Aquatic therapy

• Aquatic Therapy


  Therapeutic treatment which combines the mechanical and thermal characteristics of water plus specific treatment methods to facilitate the function and to reach a target
• Hydrotherapy


  Use of the mechanical and thermal characteristics of water for therapeutic purposes with different temperature and pressure
• Specialized Physiotherapists


  • Required for aquatic therapy
• Specific Installations


  • Required for aquatic therapy
• Type of water used

  • Tap water with chlorine alone (pool therapy)
  • Tap water with therapeutic additives (tub, tank, bath therapy)
  • Natural waters and muds with their own minerals (spa/balneotherapy/thalassotherapy)
• Water physical characteristics


  • Mechanical characteristics
  • Thermal characteristics
• Hydrostatic pressure (HP)


  The water pressure exerted on a submerged object/body in water
• Relative density


  The ratio between the immersed body/object density to the weight density of water
• Buoyancy force


  An upward thrust on the body in the opposite direction to the force of gravity
• Buoyancy force


  • Assistive if acting in the same direction as the desired body movement
  • Resistive if acting in the opposite direction to the desired body movement
  • Support neither helps nor resists the movement
• Factors affecting buoyancy


  • Sex
  • Age
  • Vital capacity
  • Corporal density
  • Body part
• Metacentric effect


  The distance between the centres of gravity and buoyancy is small but significant, causing permanent muscular activity to maintain equilibrium
• Apparent weight


  The weight of the body less the buoyant force pushing up on the object, which depends on the immersion level
• Apparent weight at different immersion levels

  • 7.5% Neck
  • 20% Underarm
  • 33% Chest
  • 50% Navel
  • 66% Great Trochanter
  • 90% Knee
• Hydrodynamic resistance


  The resistance provided by the viscosity of the water against the motion of a body in water
• Factors affecting hydrodynamic resistance

  • Limb moving through the water surface
  • Water depth
  • Position of the body inside water
  • Speed of the movement
• Pressures on an object moving in water

  • Maximum pressure at the front due to the water fluid displaced
  • Minimum pressure at the back (wake) which is an area of decreased pressure
• Specific heat


  The capacity to store heat, which is higher for water than air or other liquids
• Thermal conductivity


  The capacity to conduct heat, which is higher for solids than gases
• PHYSIOLOGICAL EFFECTS DUE TO IMMERSION

  • MUSCULOSKELETAL EFFECTS
  • CARDIOVASCULAR EFFECTS
  • RESPIRATORY EFFECTS
  • RENAL EFFECTS
  • NERVOUS EFFECTS
  • PSYCHOLOGICAL EFFECTS
  • CLEANSING EFFECTS (Wounds)
• MUSCULOSKELETAL EFFECTS


  • Increase in muscular blood flow: helps tissue oxygen availability and accelerates the removal of waste products
  • Reduces edema
  • Reduces articular load
  • Bone density is improved (exercise)
• CARDIOVASCULAR EFFECTS


  • HP exerted on the distal extremities with upright immersion in water displaces venous blood proximally from the extremities
  • Enhances venous return by shifting blood from the periphery to the trunk vessels, the thorax and the heart
  • There is also an increase in cardiac work, stroke volume and cardiac input
• RESPIRATORY EFFECTS


  • Increases the work of breathing
  • The shift of venous blood from the peripheral to the central circulation increases the circulation in the chest cavity, and the HP on the chest wall increases the resistance to lung expansion
  • HP compresses the abdomen more than the thorax, moving the diaphragm upwards
  • Breathing muscles work harder, complicating inspiration and facilitating expiration
  • The greater the immersion depth, the greater the intrathoracic pressure and lesser the residual volume
  • The oxygen consumption is lower due to muscle relaxation and muscle tone reduction
• RENAL EFFECTS


  • Increased urine production or diuresis
  • Increased sodium excretion
  • Increased potassium excretion
  • Increased waste product elimination
  • Decreased blood pressure
  • Decreased antidiuretic hormone (ADH) and aldosterone
• NEUROMUSCULAR EFFECTS


  • Analgesic and relaxing effect
  • Improves the body schema and propioception
  • Improves motor coordination
• PSYCHOLOGICAL EFFECTS


  • Water provides freedom and weightlessness
  • Water allows motivation and participation of the patients
  • Water immersion can be invigorating (cold water) or relaxing (hot water)
• Thermotherapy


  • Temperature: 36,5-40,5ºC
  • Techniques: Total/Partial baths and steam baths
  • Adding kinetic factors: Showers and Jets, Hydromassage, Subaquatic shower, Whirlpool baths
• HOT WATER PHYSIOLOGICAL EFFECTS

  • Superficial vasodilation
  • Increased blood flow
  • Analgesia
  • Muscle relaxation
  • Anti-inflammatory effects on connective tissue
• SUPERFICIAL VASODILATION


  • Hyperemia causes analgesia, anti-inflammatory effect, increases metabolism, increases catabolite elimination and speed up tissue healing
• INCREASED BLOOD FLOW AND CORPORAL TEMPERATURE

  • The hyperemia starts with sweat and skin redness in dermis and epidermis
  • Using hydrokinetic factors, less temperature will be needed
  • If higher temperatures are used in structures with less fat/soft tissues (hands/feet) the heating will be greater
  • A distant vasodilation may be used to increase blood flow to an area where it is difficult or unsafe to apply a heating agent directly
• ANALGESIA


  • Directly: GAIT CONTROL THEORY
  • Indirectly: Vasodilation improves healing and reduces ischemia
• MUSCLE RELAXATION AND ANTISPASMODIC EFFECT OVER STRIATED AND SMOOTH MUSCLE

  • Very hot and short-time applications increase muscle tone and improve its efficiency
  • Very hot and long-time applications (36-38ºC) relax muscle tone and have a decontracting effect
• ANTI-INFLAMMATORY EFFECT


  • Blood vessel dilatation
  • Enhanced local blood flow
  • Decreasing edema
• EFFECTS ON CONNECTIVE TISSUE

  • Decreases joint stiffness and increase joint ROM
  • Increases collagen elasticity
  • Reduces viscosity
• HOT WATER EXERCISES EFFECT

  • Improves emotional state
  • Muscle reeducation
  • Increases blood circulation
  • Reduces muscle spasm and pain
  • Patient relaxation
  • Gait training
  • Improves articular mobility
• Cryotherapy


  • Temperature: 1-20ºC
  • Techniques: Locally/totally, Wraps, compresses, Partial showers, Baths
  • Duration of the application
  • Area
• COLD WATER PHYSIOLOGICAL EFFECTS

  • Decreased blood flow (VASOCONSTRICTION)
  • Decreased edema and swelling
  • Decreased pain and muscle spasm
• SUPERFICIAL VASOCONTRICTION


  • After cold water application: 1st decreased temperature of the skin, 2nd cutaneous VC, pale coloration and piloerection
  • Cold perception could be painful (low temperature long applications)
  • Short cold application and comfortable situation: skin VC + reactional VD
• SUPERFICIAL VASOCONTRICTION:THERMAL CHILL


  • Lower intensity applications: VC
  • When local temperature reduces during a long period, every 20-30' a VD
  • Greater intensity applications: compensatory mechanisms activated, Increased muscle tone, Involuntary muscle contrations (chills)
• DECREASED EDEMA AND SWELLING

  • Decreased metabolic rate: Cryotherapy can be used to control acute inflammation but it is not recommended when healing is delayed
  • Cryotherapy must be applied ASAP after the trauma (5 minutes) over the injured area
  • When cryotherapy is applied with the goal of controlling inflammation, the treatment time is limited to 15 minutes or less