Hydrotherapy, Traction, and Compression Modalities

specific heat

amount of energy required to raise the temperature of a material by a given number of degrees
higher - more energy
4x that of air and stores 4x more heat

thermal conductivity

rate at which heat is transferred by conduction
25x that of air
heat is transferred by conduction and convection

buoyancy

upward force opposite that of gravity

Archimedes' principle

upward thrust is equal to the weight of displaced fluid on land
depends on density of immersed body relative to density of liquid
human body less dense than water = floats

hydrostatic pressure

fluid exerts equal pressure on a body at a given depth, and increases in proportion to the depth of the fluid
can help promote circulation like a compressive device

resistance

viscosity of the water provides
increases in proportion to the speed of the body part
increases with frontal area in contact of the water

How much is weight bearing reduced when immersed 75% in water

75%

What is the % increase in muscle blood flow with hydrotherapy?

100-225%

Body weight % when immersed to C7%

10%

Body weight % when immersed to the xiphoid process

33%

Body weight % when immersed to the ASIS

50%

Cardiovascular effects of hydrotherapy: INCREASE/DECREASE venous circulation

increase

Cardiovascular effects of hydrotherapy: INCREASE/DECREASE cardiac volume

increase

Cardiovascular effects of hydrotherapy: INCREASE/DECREASE cardiac output

increase

Cardiovascular effects of hydrotherapy: INCREASE/DECREASE HR at same workload compared to land exercise

decrease

Cardiovascular effects of hydrotherapy: HIGHER/LOWER systolic BP compared to land-based exercises

lower

Cardiovascular effects of hydrotherapy: HIGHER/LOWER VO2

lower

Respiratory effects of hydrotherapy: INCREASE/DECREASE compression of chest wall

increase

Respiratory effects of hydrotherapy: INCREASE/DECREASE vital capacity

decrease

Respiratory effects of hydrotherapy: INCREASE/DECREASE work of breathing

increase

Respiratory effects of hydrotherapy: INCREASE/DECREASE circulation of chest cavity

increase

High air humidity INCREASES/DECREASES exercise-induced asthma.

decreases

Renal effects of hydrotherapy: INCREASE/DECREASE renal blood flow

increase

Renal effects of hydrotherapy: INCREASE/DECREASE urine, potassium, sodium

increase

Renal effects of hydrotherapy: INCREASE/DECREASE edema

decrease

Renal effects of hydrotherapy: INCREASE/DECREASE central blood volume,

increase

Renal effects of hydrotherapy: INCREASE/DECREASE ADH, aldosterone

decrease

Superficial heating or cooling

Effects the superficial modalities: dependent position can increase swelling

Effects of superficial heating

Vasodilation
Increased circulation
Decreased joint stiffness
Increased Joint ROM

Effects of superficial cooling

Vasoconstriction
Decreased circulation
Decreased joint stiffness
Increased joint ROM

nonimmersion

hydrotherapy for wound care: cleansing > softens necrotic tissue, removes debris > decrease bacterial load and barrier to epithelialization > increase wound healing

immersion

hydrotherapy for wound care: hydrostatic pressure heat > increase circulation > increase nutrients and removal of waste products > increase wound healing

IMMERSION/NONIMMERSION techniques are used in debridement of necrotic tissue in burn care because it is less painful and ease of patient handling

nonimmersion

Hydrotherapy Temperatures: acute inflammation (cold)

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

a

Hydrotherapy Temperatures: medium for exercise/acute inflammation if colder temp not tolerated (tepid)

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

b

Hydrotherapy Temperatures: open wounds, medically compromised patients with circulatory, sensory, or cardiac disorders; disease tone (neutral warmth)

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

c

Hydrotherapy Temperatures: increase mobility in burn patients

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

d

Hydrotherapy Temperatures: control pain (hot)

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

e

Hydrotherapy Temperatures: increase soft tissue extensibility; chronic conditions, limited body area only (very hot)

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

f

Hydrotherapy Temperatures: should not be used

a. 32-79 deg F

b. 79-92 deg F

c. 92-96 deg F

d. 96-98 deg F

e. 99-104 deg F

f. 104-110 deg F

g. >110 deg F

g

List four exercise considerations for hydrotherapy.

velocity dependent strengthening
open/closed chain environment (slowing bone density loss)
decreased joint weight bearing
AAROM

benefits of aquatic exercises for neurological conditions

proprioceptive input
increased safety
improved balance

benefits of aquatic exercises for cardiovascular conditions

cardiac conditioning when land tolerance is limited

benefits of aquatic exercises for pregnancy

decreased weight bearing
less elevation in heart rate
reduces peripheral edema

benefits of aquatic exercises for exercise induced asthma

Decreased incidence of exercise induced asthma

How many degrees F is used for pool therapy?

79-97

local immersion hydrotherapy contraindications

maceration of skin around wound
bleeding around wound

local immersion hydrotherapy precautions

impaired thermal sensation
infection in area to be immersed
mental confusion or impaired cognition
recent skin graft

full body immersion hydrotherapy contraindications

cardiac instability
infections that may be spread to water
severe epilepsy
suicidal patients

full body immersion hydrotherapy precautions

confusion
disorientation
alcohol ingestion
extreme limitations of strength, ROM, endurance, or balance
CV medications
urinary incontinence
severe respiratory problems

Full body immersion in very warm/hot water contraindications

pregnancy
multiple sclerosis
poor thermal regulation

mechanical compression

pneumatic device used to apply external pressure to extremities to improve fluid balance and circulation, and modify scar tissue formation (particularly amputees)

What is the purpose of mechanical compression

Improve venous and lymphatic circulation

Process of mechanical compression

External pressure increases interstitial pressure → increases lymph drainage → decrease interstitial fluid → increased circulation

List the benefits of mechanical compression (6).

edema (venous insufficiency)
lymphedema
DVT prevention
venous stasis ulcers
limb shaping (amputation)
hypertrophic scarring

compression contraindications

HF, pulmonary edema
recent or acute DVT
thrombophlebitis or pulmonary embolism
obstructed lymphatic or venous return
severe arterial disease
acute local skin infection
acute fracture or trauma

compression precautions

impaired sensation/mentation
uncontrolled hypertension
cancer

mechanical traction

separate joint surfaces, elongates soft tissue, reduce disc protrusions

What does separation of joint surfaces/joint distraction do

Alleviate pressure on spinal nerve roots by opening of lateral foramen

joint distraction

reduces compression on joint surfaces

What % of the body weight in force is necessary to distract apophyseal joints in lumbar spine?

50%

joint moblization

may occur with prolonged application of forces

intermittent traction

stimulation of golgi tendon organs to inhibit alpha motor neuron firing
may also be secondary effect of the inhibition of pain causing an interruption of the pain-spasm-pain cycle

static traction

reduces tone by application of a constant stretch

cervical traction

forces up to 7% of the body weight to cause distraction (recommend 10-20 lbs)

lumbar traction

forces up to 50% of the body weight to cause distraction
60-120 lbs can reduce disc prolapse and clinical improvement

List the two commonly used intervals for intermittent traction.

60/20 or 15/15

commonly used duration for intermittent traction

20 min

commonly used force for cervical traction (lb)

11-15 lb

20-50%

commonly used force for lumbar traction (%)

List four indications for traction.

disc bulge/herniation
nerve root impingement
joint hypomobility
paraspinal muscle spasm

traction contraindications

motion
acute injury/inflammation, hypermobility, or instability
increased peripheral symptoms
uncontrolled HTN
unstable fractures
disease affecting spine
displaced annular ligament
claustrophobia
inability to be prone or supine
disorientation
pressure from belts

traction precautions

positive vertebral artery test
TMJ pain
dentures