PT611: Hydrotherapy & Short Wave Diathermy

Types of hydrotherapy

1. Whirlpool

2. Exercise program in full sized pool

3. Contrast baths

Hydrotherapy indications

• Wound care

• Thermal effects

• Pain relief

• Muscle relaxation

• Muscle weakness- supported exercise

What is hydrostatic pressure?

Perpendicular force of water against body. Increases venous return.

Effects of immersion - Cool temperature under 80F

• Peripheral vasoconstriction

• Increased HR (if face not submerged)

• Increased BP

• Analgesia

Effects of immersion - Hot temperature above 95F

• Vasodilation

• Increased HR

• Relaxation

• Increased blood flow to muscle

• Increased fatigue

Physiologic effects of immersion

• Hydrostatic pressure on chest inhibits lung expansion, increased work of breathing

• Causes dehydration via diuresis

• Warm = relaxing, cold = stimulating

Indications for aquatic therapy

• Mobility

• Strength training

• Decreased stress on weight bearing joints

• Gait training

• OA/RA patients

• LBP

Why use a pool exercise program?

• Low impact

• Resistance of water for training

• Can use specialized equipment to increase resistance

• Heated to 83-90F recommended for OA

Indications for whirlpool therapy

• Wound care

• Need submersion of extremity

• Mechanical debridement

• Increased local circulation

• Analgesic effect

Whirlpool Use

• Temperature depends on goals (VD/VC, acute, wounds) - 27-43.5C

• Not warmer than 38C for pts with CV disease

• Treatments 20-30 mins

• Direct water turbulence at area being treated

Hydrotherapy Precautions

• Medical devices (catheters)

• Cognitive impairments

• Open wounds

• Bowel/bladder incontinence

• Impaired sensation/precautions related to temperature

• Tracheostomy

• Submersion and significant cardiac disease

Contrast Bath

• Sub-acute/chronic conditions or after exertion

• Hot and cold water to promote vasodilation and vasoconstriction for circulation

• Not great evidence

Contrast Bath Use

• Submersion in warm and cold water

• 38-43C and 13-18C

• 3-6 min warm, then cold 1 min (3:1 or 4:1 hot:cold)

• 20-30 min

Pulsed Shortwave Therapy

• Heating tissue using radiation (electromagnetic waves)

• 2 types of diathermy devices = electric field or magnetic field

• Non-thermal benefits

Electromagnetic Radiation in therapy

• EM energy from radio frequency area of spectrum

• Most use 27.12 MHz for electrical

• Non-ionizing radiation

• Can either be pulsed or continuous delivery

Electric Diathermy

A unit that uses high frequency generator that is amplified producing electron oscillation (capacitive)

Electric Diathermy

A unit that uses high frequency generator that is amplified producing electron oscillation (capacitive)

Pulsed shortwave therapy measurements

• Pulse rate (Hz or pps)

• Pulse duration (time)

• Power (watts)

  • Peak

  • Mean - average power determines how much heating can be achieved

Thermal effects of pulsed shortwave therapy

• Increased temperature of muscle

• Increased metabolism

• Analgesic heat effects

• Local vasodilation, increased circulation

• Increased extensibility of tissue

• Heats tissue 3-5 cm deep

Non-thermal effects of PSWT

• Increased WBC, fibroblasts in wounds

• Faster absorption of hematoma, edema *

• Increased collagen

• Reduces inflammation *

• Has to be with temperature low enough to not heat the tissue*

Indications for PSWT

• Chronic pain

• Decreased ROM

• Acute muscle and soft tissue injury

• OA

Contraindications/precautions for PSWT

• Pregnancy

• Pacemaker/other implanted nerve stimulators

• Metal

• Bleeding

• Fever

• Over epiphyses of immature bone

• Over developing gonads

• Ischemia areas

• PVD/infection

• Malignancy

Use of PSWT

• Remove clothing AND jewellery in area

• Single towel layer over area

• Patient should not feel excessive heat or pain

• Patient must remain still

Dosage for PSWT

Is US or SWD more effective in heating tissue?

SWD is more effective for heating larger deep tissue areas

Is US or SWD more effective in heating tissue?