This Lecture is Specially designed for Physical therapy students and as well as for general public.
In which general properties of water, temperature and specific exercises are presented.
3. INTRODUCTION:
Hydrotherapy is a method of treating disease
by using water at different temperatures and
in different ways.
Any activity performed in water to assist in
rehabilitation and recovery from hard training
or serious injury.
It is a part of medicine, Specially in
physiotherapy, that involves the use of water
for pain relief and treatment.
4. The term (Hydrotherapy)encompasses a
broad range of approaches and therapeutic
methods that take advantage of the physical
properties of water, such as temperature and
pressure, for therapeutic purposes, to
stimulate blood circulation and treat the
symptoms of certain diseases.
5. Hydrotherapy is the union between water and
physical therapy. It is being used widely
throughout the world as a form of physical
therapy.
By working in a hydrotherapy department of a
physical therapy clinic, one may see how
patients use hydrotherapy for treating their
conditions.
6. Patients are instructed through a specific
program designed to help their physical
conditions.
Hydrotherapy is a great way to exercise the
body.
7. Facilitate range of motion (ROM) exercise
Initiate resistance training
Facilitate weight-bearing activities
Enhance delivery of manual techniques
Provide three-dimensional access to the patient
Facilitate cardiovascular exercise
Initiate functional activity replication
Minimize risk of injury or re-injury during
rehabilitation
Enhance patient relaxation
8. The four most important properties of water
from a treatment point are:
1. Water is non-irritating, non-allergic, and
totally compatible with human physiology
both inside and outside of the body.
2. Water is a good heat conductor and at the
same time greatly heat storing in capacity so
that it is the ideal agent for manipulating
body temperature.
9. 3.Water is totally conformable to the body
surfaces. This means that it makes an
intimate interface with whatever it comes in
contact, which greatly facilitates its ability to
affect the temperature the object it contacts.
4.Water is inexpensive in spite of all its
marvelous properties.
10. In common with other forms of matter, water
has certain physical properties which include
weight, density, buoyancy, Hydrostatic
pressure, and surface tension.
The most important physical laws of water
that physiotherapist should understand and
apply when giving hydrotherapy, are buoyancy
and hydrostatic pressure.
11. Buoyancy is the force experienced as an up
thrust which acts in the opposite direction to
the force of gravity.
A body in water is therefore subjected to two
opposing forces.
12.
13. When the weight of the floating body equals
the weight of the liquid displaced, and the
centers of buoyancy and gravity are in the
same vertical line, the body is kept in stable
equilibrium.
If the centers are not in the same vertical line
the two forces acting on the body will cause it
to roll over until it reaches a position of
stable equilibrium.
14.
15. Decrease stress and compression to body
tissues (weight-bearing surfaces)
Assist weak muscles.
16. Pressure exerted by fluid on body immersed
in fluid.
Pascal’s Law
A fluid exerts equal pressure on all surfaces
of a body at rest, at a given depth…
This pressure increases in proportion to
depth of fluid.
17.
18. Water can have similar effect as compression
bandages.
Helpful in decreasing edema
Greatest effects of hydrostatic pressure occur
in vertical position.
NO hydrostatic pressure effects with non-
immersion hydrotherapy.
19. CLEANSING EFFECTS:
Water can be used as a cleanser.
Water is most commonly used as cleansing
agent for skin.
Hydrating effects and friction of water used
to soften and remove the Debris.
Water is used clinically both as wound
exudate or necrotic tissue, and as a cleanser
to remove exogenous waste.
20. MUSCULOSKELETAL EFFECTS:
The Buoyancy of water unload the weight-
bearing of anatomical structures and allow
patients to perform exercise with less trauma and
pain.
Buoyancy effect can help patients with;
Decrease weight bearing (Arthritis)
Increase blood flow to muscles
Muscle Strengthening
Ligamentous instability
And other degenerative or traumatic conditions.
21. CARDIOVASCULAR EFFECTS:
The Cardiovascular benefits of hydrotherapy
are primarily due to the effects of hydrostatic
Pressure.
Increased Venous circulation
Increase Cardiac Volume
Increase Cardiac Output.
22. RESPIRATORY EFFECTS:
Immersion of the whole body in water
increases the Work of Breathing.
Hydrostatic Pressure on the chest wall
increases the resistance to lungs expansion.
Water based exercise is also often
recommended for patients with EXERCISE-
INDUCED ASTHMA because it appears that
High Humidity of the air inspired during
water exercise, which prevents drying and/or
cooling of the Respiratory mucosa.
23. RENAL EFFECTS:
Increase Sodium and Potassium excretion
Increase Urine Production
May be used to treat the patient with
hypertension and peripheral edema.
24. PSYCHOLOGICAL EFFECTS:
Water immersion can be invigorating and/or
Relaxing.
The Variation in the Psychological effects
depends primarily on the temperature of water
25. SUPERFICIAL HEATING AND COOLING:
Warm or cold water can be used clinically to
heat or cool the superficial tissues
Advantages
Even contact with skin
Does not need to be fastened
Allows movement of heat/cold
Disadvantages
Extremity often in dependent position
26. WOUND CARE:
Cleansing properties facilitate
Rehydration
Softening and debridement of necrotic tissue
Removal of wound debris
Hydrostatic pressure and heat increase
circulation
Provides moist environment to optimize
healing
27. PAIN CONTROL:
Increased sensory stimulation to peripheral
mechanoreceptors
Cold water decreases inflammation
Decreases weight-bearing, increases “ease of
movement”.
28. EDEMA CONTROL:
Water immersion has shown to reduce
peripheral edema.
This effect is due to Hydrostatic pressure
Contrast Baths are frequently used to control
edema
29. Miscellaneous conditions;
a. Control of Pain & swelling – Cold whirlpools
b. Acute Sprains & strains - Cold whirlpools
c. Facilitate motion & ex’s for Sub acute & chronic stages of
sprains & strains - Warm whirlpools
d. Facilitation of stretching of contracture (simultaneous or
immediate pre application of Warm whirlpools)
e. Postsurgical repair of joints (after post surgical wounds are
healed fully – to help soften scar tissue, ↓ pain & promote
restoration of motion )
30. f. Healing fractures of bones – after clinical union has been achieved.
g. Assist in ↑ of mobility – thermal & buoyancy of warm whirlpools
h. OA & RA – Buoyancy effects of warm whirlpools – off loading of the
affected joints – leading to decrease in pain & ↑ in mobility.
i. Help to ↓ post operative peripheral edema – Hydrostatic pressure.
j. Psychological effect – Relaxation & ↓ of anxiety
k. Wound care – Mechanical debriding by removing necrotic material &
cleansing.
31. CONTRAINDICATION (LOCAL IMMERSION):
Maceration
Increased maceration,
increased size of wound
Bleeding
In or near the area
(Maceration is defined as the softening and breaking
down of skin resulting from prolonged exposure to
moisture).
32. CONTRAINDICATION (FULL BODY IMMERSION):
Cardiac instability
Uncontrolled hypertension or heart failure
Infectious conditions that spread with water
like UTI’s, plantar warts, tinea pedis (pool)
Severe epilepsy
Increased risk of drowning
Suicidal patients
Increased risk of drowning
33. Acute inflammatory conditions - ↑ intravascular pressure -
↑ in oedema.
Hyperpyrexia - ↑ tissue temperature
Malignancies – Spreading - ↑ blood flow
Active bleeding – Prolonging arterial blood flow
Cardiac dysfunction – Not able to adapt to thermal homeostasis
Respiratory dysfunction – Not able to resist hydrostatic
pressure, tolerate heat or both
34. ↓ thermal sensation – Inability to sense too much heat / cold
PVD – Not able to meet ↑ metabolic demand
X-ray therapy – Not able to meet ↑ metabolic demand
Venous ulcers – May promote venous congestion
Surface infections – Cross contamination
Uncontrolled bowels – Contaminate water
Dermatological conditions(Atopic eczema) – Exacerbate
Severe epilepsy – Risk of drowning (Full body immersion)
35. PRECAUTION (LOCAL IMMERSION):
Impaired thermal sensation
Check temperature of water with thermometer
first
Infection
Universal Precautions
Clean WP
Confusion, impaired cognition
Use constant, direct supervision
Temperature of water near body temperature
Recent Skin Grafts
Neutral or mild warmth (96 - 98 F)
36. PRECAUTION (FULL BODY IMMERSION):
Confusion, Disorientation
Keep head above water
Constant supervision
Low temperature
Patients with limited strength, endurance, balance, ROM
Hands-on approach required
Patients on medications
Physician clearance sometimes required
Patients with fear of water
Patients with respiratory problems
Watch for signs of respiratory distress, especially in hot
or very warm water
37. Impaired thermal sensation in area to be immersed – Burns
Infection in area to be treated – Need additional infection control
measures
Impaired cognition – Not able to report problems or discomfort
Recent skin grafts – May not able to tolerate agitation or not able to
compensate for extreme of heat or cold
After ingestion of alcohol– Impaired judgment – risk of drowning.
Limited strength, endurance, balance or ROM (full body immersion) –
Safety hazard – risk of drowning
Medications – May alter CVS
38. Urinary incontinence (full body immersion) – Risk of UTI
Fear of water (full body immersion) – May refuse to participate
Respiratory problems – ↑ respiratory distress
Multiple sclerosis (full body immersion) – ↑ fatigue & weakness
Poor thermal regulation (full body immersion) – Risk of
thermal shock
Previously existing edema (full body immersion) – ↑ edema
Sea sickness – Cause anxiety
39. GENERAL RULES OF APPLICATION:
Assess problem and set goals of treatment
Determine if most appropriate treatment
Make sure no contraindications
Select appropriate form of hydrotherapy
Whirlpool
Hubbard Tank
Contrast bath
Non-immersion device
Pool
Explain the procedure, purpose, sensations
Apply appropriate form of hydrotherapy
Assess outcome
Document
40. SELECTION OF HYDROTHERAPY MEANS:
Select the appropriate form of hydrotherapy
according to the
condition to be treated
desired treatment effects
Size of area to be treated
Allowance for safety,
control of infection
Cost-effectiveness
43. These are stainless steel tanks of various sizes.
It has an attached motor called – TURBINE.
The turbine – AGITATES the water in the tank to
create the whirlpool effect.
These WP are intended to used as single-patient
treatments & must be drained & cleaned after
each use.
44. Agitator/ Turbine ejector/ Aerator
Hot and cold water mixing valve
Temperature gauge
Gravity drain
Seat / Chair
46. stimulation of circulation
promotion of muscle relaxation
and pain relief
debridement
facilitation of exercise
47. It is designed for ease of transfer in & out of
the tank by virtue of low walls & length.
Patients in a low boy are usually in a long
sitting position.
49. It’s also referred as “HIP” tanks.
It requires a chair or lift to transfer the patient in
& out of the tank.
Patients in a high boy tank usually sit on a
removable seat attached to rungs on the side of
the tank or may sit on a chair outside the tank
with their lower extremity dangling in the tank.
51. The WP tank is smaller in size, designed
especially to treat distal extremities.
(Ankle/foot/hand)
It is often portable with attached wheels
for ease of movement.
53. These are large whirlpools designed for full body
(Head out) immersion & for patients who are
unable to stand.
Mainly designed for under water ex’s.
The wide top & bottom & narrow middle allow
room for ex’s for the extremities & PT access to
the patient for assistance with ex’s.
Pt’s are typically lowered into tank on a stretcher
by an over head hydraulic hoist.
It is equipped with 2 turbines, that can be moved
around the perimeter of the tank to direct &
control the agitation pattern.
55. Walk trough
Adjustable seat
Motorized chair lift
Hydro stretcher with hydraulic lift
56. Pressured water
irrigation system:
It is mainly used for wounds,
where it is impossible or not
required to immerse the body
part treated.
• It should range between 4 to
15 pounds /square inch (psi).
• Used to treat one patient at a
time.
• Reusable.
57. WP is recommended for
◦ Delayed primary wound – Wounds that are
surgically closed after 5 days.
◦ Secondary intention – Wounds are allowed to close
by granulation, marginal or budding
epithelialization & wound margin contracture.
58. WP application – facilitates;
◦ Cleansing
◦ Softening and debridement of necrotic tissue
◦ Removal of wound debris
◦ Antibacterial action
◦ Circulation enhancement
The WP could be carried out until the wound closes.
59. 1. THE RELIEF OF PAIN & MUSCLE SPASM
2. MAINTANANCE OR INCREASE IN RANGE OF
MOTION OF JOINTS
3. THE STRENGTHENING OF WEAK MUSCLES & AN
INCREASE IN THEIR TOLERANCE TO EXERCISE
4. THE RE-EDUCATION PARALYSED MUSCLES
5. THE IMPROVEMENT OF CIRCULATION
60. 6. THE ENCOURAGEMENT OF FUNCTIONAL ACTIVITIES
7. THE MAINTANANCE & IMPROVEMENT OF BALANCE,
CO-ORDINATION & POSTURE
8. WOUND HEALING IS ENHANCED
9. SEDATIVE EFFECT & RELAXATION
10. FACILITATES CARDIOVASCULAR EXERCISES
11. FACILITATES THE WEIGHBEARING ACTIVITIES
61. Assess problem and set goals of treatment
Determine if most appropriate treatment
Make sure no contraindications
Select appropriate form of hydrotherapy
◦ Whirlpool
◦ Hubbard Tank
◦ Contrast bath
◦ Non-immersion device
◦ Pool
Explain the procedure, purpose, sensations
Apply appropriate form of hydrotherapy
Assess outcome
Document
62. Base decision on
◦ Desired effects
◦ Size of area to be treated
◦ Allowance for safety, control of infection
◦ Cost-effectiveness
63. Cold (32-790 F)
Acute inflammation
Tepid (79-920 F)
Exercise
Acute inflammation if cold not tolerated
Neutral warmth (92-960 F)
Open wound
Medically compromised patients
Decrease tone
64. Mild warmth (96-980)
◦ Increase mobility
◦ Burn
Hot (99-1040)
◦ Pain,
◦ Increase ROM
◦ Increase soft tissue extensibility
Very Hot (104-1100)
◦ Limited body area
◦ Chronic conditions
DO NOT use WP at temperatures > 1100 F !!
65. Prevention of falls
Precautions for prevention of
drowning
Electrical safety
66. 20 min when strictly used as a heating modality
– skin muscle & joint temperature.
5 – 20 min when used for debridement –
depending on amount of necrotic tissue.
10 – 20 min for ex’s – depending on pt’s medical
status.
67. High boy tank:- it requires the pt’s to flex their hip &
knee & limits the amount of ROM ex’s. But its depth
allows a greater body surface area to be submerged
safely & comfortably to as high as the mid thorax
region.
Low boy tank:- Not deep but allows the pt’s to fully
extend their lower extremity & perform full ROM ex’s.
Extremity tank:- When only distal portion of the lower
extremity has to be immersed, then extremity tank with
use of chair will be appropriate.
68. The patient should be seated comfortably next to
the extremity tank, with a towel or other form of
padding on the tank edge to avoid compression
of axillary area.
69. E.g.
1. Pt’s with arthritis & is unable to negotiate
transfers.
2. Pt’s with neurologically involved – paralysis,
who can actively move the limbs in water with
the help of water & unable to do the same in air.
3. A burn pt,
4. An elderly patient with an open wound.
70. Pt’s skin thermal sensory discrimination testing
Skin status
Health & mental status
Hydro equipment
Accessories
Water temperature
Water Additives (When applicable) – Name &
concentration of solution.
Body part treated
Treating method – non immersion or immersion
If immersion – level – partial or full
If immersion - Duration