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

buoyancy

physical principles of water; upward force opposite that of gravity

Archimedes' principle

physical principles of water; 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

pressure exerted on the body by the fluid; 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

100-225%

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

increase

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

decrease

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

lower

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

lower

Cardiovascular effects of hydrotherapy: HIGHER/LOWER VO2

increase

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

decrease

Respiratory effects of hydrotherapy: INCREASE/DECREASE vital capacity

increase

Respiratory effects of hydrotherapy: INCREASE/DECREASE work of breathing

increase

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

decreases

High air humidity INCREASES/DECREASES exercise-induced asthma.

increase

Renal effects of hydrotherapy: INCREASE/DECREASE renal blood flow

increase

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

decrease

Renal effects of hydrotherapy: INCREASE/DECREASE edema

increase

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

decrease

Renal effects of hydrotherapy: INCREASE/DECREASE ADH, aldosterone

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

nonimmersion

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

a

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

b

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

c

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

d

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

e

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

f

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

g

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

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

List four exercise considerations for hydrotherapy.

neurological

benefits of aquatic exercises; proprioceptive input, increased safety, improved balance

cardiovascular

benefits of aquatic exercises; cardiac conditioning when land tolerance is limited

pregnancy

benefits of aquatic exercises; decreased weight bearing, less elevation in heart rate, reduces peripheral edema

79-97

How many degrees F is used for pool therapy?

local immersion hydrotherapy

Contraindications: maceration of skin around wound, bleeding

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

mechanical compression

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

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

List the benefits of mechanical compression (6).

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

joint distraction

reduces compression on joint surfaces; alleviates pressure on spinal nerve roots by opening of lateral foramen

50%

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

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

60/20 or 15/15

List the two commonly used intervals for intermittent traction.

20 min

commonly used duration for intermittent traction

11-15 lb

commonly used force for cervical traction (lb)

20-50%

commonly used force for lumbar traction (%)

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

List four indications for traction.

traction

Contraindications: motion, acute injury/inflammation, hypermobility, 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