Use of Hydrotherapy for the Management of Ankylosing Spondylitis (AS)

Welcome to the Nottingham University Spinal Rehabilitation Project. This space was created by and for the students at Nottingham University. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Harrison Chipchase

Top Contributors - Wilson Gay, Angeliki Chorti, Harrison Chipchase, Lucy Olivia Thomas, Khloud Shreif, Nico Pennant, Kim Jackson and Cindy John-Chu  

Clinical Relevance

Mr Smith Case study:

'

Benefits of Hydrotherapy

Benefits of hydrotherapy:

stiffness, pain, risk of developing a stooped posture and fatigue are all issues associated with AS.  

Hydrotherapy can be beneficial as:

• The warmth and the buoyancy make stretches more effective
• It’s less painful
• It’s easier to stay upright because the effect of gravity is less
• It requires less physical effort
• Afterwards you usually have a really good night’s sleep

• Water can act as resistance to help strengthen muscles  
• Can provide shock absorption  

(National axial spondylitis association)  

Patient experience studies:  

(Martin et al., 2018)

250 members of the national axial spondylitis association (NASS) completed an online survey on the patients’ experience of hydrotherapy. From thematic analysis of the questionnaires, five themes emerged.

1.Emotional well being : Patients described greater control over their condition when exercising in water

2. Exercise behaviour : patients often performed a wider variety of exercises including challenging exercises that they would not usually attempt on land

3. Group effect : patients described a sense of motivational support when exercising with others in a group  

4. Professional support : Patients cited the benefit of hydrotherapy sessions led by a physiotherapist who shared their expertise and discussed problems.

5 - Pool Environment: Patients described gains from non-impact exercise      and weightlessness in the water. The warmer pool temperature was stated as a reason for the benefits obtained.

Hydrotherapy was shown to be most beneficial for improving pain relief, mood, quality of life stiffness and flare management, but less beneficial for improving sleep quality and fatigue.  

Randomised control trial:  

(Dundar et al., 2014)

A total of 69 patients (58 male and 11 female) completed the study. Patients were randomly allocated to a land exercise or aquatic exercise group. The study found that both groups showed significant improvements in their symptoms. However, improvement in VAS score, bodily pain, general health and social functioning were greater in the aquatic exercise group.  

Barriers and contraindications to the use of Hydrotherapy for the management of AS

Absolute Contraindications	Relative Contraindications	Precautions	Considerations
Acute Systemic Illness	Irradiated Skin during course of radiotherapy	Incontinence of urine/faeces	Shortness of breath with exertion (unfit or if any other causes)
Pyrexia	Known aneurysm	Gross obesity	Vertigo/nausea/blackouts
Acute vomiting or diarrhoea	Open wounds	Epilepsy	Multiple Sclerosis (especially those with high sensitivity to high temperatures)
Medical Instability following an acute episode	Unstable diabetes	Haemophilia	Communication problems
Proven chlorine or bromine allergy	Thyroid Deficiency	Widespread MRSA	Dermal sensitivity due to sanitising agents/Psoriasis
Resting Angina	Neutropaenia	Hypotension	Verruca/Tinea Pedia
Shortness of Breath at rest	Oxygen Dependency	Renal Failure	Boisterous, unpredictable or aggressive behaviour
Uncontrolled cardiac failure/paroxysmal nocturnal dyspnoea	Weight in excess of the evacuation equipment’s limit	Poor Skin integrity or open/surgical wounds	Contact lenses and conjunctivitis
Open, infected wounds		Pregnancy if water temperature exceeds 35°C	Hearing aids/grommets
Known HIV positive and Hepatitis C patients – not to enter pool during menstruation		Invasive tubes in situ	Impaired sensation/vision/hearing

Conclusion

Add your content to this page here!

References

see adding references tutorial.

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (Template:23/Template:05/Template:2022)