Hydrotherapy - Julie Harrison PDF

Hydrotherapy is an umbrella term that covers many things Physiotherapists do aquatic physiotherapy ‐ this is only one part of hydrotherapy HISTORY OF HYDROTHERAPY “Hydrotherapy” has been used to describe:  compresses ice packs  enemas sprays  hosing techniques whirlpool baths  contrast...

Hydrotherapy is an umbrella term that covers many things Physiotherapists do aquatic physiotherapy ‐ this is only one part of hydrotherapy HISTORY OF HYDROTHERAPY “Hydrotherapy” has been used to describe:  compresses ice packs  enemas sprays  hosing techniques whirlpool baths  contrast baths hot or cold pools Used by different civilizations: ‐ 2400BC records show use of mineral water for curative purposes ‐ John Wesley in 1747 wrote 'An easy and natural way of curing most diseases' ‐ Roman civilisation used many types of baths (hot, cold, saunas) ‐ Over the years “hydrotherapy” has developed differently in different cultures ‐ Physio courses also started then began in Australia in 1985 ‐ Now the use of hydrotherapy by physios should align with the basics behind the land physiotherapy Recreational pools: ‐ Use of water for recreation has changed ‐ 1754 first seawater bathing ‐ 1846 Act of parliament allowing people to open public pools (no such thing as filtration) ‐ 1930 first wave pool in Edinburgh Bad Ragaz Halliwick Watsu Aqua Stretch Hydrotherapy Water and therapy Hydrotherapy (Water & therapy) Water Exercise Back, arthritis Classes Fitness Balance Classes Aqua Aerobics Deep-water Running Disabled Swimming Para Olympics Aquatic Physiotherapy Special Schools Individual Treatment Group Treatment Physiotherapists are movement experts Where do people move? Think like a physiotherapist! • On land we do not use just 1 particular technique to treat patient • We would not just use Pilates alone • We would not just use Laser, dry needling • We would not just get patient to do Yoga Physiotherapists use clinical reasoning to use the most appropriate modalities to achieve the best outcome. The use of hydrotherapy as a modality by physios should align with the basics behind the land physiotherapy • Science • Clinical reasoning (assess, goals, treat hands‐ on or not, reassess) • Clinical consensus • Research • Evidence Aims of treatment (musculoskeletal patient) • Reduce pain • Increase accessory & physiological movement • Improve stability & strength • Improve patterns of movement • Improve co‐ordination • Improve function • Increase fitness & endurance How?? • • • • • Positioning Hands‐on Water Exercise Deep water running Disabled swimming “Specialized techniques” • Bad Ragaz • Halliwick • Watsu • AquaStretch Bad Ragaz “The Bad Ragaz Ring Method is a type of aquatic therapy used for physical rehabilitation based on proprioceptive neuromuscular facilitation.” • • • • • Like PNF in water Developed in Bad Ragaz Swizerland Patterns of movement Use of equipment Not good stability Halliwick • Developed to teach those with intellectual disabilities to swim • Started by James McMillan (physicist) • Against use of any equipment • “Halliwick” has been patented and many other physio type techniques included Watsu “Watsu is a form of aquatic bodywork used for deep relaxation and passive aquatic therapy. Watsu is characterized by one‐on‐one sessions in which a practitioner or therapist gently cradles, moves, stretches, and massages a receiver in chest‐deep warm water.” Aqua Stretch “ A hands‐on, holistic, myofascial release technique that uses buoyancy, resistance or manual therapy to produce outstanding results from athletic performance to rehabilitation.” As physiotherapists we will show you how we combine our land myofascial techniques with the properties of water to gain improved outcomes for many types of patients. AQUATIC PHYSIOTHERAPY AQUATIC PHYSIOTHERAPY Combines the properties of water with the knowledge and skills of the physiotherapist to improve the outcome of the rehabilitation process. How do physics principles affect what we do to treat these groups of patients? Buoyancy is determined by the relative densities of the human and the liquid they are immersed in (fresh water, salt water) Buoyancy is related to density What is density? Density = Mass Volume • Two tennis ball size objects The picture can't be display ed. • 1 made of metal, 1 made of foam • Metal has more molecules in the same volume • The metal ball is more dense • The metal ball sinks Foam Metal Density and specific gravity • • • • • Fresh water ‐ 1000kgs/m3 or 1 Salt water ‐ 1024kgs/m3 or 1.024 Iron ‐ 8800kgs/m3 or 8.8 Wood ‐ 750kgs/m3 or .75 Human ‐ 950kgs/m3 or .95 If specific gravity is less than 1 the object will float If specific gravity is .95 95% of the object under water 5% of object above water Variations in buoyancy • Different body types change flotation – men are often more dense than women – athletes have less % body fat • Buoyancy changes throughout life – babies float easily – young adults sink – older people float too easily • Disability affects buoyancy –  neurological tone causes  density Important when handling patients! • Some humans (especially men) with dense legs sink • Some older women float too easily and this can be terrifying for them • Some will not float symmetrically • If the patient sinks the physiotherapist must handle them correctly Archimedes ‐ force of buoyancy is equal to weight of water displaced Force of gravity Force of buoyancy Decreased Weight Bearing Forces 10% 30% 50% These forces are for a man standing still in water. The forces change when the person begins to move. Weight bearing? Patients may learn to walk in water when they cannot walk on land. Immersion can decrease a patient’s pain. Resistance to movement in water Frontal resistance ~~~~~~ ~~~ ~~~~ Turbulent drag ~~~~~ ~~~ ~~~ Skin resistance 1. Frontal Resistance • Like a wave in front of a boat • Water is not solid • Water divides and goes either side 2. Skin resistance • 790 times greater in water than on land 3. Turbulent Drag Streamlined flow Unstreamlined flow Turbulent Drag • Is created when water moves in eddies not in smooth laminar flow • Increases with speed • Creates negative pressure behind person or object • Is the major component of resistance (80%) Energy of Molecule = Constant • Kinetic energy • Pressure energy • Potential energy = Constant Value Low pressure or suction with  speed of molecules Resistance to movement in water • Allows muscle strengthening • Dampens down unwanted movements and allows time to recover when overbalanced Leg lifted against resistance of water Equal & opposite resistance up through leg Running With Feet on Pool Bottom • The Peak Vertical Ground Reaction Force (VGRF) through the supporting leg changes as the person moves faster in the water • When a person performs stationary running in hip deep water the VGRF could be 1.7 to 2 body weight • In neck deep water VGRF could be 1.12 to 1.15 times body weight VGRF = or > weight bearing when walking on land “Force Analysis of Underwater Stationary Running” Haupenthal et al ISBS Symposium 2007, Brazil Vertical Ground Reaction Forces • Stress fractures (careful when tell athletes to run in shallow at the beach) • Osteoporosis (may give equivalent weight bearing as walking on land without fear of falling over and #) Types of muscle contraction occurring in water • • • • Concentric ‐ concentric Less treatment soreness Difficult to get eccentric Pre‐functional (against less weight than on land) • Movements are slower  • More slow muscle fibres used? Light Refraction Physiological effects • • • • • • • Cardiovascular Respiratory Renal Temperature regulation Fluid balance Sensory Metabolic Hydrostatic Pressure • Pressure increases with depth • P2>>P1 P1 Dam Wall P2 Pressures exerted on a body during head out of water immersion  Swelling & Improved Circulation The picture can't be display ed. • How many crepe bandages does hydrostatic pressure produce? Cardiovascular • Increased central blood volume • Stroke volume  by 50% • Cardiac output  by 30% (at 33º C) Useful in cardiac rehabilitation & swelling Renal • Increased central blood volume • Diuresis • Increased sodium, potassium and calcium excretion May result in dehydration for both patients and therapists. Respiratory • • • • Hydrostatic pressure on trunk Pulmonary vascular engorgement Increased work of breathing Increased airways resistance “Patients work their respiratory system just getting in the pool” Negative Pressure Breathing Hydrostatic pressure acts on the abdominal wall and the rib cage to produce a pressure that is greater than atmospheric pressure thus causing a situation of negative pressure breathing. Water Temperature ‐ 34ºC • Relaxation • Decreased pain Temperature regulation • 34º C is thermoneutral • Core temperature not affected during normal hydrotherapy sessions at thermoneutral • Colder pools can increase muscle spasm Altered sensory input •  Proprioceptive input •  Tactile input •  Vestibular stimulation Beneficial in the treatment of neurological patients In water many aims can be achieved at the same time! Benefits of Aquatic Physiotherapy Why go to extra effort to put patients in the hydrotherapy pool? Benefits of Aquatic Physiotherapy 1. Pain reduction 2. Decreased muscle spasm & guarding 3. Decreased swelling & improved circulation 4. Decreased weight bearing forces 5.  range of movement & flexibility 6.  muscle strength 7.  postural control 8.  cardiovascular fitness & endurance 9.  respiratory fitness 10. Facilitation of head righting & balance reactions Benefits (continued) 11.  movement initiation without the fear of falling 12. Re‐education of functional activities 13.  water confidence & swimming ability 14. Improved co‐ordination & fitness 15.  in metabolic activity 16. Relaxation 17. Improved psychological well being & motivation 18. Changes in sensory input (including visual, vestibular, tactile and proprioceptive) 19. Decreased neurological muscle tone 20. Ease of handling heavy dependent patients Pain Reduction • • • • Physiotherapist’s first aim of treatment Temperature % weight bearing Reduces fear of movement  Muscle Spasm & Guarding • Less stretch on Golgi tendon organs • Care not to do too much as may cause pain after treatment • Get better stretch in warm water • Easier to feel if some spasm still present with injury