosis and all that will remain of the wound healing process will be a scar.6,7

Factors affecting wound healing

There are different types of scars that can be formed following the wound-healing process:

  • Normal scarring, 
  • Keloid scarring, 
  • Hypertrophic scarring,
  • Chronic scars: Ulcers.

Each type of scar depends on the site of injury, how deep the wound was and the wound healing. When wound healing is disrupted, it can cause different scarring to occur. 

  1. Normal scarring is when the wound healing is not disrupted, and is a faint scar that will fade over time. 
  2. Keloid scarring is a large thick scar (usually found in darker skin tones) and this scar occurs because there is too much collagen present during the proliferation phase.
  3. Hypertrophic scars are large thick red scars that are also caused by too much collagen during the proliferation phase. 
  4. Ulcers however is are chronic wounds that do not heal at all. This is caused by a disruption in wound healing stages or when the wound healing does not follow the correct wound-healing process. This means that the wound takes a long time to close up and there is a high chance of infection. 

There are many factors that are responsible for affecting wound healing:5 

  1. Blood flow
  2. Infection
  3. Oxygen levels,
  4. Nutrition.

The amount of blood flow is an important factor as it is responsible for supplying oxygen and nutrition levels to the tissues. Tissues require a lot of oxygen and nutrients to carry out the metabolic requirements needed for the cell to carry out their function, e.g. neutrophils need energy to ingest any pathogens5. Infection is another factor that can affect wound healing as the presence of infection will recruit immune cells which will cause inflammation5. The presence of inflammation and immune cells will mean that the wound healing process cannot go to the next proliferation phase and this leads to chronic scars to form like ulcers. 

Age, sex, medicine, stress, diabetes, and obesity can also affect the wound-healing process.5

Mechanisms of thermotherapy

Thermotherapy works by applying heat to the wound with the target of raising the temperature of the wound.4 This is done to increase the blood flow and enhance tissue oxygenation to enhance wound healing.4 Thermotherapy does need to be controlled to not affect any of the surrounding tissues.5

Increased blood flow:

When the temperature is increased, the blood vessels become dilated (vasodilation) which increases more blood to flow in the vessels. This means that there is more blood flow to the area where temperature is applied to - which in this case is the wound site.

Enhanced tissue oxygenation

With an increase in blood flow, it will mean there is more blood being delivered to the wound site, bringing with it, more oxygen. The oxygen is provided to the wound site alongside with nutrients, enhancing the wound healing.

Types of thermotherapy

Thermotherapy has been used in China for more than 1200 years to treat chronic wounds in a process called local warming therapy which is a thermotherapy technique.5 There are many different types of thermotherapy available. 

Localized thermotherapy:

Localized thermotherapy is when a specific area of the body is heated and this is done for a precise delivery of heat to the wounded area and to prevent any side effects to the surrounding tissue areas. These can include:

  1. Hot Packs: are a heat packet that is heated up or releases heat and is placed on the wound area to reduce pain and to encourage wound healing.
  2. Warm compresses: is when a cloth is soaked in warm water which is then applied to the wound site to supply heat to the area. 
  3. Infrared therapy:  uses low levels of infrared radiation (usually from an infrared lamp) directly on your wound site to heat up the injury site, providing the benefits of thermotherapy. 

Whole body thermotherapy

Whole-body thermotherapy is the opposite of localized thermotherapy and instead of one area of the body being targeted, the entire body is heated up. Whole-body thermotherapy techniques include: 

  1. Hot water immersion: is when you immerse yourself in hot water, either in a hot water bath, hot springs or thermal springs. This way, your entire body is being heated up, promoting the effects of thermotherapy and improving wound healing. 
  2. Sauna therapy: is a thermotherapy treatment that has been used for years and it works by heating up the body as you are sitting in a hot room for some time.
  3. Hyperthermia treatments: are thermotherapy treatments that are used in cancer therapy and it works by heating up the body temperature above body temperature and can go as high as 45 degrees celsius. 

Application of thermotherapy in wound healing

Thermotherapy in wound healing can be used to treat: 

Practical considerations and guidelines

The practical considerations and guidelines for thermotherapy will depend on the wound you are trying to heal, and the technique you are using alongside with your health. Before you begin with thermotherapy, it is recommended that you discuss it with your healthcare provider as they are best suited to advise you and give you recommendations. It is even more important if you have any underlying health conditions. Starting slowly and following the safety precautions is recommended as being careful is the best way to protect yourself from further harm.

Summary 

Thermotherapy is a process that uses heat to increase healing and it works by increasing blood circulation which in then provides more oxygen and nutrients. These are crucial for tissue regeneration and are needed during wound healing. Increase in blood flow also means more immune cells being recruited, which decreases the chance of infection and decreases wound healing time. Thermotherapy is a process that has been used for thousands of years and has many health benefits as long as you are careful and use common sense and medical advice. 

References: 

  1. Oxford Reference. ‘Thermotherapy’. Accessed 8 February 2024. https://doi.org/10.1093/oi/authority.20110803103911732.
  2.  Top Doctors. ‘Heat Therapy: What Is It, Symptoms and Treatment’. Accessed 8 February 2024. https://www.topdoctors.co.uk/medical-dictionary/thermotherapy.
  3. Grubbs, Hailey, and Biagio Manna. ‘Wound Physiology’. In StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. http://www.ncbi.nlm.nih.gov/books/NBK518964/.
  4. Sun, Zhongren, Jinhuan Yue, and Qinhong Zhang. ‘Local Warming Therapy for Treating Chronic Wounds’. The Cochrane Database of Systematic Reviews 2017, no. 7 (3 July 2017): CD011728. https://doi.org/10.1002/14651858.CD011728.pub2.
  5. Guo, S. & DiPietro, L., 2010. Factors Affecting Wound Healing. Journal of dental research, 89(3), pp. 219-229
  6. Rodrigues, M., Kosaric, N., Bonham, C. A. & Gurtner, G. C., 2018. Wound healing: A cellular perspective. Physiological review, Volume 99, pp. 665-706.
  7. Schultz, G. S., Chin, G. A., Moldawer, L. & Diegelmann, R. F., 2011. 23 Principles of wound healing. In: R. Fitridge & M. Thompson, eds. Mechanisms of vascular disease: A reference book for vascular specialists [internet]. Adelaide: University of Adelaide Press. 

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Asha Moalin

Master’s degree in Healthcare Technology, University of Birmingham

Asha is a recent graduate with a Master’s degree in Healthcare Technology from the University of Birmingham. With a passion for innovating medical therapies and technologies, Asha is dedicated to contributing advancements that allow patients to lead longer and healthier lives.

Her expertise includes both laboratory research and comprehensive literature reviews. Drawing on several years of academic writing, Asha enjoys translating complex data into accessible and informative articles.

She is committed to bridging the gap between scientific intricacies and public understanding. Beyond healthcare, Asha also possesses exposure to the business world. This is evident in her work experience at J.P Morgan chase and Turner & Townsend, where she explored finance, consultancy and sustainability. These experiences have equipped her with a diverse skill set and understanding of the connection between healthcare and business.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
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