Hydrotherapy Lecture Notes PDF

18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Under Water Exercises Dr. Wael Osama Aly Hydrotherapy- Basic Science Department 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC Objectives of this lecture To know...

18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Under Water Exercises Dr. Wael Osama Aly Hydrotherapy- Basic Science Department 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC Objectives of this lecture To know the types of water exercises and connect them to the water properties. To realize the general uses (benefits) of water exercises To understand the effect of water exercises for rehabilitation of specific conditions/cases. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Types of underwater exercise: Different types of exercise can be performed in water, as swimming, running, walking, kicking, cycling, with the patient wearing floatation instruments or not according to his /her condition. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC General Uses/benefits of Under Water Exercise (WHY?) Exercise in water can be used to: Increase circulation. Improve soft tissue flexibility and joint mobility Strengthen muscle. Improve ambulation. Enhance coordination and balance. Improve cardiovascular and respiratory conditioning. Improve the psychological well-being. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  How we can use the physical properties of water to achieve these uses/benefits of under water exercises? Heat transfer and Exercises Buoyancy and Exercises Resistance of water and exercises Hydrostatic pressure and exercises 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Heat transfer and Exercises: The ability of water to retain and conduct heat can be used clinically in case of total or partial immersion of the patient in warm water. The combination of heat transfer and exercise is particularly effective in certain cases because increasing the temperature of soft tissue will cause vasodilatation, increased circulation, decreased joint stiffness, increased joint ROM, and enhanced functional abilities that result from exercise. The relaxing effects of immersion in warm water may also improve the psychological well-being of the patient during and after exercising in water. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Buoyancy and Exercises: Buoyancy of water decreases the gravitational forces placed on weight-bearing structures, so patients with muscle weakness or load-sensitive joints can perform strengthening, conditioning, and coordination exercises in water more easily than on dry land. This can help to improve functional mobility and strength for those patients. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Resistance of water and exercises: Resistance provided by water can be changed during exercise by altering the DIRECTION or SPEED of motion of the water or the speed of movement of the patient, which can alter the clinical effects of exercise in water. Regarding Direction: - If the water is applied against the direction of muscle action, this can be used to develop strength of the muscle. - While when water is applied in the same direction of patient movement, it assists the weak muscles in the production of movement and increasing the available active range of motion of the patient. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Regarding speed: - The faster the water moves toward the patient, against the patient’s direction of movement, or the faster the patient moves in the water, the greater will be the resistance against the patient’s movement, and thus the greater the strengthening or endurance-building effect of the activity. - So exercise intensity can be gradually increased by increasing the speed of motion in water. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Hydrostatic pressure and exercises: Because hydrostatic pressure facilitate venous return from the extremities, circulation may be more enhanced than when similar exercise is performed on dry land. The circulatory changes produced by hydrostatic pressure of water on the extremities during water-based exercise results in facilitating cardiovascular and respiratory conditioning and can help to reverse and control the formation of peripheral edema. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Specific Uses (benefits) of Water Exercise: A) Musculoskeletal Problems. B) Neurological rehabilitation. C) Cardiac respiratory Fitness. D) Pregnancy E) Exercise-Induced Asthma F) Age-Related Deficits G) pain control H) Edema control I) Wound care/healing 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  A)Benefits for Musculoskeletal Problems: Decreased weight bearing on joints Velocity-dependent resistance Closed- or open-chain exercises Decrease pain. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC Most of musculoskeletal benefits are achieved by Floating (buoyancy): Weight bearing during aquatic exercise can be graduated by varying the depth of water immersion or by using floatation devices. Increasing depth of water or using floatation devices will help in much decrease of loading on weight bearing joints and muscular demand, thus help increasing the active participation of patients with load-sensitive conditions such as osteoarthritis or spinal disc lesion to perform exercises that are difficult to perform on dry land, allowing earlier recovery and greater functional mobility. Flotation devices also allow greater muscular relaxation in the water by eliminating or reducing the amount of work required by the patient to stay floating. It also provides greater reduction in pain levels and decreases joint stiffness. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  For example, patients with load-sensitive spinal conditions, such as disc bulges or herniations or nerve root compression, may benefit from relaxed vertical floating in water, supported by a flotation belt, to allow unloading of the spinal intraarticular structures (thus relieving the compression) and relaxation of the paraspinal muscles. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Closed chain Vs Open chain Exercises performed in water can be in the form of closed-chain or open chain. Closed-chain exercises can be performed using the bottom of the pool to fix the distal extremity when the patient is in shallow water or using the side of the pool to fix the distal extremity when the patient is in deeper water. Open-chain exercises can also be performed in deep or shallow water, depending on the area of the body involved and the type of exercise to be performed. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC Special considerations and important notes: Running on dry land is primarily a closed chain activity, whereas running in deep water using a flotation vest is totally an open-chain activity that can reduce pain from tibiofemoral joint compression by decreasing weight bearing on this joint. Water exercise can have a positive impact on the overall health of women with osteoporosis and can be a safe way to exercise for those at high risk for falls. But it may not increase bone density as effectively as weight bearing exercise. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Closed chain exercises 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Open chain exercises 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  B) Benefits for Neurological rehabilitation Water-based exercise provides: 1-Proprioceptive input: The proprioceptive input may be particularly beneficial for patients with central sensory deficits, such as patients with stroke or traumatic brain injury. 2- Functional activities and balance: The weight relief: - Makes the movement easier - Reduce the risk of falling - Facilitate greater movement ability, functional activity training, balance enhancement and strengthening in patients with weakness or impaired motor control. 3- Reduction of spacticity (hypertonicity): In patients with spasticity, passive ROM combined with water exercise help in reducing spasticity. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  C) Benefits for Cardio respiratory Fitness Allows cardiac conditioning in patients with poor tolerance for land-based exercise (such as osteoarthritis, postoperative recovery, or joint instability) or for those who wish to increase their cardiovascular fitness. Water exercise has also been found to be beneficial in following conditions: - Chronic Obstructive Pulmonary Disease (COPD) by improving respiratory functions, physical capacity and quality of life. - Patients with congestive heart failure, but should be Closely monitored. - Water exercise may improve both breathing and cardiac function in patients with emphysema. - Exercise in water has also been shown to normalize heart rate, and work capacity in healthy older adults. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  D) Benefits during Pregnancy 1 Decreased weight bearing: -Exercise in water for pregnant women provides the benefits of unloading the weight-bearing joints. 2 Less elevation of heart rate with exercise: -Less elevation of heart rate, blood pressure, and body temperature than when similar exercise is performed on dry land. 3 Enhanced venous return and controlled peripheral oedema: -Immersion in water, especially in upright position, places hydrostatic pressure on the immersed areas resulting in improved venous and lymphatic flow thus can be used to help in reducing peripheral edema in pregnant patients. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  4 Improve body image: -less physical discomfort, greater mobility, and improved body image. 5 less risk on fetus: -Exercise in water is thought to be less risk to the fetus than land-based exercise because it has been shown that the incidence of post exercise fetal tachycardia is lower with this type of exercise than with land-based exercise. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  E) Benefits with Exercise-Induced Asthma Exercising in water results in less exercise-induced asthma than with other forms of exercise (dry land exercises). Studies have shown decreased symptoms of asthma and increased fitness in asthmatic patients, in response to swimming exercise. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  F) Benefits with Age-Related Deficits water exercises are particularly helpful for elderly people over 60 years in the form of: Improving balance Improving strength Improving cardiorespiratory fitness Improving functional mobility and quality of life Alleviating age related aches and pains during exercise (due to buoyancy) and helps support people who have poor balance on land. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  G) Pain control: -Hydrotherapy is often recommended as treatment for the control of pain. -Hydrotherapy is thought to control pain by providing a high level of sensory stimulation (pressure, mechanical changes) to peripheral mechanoreceptors to gate the transmission of pain sensations at the spinal cord (pain gate theory). -Hydrotherapy can provide the greatest sensory stimulation, when water is set at a high temperature with a high level of agitation, which together are particularly effective in reducing pain. -Cold water may contribute to the reduction of pain by reducing acute inflammation and reducing the sensory nerve conduction velocity. - Pain control may also result from decreased weight bearing and increased ease of movement caused by water immersion. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  H) Edema control -Water immersion has been shown to reduce peripheral edema as a result of the hydrostatic pressure of water and resulting changes in circulation and renal function. -Therefore, it is recommended for the treatment of peripheral edema with a variety of causes, including venous or lymphatic insufficiency, renal dysfunction, and postoperative inflammation. -In acute conditions, the cooling effects of cold water may contribute to edema reduction by causing vasoconstriction and reducing vascular permeability. Therefore, cold water immersion/application is used as a component of the treatment of edema resulting from recent trauma when other signs of acute inflammation are present. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  Immersion in warm or hot water is avoided in acute conditions because heating the injured area and placing it in a dependent position can increase tissue temperature, intravascular pressure, resulting in increased inflammatory process, peripheral arterial flow, and vascular permeability and thus increased rather than decreased edema. -In such cases, it has been found that the higher the temperature of the water, the greater the amount of edema can be formed. Contrast baths are frequently recommended and clinically used to control edema. 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC  I) Wound care/healing 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC 18/8/2020 Dr. Wael Osama Aly, Lecturer of Basic Science, BUC