Aquatherapy

Definition/Description[edit | edit source]

Hydrotherapy (Aquatherapy) is any activity performed in water to assist in rehabilitation and recovery from eg.hard training or serious injury.[1][2] It is a form of exercise in warm water and is a popular treatment for patients with neurologic and musculoskeletal conditions.[3] The goals of this therapy are muscle relaxation, improving joint motion and reducing pain.[4]  This therapy is been used for thousands of years.

Physiotherapists are often involved in hydrotherapy in a rehabilitation setting. Client satisfaction and adherence to this form of exercise is often high.The therapeutic effects are often enhanced by the social setting of the sessions.

Hygiene and infection control need be closely monitored.

Physical properties of water[edit | edit source]

In common with other forms of matter, water has certain physical properties which include mass, weight, density, relative density, buoyancy, Hydrostatic pressure, surface tension, refraction and reflection. [5][6]

Of the physical laws of water that the physiotherapist should understand and apply when giving Aquatherapy, those of buoyancy and hydrostatic pressure are the most important. The lateral pressure exerted and the effect of buoyance together will give the feeling of weightlessness.[5]

Buoyancy [7][edit | edit source]

Buoyancy is the force experienced as an upthrust which acts in the opposite direction to the force of gravity. A body in water is therefore subjected to two opposing forces. When the weight of the floating body equals the weight of the liquid displaced, and the centres of buoyancy and gravity are in the same vertical line, the body is kept in stable equilibrium.[6] If the centres are not in the same vertical line the two forces acting on the body will cause it to roll over untill it reaches a position of stable equilibrium.

Hydrostatic pressure [7][edit | edit source]

The molecules of a fluid thrust upon each part of the surface area of an immersed body. Pascal's law states that fluid pressure is exerted equally on all surface areas of an immersed body at rest at a given depth. Pressure increased with the density of the fluid and with its dept. This means that swelling will be reduced more easily if exercises are given well below the surface of the water where the increased pressure may be used.[6]

The hydrostatic pressure place on the outside of the body causes a decrease in BP peripherally and an increase in the BP in and around the heart. This can cause potential problems for eg CHF and CAD clients and needs be taken into consideration. The greater the depth the greater the changes described above would be.[8]

Physiological effects[edit | edit source]

The physiological effects of water therapy combine those brought by the hot water of the pool with those of the exercises. The exent of the effects varies with the temperature of the water, the lenght of the treatment and the type and severity of the exercise.[5]

The physiological effects of exercise in water are similar to those of exercise on dry land. The blood supply to the working muscles is increased, heat is evolved with each chemical change occurring during the contraction, and the muscles temperature rises. There is an increased metabolism in the muscles resulting in a greater demand for oxygen and increased production of carbon dioxide. These changes augment the similar changes brought about by the heat of the water, and both contribute towards the final effect. The range of joint movement is either maintained or increased, and muscle power increases.[6]

During the immersion the physiological effects are similare to those brought about by any other form of heat but less localized. A rise in body temperature is inevitable because the body gains heat from the water and from all the contracting muscles performing the exercises. As the skin becomes heated the superficial blood vessels dilate and the peripheral blood supply is increased. The blood flowing through these vessels is heated and by convection, the temperature of the underlying structures rises.[6]

The relatively mild heat of the water reduces the sensitivity of sensory nerve endings and the muscle tone will diminish when the muscles are warmed by the blood passing through them.[6]

Therapeutic effects [edit | edit source]

  • Relieve pain and muscle spasm[6]
  • To gain relaxation [6]
  • To maintain or increase the range of joint movement[5]
  • To re-educate paralyzed muscles[5]
  • To strengthen weak muscles and to develop their power and endurance.[6]
  • To encourage walking and other functional and recreational activities.[5]
  • To improve circulation ( throphic condition of the skin ) [6]
  • To give the patient encouragement and confidence in carrying out his exercises, thereby improving his morale.[6]
  • The warmth of water blocks nociception by acting on thermal receptors and mechanoreceptors, thus influencing spinal segmental mechanisms.[3]
  • Warm water stimulates blood flow positively, which leads to muscle relaxation[3].
  • the hydrostatic effect may relieve pain by reducing peripheral edema and by dampening the sympatic nervous system activity.[3]

Clinical Contraindications [6][9][edit | edit source]

Serious Contraindications Absolute Contraindications
  • Cardiovascular disease
  • cardiopulmonary disease
  • Diabetic
  • Balance disorder
  • History of CVA, Epilepsy
  • Incontinence
  • Labyrinthitis
  • a cold
  • Influenza
  • Fever
  • skin conditions
  • Chemical allergies (Chlorine)
  • Contagious diseases
  • Hepatitis
  • Tracheotomy
  • Urinary tract infection
  • Serious Epilepsy
  • Urinary incontinence
  • Open Wounds 
  • Recently Surgery 
  • Hydrophoby


Difference between aquatic exercise and balneotherapy[edit | edit source]

Balneotherapy is hydrotherapy but without exercise and is also called “Spa therapy”. It is frequently used in alternative medicine as a disease cure and is very popular for treatment of all types of arthritis.[3]

There are not much studies that describe the difference in therapy effects between aquatic exercise and balneotherapy without exercise. In the following review article, ‘Effectiveness of Aquatic Exercise and Balneotherapy’, results show that Aquatic exercise had a small significant effect on pain reduction, improvement of function, quality of life and mental health. Compared to balneotherapy, exercise in water is more effective for the treatment of musculoskeletal diseases than passive immersion. There are no long-term effects, so to keep the disease stable, it is necessary to frequently participate in water exercises.
It is not clear what exact the effect is of balneotherapy in musculoskeletal diseases because the studies involving this subject have poor methodological quality, which makes it difficult to determine the individual effect in this therapy.[4]

Recent research - specific disorder subgroups[edit | edit source]

[10]

A systematic review in 2017 found that the effectiveness of hydrotherapy with Parkinson’s disease clients, with or without other therapies may improve balance and functional mobility with ABE [ aquatic based exercise]compared to LBE [land based exercise][11]

[12] A 2018 randomised trial found that the effectiveness of hydrotherapy on knee osteoarthritis clients had comparable results with ABE vs LBE . However client satisfaction and compliance was better in the hydrotherapy group.[13]

A systematic review in 2017 into effectiveness of hydrotherapy on multiple sclerosis clients found that LBE vs ABE had better functional gains than no intervention.[14]

A 2015 study found that the effectiveness of hydrotherapy on fibromyalgia clients was beneficial [15] [low moderate evidence]

[16]

A 2014 study into the effectiveness of hydrotherapy on chronic low back pain people found that

"A two-month intensive aquatic therapy programme of high-frequency (five times/week) decreases levels of back pain and disability, increases quality of life, and improves body composition and health-related fitness in sedentary adults with chronic low back pain."[17]

Hydrotherapy in patients with rheumatoid arthritis[edit | edit source]

The study of A. Billberg confirms that temperate pool exercise has a significant effect on endurance and flexibility of the muscles, in upper and lower extremities in patients with RA. To gain this endurance and flexibility, exercises against resistance (Eccentric and concentric exercises) are necessary. Recent studies also indicate that patients with low muscle function can improve their muscle endurance with low impact exercises. The vitality of patients with Rheumatoid arthritis who participate in exercises in water is significantly improved after the hydrotherapy session. [18]

Two trials compared hydrotherapy to land-based exercise and failed to find any long
term differences in quality of life, health status, pain or functional scores. When we compare aquatic exercises to no exercise at all, there is a significant improvement in reducing pain in patients who participated in aquatic exercises.[19]

Concluding remarks
Hydrotherapy is an ancient form of therapy and is proving beneficial in treating many MSK and neurological conditions. Physiotherapists are well placed to be instructional in implementing many varied programs.

Examples of alternative methods [20] of hydrotherapy[edit | edit source]

The "Watsu Method"[edit | edit source]

Also called “water Shiatsu", is a combination of Aquatherapy and Shiatsu. Watsu is based on stretching the body in the supportive, relaxing medium of warm water. Beside the physical aspect, also the mental aspect has a great importance during this therapy. The Watsu method has a general relaxation and calming effect that soothes the muscle tension and stimulates all of the body systems and organs by nourishing the energy flow.[20]

The "Bad Ragaz Ring Method"[edit | edit source]

This is an aquatic treatment approach based on proprioceptive neuromuscular facilitation.

The "Feldenkrais Method"[edit | edit source]

This method promotes teaching individuals about the quality of their movements and how to move effortlessly with ease and efficiency.[21]The "Halliwick Method"[edit | edit source]

This method takes a holistic approach using Aquatherapy as a learning activity for all people, particularly those with physical or learning difficulties, to be confident to move independently and become a part of a group setting involving water activities.[22]

The "Burdenko Method"[edit | edit source]

A method of Aquatherapy designed to address the 6 precepts of fitness: strength; flexibility; balance; co-ordination; endurance and speed. It is promoted a great way to recover from injury or surgery.[23]

Resources[edit | edit source]

https://www.hydroworx.com/blog/how-to-implement-aquatic-therapy-in-your-clinic/

http://www.healthtranslations.vic.gov.au/bhcv2/bhcht.nsf/PresentDetail?Open&s=Hydrotherapy_exercise_cue_cards


funny fact ......what direction does a chicken swim in.....cluckwise............hmmmmm

Fun fact.jpg

References[edit | edit source]

  1. Bartels et al., Aquatic exercise for the treatment of knee and hip osteoarthritis (Review),The Cochrane Library 2007, Issue 4 (Level of evidence : 1A)
  2. Lori T. Brody, Paula R. Geigle (2009) Aquatic Exercise for Rehabilitation and Training. United states of America: Human Kinetics.
  3. 3.0 3.1 3.2 3.3 3.4 Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T. Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. Journal of Epidemiology. 2010 Jan 5:0910270113-.
  4. 4.0 4.1 Eversden L, Maggs F, Nightingale P, Jobanputra P. A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. BMC musculoskeletal disorders. 2007 Dec;8(1):23.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Duffield M.H (1969) Exercise in water. Baltimore: The Williams & Wilkins Company.
  6. 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 Meeusen R. (2003) Sportrevalidatie: Aquatherapie (deel 1). België: Kluwer
  7. 7.0 7.1 Joanne M. Koury. (1996) Aquatic therapy programming: Guidelines for orthopedic rehabilitation. United stats of America: Human Kinetics.
  8. Murry J. Advantages and concerns of aquatic exercise for cardiovascular rehabilitation patients(Doctoral dissertation).[1]
  9. Lori T. Brody, Paula R. Geigle (2009) Aquatic Exercise for Rehabilitation and Training. United states of America: Human Kinetics.
  10. Lee Health. Jumping into swim therapy. Available from:https://www.youtube.com/watch?v=E5EcUOT_3ZU [last accessed 15.2.2019]
  11. Pinto C, Salazar AP, Marchese RR, Stein C, Pagnussat AS. Is hydrotherapy effective to improve balance, functional mobility, motor status, and quality of life in subjects with Parkinson’s disease? A systematic review and meta-analysis. PM&R. 2018 Sep 25.
  12. Ofer Nitzan. Aquatic exercise routines for OA. Available fromhttps://www.youtube.com/watch?v=Q5eP0TpMiA8&t=191s [last accessed 15/2/2019]
  13. Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, Wang P, Xiao L, Tong P. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?. Medicine. 2018 Dec;97(52).
  14. MEDICA EM. Efficacy of aquatic therapy for multiple sclerosis: a systematic review. European journal of physical and rehabilitation medicine. 2017 Feb 17.
  15. Bidonde J, Busch AJ, Webber SC, Schachter CL, Danyliw A, Overend TJ, Richards RS, Rader T. Aquatic exercise training for fibromyalgia. Cochrane Database of Systematic Reviews. 2014(10).
  16. Active Chiropractic. 8 low back exercises in the pool/hydrotherapy. Available fromhttps://www.youtube.com/watch?v=GjHMoj3HT8I&feature=youtu.be [last accessed 15/2/2019]
  17. Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clinical rehabilitation. 2014 Apr;28(4):350-60.
  18. A. Bilberg, M. Ahlme’n and K. Mannerkorpi. Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Rheumatology 2005;44:502–508
  19. Gordon S. Doig. Evidence-based systematic review of the effectiveness of hydrotherapy in acute and chronic medical conditions. www.EvidenceBased.net.
  20. 20.0 20.1 Meeusen R. (2003) Sportrevalidatie: Aquatherapie (deel 1). België: Kluwer
  21. Neuroaquatics. Feldenkrais. Available from: http://www.neuroaquatics.com.au/feldenkrais (last accessed 21.2.2019)
  22. Aquabalance. The Halliwick concept.Available from: http://aqua4balance.com/aquatic-exercises/halliwick-concept.html (accessed 21.2.19)
  23. CanyonRanch. Burdenko water exercise. Available from: https://www.canyonranch.com/tucson/explore-experiences/aquatic-experiences/burdenko-water-exercise/ (last accessed 21.2.2019)