Week 10: Hydrotherapy & Compression Therapy

What is hydrotherapy?

The application of water for therapeutic purposes

What does high specific heat mean in hydrotherapy?

Water can transfer heat by conduction and convection, used for superficial or deep heating

What is buoyancy and how does it help therapy?

Upward thrust against gravity that assists or resists exercise and decreases stress on joints, muscles, and connective tissues

How does resistance change with movement speed in water?

Resistance increases with faster movement due to viscosity, the internal friction between water molecules

What is hydrostatic pressure and what affects it?

The force water exerts equally in all directions that increases with depth and varies with body position

What are the cleansing effects of hydrotherapy?

• Softens scars

• Exerts pressure

• Debrides necrotic tissue

• May include antimicrobial additives

What are the musculoskeletal effects of hydrotherapy?

• Decreased weight bearing

• Resistance for strengthening

• Increased resting muscle blood flow by 100–225% with immersion to the neck

What cardiovascular effects occur with upright immersion to the neck?

• Central blood volume increases by about 60%

• Cardiac volume by about 30%

• Cardiac output by about 30%

• Heart rate decreases

• Borg RPE should guide intensity

What respiratory effects result from hydrostatic pressure?

Decreased vital capacity and increased work of breathing due to chest wall compression and circulation changes, with humidity reducing exercise-induced asthma

What renal effects occur with immersion?

Increased urine production, renal blood flow, and excretion of sodium and potassium due to decreased ADH and aldosterone, which reduces edema

Why should patients empty their bladder before immersion?

Because immersion increases urine production

What are the psychological effects of hydrotherapy?

Warm water is relaxing, cold water is energizing, and both are beneficial for adults and children

What are advantages of using water for superficial heating or cooling?

Perfect skin contact, no need for fastening, and allows movement

What is a disadvantage of immersion for superficial heating or cooling?

Dependent positioning can worsen edema

What are common uses of water exercise?

Improves circulation, strength, flexibility, ROM, coordination, cardiovascular conditioning, and psychological well-being while reducing pain and stiffness

What are benefits of water exercise for musculoskeletal problems?

Decreased joint loading, velocity-dependent resistance, closed or open chain exercise options, helps bone density, and benefits fibromyalgia

What are benefits for neurological conditions?

Provides proprioceptive input, increases safety, and improves balance

What are benefits for reduced cardiac fitness?

Allows safe cardiac conditioning for those intolerant to land-based exercise

What are benefits for pregnancy?

Decreases weight bearing, heart rate elevation, and risk of maternal hyperthermia

What are benefits for exercise-induced asthma?

Less likely to trigger asthma symptoms than land exercise

What are benefits for age-related deficits?

Improves balance, strength, cardiovascular fitness, and mobility

How does hydrotherapy help pain control?

• Provides sensory stimulation that gates pain

• Reduces joint compression through buoyancy

• Cold water decreases inflammation

How does hydrotherapy control edema?

• Hydrostatic pressure enhances circulation

• Cold water causes vasoconstriction

• Hot water should be avoided with edema

How does hydrotherapy promote wound healing?

Rehydrates, softens, and debrides tissue while increasing circulation for faster healing

How do hydrostatic pressure and heat improve wound healing?

They increase circulation, nutrient delivery, and waste removal

Which is safer, immersion or non-immersion irrigation?

Non-immersion irrigation because it has less infection risk

What pressure should be used for non-immersion irrigation?

4 to 15 psi

What is negative pressure wound therapy?

Also called Wound-VAC, it applies controlled suction to promote healing

What safety checks are important with hydrotherapy?

• Proper grounding of whirlpools

• Infection control

• Patient training

• Monitoring water depth and temperature

• Using RPE for intensity

What are contraindications for local immersion hydrotherapy?

Maceration around a wound and active bleeding

What are contraindications for full-body immersion?

• Cardiac instability

• Contagious infections

• Bowel or bladder incontinence

• Severe epilepsy

• Suicidality

What are contraindications for negative pressure wound therapy?

• Necrotic tissue

• Untreated osteomyelitis

• Malignancy

• Malnutrition

• Exposed vessels or nerves

• Unexplored fistulas

• Exposed anastomoses

What are precautions for local immersion?

• Impaired sensation

• Infection

• Confusion

• Recent skin grafts

What are precautions for full-body immersion in hot water?

• Pregnancy

• Multiple sclerosis

• Poor thermal regulation

What are precautions for negative pressure wound therapy?

• Anticoagulant therapy

• Difficult hemostasis

• Disorientation

What are common adverse effects of hydrotherapy?

• Drowning

• Burns

• Fainting

• Bleeding

• Hyponatremia

• Infection

• Worsened edema

• Asthma exacerbation

How can hyponatremia occur and how can it be prevented?

Loss of salts from burn wounds, prevented by adding salt to the water

Why can chlorine pools worsen asthma?

Chlorine fumes may reduce FEV

What are the general steps of hydrotherapy application?

• Evaluate the patient

• Determine safety

• Select method

• Explain, apply, assess, and document

What should documentation include?

• Type of hydrotherapy

• Patient position or activities

• Water temperature

• Treatment duration

• Patient response

• If applicable, fluid pressure and additives

What is compression therapy?

The application of external mechanical pressure to the body for therapeutic purposes

What are the main purposes of compression therapy?

To aid fluid balance, circulation, and scar tissue formation, and to control or minimize edema

What are the two types of compression?

Static and intermittent

How does compression improve venous and lymphatic circulation?

By forcing fluid out of interstitial spaces into venous and lymphatic vessels and increasing external hydrostatic pressure

Why might intermittent compression be more effective than static compression?

It “milks” fluid from distal to proximal vessels

How does compression limit the shape and size of tissue?

By providing external pressure, useful after amputation or burns

How does compression affect tissue temperature?

It increases tissue temperature and may activate temperature-sensitive collagenases to help control scar formation

How does compression reduce edema?

By improving the healing environment, reducing pain, improving ROM, and decreasing neuromuscular inhibition

How does compression prevent or reduce DVT?

By increasing venous flow and preventing clot formation, especially when combined with other prophylactic methods

What is the main clinical indication for compression therapy?

Edema control

What causes edema?

• Imbalance between hydrostatic and osmotic pressures

• Venous or lymphatic obstruction

• Increased capillary permeability

• Immobility

• Pregnancy

• Systemic diseases

Should systemic disease–related edema be treated with compression?

No, it should not

What causes lymphedema?

• Decreased plasma proteins

• Mechanical lymphatic obstruction

• Poor lymph node distribution

How does compression reduce edema?

By increasing extravascular hydrostatic pressure and promoting proximal fluid movement through circulation

How does compression help prevent DVT?

By increasing local circulation and decreasing venous stasis

How does compression help venous stasis ulcers?

Improves venous circulation and healing, with multilayered and high-pressure compression being most effective

What are other uses for compression therapy?

Residual limb shaping after amputation and control of hypertrophic scars

What is the minimum ABI required for compression therapy?

Greater than 0.8 mmHg

What is ABI and how is it calculated?

Ankle-brachial index = systolic BP in LE divided by systolic BP in UE

When should ABI be checked?

If arterial insufficiency is suspected from the patient’s history

What are contraindications for intermittent or sequential compression pumps?

• Heart failure

• Pulmonary edema

• Acute DVT

• Thrombophlebitis

• Pulmonary embolism

• Obstructed venous or lymphatic return

• Severe PAD

• Arterial insufficiency

• Acute infection

• Hypoproteinemia

• Acute trauma or fracture

• Arterial revascularization

Can static compression be used after acute trauma or fracture?

Yes, immediately to prevent edema and control bleeding

Why should intermittent compression be avoided after acute trauma or fracture?

It may aggravate the condition

Why is compression contraindicated after arterial revascularization?

It can occlude vessels and cause ischemia

What are precautions for compression therapy?

• Impaired sensation or mentation

• Uncontrolled hypertension

• Cancer

• Stroke or cerebrovascular insufficiency

• Superficial peripheral nerves

What should be monitored with superficial peripheral nerves?

Signs of nerve compression

What are potential adverse effects of compression therapy?

Aggravation of edema cause or impaired circulation from excessive pressure

What are the general steps of compression application?

• Evaluate the patient

• Determine safety

• Select form of compression

• Explain procedure

• Apply

• Assess outcome

• Document

Are compression garments custom or off-the-shelf?

They can be either

What pressure is used for DVT prevention?

16–18 mmHg

How often should DVT prevention garments be worn?

24 hours per day

Do DVT garments prevent clots in dependent limbs?

No, they do not

What pressure is used for scar tissue control?

20–30 mmHg

What pressure is used for edema control?

30–40 mmHg

When should compression garments be fitted?

When edema is minimal

What is a common compliance issue with compression garments?

They can be difficult to put on or remove

What is an intermittent pneumatic compression pump used for?

More aggressive compression to reverse or control edema

Can a pneumatic pump be used for scar tissue modification?

No, it cannot

What are disadvantages of pneumatic compression pumps?

They are expensive and the treated limb cannot be used during treatment

What should be done before applying intermittent compression?

• Ensure no contraindications

• Remove jewelry/clothing

• Inspect skin

• Elevate the limb

What measurements should be taken before applying intermittent compression?

Blood pressure and limb circumference

What should be applied before the compression sleeve for intermittent compression?

A smooth stocking over the area

What inflation-to-deflation ratio is used for intermittent compression?

3:1 or 4:1

How is inflation pressure determined for intermittent compression?

Slightly less than the patient’s diastolic BP

What should be done during intermittent compression?

Monitor BP and provide a means for the patient to call the therapist

What should be done after intermittent compression?

• Turn off the unit

• Disconnect

• Remeasure limb volume

• Inspect skin

• Check BP

• Apply a compression garment or bandage

What should be documented after compression therapy?

• Type of compression

• Area treated

• Patient position

• Inflation and deflation times

• Inflation pressure

• Treatment duration

• Patient response