Efficacy of Paraffin Wax Bath with and without Joint Mobilization Techniques in Rehabilitation of post-Traumatic stiff hand
Fozia Sibtain,1Asghar Khan,2 and Syed Shakil-ur-Rehman3
1Dr. Fozia Sibtain, Assistant Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
2Dr. Asghar Khan, Associate Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
3Dr. Syed Shakil-ur-Rehman, Assistant Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
Correspondence: Dr. Syed Shakil-ur-Rehman, Assistant Professor, Riphah College of Rehabilitation Sciences Riphah International University, Islamabad, Pakistan. E-mail: firstname.lastname@example.org
Author information ►Article notes ►Copyright and License information ►
Received 2012 Nov 14; Revised 2012 Dec 18; Accepted 2012 Dec 25.
Pak J Med Sci. 2013 Apr; 29(2): 647–650.
This article has been cited by other articles in PMC.
Objective: 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.
Methodology: 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.
Results: 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.
Key Words: Post-traumatic stiff hand, Joint mobilization techniques, Paraffin wax bath
The post-traumatic stiff hand commonly occurs in post traumatic upper extremity (UE) fractures, and is clinically complex problem. It generally results in common symptoms of edema, immobility and pain. The post-traumatic stiff hand generally leads to disuse of hand function, due to restricted range of motion and loss of muscle strength. The physical therapists rehabilitate the patients with post-traumatic stiff hand by joint mobilization techniques, stretching and strengthening exercises.1 If the patients with post-traumatic stiff hand are not rehabilitated, they will develop contractures in hand muscles and will result in a position of dysfunction. The physical therapy plan of care is based on physical examination, includes evaluation of PROM, muscle strength, edema, gross sensation, bone healing, and adhesions. The common goals of physical therapy management of post-traumatic stiff hand are to manage pain, increase PROM, and muscle strength.2
The improvement in joint PROM is the key component of physical therapy management, due to musculotendinous tightness. The joint mobilization techniques are used to improve joint PROM, by producing passive glides with distraction between the articular surfaces of hand joints to manage pain, break adhesions, and improve joint PROM. The grade I and II are used to manage pain and grade-III for improvement in joint PROM.3
The paraffin wax bath is commonly used as effective remedy to improve circulation and promotes relaxation.4 Both hands and feet are most common segments to be treated with paraffin wax bath in physical therapy. Paraffin Wax bath treatment followed by active hand exercise resulted in significant improvements of range of motion.5
This study is a randomized clinical trial on 71 patients, with the mean age of 39.5 years with minimum age 21 years and maximum 52 years conducted, in department of physical therapy and rehabilitation, Riphah International University Islamabad. This interventional study was conducted from November, 2010 to September, 2012. The inclusion criteria were age range from 20-60 years, pain, loss of PROM, with history of trauma and distal upper extremity fractures. The patient with age less than two years and more than 60 years with any non-traumatic cause of fractures were considered as exclusion criteria. The study variables were measured and documented at the baseline including, age, gender, dominant hand, hand involved, prior level of activity, pain intensity score, Thumb function score, and PROM of wrist flexion, extension, radial and ulnar deviation (Table-I). The PROM was measured by goniometer in sitting position.
Baseline characteristics of 71 patients with post-traumatic stiff hand
Thirty six patients were placed randomly in group A, and treated with joint mobilization techniques and paraffin wax bath, and 35 patients were included in group B and were treated with joint mobilization techniques alone. All the patients of both the groups were treated 4 days per week for 6 weeks. The paraffin wax bath was applied for 20 minutes prior to every physical therapy session and followed by joint mobilization techniques including glides of the articular surfaces in sitting position at 8-12 glides at every joint of the hand and wrist. The joint mobilization grade-I and grade-II were used for pain management and relaxation, while grade-III for improvement in the PROM of hand and wrist. The study variables were also calculated at the completion of six weeks physical therapy treatment program.
Statistical analysis was done by SPSS version-20 and the paired t-test was applied at 95% level of significance to calculate the p values for pain intensity score on VAS 0/10, TFS and PROM of wrist flexion, extension, radial and ulnar deviation (Table-II).
Clinical and functional changes at six weeks in patients with post-traumatic stiff hand
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. Table-II.
In our study, the base line measurements of study variables were matched with measurements after six weeks of physical therapy intervention, including joint mobilization with paraffin wax bath in group A and in group B alone. The patients in group A showed significant improvement in pain score, TFS, and PROM of wrist flexion, extension, radial and ulnar deviation, as compare to group B.
Dellhag and colleagues conducted a clinical trial on 52 patients of rheumatoid arthritis and all were randomly placed into four groups, including exercise and wax bath, exercise only, wax bath only, and controls. All the patients were treated three times a week for four weeks. The group of patients treated with paraffin wax bath and followed by active exercises showed significant improvement as compared to the other groups treated with other techniques.6
Ayling and Marks carried out a systematic review on efficacy of paraffin wax bath for rheumatoid arthritic hand and critically examined whether paraffin wax is efficacious for this condition in light of this information. They found 4 randomized control trials, and 3 out of 4 reported that after 3-4 weeks of management, paraffin wax applications were accompanied by significant improvements in rheumatoid arthritic hand function when followed by exercise.7
Sandqvist and team conducted a clinical trial to determine the effect of paraffin wax bath combined with exercise, on one hand of 17 patients with scleroderma, while the other hand was treated with exercise only. They concluded that paraffin wax bath combined with exercise improved mobility, decrease stiffness, and increase elasticity.8
Valdes and Marik worked on a systematic review on the physical therapy management of osteoarthrtic hand, and they searched and evaluated evidence on multiple hand physical therapy interventions, including splinting, joint protection technique instruction, paraffin wax bath, exercises, and provision of a home exercise program. They concluded that literature supports the effectiveness of paraffin wax bath, joint protection instructions, and orthotic support for improvement in hand grip strength and function.9
Glasgow and team conducted a systematic review on mobilizing the stiff hand: combining theory and evidence to improve clinical outcomes. The purpose was to evaluate the available evidence on stiff hand. They concluded that mobilization exercise and splinting can prevent contractures in stiff hand.10
Sultana and colleagues carried out a systematic review on the role of mobilization after tendon transplant to evaluate the evidence on the role of mobilization after tendon transplant for the improvement of PROM pain at the wrist. They concluded on the basis of available studies of joint mobilization techniques, which are effective for pain management and improve function.11
We conclude that paraffin wax bath combined with joint mobilization techniques are more effective in the physical therapy rehabilitation of post-traumatic stiff hand as compared to joint mobilization techniques alone.
Source of funding: Riphah International University Islamabad.
1. Hoch MC, Andreatta RD, Mullineaux DR, English RA, Medina-McKeon JM, Mattacola CG, et al. Two‐week joint mobilization intervention improves self‐reported function, range of motion, and dynamic balance in those with chronic ankle instability. J Orthop Res. 2012;30(11):1798–1804.[PubMed]
2. Morey KR, Watson AH. Team approach to treatment of post-traumatic stiff hand. Physical Ther. 1986;66(2):225–228.[PubMed]
3. Randall T, Portney L, Harris B. Effects of joint mobilization on joint stiffness and active motion of the metacarpal-phalangeal joint. J Orthopedic Sports Med. 2012;16(1):30–36.[PubMed]
4. Welch V, Brosseau L, Casimiro L, Judd M, Shea B, Tugwell P, et al. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2002;(2):CD002826.[PubMed]
5. Harris R, Millard J. Paraffin-wax baths in the treatment of rheumatoid arthritis. Annals of the Rheumatic Diseases. 1955;14(3):278–283.[PMC free article][PubMed]
6. Dellhag B, Wollersjo I, Bjelle A. Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients: randomized trial. Arthritis & Rheumatism. 2005;5(2):87–92.[PubMed]
7. Ayling J, Marks R. Efficacy of paraffin wax baths for rheumatoid arthritic hands. Physiotherapy. 2000;86(4):190–201.
8. Sandqvist G, Akesson A, Eklund M. Evaluation of paraffin bath treatment in patients with systemic sclerosis. Disabil Rehabil. 2004;26(16):981–987.[PubMed]
9. Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther. 2010;23(4):334–351.[PubMed]
10. Glasgow C, Tooth LR, Fleming J. Mobilizing the stiff hand: combining theory and evidence to improve clinical outcomes: a systematic review. J Hand Ther. 2012;23(4):392–401.[PubMed]
11. Sultana SS, MacDermid JC, Grewal R, Rat S. The Effectiveness of Early Mobilization after Tendon Transfers in the Hand: A Systematic Review. J Hand Ther. 2012 [Epub ahead of print] [PubMed]
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This article is about a beauty treatment for fingernails. For the song by Lady Gaga, see Artpop.
"French nails" redirects here. For the carpentry product, see wire nails.
A manicure is a cosmeticbeauty treatment for the fingernails and hands performed at home or in a nail salon. A manicure consists of filing and shaping the free edge, pushing and clipping (with a cuticle pusher and cuticle nippers) any nonliving tissue (but limited to the cuticle and hangnails), treatments with various liquids, massage of the hand, and the application of fingernail polish. When the same is applied to the toenails and feet, the treatment is referred to as a pedicure.
Some manicures include painting pictures or designs on the nails, or applying small decals or imitation jewels. Other nail treatments may include the application of artificialgel nails, tips, or acrylics, which may be referred to as French manicures.
In many areas, manicurists are licensed and follow regulations. Since skin is manipulated and is sometimes trimmed, there is a risk of spreading infection when tools are used across many people. Therefore, having proper sanitation can be a serious issue.
The English word manicure comes from the French word manucure, meaning "care of the hands", which in turn originates from the Latin words manus, for "hand", and cura, for "care". Similarly, the English word pedicure comes from the Latin words ped, for "foot", and cura, for "care".
The popularity and fascination with nail art has increased in recent years due to a flourishing online community that shares tips, tricks and designs via social media sites like Facebook, Instagram, Tumblr, and Pinterest.
Manicures began 5,000 years ago.
Jeff Pink founder of professional nail brand Orly is famed with creating the Natural nail look later called the French manicure in 1976.
French manicures can be made with artificial nails, which are designed to resemble natural ones and are characterized by lack of base color, or natural pink base nails with white tips. The nail tips are painted white, while the rest of the nails are polished in a pink or a suitable nude shade. However, it is also as common to perform a French manicure on natural nails. Another technique is to whiten the underside of the nail with white pencil and paint a sheer color over the entire nail.
Hot oil manicures
A hot oil manicure is a specific type of manicure that cleans the cuticles and softens them with oil. Types of oils that can be used are mineral oil, olive oil, some lotions or commercial preparations in an electric heater.
Dip powder manicures
Dip powder manicures are an alternative to traditional acrylic nails and gel polish. Dip powders have become popular due to ease of application. They are similar to traditional silk or fiberglass enhancements, with the fiber being replaced by acrylic powder. Both methods rely on layering cyanoacrylate over the natural nail and encasing either the fiber or acrylic powder. While a single layer of fiber is typical, multiple alternating layers of powder and cyanoacrylate may be used in dip nails.
Paraffin wax treatments
Hands or feet can be covered in melted paraffin wax for softening and moisturizing. Paraffin wax is used because it can be heated to temperatures of over 95 °F (35 °C) without burning or injuring the body. The intense heat allows for deeper absorption of emollients and essential oils. The wax is usually infused with various botanical ingredients such as aloe vera, azulene, chamomile, or tea tree oil, and fruit waxes such as apple, peach, and strawberry, are often used in salons. Occasionally, lotion is rubbed on the hand or foot before being coated in paraffin. Paraffin wax treatments are often charged as an addition to the standard manicure or pedicure. They are often not covered in general training and are a rare treatment in most nail salons.
Professional services should not include dipping clients' hands or feet into a communal paraffin bath, as the wax can be a vector for disease. Paraffin should be applied in a way that avoids contamination, often by placing a portion of the wax into a bag or mitt, which is placed on the client's hand or foot and covered with a warm towel, cotton mitt, or booty to retain warmth. The paraffin is left for a few minutes until it has cooled.
Common manicure tools and supplies
Common manicure/pedicure tools include:
Common manicure/pedicure supplies include:
- Cotton balls/pads
- Cuticle remover
- Hand cream
- Hand towels
- Massage lotion
- Nail jewels (often self-adhesive)
- Nail polish
- Nail polish remover or nail polish remover wipes
- Base coat polish & ridge filler polish
- Color varnish
- Top coat or sealant
For decoration (optional):
- Fimo/Nail art cane slices
- Flocking Powder
- Sanitizing spray/towels
- Small dried flowers
In Australia, the United States, and other countries,[where?] many nail salons offer personal nail tool kits for purchase to avoid some of the sanitation issues in the salon. The kits are often kept in the salon and given to the client to take home, or are thrown away after use. They are only used when that client comes in for a treatment.
Another option is to give the client the files and wooden cuticle sticks after the manicure. Since the 1970s, the overwhelming majority of professional salons use electric nail files that are faster and yield higher quality results, particularly with acrylic nail enhancements.
There are several nail shapes: the basic shapes are almond, oval, pointed, round, square, square oval, square with rounded corners, and straight with a rounded tip. The square oval shape is sometimes known as a "squoval", a term coined in 1984. The squoval is considered a sturdy shape, useful for those who work with their hands.
New York Controversy
On May 7, 2015, The New York Times journalist Sarah Maslin Nir broke the two-part story titled "The Price of Nice Nails" and "Perfect Nails, Poisoned Workers" about abuses in New York salons related to ill-treatment of workers and associated health risks. As a result, on May 11, 2015, New York governor Andrew Cuomo took immediate measures announcing a Multi-Agency Enforcement Task Force to tackle the abuse in the nail salon industry.
|Wikimedia Commons has media related to Manicure.|
|Look up manicure in Wiktionary, the free dictionary.|
- ^"What is a French Manicure?". Wisegeek.com.
- ^"Manicure definition". Online Etymology Dictionary.
- ^"Pedicure definition". Online Etymology Dictionary.
- ^"Archived copy". Archived from the original on 2014-11-13. Retrieved 2014-11-13.
- ^"Aha! Moment: The French Manicure". Women's Wear Daily.
- ^Elaine Almond (Sep 19, 1994). Manicure, Pedicure And Advanced Nail Techniques. Cengage Learning EMEA. p. 116.
- ^Esla Mcalonan (19 April 2009). "Home beauty school - Founder of Jessica Nails, Jessica Vartoughian, on a proper salon manicure". Mail Online. The Daily Mail, UK. Retrieved 2009-07-23.
- ^Crowley, Tim (2007). "Getting Nails Into Shape", Nails, p.81. November issue accessed 02/15/08.
- ^Alisha Rimando Botero; Catherine M. Frangie; Jim McConnell; Jacqueline Oliphant (May 28, 2010). Milady's Standard Nail Technology. Cengage Learning. p. 217.
- ^Maslin, Sarah (May 7, 2015). "The Price of Nice Nails". New York Times. Retrieved 12 May 2015.