Journal of Orthopaedic & Sports Physical Therapy

Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
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Effect of Fluidotherapy on Superficial Radial Nerve Conduction and Skin Temperature

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Kathleen A. Westphal, PT, PhD 2 John S. Halle, PT, PhD, ECS 3 Shipping/Billing Information David G. Greathouse, PT, PhD, ECS 4

Name _______________________________________________________________________________________________ Address _____________________________________________________________________________________________ Address Design: Cross-sectional study. Study _____________________________________________________________________________________________ luidotherapy is a dry, suObjectives: The purpose of this study was to examine the effects of the superficial heating City _______________________________State/Province __________________Zip/Postal Codeperficial heating modal_____________________ modality, Fluidotherapy, on skin temperature and on sensory nerve action potential (SNAP) ity that transfers heat conduction latency and amplitude of the superficial radial nerve in healthy individuals. Phone _____________________________Fax____________________________Email _____________________________ convectively.18 Finely diBackground: Fluidotherapy is a dry, superficial heating modality, which also provides tactile vided synthetic cellulose Would you like to receive JOSPT email updates and renewal notices? literature has I No stimulation through the bombardment of air-fluidized cellulose particles. Previous I Yes particles (Cellex) are circulated documented a direct relationship between skin temperature and neural conduction velocity; around a treated area by a warm however, there is an absence of published research examining the effects of Fluidotherapy, and of air current, creating a fluid-like tactile stimulation specifically, on neural conduction. Payment and Measures: Twenty-one subjects between the ages of 22 and 31 years (mean SD, medium. A patient can thus expeInformation Methods 25.5 0.7 years) and without prior history of diabetes, alcoholism, renal or metabolic rience a sensation not unlike havI Check enclosed (made payable to the JOSPT). dysfunction, current pregnancy, or heat sensitivity were invited to participate. Subjects completed ing a limb suspended in a heated an upper quarter screening prior to participation. whirlpool. However, due to specific I Credit Card (circle one) exam and medical history formAmerican Express One group MasterCard VISA underwent heat (46.7C-48.9C) and tactile stimulation, a second group underwent tactile heat differences, patients can ofstimulation alone, while a third served as controls. Dependent variables were assessed at 3 ten tolerate a higher temperature Card Number ___________________________________Expiration Date _________________________________________ intervals: before the intervention, immediately after the intervention, and 20 minutes after the when treated with Fluidotherapy, intervention. All interventions were 20 minutes in length. Signature ______________________________________Date __________________________________________________ Results: A mixed 2-way analysis of variance indicated a significant interaction between time of thereby enhancing the heating 3-4 As with any heating moneural conduction velocity assessment and treatment group for the dependent variables of sensory effects. nerve action potential latency (P .001) and skin temperature (P .001). Appropriate post hoc tests dality, this treatment is used to were performed for simple effect comparisons. Anorder linear relationship existedor mail to: reduce pain and muscle spasm, To inverse call, fax, email between skin temperature and latency (r 2 = .65; Pearson product coefficient, .81). increase 1111 North Fairfax Street, Suite 100, Alexandria, VA 22314-1436 range of motion, and proConclusions: Fluidotherapy treatment, which combines the effects of heat and tactile stimulation, vide potential desensitization to Phone 877-766-3450 tactile stimulation alone Email: subscriptions@jospt.org significantly elevated superficial skin temperature, whileFax 703-836-2210 and no treatment distal extremities.11,18 (control group) did not bring about a temperature change. As the superficial skin temperature Fluidotherapy administered at increased, there was a concomitant decrease in the distal sensory latency of the superficial radial Thank you for subscribing! sensory nerve action potential. These results should be an important consideration for the clinician clinically applied temperatures (46.7C-48.9C) has been demonusing superficial heating modalities. J Orthop Sport Phys Ther 2005;35:16-23. strated as an effective method of Key Words: heat, latency, neural conduction, physical agents transferring heat to human soft tissue. Borrell and associates 3 1 Student (at time of study), Doctorate of Physical Therapy Program, Belmont University, Nashville, TN. documented a tissue absorbency of 2 Associate Professor (at time of study), Belmont University School of Physical Therapy, Nashville, TN; 17.2 BTU in the hand after a Lecturer, University of Montana, Missoula, MT. 3 Professor, Department of Physical Therapy, Nashville, TN; Clinical Electrophysiologist (EMG/NCS), 15-minute Fluidotherapy treatment Neurology Clinic, Blanchfield Army Community Hospital, Fort Campbell, KY. at 48.9C. This was compared to 4 Professor and Associate Dean, Department of Physical Therapy, Nashville, TN; Clinical Electrophysiolo5.6 absorbed BTU with a 40.7C gist (EMG/NCS), Neurology Clinic, Blanchfield Army Community Hospital, Fort Campbell, KY. This study was approved by the Belmont University Institutional Review Board. The authors have no whirlpool and 4.8 absorbed BTU financial affiliation (including research funding) or involvement with any commercial organization that with a 52.2C paraffin bath, both has a direct financial interest in any matter included in this manuscript. Address correspondence to David G. Greathouse, Professor and Chairman, School of Physical Therapy, also applied for 15 minutes. If skin Belmont University, Nashville, TN 37212. E-mail: greathoused@mail.belmont.edu temperature remains relatively
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constant, then heat transfer is a function of bath temperature, velocity of the medium, and the thermal properties of the modality. In a separate study, Borrell et al4 recorded joint capsule and muscle tissue temperature rises of 9.0C and 5.7C, respectively, after a 20-minute Fluidotherapy treatment at 47.8C. These changes were significantly greater than temperature increases produced by paraffin and whirlpool treatments. Studies investigating the relationship between tissue temperature changes and nerve action potential velocity and amplitude have produced contradictory results. Madsen and Gersten,16 as well as Zankel,25 documented decreased conduction velocities of various motor nerves and the ulnar nerve following ultrasound application. However, the balance of literature has reported an inverse linear relationship between latency and temperature change,1,2,5,6,8,15 with increasing temperature resulting in decreased latency (increased conduction velocity). Abramson et al1 demonstrated increased conduction velocity of the median and ulnar ner ves following shortwave diathermy and topically applied heat. In 1 study, the investigators reported that immersion of the distal lower extremity in water of varying temperatures resulted in an inverse linear change in sensory nerve action potential (SNAP) latency of the sural nerve with temperature.6 Ultrasound applied over the superficial radial nerve has been shown to significantly decrease latency following modality-induced tissue temperature increases.5,8 Just as the effect of temperature on the velocity and latency of peripheral nerve action potentials is yet to be resolved, such is the case of the effect of temperature on SNAP amplitude. Bolton et al2 showed decreased amplitude of the action potential of the superficial radial nerve with increased temperatures. Currier et al5 demonstrated no change in amplitude of the action potential of the same nerve following ultrasound application, while Greathouse et al6 found a direct relationship between action potential amplitude and temperature change in the sural nerve. These changes were produced by immersion of a leg in an ice bath followed by the application of infrared radiation. These conflicting findings may demonstrate a range-dependent effect of temperature upon action potential amplitude. This explanation is substantiated by the results of Ludin and Beyeler.15 Median SNAP amplitude increased with temperature from 22C to 26C, then decreased progressively as temperature increased to 36C. In addition to causing tissue temperature increases, Fluidotherapy has the added effect of tactile stimulation of the treated limb. This tactile stimulation could theoretically produce analgesic effects. According to Melzack and Walls gate control theory, the activation of large-diameter cutaneous afferent fibers by the bombardment of synthetic cellulose particles
J Orthop Sports Phys Ther Volume 35 Number 1 January 2005

could reduce pain transmission signals to the brain.17 Satran and Goldstein24 reported an increased tolerance to pain for 20 minutes following vibratory electrical stimulation. Also, Higgins et al12 found increased tolerance to pain following tactile stimulation. According to the gate control theory, both decreased conduction latencies (in response to increases in temperature) and tactile stimulation may facilitate pain modulation through activation of largediameter cutaneous afferent fibers.17 No report of the relationship between tactile stimulation and nerve action potential latency or amplitude could be found in the literature. The sensory nerve action potential response to Fluidotherapy has not been reported in the literature. There is currently a dearth of research concerning both sensory neural responses to tactile stimulation, as well as the specific heating properties associated with the modality of Fluidotherapy. Specifically, the purposes of this study were to examine the effects of a superficial heating modality, Fluidotherapy, on skin temperature, and on sensory nerve action potential conduction latency and amplitude of the superficial radial nerve in healthy individuals. Nerve conduction studies involving the superficial radial nerve are well described and easy to perform.13 Furthermore, the superficial location of this nerve affords the ability to examine temperature effects without invasive maneuvers. The treatment effects of heating and tactile stimulation were differentially analyzed through manipulation of treatment groups. By design of the study, the results should further elucidate the controversial and unknown effects of heat and tactile stimulation, both separately and in combination, on the neural conduction variables of latency and amplitude.

METHODS Subjects
The study was approved by the Institutional Review Board of Belmont University. Participants included 21 volunteers (18 female, 3 male) from the student population of Belmont University in Nashville, TN. All subjects were between 22 and 31 years of age (mean SD, 25.5 0.7 years). The number of subjects (7 per group) was determined based on an a priori estimate of n for a statistical power of 0.80 using pilot data. Prior to participation in the study, each subject was informed of the experimental protocol and the risks involved. Signed informed consent documents were then obtained. Subjects were also informed of their right to withdraw from the study at any time. All subjects completed a medical history questionnaire and underwent a screening of upper limb muscle strength, muscle stretch reflexes, and skin sensation.
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RESEARCH REPORT

Swelling of the wrist was screened for by measuring wrist girth bilaterally and clear asymmetry was used as an exclusion criteria. Any subject with a history of diabetes, alcohol abuse, renal or metabolic dysfunction, peripheral neuropathy, or heat sensitivity was excluded from the study. Any subject who was pregnant, under the age of 18, or over the age of 40 was also excluded. Medical questionnaires were completed to assess the exclusion criteria as well as to determine the dominant upper extremity.

Design
The subjects were randomly assigned to 2 experimental groups and a control group. The first experimental group received the conventional Fluidotherapy treatment (heat and tactile stimulation). Individuals assigned to the second experimental group received Fluidotherapy without heat (tactile stimulation alone). The subjects in the control group placed their arm in a nonoperational Fluidotherapy unit, so were not exposed to heat or tactile stimulation. For individuals in all groups, the dependent variables (superficial radial nerve action potential latency and amplitude, and skin temperature) were measured at 3 different intervals: before the treatment, immediately after the treatment, and 20 minutes following the termination of the Fluidotherapy application.

Instrumentation
The Fluidotherapy unit (Model 110D; Henley Healthcare, Inc, Sugarland, TX) was used in the study. Following the protocol suggested by Henley10: each subject was instructed to sit as close to the unit as possible, with the forearm completely contained within the unit, as far proximally as the olecranon process. Herrick and Herrick11 reported maximum skin temperature with Fluidotherapy as occurring after 15 minutes of application. To ensure that maximum temperature was reached in our study, we chose to apply 20 minutes to allow for some margin of error. The accepted temperature range for Fluidotherapy is reported as 43.3C to 50.6C.9 The Model 110D was preset to a temperature of 47.8C. However, through previous trials, the researchers observed that the actual temperature reading on the unit display fluctuated by up to 1.6C. For this reason, a range of 46.7C to 48.9C was maintained. The maximum air velocity (0.9 m/sec)9 produced by the unit was utilized for all subjects receiving tactile stimulation.

Procedures
This study was performed in a treatment room located in the Belmont University Physical Therapy
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Building. All subjects were asked to abstain from any vigorous physical activity, caffeine consumption, or nicotine use for 1 hour prior to participation in the experiment. All subjects were seated with their dominant arm resting on a plinth.13 A cutaneous temperature reading was recorded at the radial styloid process using a VWR Model 100A telethermometer (VWR Scientific, West Chester, PA), after a 10-second stabilization period. The superficial radial neural conduction studies were performed using standard techniques.13 A Nicolet disposable ground electrode (Nicolet Biomedical, Inc, Madison, WI) was placed on the medial dorsum of the dominant hand. Each recording electrode was 1 cm in diameter. The cathode (negative) recording electrode was attached with tape over the superficial radial nerve as it crossed dorsal to the extensor pollicis longus tendon, as determined by palpation. The anode (positive) recording electrode was taped over the belly of the first dorsal interosseous muscle. The stimulating electrode was placed 10 cm proximal to the center of the negative recording electrode, just volar to the lateral aspect of the radial shaft. Approximately 1 to 2 ml of Aquasonic ultrasound gel was utilized to provide for better electrical conduction between skin and electrodes. The amount of gel used just covered the surface of the electrodes, while not allowing for conduction between electrodes. Antidromic SNAP latencies and amplitudes were recorded using the Cadwell Sierra LT electromyograph and stimulator (Cadwell Laboratories, Inc, Kennewick, WA). The stimulating current was a monophasic pulse 0.1 milliseconds in length. The oscilloscope was set to a sweep duration of 2.0 milliseconds per division and a gain of 20 V per division. The bandwidth of the amplifier was 10 Hz to 2.0 kHz. Latencies (milliseconds) were measured from the supramaximal stimulus artifact to the SNAP peak, while amplitude (V) recordings were determined from the negative peak to the positive peak of the potential.13 The mean of 3 recordings for each of these 2 dependent variables were recorded manually on a data collection sheet and printed from the EMG software. These procedures were repeated for each of the 3 data collection periods. Test-retest reliability was performed on each measurement of the distal sensory latency (DSL) and amplitude of the SNAP of the superficial radial nerve in the process of producing a supramaximal stimulation of the SNAP. The electrodes were removed prior to treatment in the Fluidotherapy unit. The electrodes were reapplied following the treatment in the Fluidotherapy unit. The investigator performing the nerve conduction studies was blind to the group assignment of the subjects.
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Control Tactile Tactile + heat

(D.G.). Both investigators 5 and 6 are board-certified clinical specialists in clinical electrophysiology by the American Board of Physical Therapy Specialists of the American Physical Therapy Association.

Latency (msec)

Data Analysis
Means, standard deviations of the means, and ranges for the 3 dependent variables were determined. Each dependent variable was analyzed separately with a mixed repeated-measures 3 3 analysis of variance (factor of time was repeated and the second factor of treatment condition was independent) using SPSS Version 10.0 for Windows. Tukey post hoc tests were subsequently performed as required. Linear regression analyses using SPSS Version 10.0 for Windows were composed to visually describe the relationship between temperature and the other 2 dependent variables of latency and amplitude.

0 Pretreatment Posttreatment 20 min Posttreatment

FIGURE 1. Representation of the interaction between the independent variables of time (3 levels: pretreatment, immediately posttreatment, and 20 minutes posttreatment) and treatment group (3 levels: control, tactile stimulation only, and tactile stimulation plus heat), for the dependent variable of sensory nerve action potential (SNAP) latency (mean SD).

RESULTS
The means, standard deviations of the means, and ranges for the 3 dependent variables of SNAP latency and amplitude, and temperature are presented in the Table. A significant interaction between time and treatment group was determined for SNAP latencies (F = 13.778, P .001), and there were also significant main effects for both latency (F = 4.266, P .022), and treatment group (F = 8.696, P .002). In light of the interaction, appropriate simple effect post hoc comparisons across groups were done utilizing a Tukey post hoc analysis, and simple effect comparisons within groups were performed using paired t tests with a Bonferonni correction19 (Table). A significant interaction between time and treatment group was also found for temperature (F = 35.856, P .001), and there were also significant main effects for both time (F = 20.703, P .001) and treatment group (F = 50.571, P .001). As was the case with latency, appropriate simple effect comparisons were performed for both the independent factor of groups and the repeated factor of time.19 For the third independent variable of SNAP amplitude no statistically significant findings were present for the interaction of time and treatment group (F = 1.601, P = .195), the main effects of time (F = 0.577, P = .567), and treatment (F = 3.409, P = .056). A study of the relationship between superficial skin temperature and the other dependent variables of latency and amplitude were made by composing regression plots with best-fit lines drawn and the r 2 values included. No discernible relationship existed between skin temperature and SNAP amplitude (Figure 3) with r 2 = 0.015. A clear inverse relationship exists between skin temperature and latency, as seen in Figure 4 (r 2 = 0.65; Pearson correlation coefficient, .81).
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40 35 Temperature ( C) 30 25 20 15 10 5 0 Pretreatment Posttreatment

Control Tactile Tactile + heat

20 min Posttreatment

FIGURE 2. Representation of the interaction between the independent variables of time (3 levels: pretreatment, immediately posttreatment, and 20 minutes posttreatment), and treatment group (3 levels: control, tactile stimulation only, and tactile stimulation plus heat), for the dependent variable of superficial skin temperature (mean SD).

RESEARCH

During the 20-minute posttreatment interval, all subjects remained seated with their dominant arm at rest by the side or in their laps. In an effort to ensure consistency across subjects, 1 investigator (C.B.) collected all history data and performed all inclusion/exclusion screenings; another investigator (R.K.) administered all experimental treatments; and a third investigator (A.H.) performed all neural conduction tests. The neural conduction assessment of the superficial radial nerves that were performed by researcher 3 (A.H.) was directly monitored by either investigator 5 (J.H.) or 6
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REPORT

TABLE. Descriptive statistic summary of the means, standard deviations, and ranges for the 3 dependent variables of temperature, latency, and amplitude for each treatment group at the time of assessment. Condition/Time Control (n = 7) Pretreatment Posttreatment 20-min posttreatment Tactile (n = 7) Pretreatment Posttreatment 20-min posttreatment Tactile plus heat (n = 7) Pretreatment Posttreatment 20-min posttreatment Temperature (C) 30.3 0.5 (29.2-30.7) 29.9 1.1 (28.8-31.6) 29.1 1.1 (27.6-31.0) 30.0 0.7 (29.1-31.2) 29.3 0.9 (27.8-30.5) 28.9 1.2 (27.0-30.9) 29.9 1.2* (28.7-31.6) 35.4 0.5* (34.6-36.0) 32.9 0.9* (31.6-34.0) Latency (msec) 2.3 0.2 (2.0-2.6) 2.4 0.2 (2.0-2.7) 2.4 0.3 (1.9-2.8) 2.4 0.1 (2.1-2.6) 2.4 0.1 (2.2-2.6) 2.5 0.2 (2.3-3.0) 2.3 0.2 (2.1-2.7) 1.9 0.1 (1.7-2.1) 2.0 0.1 (1.8-2.2) Amplitude (V) 53.0 14.8 (32-73) 60.0 15.2 (34-78) 64.0 18.7 (38-84) 51.0 12.4 (35-70) 54.0 14.5 (39-82) 53.0 9.2 (37-64) 76.0 16.7 (47-93) 66.0 13.4 (49-85) 72.0 23.9 (42-118)

* Significantly different from each other (P .05) within tactile-plus-heat group. (Pairwise comparisons with Bonferroni correction used.) Significantly different from the pretreatment value within the tactile-plus-heat group, but no differences between posttreatment and 20-minute posttreatment (P .05). (Pairwise comparisons with Bonferroni used.) Significantly different than the corresponding time period for the control and the tactile conditions (P .05). (Tukey post hoc analysis used.)

DISCUSSION
Results of this study indicate that Fluidotherapy treatment, which combines the effects of heat and tactile stimulation, significantly elevated superficial skin temperature. Tactile stimulation alone and no treatment (control group), did not bring about a temperature change. Thermistor temperature measurements at the radial styloid (35.4C) were higher than initial recordings (29.9C) following the 20minute application of the Fluidotherapy treatment, as well as 20 minutes after the completion of the treatment (32.9C). This finding of Fluidotherapy increasing skin temperature was expected and previously reported by Borrell and others.3-4 Subjects who were exposed to the heat of Fluidotherapy also demonstrated changes in mean SNAP latencies. These SNAP latencies were decreased in this experimental group, with a significant reduction in mean latencies both following treatment and 20 minutes after treatment relative to those recorded initially. The arms of subjects in the other 2 groups, who were not exposed to the heat of the Fluidotherapy unit, did not demonstrate a decrease in SNAP latency. This inverse relationship between cutaneous temperature and SNAP latency supports the findings of Abramson et al1 and Greathouse et al,6 among others.2,5,8,15 However, this is the first study to have demonstrated this relationship as a result of Fluidotherapy treatment. This study will protract the controversy concerning temperature-dependent amplitude changes of the SNAPs. Neither heat nor tactile stimulation affected SNAP amplitude of the superficial radial nerve. Currier et al,5 Bolton et al,2 Greathouse et al,6 and Ludin and Beyeler15 failed to demonstrate a consistent relationship between SNAP amplitude and temperature. The findings of this study are concordant with these earlier studies.
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The mean change in superficial skin temperature of 5.5C is a clinically significant increase. There are several noteworthy positive clinical effects that may result from this change. They include cutaneous vasodilation and increased blood flow to the treated area.20-22 Superficial heating has additionally been demonstrated to provide analgesic effects at the site of application and at sites distal to the application over a superficial nerve, the superficial radial nerve at the wrist.22 Pain resulting from muscle guarding or spasm following injury may also be reduced with heat. While this research was not designed to look at mechanisms of pain modulation or even attempt to measure the impact of Fluidotherapy on pain, a physiological argument can be made that would suggest that Fluidotherapy may be more effective than heat alone in providing an analgesic effect. The gate control theory17 originally described by Melzack and Wall outlines a system where the afferent neurons that project pain to the brain are located in Rexeds lamina II (substantia gelatinosa),7 and they can be influenced by the type of afferent input received. When the afferent information brought into the central nervous system is primarily from A and C-fiber afferents, the gate is open and pain is readily conveyed to the brain.17 If the mix of the received afferent information can be biased to provide a substantially greater contribution of afferent information conveyed by larger afferent fibers (A fibers typically cited), then the gate in the substantia gelatinosa can be closed and there is a decrease in the amount of painful afferent information conveyed to the brain. As the measured decrease in latency occurs because of an increase in the NCV of the fastest projecting axons in a mixed nerve, this research demonstrates that the conduction of that population of neurons
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FIGURE 3. Scatter plot with imposed linear regression line for the variables skin temperature and sensory nerve action potential (SNAP) amplitude (r2 = .015).

RESEARCH REPORT

FIGURE 4. Scatterplot with imposed linear regression line for the variables skin temperature and sensory nerve action potential (SNAP) latency (r 2 = .65).
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was enhanced. While the conduction velocity of the slower (A and C-fibers) may also have been increased, that is speculative and not directly supported by this research, because only the conduction speed of the fastest fibers are assessed directly through this technique. Thus, these findings, at a minimum, support an equal enhancement of all the various axons contained within a mixed peripheral nerve and may suggest that the higher temperatures obtained with Fluidotherapy than with either paraffin or aqueous heat transfer21 provide a conduction advantage for the larger fiber afferents. When this is coupled with the tactile stimulation provided by the circulating cellulose particles that also stimulate receptors associated with large-diameter afferent axons 14 (Meissners corpuscle, Merkel disk receptor, Pacinian corpuscle, Ruffini ending, etc) and the increase in blood flow and metabolic rate,21 an argument can be made that this may be an effective combination to close the gate and relieve pain.12 As alluded to above, further research needs to be conducted in a variety of areas associated with this modality. Is the theoretical combination of heat, increased tactile stimulation, increased blood flow, and increased metabolic rate really more effective at providing analgesia than heat alone? Additionally, the mechanisms associated with the increase in nerve conduction velocity and the select or uniform impact on the variety of axons contained within a peripheral nerve are not currently clear. Further studies could also be undertaken to analyze the demonstrated effects of Fluidotherapy on combined motor and sensory nerves, such as the median and ulnar nerves of the upper extremity. Subcutaneous temperatures should also be examined to determine the extent and depth of temperature change following Fluidotherapy.

ment was discontinued, may be of benefit clinically when attempting to increase soft tissue extensibility or to reduce joint stiffness with active or passive treatments. Additionally, the combination of heat and tactile stimulation provided by Fluidotherapy theoretically is likely to provide a modality with analgesic benefits.

REFERENCES
1. Abramson DI, Chu LS, Tuck S, Jr., Lee SW, Richardson G, Levin M. Effect of tissue temperatures and blood flow on motor nerve conduction velocity. JAMA. 1966;198:1082-1088. 2. Bolton CF, Sawa GM, Carter K. The effects of temperature on human compound action potentials. J Neurol Neurosurg Psychiatry. 1981;44:407-413. 3. Borrell RM, Henley EJ, Ho P, Hubbell MK. Fluidotherapy: evaluation of a new heat modality. Arch Phys Med Rehabil. 1977;58:69-71. 4. Borrell RM, Parker R, Henley EJ, Masley D, Repinecz M. Comparison of in vivo temperatures produced by hydrotherapy, paraffin wax treatment, and Fluidotherapy. Phys Ther. 1980;60:1273-1276. 5. Currier DP, Greathouse D, Swift T. Sensory nerve conduction: effect of ultrasound. Arch Phys Med Rehabil. 1978;59:181-185. 6. Greathouse DG, Currier DP, Joseph BS, Shippee RL, Matulionis DH. Electrophysiologic responses of human sural nerve to temperature. Phys Ther. 1989;69:914922. 7. Haines DE. Fundamental Neuroscience. New York, NY: Churchill-Livingstone; 1997. 8. Halle JS, Scoville CR, Greathouse DG. Ultrasounds effect on the conduction latency of the superficial radial nerve in man. Phys Ther. 1981;61:345-350. 9. Henley EJ. Fluidotherapy Clinical Applications and Techniques. Oldsmar, FL: Maxxim Medical; 1991. 10. Henley Healthcare, Inc. Fluidotherapy Users Manual. Sugar Land, TX: Henley Healthcare, Inc; 2000. 11. Herrick RT, Herrick S. Fluidotherapy. Clinical applications and techniques. Ala Med. 1992;61:20-25. 12. Higgins JD, Tursky B, Schwartz GE. Shock-elicited pain and its reduction by concurrent tactile stimulation. Science. 1971;172:866-867. 13. Institute for Occupational Safety and Health, Division of Safety Research. Performing Motor and Sensory Neuronal Conduction Studies in Adult Humans. Morgantown, WV: Institute for Occupational Safety and Health; 1990. 14. Kandel ER, Schwartz JH, Jessell TM. Principles of Neural Science. 4th ed. New York, NY: McGraw-Hill; 2000. 15. Ludin HP, Beyeler F. Temperature dependence of normal sensory nerve action potentials. J Neurol. 1977;216:173-180. 16. Madsen PW, Jr., Gersten JW. The effect of ultrasound on conduction velocity of peripheral nerve. Arch Phys Med Rehabil. 1961;42:645-649. 17. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-979. 18. Michlovitz S. Thermal Agents in Rehabilitation. Philadelphia, PA: FA Davis; 1996. 19. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River: Prentice Hall; 2000.
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CONCLUSIONS
The purpose of this study was to examine the effects of heat and tactile stimulation, as well as tactile stimulation alone, on superficial skin temperature, and SNAP amplitude and conduction latency of the superficial radial nerve. The influence of the combined tactile and heat treatment upon skin temperature and SNAP latency was significant, with an inverse linear relationship demonstrated between these 2 variables (temperature increased and latency decreased). Fluidotherapy had no effect on SNAP amplitude. Tactile stimulation alone did not have a significant effect on any of the dependent variables studied. The results of this study should be of interest to those clinicians using Fluidotherapy who would like to know more about its effects on neural conduction variables as well as temperature of the skin over the nerve. The significantly higher skin temperatures that can be obtained with Fluidotherapy, which remained 20 minutes after the treat22

20. Prentice WE. Therapeutic Modalities for Physical Therapists. New York, NY: McGraw-Hill; 1998. 21. Prentice WE. Therapeutic Modalities for Physical Therapists. 2nd ed. York, NY: McGraw-Hill; 2002. 22. Rennie GA, Michlovitz SL. Biophysical principles of heating and superficial heating agents. In: Michlovitz SL, ed. Thermal Agents in Rehabilitation. Philadelphia, PA: FA Davis; 1996:107-138. 23. Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology: Electrotherapy and Electrophysiologic Testing. 2nd ed. Baltimore, MD: Williams & Wilkins; 1995.

24. Satran R, Goldstein MN. Pain perception: modification of threshold of intolerance and cortical potentials by cutaneous stimulation. Science. 1973;180:1201-1202. 25. Zankel HT. Effect of physical agents on motor conduction velocity of the ulnar nerve. Arch Phys Med Rehabil. 1966;47:787-792.

RESEARCH REPORT

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