Hydrotherapy

Prepared By: Floriza P. de Leon, PTRP

Terminologies
Hydrology the study of water and the processes by which water is moved from one place to another Medical Hydrology the use of water, in any of its three forms, internally or externally, in the treatment of disease or trauma Hydrotherapy the external application of water for therapeutic purposes

Water a colorless, transparent, odorless, tasteless compound of oxygen and hydrogen

PROPERTIES OF WATER

Chemical Properties
Major ionic constituents of natural water are:
Cations: calcium, magnesium, sodium, potassium Anions: bicarbonates, sulfate, chloride, nitrate
Pure water is a very poor conductor of electricity. The conductive property of water is closely related to the amount of dissolved matter present in ionic forms

Physical Properties
Freezing Point O deg Celsius at 760 mm Hg Boiling Point 100 deg Celsius at 760 mm Hg Density of Water at 0 deg Celsius 0.999868 Density of water at 40 deg Celsius 1.00 Density of ice 0.9168 Specific heat of water 1 calorie at 15 deg celsius

Density mass per unit volume of the substance Specific gravity the ratio of the weight of a volume of substance to the weight of an equal volume of water Surface Tension the pull of the molecules of water on the surface

Thermal Properties
Able to absorb and store heat Resistant to sudden changes in temperature Calorie amount of heat required to raise the temperature of 1 gram of water by 1 deg celsius Specific Heat the number of calories needed to change the temperature of 1 gram of substance by 1 deg celsius. ( specific heat of water 1.0) Water has superior thermal conductivity than any other ordinary liquid. It also has the highest specific heat than any other substances. These characteristics make it an ideal modality for heating or cooling.

Classification of Water According to its Temperature

Celsius Very cold Cold Cool Tepid Neutral Warm Hot Very hot 1-13 13-18 18-27 27-33.5 33.5-35.5 35.5-36.5 36.5-40 40-60 Fahrenheight 34-55 55-65 65-80 80-92 92-96 96-98 98-104 104-115

Factors to Consider in Successfully Using the Thermal Properties of Water in Therapy

The temperature of the water The temperature gradient between the skin and water The method of application The suddenness of application The extent of the area treated The duration and frequency of treatment Weight, age, and general condition of the patient

Mechanical Properties
Buoyancy upward thrust experienced by a body immersed in a liquid equal to the amount of liquid it displaced (Archimedes Principle) Cohesion attractive force exerted by each molecule on those surrounding it Viscosity or internal friction the property of liquid to resist any relative motion within it. This resistance is called Hydrodynamic Force. Cohesion is directly related to viscosity, thus with greater cohesion of a substance, the greater is the resistance and the more it is viscous. Hydrostatic pressure ratio of the magnitude of the force exerted by the fluid per body surface area

Importance Of Buoyancy
Assist upward movement Resist downward movement Relief from weight bearing

Factors That Affect Buoyancy

Posture Surface area immersed Vital capacity Weight of bones in relation to muscle and fat

Factors Affecting Hydrodynamic Force

Speed of the object increased speed will increase the resistance Size of the object larger size the greater the resistance

Shape of the object coarse and irregular objects will experience greater resistance than smooth regular objects

Hydrostatic Pressure will depend on the following

Depth of immersion Density of the liquid

Effects of Hydrostatic Pressure on the Human Body

Increase venous blood flow Increase lymphatic flow Increase urine output

Properties of Water Important in Hydrotherapy

buoyancy (most important) Thermal conductivity and specific heat Hydrostatic pressure Cohesion Viscosity
Water also reduces friction of solids moving in contact with one another. It is also a non-irritating cleansing solution

Physiologic Effects of Heat & Cold

Hypothalamus Anterior Hypothalamus Heat Loss Center prevent T rise Acts as a terminal receptor organ for T Posterior Hypothalamus Heat Maintenance Center prevent cooling Functions as a synaptic relaying activity from thermoreceptors in the skin

Physiologic Effects of Heat & Cold

Hunting Response of Lewis Vasoconstriction Reflex vasodilation Erythema 43C - 45C (109F - 113F) = skin tolerance to HEAT 15C (59CF) = skin tolerance to COLD

 Factors that affect responses of human body to Heat & Cold Application: 1. 2. 3. 4. Dose & Intensity Nature of heating energy Extent & Duration of Application Degree of interference offered by the body

Factors Affecting Perception of Heat or Cold

1. 2. 3. 4. Density of thermal receptors stimulated Degree of T produced Size of area heated Rate of T change

 Skin = cold receptors (Krauses end-bulbs) > heat receptors (Ruffinis corpuscles) = 11.3/cm2 : 3.3/cm2 Controlling Factors: Heat regulation - T of skin T sensation rate of skin T change

Responses to Thermal Sensory Experiences

Thermal Shock Reactions to Heat/Cold

Mild Analgesia

Moderate

Extreme

Stimulating Fight/Flight Fear/Pain

(invigorating) (Gen. Relaxation, Decrease pain, Muscle spasm)

Responses ( eye dilation,, BP, PR, facial color changes)

HEAT

Erythema ( increase blood to area)

Sweating

COLD

Skin Blanch or Cyanotic (decrease blood to area)

Piloerection

Physiologic Effects of Systemic Application of Heat

1. Cutaneous vasodilation 2. 25-35% increase in resting metabolism 3. Increase blood flow, blood volume, & cardiac output 4. Increase osmotic pressure of body cells 5. BP changes

Physiologic Effects of Systemic Application of Heat

6. Heat in abdominal

wall decrease GI activity Ingestion of hot H2O increase gastric motility External applied heat decrease intestinal blood flow, activity, & acid secretion in stomach 7. Decrease urinary output 8. Decrease gamma spindle firing

Physiologic Effects of Local Application of Heat

1. 2. 3. 4. 5. Increase blood flow Decrease blood viscosity Increase metabolic rate Analgesic Consensual heat vasodilation

*43-44C (109-111F) = pain

Physiologic Response to Heat Application

METABOLIC RESPONSE

Increase Metabolic Rate

Increase Phagocytosis

Arteriolar Dilatation

Physiologic Effects of Systemic & Local Application of Cold

Effects are opposite of the effects of heat

1. Decrease metabolism 2. Arteriolar vasoconstriction, due to: 1. Decrease formation of metabolites 2. Local effect of cold on small blood vessels on skin 3. Reflex vasoconstriction by the hypothalamus 3. Decrease edema formation & lymph production

Physiologic Effects of Systemic & Local Application of Cold

4. Increase arterial BP due to muscular contraction & vasodilation 5. Decrease muscle tone 6. Decrease pain, due to decrease muscle spasm & slowing in nerve impulses 7. Weakness & decrease ease, precision of movements

LOCAL COOLING is used to:

1. Decrease extravasation of fluid following acute soft tissue trauma 2. Decrease pain & muscle spasm 3. Better control of spasticity 4. Preserve viability of parts 5. Retard development of gangrene

HEAT VERSUS COLD

FACTORS MUSCLE SPASM SPASTICITY Decrease Cause only transient/short decrease Relieves pain HEAT Decrease Very effective in decreasing spasticity Relieves pain COLD

PAIN

CAPABILITY TO SUSTAIN MUSCLE CONTRACTION

STRENGTH OF MUSCLE CONTRACTION TISSUE METABOLISM BLOOD FLOW

Decrease
Slight increase strength Increase Increase blood flow & tendency to bleed

Increase
Slight cooling will increase strength Decrease Decrease blood flow & tendency to bleed

HEAT VERSUS COLD

FACTORS EDEMA JOINT STIFFNESS SKILLED MOVEMENTS ORTHOSTATIC HYPOTENSION STAGE OF CONDITION HEAT Tend to produced edema Decrease Does not impair
Readily produce orthostatic hypotension with total or large body exposure Used in late stage of inflammatory rxn/injury to assist in their resolution

COLD Prevents further edema Increase Impair Decrease due to vasoconstriction Used in acute inflammatory rxn/injuries to prevent aggravation Can alleviate burns if applied immediately

EFFECT ON FROSTBITE OR BURNS

Can reduce effect of frostbite if the parts is warmed quickly