Week 10: Hydrotherapy & Compression

What is hydrotherapy?

A therapeutic intervention that uses water to facilitate physiological effects and enable patients to achieve therapy goals.

Hydrotherapy takes place in

large pool or a tank like whirlpool

What is another name for hydrotherapy?

Aquatic therapy.

What conditions can hydrotherapy treat?

Joint stiffness, painful scars, adhesions, arthritis, heating or cooling the body, debridement of wounds, and muscle relaxation.

Physical properties of water

buoyancy, viscosity, thermal conductivity, specific heat capacity

High specific heat and thermal conductivity for water

heat transfer by conduction and convection to allow heating or cooling

What is buoyancy in the context of hydrotherapy?

The upward thrust against gravity that allows the body to float, determined by the weight of the displaced liquid.

Archimedes' Principle

the buoyant force on an object is equal to the weight of the fluid displaced by the object

Buoyancy can be affected by

postural alignment

Body comp

Vital capacity of lungs

Immersion up to the neck reduces weight-bearing to about

10% of body weight

Immersion up to the xiphoid process reduces weight-bearing to about

33% of body weigh

Immersion up to the anterior superior iliac spines reduces weight-bearing to about

50% of body weight

specific gravity

ratio of object's density to water's density

What is the specific gravity of water?

1.

The average human body with air in the lungs has a specific gravity of

0.96 and will displace about 90% of water, with about 2.6% floating.

Fully inflated lungs and a higher body fat percentage (e.g., in females or obese individuals)

increase buoyancy

What role does resistance play in hydrotherapy?

Water's cohesive molecules increase resistance to movement, making it harder to perform range of motion exercises.

Greater speed of liquid=

viscosity

More streamlined object can

move easier through water

What is hydrostatic pressure?

The force exerted by water on the body, which increases with depth and density.

Hydrostatic pressure dependent on

depth of submerged part and density of the liquid

How does hydrostatic pressure affect movement in water?

It makes motion easier at shallower depths and provides resistance at greater depths.

Buoyancy: Upward thrust against gravity

- Can provide assistance or resistance for exercises

- The density of the human body < water

- Decreased stress on and compression on weight bearing joints, muscles, connective tissues

What is viscosity in hydrotherapy?

The internal friction of liquids that increases with the relative speed of the body's motion.

Viscosity increases with

relative speed of body's motion and contact area

What is drag force in the context of hydrotherapy?

A force that resists movement, acting parallel to the direction of motion but in the opposite direction.

Doubling the velocity will___ the magnitude of the drag force

quadruple

Drag force is also affected by

the surface area perpendicular to the movement

Hydrodynamics

The physical properties of water in motion

streamline objects

smooth flow

turbulent flow

erratic, eddy currents). Turbulent flow increases the resistance to movement

What are the physiological effects of hydrotherapy?

• Cleansing

• Musculoskeletal

• Cardiovascular

• Respiratory

• Renal

• Psychological

• Thermodynamic effects.

Thermodynamics of water

-Water requires a lot of energy to heat it

-Heat transfer to water is significantly faster than to air (25 times greater)

Heat transfer in water occurs primarily by

Convection when the patient or water is moving. Conduction occurs when at rest

How does warm water affect blood vessels?

Warm water around 95.9º causes vasodilation, while cold water below 80.6º causes vasoconstriction.

What is the dive reflex?

A physiological response to immersion that causes bradycardia, peripheral vasoconstriction, and preferential blood shunting to vital organs.

Cleansing effects of hydrotherapy

- Softens materials

- Exerts pressure

- Debriding agent for exudate or necrotic tissue

- Antimicrobial or surfactant additives may be used

What are the musculoskeletal effects of hydrotherapy?

Decreased weight bearing, increased muscle blood flow, and potential relaxation of muscle spasms, less fat loss than other forms of exercise

Hydrostatic pressure increases resting muscle blood flow by

100%-225% during immersion of the body up to the neck

Warm water increases blood flow, which may help with

relaxation of muscle spasm. Agitation may also break the "pain/spasm" cycle via increased sensory stimulation

How does hydrotherapy impact cardiovascular health?

It enhances venous return and increases central blood volume and cardiac output during immersion, venous blood is displaced proximally, lower HR

Cardiovascular Effects primarily result of

hydrostatic pressure with upright immersion

Venous blood displaced proximally from the extremities

Enhanced venous return because the pressure exerted on vessels causes venous return

with immersion to the neck, central blood volume increases by ---

~60%

-Cardiac volume increases by ~30% →~30% increase in cardiac output

-Lower heart rate response to exercise

HR is already lower in water

Monitoring HR may not be accurate because of HR being somewhat blunted

Measure intensity in water with

RPE

Cardiovascular effects of immersion

Hydrostatic pressure displaces venous blood proximally

Leads to increased cardiac volume

Which leads to increased SV and CO= Lower HR because of more volume

What respiratory effects occur during hydrotherapy?

Increased work of breathing due to chest wall compression and hydrostatic pressure, which can inhibit lung expansion., increased circulation in chest cavity

Humidity reduces exercise

exercise induced asthma

Hydrostatic pressure increases chest wall compression and increased circulation in the chest cavity which leads

to a decrease in vital capacity and an increase in work of breathing up to 60% with neck-deep immersion

What renal effects does hydrotherapy have?

Increased urine production, sodium and potassium excretion, and decreased edema due to increased renal blood flow, Increased central blood volume

-Increased central blood volume

Also increases renal BF

Causes Decreased ADH and aldosterone

What psychological effects can hydrotherapy induce?

Relaxation or invigoration, depending on the water temperature.

warm water good for

relaxing

Cold water good for

invigorating

What are some uses of hydrotherapy?

Superficial heating or cooling, water exercise, pain control, edema control, and wound care.

What are the advantages of superficial heating or cooling in hydrotherapy?

Perfect contact with skin, does not need to be fastened, and allows movement.

Disadvantages of superficial heating or cooling in hydrotherapy

-Dependent position may aggravate edema from blood pooling

What types of water exercises are commonly used in hydrotherapy?

Swimming, running, walking, and other activities, with or without tethering.

Pool tether

keeps people in place in one singular area

Uses of water exercise

-Used to increase circulation, muscle strength, joint viscoelasticity, flexibility, range of motion, ambulation, coordination, cardiovascular and vascular conditioning, psychological wellbeing

-Leads to decreased pain, muscle spasm, and stiffness

What is the desired temperature range for an exercise pool?

79° to 90°F.

How does hydrotherapy benefit patients with musculoskeletal problems?

It decreases weight bearing on joints, provides velocity-dependent resistance, and can improve joint pain and stiffness.

Decreases muscle spasms

Increases ROM

Decreases lactic acid build up

What is the effect of hydrotherapy on bone density loss?

It can have beneficial effects on bone density loss and is effective for conditions like rheumatoid arthritis and osteoarthritis.

Hydrotherapy or orthopedics

Effective for short-term pain reduction and improved function in patients with rheumatoid arthritis (RA) and knee osteoarthritis

How can slow rhythmical and rotary movements benefit patients with cerebral palsy?

They can decrease spasticity and improve motor function and gait.

Benefits of water exercise for neurological problems

Can help recover from neurological insults

Proprioceptive input

Increased safety

Improved balance

How does hydrotherapy assist patients with poor tolerance for land-based exercise?

It provides cardiac conditioning.

What are the benefits of hydrotherapy during pregnancy?

It decreases weight bearing, elevates heart rate less with exercise, and reduces the risk of maternal hyperthermia.

Exercise induced asthma and water exrcise

less than land based

What is the effect of hydrotherapy on age-related deficits?

It improves balance, strength, cardiorespiratory fitness, and functional mobility.

How does hydrotherapy contribute to pain control?

It provides sensory stimulation to gate pain transmission and allows blocking pain at the spinal cord level.

What is the impact of cold water in hydrotherapy?

It may reduce inflammation and decrease joint compression due to buoyancy.

How does hydrostatic pressure assist with edema control?

Results in changes in circulation and renal function

Requires deep immersion

Cold water may also cause vasoconstriction and reduce vascular permeability

Avoid hot water immersion with edema

Edema control ranges

Range is 70s and low 80s

Hydrotherapy for wound care

Hydrotherapy accelerates wound healing

Facilitates rehydration, softening, debridement

May improve circulation

Nonimmersion hydrotherapy

cleansing →softens necrotic tissue→decreased bacterial load and barriers to epithelialization→increased wound healing

Immersion hydrotherapy

Same as non immersion

Hydrostatic pressure and heat→increase circulation→increase nutrients and removal of waste products→increased wound healing

wound care considerations

- Immersion vs nonimmersion

- +/- additives

- Pain, particularly with debridement of burns

- Negative pressure wound therapy (vacuum-assisted)

Temp for reducing inflammation

32-79

Temp for exercise

79-92

Temp for open wounds, control tone

92-96

Temp for burns after epithelialization

96-98

Temp for pain control, increase of soft tissue, extensibility

99-110

What are the advantages of nonimmersion irrigation over whirlpool therapy?

It has less risk of infection due to single-use properties.

Non immersion parameters

Control pressure at 4-15 psi

Various devices available

Safety Issues with hydrotherapy

-Whirlpool must be properly grounded.

-Pay close attention to infection control with hydrotherapy devices

-Ensure proper training for pool exercise for both the patient and therapist

What are contraindications for local immersion hydrotherapy?

Maceration around a wound and bleeding.

Contraindications for full body immersion

-Cardiac instability

-Infectious conditions that may be spread by water

-Bowel and incontinence

-Severe epilepsy

-Suicidality

Contraindications for NPWT

-Necrotic tissue

-Untreated osteomyelitis

-Malignancy in the wound

-Untreated malnutrition

-Exposed vessels, nerves, or organs

-Nonenteric and unexplored fistulas

-Exposed anastomotic sites

Precautions for local immersion

-impaired thermal sensation

-infection

-impaired cognition

-recent skin grafts

What precautions should be taken for full body immersion in hot water?

Consider pregnancy, multiple sclerosis, and poor thermal regulation.

Precautions for full body immersion for any temperature

-Confusion or disorientation

-Alcohol ingestion

-VERY Limited strength, endurance, balance, or ROM

-Certain Medications

-Urinary incontinence

-Fear of water

-Respiratory problems

precautions of nonimmersion hydrotherapy

-Maceration

-May be ineffective

Precautions of NPWT

-Anticoagulant therapy

-Difficult hemostasis

-Confusion, disorientation

What are potential adverse effects of hydrotherapy?

Drowning, burns, fainting, bleeding, hyponatremia, infection, and asthma exacerbation.

Hyponatremia care with hydrotherapy

Loss of salts in patients with extensive burn wounds

Avoid by adding salt into the whirlpool

Asthma and hydrotherapy

Fumes from chlorinated pools and whirlpools can cause a reduction in FEV in patients with asthma

What is the general application technique for hydrotherapy?

Evaluate the patient, determine appropriateness, select the form of hydrotherapy, explain the procedure, apply treatment, assess outcomes, and document.

What should be documented after a hydrotherapy session?

Type of hydrotherapy, patient position, water temperature, treatment duration, response to intervention, and any applicable fluid pressure or water additives.