Hydrotherapy and Underwater Exercises

Hydrotherapy

• Hydrotherapy is a treatment using water
• It's used for various conditions, including musculoskeletal problems, neurological rehabilitation, cardiac respiratory fitness, pregnancy, exercise-induced asthma, age-related deficits, pain control, edema control, and wound care/healing.

Under Water Exercises

• Different types of exercises can be done in water, such as swimming, running, walking, kicking, cycling, with or without flotation devices.
• The type of exercise depends on the patient's condition.

Objectives of the Lecture

• Understand the types of water exercises and relate them to the properties of water.
• Understand the general uses (benefits) of water exercises.
• Understand the effects of water exercises in rehabilitation for specific conditions.

General Uses/Benefits of Underwater Exercise

• Increases circulation
• Improves soft tissue flexibility and joint mobility
• Strengthens muscles
• Improves ambulation
• Enhances coordination and balance
• Improves cardiovascular and respiratory conditioning
• Improves psychological well-being

How to Achieve Benefits Through Water Properties

• Heat transfer and exercises
• Buoyancy and exercises
• Resistance of water and exercises
• Hydrostatic pressure and exercises

Heat Transfer and Exercises

• The ability of water to retain and conduct heat is used clinically for total or partial immersion in warm water.
• This combination increases soft tissue temperature, causing vasodilation, improved circulation, reduced joint stiffness, increased range of motion (ROM), and enhanced functional abilities.
• Warm water immersion may improve psychological well-being during and after exercise.

Buoyancy and Exercises

• Water buoyancy decreases gravitational forces on weight-bearing structures.
• This helps patients with muscle weakness or load-sensitive joints to perform strengthening, conditioning, and coordination exercises more easily than on land.
• Improves functional mobility and strength.

Resistance of Water and Exercises

• Water resistance can be adjusted during exercise by changing the direction or speed of movement—either of the water or the patient—altering exercise effects.
• Applying water pressure against the direction of muscle action strengthens muscles,
• Applying it in the same direction assists weak muscles and increases the range of movement.
• Increasing the speed of motion increases exercise intensity.

Hydrostatic Pressure and Exercises

• Hydrostatic pressure improves venous return from the extremities.
• This enhancement occurs more in water-based exercise than in land-based exercise.
• Water-based exercise improves cardiovascular and respiratory conditioning and helps reverse and control edema formation.

Specific Uses (Benefits) of Water Exercise

• Musculoskeletal Problems: Decreased weight bearing on joints, velocity-dependent resistance, closed- or open-chain exercises, decrease pain. Primarily achieved by floating (buoyancy).
• Neurological Rehabilitation: Proprioceptive input, functional activities and balance, reduced risk of falls, greater movement ability, and enhanced motor control.
• Cardiovascular/Respiratory Fitness: Improves cardiac conditioning, beneficial for patients with conditions such as COPD, congestive heart failure, and emphysema, and normalizes heart rate and work capacity.
• Pregnancy: Decreased weight bearing, less elevation of heart rate and blood pressure during exercise, enhanced venous return and controlled peripheral edema.
• Exercise-Induced Asthma: Less exercise-induced asthma than other exercise forms. Studies show decreased symptoms and increased fitness in patients.
• Age-Related Deficits: Improves balance, strength, cardiorespiratory fitness, functional mobility, and quality of life, and alleviates aches and pains.
• Pain Control: High level of sensory stimulation (pressure and mechanical changes) to peripheral mechanoreceptors reduce pain transmission in the spinal cord (pain gate theory).
• Edema Control: Reduces peripheral edema due to hydrostatic pressure of water, affecting circulation and renal function. Cooling effects of cold water may contribute to reducing edema in acute conditions.
• Wound Care/Healing: Softens necrotic tissue, removes wound debris, facilitates better circulation, and reduces barrier to epithelialization.

Closed Chain vs Open Chain Exercises

• Exercises performed in water can be closed-chain or open-chain.
• Closed-chain exercises typically fix distal extremities to pool bottom or side in shallow water, and in deeper water for exercises that incorporate other portions of the body.
• Open-chain exercises are often performed in deep or shallow water depending on the area of the body being worked.

Special Considerations and Important Notes

• Running in water for some conditions reduces pain and compression.
• Water exercises can be safe and beneficial for women with osteoporosis as a way to maintain overall health without high risk of falls.
• However, water exercises may not increase bone density as effectively as weight-bearing exercises.

Benefits for Neurological Rehabilitation

• Proprioceptive input (important for patients with central sensory deficits)
• Functional activities and balance (weight relief makes movement easier and reduces risk of falls)
• Facilitates greater movement ability, functional activity training, balance enhancement, and strengthening when motor control is impaired.
• Reduces spasticity (passive ROM combined with water exercise)