Understanding Burn Injury: Types, Causes, Signs, Prevention, Treatment, and Physiotherapy’s Role
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 23, 2024
Burn injuries occur when the skin or other tissues are damaged by heat, chemicals, electricity, or radiation. These injuries can range from minor to severe, impacting not only physical health but also emotional and psychological well-being. Understanding burn injuries is crucial for affected individuals and their caregivers as it helps in managing treatment, recovery, and rehabilitation effectively.
Physiotherapy plays a significant role in the recovery process, focusing on improving mobility, reducing pain, and enhancing the overall quality of life for burn survivors. By incorporating targeted exercises and rehabilitation strategies, physiotherapy can aid in restoring function and preventing complications.
What is a burn injury?
A burn injury is damage to the skin or other tissues caused by exposure to heat, chemicals, electricity, or radiation. Burns are classified by their severity, which ranges from minor to life-threatening, depending on the depth and extent of tissue damage.
How burn injuries occur
Heat burns: These occur from contact with hot objects, liquids, or flames. They are the most common type of burn injury.
Chemical burns: Result from contact with acidic or alkaline substances that can cause chemical reactions damaging the skin and tissues.
Electrical burns: Occur when electricity passes through the body, causing internal damage and potentially severe burns at the entry and exit points.
Radiation burns: Caused by exposure to radiation, such as from the sun or certain medical treatments, leading to damage similar to sunburn.
Impact on the skin and body
Burn injuries damage the skin’s layers, leading to symptoms such as redness, swelling, pain, and blisters. In severe cases, burns can destroy skin layers entirely, leading to scarring, infection, and loss of function. Beyond the skin, extensive burns can affect other bodily functions, including fluid balance, temperature regulation, and immune response, making comprehensive medical and rehabilitative care essential for recovery.
Types of burn injuries
First-degree burns
Affect only the outer layer of skin (epidermis). They cause redness, minor swelling, and discomfort.
Typical causes: Sunburn, brief contact with hot objects, or mild scalding.
Severity: Generally mild and often heal within a week without scarring.
Second-degree burns
Extend through the outer layer and into the underlying layer of skin (dermis). They cause redness, blistering, swelling, and pain.
Typical causes: Scalding liquids, contact with hot surfaces, or severe sunburn.
Severity: More serious than first-degree burns and may take several weeks to heal. They can cause scarring and may require medical treatment.
Third-degree burns
Destroy both the outer and underlying layers of skin. The area may appear white, charred, or leathery, and can be numb due to nerve damage.
Typical causes: Prolonged exposure to hot liquids or flames, electrical burns, or severe chemical burns.
Severity: Very serious and require immediate medical attention. Healing often involves skin grafts and can lead to significant scarring.
Fourth-degree burns
Extend beyond the skin into deeper tissues, including muscles, tendons, and bones. The area may appear charred or blackened.
Typical causes: Severe burns from prolonged exposure to flames, high-voltage electrical injuries, or extreme chemical burns.
Severity: Critical and life-threatening, often requiring extensive surgical intervention and long-term rehabilitation. They can result in permanent disability and severe complications.
Causes of burn injuries
Thermal burns
These occur from contact with high temperatures. Common scenarios include:
Fire: Flames from a fire can cause severe burns.
Steam: Hot steam from boiling water or pressure cookers.
Hot Objects: Contact with heated surfaces, such as stoves, irons, or pipes.
Chemical burns
Result from exposure to harmful chemicals that damage skin and tissues. Common scenarios include:
Acids: Spills or splashes from industrial acids or cleaning products.
Alkalis: Exposure to substances like bleach or ammonia.
Other Chemicals: Contact with corrosive or irritant chemicals in various settings.
Electrical burns
Caused by electrical currents passing through the body. Common scenarios include:
Electrocution: Contact with live electrical wires or faulty appliances.
High Voltage: Accidental exposure to high-voltage sources, such as power lines.
Radiation burns
Result from exposure to radiation or UV rays. Common scenarios include:
UV Rays: Prolonged sun exposure without protection leading to sunburn.
Radiation Therapy: Burns from medical treatments involving radiation.
Signs and symptoms of burn injuries
First-degree burns:
Signs: Redness, mild swelling, and pain.
Symptoms: Skin may appear pink or red but remains intact. The area is usually tender and warm.
Second-degree burns:
Signs: Redness, blistering, severe pain, and swelling.
Symptoms: The burn area may have blisters filled with fluid. The skin may look red and swollen, and pain is often intense.
Third-degree burns:
Signs: White, charred, or leathery appearance; numbness.
Symptoms: The burn area might appear blackened or brown. There is often a lack of pain due to nerve damage, but significant swelling and potential exposure of underlying tissues are evident.
Fourth-degree burns:
Signs: Charred or blackened appearance, extending into deeper tissues.
Symptoms: The burn affects not only the skin but also muscles, tendons, or bones. The area may be blackened or severely damaged, and pain may be absent due to extensive nerve destruction.
Identifying severity:
First-degree burns: Typically involve only the outer layer of skin with minimal complications.
Second-degree burns: Extend deeper, affecting the dermis, often requiring medical evaluation.
Third-degree burns: Destroy both skin layers and may require immediate professional medical intervention and possibly surgery.
Fourth-degree burns: Involve extensive damage to deeper tissues, requiring urgent medical care and complex treatment
Prevention of burn injuries
Practical tips
Kitchen safety:
Keep hot items out of reach: Use back burners and turn pot handles inward to avoid accidental spills.
Use oven mitts: Always use oven mitts or pot holders when handling hot cookware.
Be cautious with hot liquids: Avoid overfilling pots and cups, and always stir hot liquids carefully.
Handling chemicals:
Follow instructions: Use chemicals according to manufacturer instructions and safety guidelines.
Wear protective gear: Use gloves, goggles, and masks when handling harmful chemicals.
Store properly: Keep chemicals in clearly labeled containers and store them out of reach of children.
Fire safety at home:
Install smoke alarms: Place smoke alarms on every level of your home and test them regularly.
Create a fire escape plan: Develop and practice a fire escape plan with all family members.
Avoid overloading electrical outlets: Use electrical devices according to safety guidelines and avoid overloading circuits.
Importance of education
Children: Educate children about the dangers of hot surfaces, chemicals, and fire. Teach them safe practices and supervise them, especially in the kitchen and around heating devices.
Elderly: Ensure that elderly individuals are aware of fire safety and the risks of burns. Provide assistance with using heating devices safely and handling chemicals.
Education and awareness are key to preventing burn injuries and ensuring that safety measures are practiced consistently.
Treatment and diagnostics of burn injuries
Initial first aid
Cool the burn: Immediately cool the burn under cool (not cold) running water for 10-20 minutes. This helps reduce pain and limits skin damage.
Cover the burn: Use a clean, non-stick bandage or cloth to cover the burn. Avoid using cotton or materials that might stick to the wound.
Avoid breaking blisters: If blisters form, do not burst them as they protect the underlying skin.
Seek medical help: For burns that are larger than 3 inches in diameter, involve the face or genitals, or are third-degree, seek emergency medical attention.
Medical treatment
Wound care: Clean and dress burns with appropriate bandages and topical antibiotics to prevent infection. Use special burn dressings for deeper burns.
Surgery: Severe burns may require debridement (removal of dead tissue) or surgical interventions to repair damaged tissues.
Skin grafts: For extensive burns, skin grafts may be necessary to cover large areas of damaged skin, helping to heal and restore function.
Diagnostics
Burn depth assessment: Clinicians assess the depth of burns by examining the color and texture of the skin. This may include a physical examination and sometimes biopsy.
Imaging techniques: Techniques such as ultrasound or MRI may be used to evaluate deeper tissue damage and guide treatment.
Pain management
Medications: Use over-the-counter pain relievers like ibuprofen or acetaminophen for mild burns. Prescription pain medications may be needed for more severe burns.
Topical treatments: Apply prescribed topical analgesics or burn creams to alleviate pain.
Non-pharmacological methods: Techniques like cooling, elevation, and relaxation exercises can also help manage pain.
Timely and appropriate treatment, along with accurate diagnostics, is essential for effective burn management and recovery.
The role of physiotherapy in burn injury recovery
Physiotherapy plays a crucial role in the recovery process for burn injuries, addressing physical, psychological, and functional challenges to support overall healing and well-being.
Physical rehabilitation
Techniques: Physiotherapists use various techniques to improve mobility and strength in affected areas. This includes range-of-motion exercises, strength training, and functional activities designed to restore movement and prevent stiffness.
Rehabilitation plans: Customized rehabilitation plans are developed based on the severity and location of the burn, aiming to enhance functional outcomes and quality of life.
Scar management
Approaches: Physiotherapy includes scar management techniques to minimize and manage scarring. These may involve:
Massage therapy: To soften and flatten scar tissue.
Compression garments: To reduce swelling and pressure, helping to prevent hypertrophic scarring.
Silicone gel sheets: To improve the appearance and elasticity of scars.
Pain management
Techniques: Physiotherapists employ several techniques to manage pain and discomfort, including:
Modalities: Such as heat, cold therapy, and electrical stimulation to alleviate pain.
Manual therapy: Techniques to release tension and improve blood flow.
Exercise therapy: Tailored exercises that help reduce pain through improved movement and function.
Psychological support
Support: Physiotherapists offer psychological support by:
Counseling: Providing emotional support and coping strategies for dealing with the psychological impact of burn injuries.
Motivational support: Encouraging patients through the rehabilitation process and setting achievable goals to boost confidence and morale.
Success stories
Case studies: Examples of successful physiotherapy interventions include patients who have regained full mobility and function after severe burns. For instance, individuals who initially struggled with severe contractures and pain have achieved significant improvements through comprehensive physiotherapy programs, demonstrating the effectiveness of these treatments in enhancing recovery and quality of life.
Overall, physiotherapy is integral to burn injury recovery, addressing both physical and emotional aspects to support a holistic healing process.
Conclusion
Burn injuries, whether minor or severe, require careful management to ensure effective recovery. Understanding the types of burns, their causes, and the appropriate treatment options is crucial for mitigating damage and enhancing healing. Initial first aid, followed by comprehensive medical and physiotherapeutic care, plays a vital role in managing burn injuries.
Key points:
Burn types: Recognize the severity of burns—first-degree, second-degree, third-degree, and fourth-degree—to guide appropriate treatment and care.
Causes: Understand common causes, including thermal, chemical, electrical, and radiation burns, to implement effective prevention strategies.
Treatment and diagnostics: Utilize initial first aid, medical treatments, and diagnostic tools to assess and manage burn injuries properly.
Role of physiotherapy: Physiotherapy supports burn recovery through physical rehabilitation, scar management, pain management, and psychological support.
If you or someone you know is dealing with a burn injury, seeking professional medical advice and physiotherapy is essential. A certified physiotherapist can provide a personalized treatment plan tailored to individual needs, helping to optimize recovery and improve quality of life.
Consult with a certified physiotherapist to develop a customized treatment plan and support your journey towards recovery from a burn injury. Your health and well-being are paramount, and professional guidance can make a significant difference in your healing process.
References:
Elżbieta Radzikowska-Büchner, Łopuszyńska, I., Flieger, W., Tobiasz, M., Maciejewski, R., & Flieger, J. (2023). An Overview of Recent Developments in the Management of Burn Injuries. International Journal of Molecular Sciences, 24(22), 16357–16357. https://doi.org/10.3390/ijms242216357
Jeschke, M. G., van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S., & Logsetty, S. (2020). Burn injury. Nature Reviews. Disease Primers, 6(1). https://doi.org/10.1038/s41572-020-0145-5
Nielson, C., Duethman, N., Howard, J., Moncure, M., & Wood, J. (2017). Burns: Pathophysiology of Systemic Complications and Current Management. Journal of Burn Care & Research, 38(1). https://doi.org/10.1097/BCR.0000000000000355
Procter, F. (2020). Rehabilitation of the burn patient. Indian Journal of Plastic Surgery, 43(3), 101. https://doi.org/10.4103/0970-0358.70730
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.