11/10/2019

Topic Outline
Hydrotherapy
• Physical Properties of Water
• Physiologic Properties of Water
• Uses/Indications of Hydrotherapy
• Precautions and Contraindications
• Adverse Effects

Asst. Prof. Christian Rey D. Rimando, MSPT, PTRP

College of Rehabilitation Sciences
University of Santo Tomas

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Hydrotherapy Physical Properties of Water

Specific Heat • Heat transfer: conduction and
Hydro Thermal
convection
Conductivity Thermal
Specific Heat
Therapeia Buoyancy
Unit of
measure
J/g/0C
Conductivity
(cal/sec) /
(0C/cm)
Water 4.19 0.0014
Resistance Air 1.01 0.000057
Water:air
4.14 24.56
ratio
Hydrostatic
Pressure

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Physical Properties of Water Physical Properties of Water

Temperature
Clinical Application
• Archimedes’ principle: when a body
Specific Heat Range (0C/0F) Specific Heat
is immersed in fluid at rest, it creates
0-18/32-64 Very cold to cold an upward thrust equal to the amount
Thermal 18-26/64-79 Cool: acute inflammation Thermal of fluid displaced
Conductivity 26-33.5/79-92 Tepid: for exercise, acute Conductivity • Specific Gravity: density of material:
inflammation if can’t tolerate cold density of water ratio
Buoyancy 33.5-35.5/92-96 Neutral warmth: open wounds, Buoyancy Substance Specific Gravity
medically-compromised pts, 
tone Pure water 1
35.5-37/96-99 Mild warmth:  mobility of burns Salt water 1.024
Resistance Resistance Ice 0.917
37-40/99-104 Hot: pain control
40-43/104-110 Very hot:  tissue extensibility, Air 0.00121
Hydrostatic chronic conditions Hydrostatic Average human body 0.974
Pressure >43/>110 Should not be used Pressure Subcutaneous fat 0.85

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Physical Properties of Water Physical Properties of Water

• Due to Viscosity → thickness or
Specific Heat Specific Heat
resistance to flow of a liquid
– d/t friction between molecules of the
Thermal Thermal liquid
Conductivity Conductivity

Buoyancy Buoyancy

Resistance Resistance

Hydrostatic Hydrostatic
Pressure Pressure

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Physiological Effects of
Physical Properties of Water
Hydrotherapy
• Pascal’s Law: a fluid exerts equal
Specific Heat
pressure on all surfaces of a body at CLEANSING EFFECTS
rest at a given depth • Pressure to remove debris
Thermal – Proportionate to the depth of fluid
Conductivity
• Dissolved surfactants and anti-microbials in water

Buoyancy MUSCULOSKELETAL EFFECTS

• Decreased weight-bearing (assistive)
• Strengthening (resistive)
Resistance • Effects on bone density loss
• Less fat loss (vs other exercises)
Hydrostatic
Pressure

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Physiological Effects of Physiological Effects of

Hydrotherapy Hydrotherapy
THERMAL EFFECTS CARDIOVASCULAR EFFECTS
Cold Water Warm Water •  venous circulation
•  cardiac volume
•  cardiac output
•  heart rate
•  systolic BP
• Increases metabolism • Relaxes muscle
•  rate of O2 uptake (VO2)
• Pain relief • Increases flexibility
• Controls inflammation • Improves circulation
• Increases tissue
extensibility

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Physiological Effects of Physiological Effects of

Hydrotherapy Hydrotherapy
RESPIRATORY EFFECTS RENAL EFFECTS
•  vital capacity • Diuresis
•  work of •  Na+ & K+
breathing excretion
•  exercise-induced
asthma

PSYCHOLOGICAL EFFECTS
• Relaxing (warm), energizing (cool)

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Uses of Hydrotherapy Uses of Hydrotherapy

• Superficial Heating or Cooling • Water Exercises
– Heat transfer by conduction or convection – Underwater exercises
(eg walking, cycling,
etc)
• Pain Control
– Assistive or Resistive
– Reduction of WB (eg OA, knee injuries, etc)
exercises
– Thermal effects

• Wound Care
• Edema Control – Rehydration, softening
– Hydrostatic pressure and debridement of
wound

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Precautions & Contraindications

Precautions & Contraindications
for Full-Body Immersion
for Local Immersion Hydrotherapy
Hydrotherapy
CONTRAINDICATIONS PRECAUTIONS CONTRAINDICATIONS PRECAUTIONS
• Maceration around a • Impaired sensation • Cardiac instability • Confusion, disorientation
wound • Infection • Infection spread in water • Alcohol ingestion
• Bleeding • Impaired cognition • Bowel incontinence • Limited strength, endurance
• Recent skin grafts or balance
• Severe epilepsy
• Medications for CV disease
• Suicidal patients
• Urinary incontinence
• Fear of water
• Respiratory compromise

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Adverse Effects of
Application Techniques
Hydrotherapy
• Whirlpool
• Drowning
• Burns, Fainting and Bleeding (use of warm/hot)
• Hyponatremia (with extensive wound burns)
• Infection (should add anti-microbials in water)
• Aggravation of edema in UE (use of warm/hot)
• Asthma exacerbation

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Application Techniques Application Techniques

Whirlpool Types Whirlpool Types
Hubbard Extremity High-boy Low-boy
Mid-
Mid-
thoracic;
Full-body Distal thoracic;
doesn’t
immersion extremity allows full
allow full
LE ext
LE ext
Width 6 ft 15” 20-24” 24”
Length 8 ft 28-32” 36-48” 28”
Depth 4 ft 18-25” 28” 18”
Gallons 425-700 10-45 60-105 75-105
Duration 20-30 min

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Application Techniques Application Techniques

• Contrast Bath
– Warm water: 38-430C (100-1100F)
– Cold water: 13-180C (55-650F)
– Technique:
• Hot (3-4 minutes) → Cold (1-2 minutes)
• Repeat the cycle for 20-30 minutes
• Last immersion:
– Acute to Subacute: cold water
– Subacute to Chronic: hot water
– Usually: end with warm water
• Exercise Pool
– To optimize cardiovascular, respiratory, renal and
psychological effects
– Allows full-body immersion
– Swimming pools: 100 ft long x 25 ft wide x 8 ft depth
– Sloping bottom
– Temp: 26-360C; common = tepid
• Warm: 34-360C for low-intensity exercises
• Cool: 26-290C for more intense exercises

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Application Techniques Application Techniques

• Exercise Pool • Non-immersion Irrigation Devices
– Sprays water to open wound
– Pressure: 4-5 psi
– Pulsatile irrigation device → delivers fluid at controlled
pressure + removes contaminated fluid (suction) =
PULSED LAVAGE

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Safety Measures Safety Measures

• Safety • Infection Control
– Check electrical safety of machine and wires – Appropriate cleaning protocol of the tank
– Do not run the turbine without the water – Use of clean water
– A room temperature of 25-300C with relative humidity of – Drain and clean tank and turbines after each use
50% is recommended • Commonly contaminated parts:
– Bottom of the tank/pool
– Overflow pipes
– Agitators
– Thermometer
– Edges of the tank/pool
– Drainage

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Documentation
P: Hydrotherapy using <tank> x <temperature> x
<duration> x <exercise done, if applicable> x <body
part> to <rationale>
References
• Cameron MH (2018) Physical Agents in Rehabilitation:
An Evidence-Based Approach to Practice 5th Ed.
• Hecox B, Mehreteab T, Weisberg J (1994). Physical
Agents: A Comprehensive Text for Physical Therapists.
• Michlovitz SL, Bellew JW, Nolan TP (2005). Modalities
for Therapeutic Intervention 5th Ed.
• Slide background and photos obtained from
http://www.pulsarmedia.eu/r_great_details_wallpapers_
23_water_wave_hd_wallpaper_56206.html
• Lecture Notes in Hydrotherapy by Marian Grace Gabor
and Maria Michaela Valenzuela.

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