Laws Governing The Effects

of Electromagnetic Energy
Lecture II
Prof. Amal HM. Ibrahim
Objectives
1. Explain the different laws affects electromagnetic energy
absorption.
2. Explain the contraindications to electromagnetic radiations.
3. List and recognize the physiological effects of heat
4. Distinguish between different modes of heat transfer
5. Enumerate different thermal agents
6. List precautions, indication, and contraindications
7. Enumerate thermal agents
1- Reflection
1- Reflection
The amount of reflection depends on:
1. Nature of radiation
ionizing or non-ionizing
1- Reflection
The amount of reflection depends on:
2- Angle of radiation: the angle of incidence has on insolation intensity with the following simple equation:
Intensity = SIN (A)
where, A is the angle of incidence and SIN is the sine function found on most calculators. Using this equation we
can determine that an angle of 90° gives us a value of 1.00 or 100% (1.00 x 100).
SIN 90°= 1.00 or 100%
• SIN 80 = 0.98 or 98%
• SIN 70 = 0.94 or 94%
• SIN 60 = 0.87 or 87%
• SIN 50 = 0.77 or 77%
• SIN 40 = 0.64 or 64%
• SIN 30 = 0.50 or 50%
• SIN 20 = 0.34 or 34%
• SIN 10 = 0.17 or 17%
• SIN 0 = 0.00 or 0%
1- Reflection
The amount of reflection depends on:
3- Nature of the surface
2- Refraction
3- Absorption
• Factors affecting absorption:
1- wave length
2- frequency
3- Absorption Angle of Incidence (degrees) Angle of Refraction (degrees)

0.00 0.00
• Factors affecting absorption: 5.00 3.8

10.0 7.5
3- Angle of incidence 15.0 11.2

20.0 14.9

25.0 18.5

30.0 22.1
35.0 25.5
40.0 28.9

45.0 32.1

50.0 35.2

55.0 38.0

60.0 40.6

65.0 43.0

70.0 45.0

75.0 46.6

80.0 47.8

85.0 48.5
3- Absorption
• Factors affecting absorption:

4- nature of the medium

5- the intensity of radiation:   is the amount of energy per unit time
passing through a unit area perpendicular to a radiation source. 
Arndt–Schultz Principle
• Reactions or changes of tissues depend on the sufficient amount of
energy absorbed
Law of Grotthus–Draper

• There is an inverse relationship between the penetration and

absorption of energy.
Cosine Law
• Effective energy= energy X cosine of the angle of incidence
Inverse Square law
I α 1/d2
Inverse Square law
Example of Electromagnetic modalities
General contraindications to Electromagnetic radiation
Contraindication Why?
Pregnancy The possible harmful effects of electromagnetic
fields on the foetus within the field area.
Pacemaker Electromagnetic energy will affect the operation
of the pacemaker which could be harmful to the
patient.
Recent deep X-ray therapy Patients who have had it in the past 3 months,
because it might reduce sensory sensation and
diminish circulation.
Metastasis May accelerate the rate of growth and spread of
the malignancy.
Metal implants The metal might significantly concentrate the
energy and cause burn.
 Mods of heat
transfer

RADIATION EVAPORATION CONVERSION

CONDUCTION CONVECTION
by a wave, the Transfer of
DIRECT CONTACT the MOVEMENT mechanical,
travelling as transformation
Like OF AIR, MATTER rays from a liquid electrical, or
1- hot packs OR LIQUID state to a gas chemical energy
1- IRR into heat
2- paraffin bath 1- hot and cold state
whirlpool 2-UVR 1- US
3- ice massage 1- Vapo-coolant
3- MWD spray 2- Diathermy
Thermotherapy
• The application of external heat to local part will produce some changes. These
changes may be produced by local or general effects.
• Their extent will depend on various factors for example:
1- Size of the area treated with external heat.
2- Intensity of the radiating heat.
3- The length of penetration of radiating heat.
4- Structure of the skin and subcutaneous tissues.
5- Age of the patient.
6- Integrity of cardiovascular and nervous system.
7- Integrity of thermo-regulatory center.
8- Duration of exposure to radiating heat.
Physiological Effects of Heat
• Metabolic Activity
• Hemodynamic (blood flow)
• Collagen tissues

Local •
•
•
Muscle tone
Pain
Muscle performance
• Tissue healing

• Vasodilatation and reduced urine flow

• Sweating
• pulse rate and respiratory rate

Systemic • blood pressure

•
• Body temperature
Metabolic Activity
• Metabolism being a series of chemical reactions, will INCREASE with
a RISE & DECREASE with a FALL of temperature
• metabolism → increase cell activity → promote tissues healing

• temperature → O2 and nutrients consumption and demand.

• temperature → Increase amount of waste products

• Temperatures > 45˚C →protein damage occurs → destruction of

cells & tissues.
Hemodynamic Effect
Increase in blood flow
• Mechanism of vasodilatation of blood vessels:
• 1- Heat has direct effect on capillaries, arterioles and venules causing them to
dilate.
• 2- The increased metabolism will lead to increase release of carbon dioxide,
lactic acid and greater acidity of heated tissues tending to provoke dilatation.
• 3- As heat can damage proteins this may cause inflammatory reaction due to
release of histamine-like substance and bradykinin which leads to
vasodilatation.
• 4- The axon reflex has been involved to account for dilatation.
Collagen Tissues
• The extensibility of collagen tissues increased
with heating if the tissue simultaneously
stretched.
• Joint stiffness has been found to be reduced by
heating.
Muscle Tone
• Therapeutic temperature (40-45°C) reduction of spasm
• (ɣ) fiber activity, firing of type II muscle spindles reduction
of spasm
• firing rates of Golgi tendon
organs, resulting in
muscle inhibition.
Pain
• Relieve sub-acute and chronic pain through the following
mechanisms:
• The pain gate theory.

• secondary muscle spasm and circulation to ischemic muscle.

• Acceleration of tissue healing.
Muscle Performance
• It is not preferable to apply heat therapy before
exercises. WHY?
• 2 hours after hot application will lead to increased
muscle strength and endurance.
Tissue Healing
• Forbidden to use hot application in the initial stage of injury.
Systemic Effects

1. The immediate systemic response is generalized cutaneous

vasodilatation, reduced hepatic clearance and reduced urine flow.
2. Sweating
3. Increase pulse rate
4. Increase respiratory rate
5. Fall in blood pressure
6. If local heating is extensive and prolonged, this causes rise in
temperature and reflex vasodilatation in remote areas.
Thermoregulation

• In humans for optimal function of the internal organs, core temperature of the human
body is maintained at 37°C. The body temperature is controlled by the
thermoregulatory center in the hypothalamus.
• The thermoregulatory center sends impulses to several different effectors to adjust
body temperature.
• When increase temperature above 37°C as in case of application of thermal modalities,
to prevent elevation of body temperature, the following mechanisms are taken to
prevent heat gain
• Increase blood flow to skin, so increases conduction and radiation of heat from the
body (by radiation)
• Increased sweat secretion, so increase heat loss by evaporation
General Precautions to heat application

Precaution Why?
Open wounds Fresh granulated tissue is too fragile for the application of many physical agents;
however, proximal application techniques may enhance circulation to healing areas.

Advanced age Older patients may have less adipose or connective tissue to insulate them against
extremes of heat. This may make them more susceptible to burns.

Pregnancy Application of heat directly over a pregnant uterus is contraindicated; however,

application to other areas of the body is not.

Impaired cognitive ability If a patient is unable to communicate discomfort, application of heat would be
contraindicated; however, if they have cognitive limitations but are able to provide this
information and their skin blanches appropriately, the intervention may be undertaken
with precaution.
General Contraindications to heat application

Contraindication Reason
Unreliable patient The patient may burn without warning.
Anti-coagulant medications The patient may experience hyperemia easily and be unable to
regulate their temperature.

Absence of sensation in the The patient may burn without warning.

treatment area

Peripheral vascular disease Heat gain cannot be dissipated so may cause burn. Also the increased
distal to the treatment area metabolic rate increases the need for oxygen causing further hypoxia
(ischemic areas or impaired
circulation)

Deep vein thrombosis Heat would exacerbate the inflammatory response that cannot
  accommodate circulatory changes. A clot could potentially dislodge
and travel to the heart, lungs, or brain.
General Contraindications to heat application

Contraindication Reason
Acute inflammation Heat could exacerbate the inflammatory response.
Acute haemorrhage, or Heat applied directly to an area will result in an increase in the
tendency to haemorrhage as in circulation and potentially increase bleeding.
menstruation
Fever Heat would exacerbate the inflammatory response and increase
discomfort.
Sensory loss The safety relies on the ability of the patient to report changes in
sensation to prevent a burn.

Metastasis Heat applied directly over or proximal to a metastasis will increase

circulation to the area and may enhance the progression.

Metal implants or metals such Concentrates the energy and cause burn. Superficial heat as IRR is not
as jewellery contraindicated for metal implants
Dangers with thermal agents

• Burns: it might be due to patients accidentally touch the hot elements if

there is no protective guard and this can be avoided by careful application,
adequate warning to the patient and checking the effects on the skin.
• Dehydration: Prolonged and intensive treatment to large body areas could
cause sweating leading to dehydration if the water lost is not replaced.
• Lowered blood pressure: as heat application cause marked cutaneous
vasodilatation, it may lead to temporary lowering of blood pressure
especially in elderly patients who have less effective vasomotor control. This
may lead to faintness especially on standing up immediately after
treatment.it may also cause headache.
•