HYDROTHERAPY

L.S. Angliadi
Department of Physical Medicine and
Rehabilitation Faculty of Medicine
University of Sam Ratulangi Manado
 HISTORICAL OVERVIEW
 ORIGIN OF THE USE OF WATER
In many cultures , the use of water was closely connected to the mystical
and religious worship of water and its perceived power of healing.
The use of hydrotherapy as a therapeutic modality is unknown, but records
dating back to 2400 BC indicate that the Proto- Indian culture made
hygienic installations. It has been noted that early Egyptians, Assyrians ,
and Moslems used curative waters for therapeutic purposes. There is also
documentation that the Hindus in 1500 BC , used water ti comat fever.
Throughout the historical records of the early Japanese and Chinese
civilizations, there is significant mention of respect for a worship of running
water and the submersion in baths for prolonged periods of time.
Homer mention the use of water to treat fatique, heal injuries,and combat
melancholy. The waters of Bath, England were used as early as 800 BC
for healing purposes.
 HISTORICAL OVERVIEW
 ERA OF WATER HEALING ,500-300 BC.
By 500 BC , the Greek civilization no longer viewed water from the standpoint of
mysticism and began to use water more logically for specific physical treatments.
Hyppocrates (460-375 BC) used hot and cold water immersion to treat many
diseases. He recommended hydrotherapy for the treatment of a variety disorders,
including rheumatism, jaundice and paralysis.
The Lacedaemonians have been credited with establishing the first public bath
system in 334 BC. The Greeks and Romans engaged in the taking of long baths
many years before the birth of Christ.
Greek civilization was the first to recognize and appreciate the relation between state
of mind and physical well-being
∎ USE OF WATER DURING THE ROMAN EMPIRE
The Roman baths were originally used by athletes , for bathing and servedthe purposes of
hygiene and prevention morethan treatment.
The Roman system evolved into a series of baths at varying temperatures
ranging from very hot (caldarium) , to lukewarm (tepidarium), to the coldest
( frigidarium ).
By the 350 AD, the primary purpose of RB was for healing and treatment
rheumatic disease, paralysis and injuries.
 HISTORICAL OVERVIEW
 USE OF WATER DURING THE DECLINE OF THE ROMAN EMPIRE AND THE
MIDDLE AGES.
 USE OF WATER DURING THE LATE 1600s AND 1700s.

Baruch credits Great Britain as the birthplace of scientific hydrotherapy, with the
publication in 1697 of Sir John Floyer treatise.
John Wesley, the founder of Methodism, published a book in 1747 entitled
An Easy and Natural way of Curing Most Diseases. This book focused on the use
water in a healing medium.
∎ RESURGENCE OF WATER FOR HEALING IN THE 1800s
The use of Hydrotherapy at this point in history continued to be primatily in nature.
The treatment techniques include sheet baths,wet packs, wet compresses, cold friction baths,
sedative baths,hammock baths and carbon dioxide baths
In 1830 , a silesian peasant, Vincent Priessnitz, developed treatment programs that primarily
used outdoor baths. His treatment consisted of cold water baths, shower,and packs.
Sebastian Kniepp (1821-1897), a Bavarian piest , modidied the Priessnitz technique
by alternating cold application with warmer and even hot partial baths
Winterwitz (1834-1912),an Austrian professor and founder of a hydrotherapy school and
research center in Vienna, is recognized as devoting “ hydratic”.
 DEVELOPMENT OF SPAS
 By Definition , A Spa is a resort that is built around a natural spring and
usually surrounded by breathtaking natural beauty .
 Baths of mineral and thermal water can be traced as far back as 500 BC
in Greek , and served as precursors to the modern spas of Europe.
 The baths near natural thermal and mineral springs were reestablished
during the Middle Ages. These baths were primarily used for soaking for
various periods of time in waters of differing temperatures. Many of the
baths had a regular spa physician who prescribed the treatment protocol
for a client.
 Spa and Hydrotherapy of the 19th Century – 20th Century
During the 19th century , more spas began to sprout out along the
Appalachians and from Connecticut to Arkansas in America.
Hydrotherapy was brought to America by many European trained
physician returning to America with knowledge of the current teachings
in Europe.
 AQUATIC PHYSICS
 Water is a substance composed of two of the most common element on
earth : oxygen and hydrogen.
 One atom of oxygen bonds with two atoms of hydrogen to form a
molecule of water.
 H2O with a molecular weight of 18.The nearest approach of water
molecules to each other is in ice, when they are separated by 2.76 Å. The
radius of molecule is 13,8 Å. The molecules are bounded triangularly .with
the hydrogen atom by an arc of 104º31’. And separated from the oxygen
atom by 0,9580 Å. This angle is greater than the expected 90º because of
the incomplete sharing of electrons between the oxygen and hydrogen
atoms, creating a partiallyionized state. The physical configuration of these
bonded molecules creates an open electrical field leading to an affinity for
many other chemical substances , and hence water’s tremendous capacity
as a solvent.
 AQUATIC PHYSICS
 Matter commonly exists at normal earth temperatures in 3 state :
SOLID , LIQUID , AND GAS
- Solid : maintains a consistent shape and size,which typically does not
change without significant force.
- Liquids : readily alter shape , but typically retain volume despite force.
- Gases : are the least fixed, lacking both fixed shape or volume.
Both liquids and gases have the ability to flow,and because flow properties
are more closely related to density then any other factor, both are referred
to as fluids. Water is used in all its forms therapeutically.

All of the biologic effects of immersion are related to the fundamental

principles of hydrodynamic and thermodynamincs.
An understanding of these principles makes the medical application process
more rational. Because aquatic activities take place in a dynamic aquatic
environment, it is useful to study the physics of both still and moving water
 AQUATIC PHYSICS

 WATER AT REST
a. Density and Specific Gravity
Density is defined as mass per unit volume and is designated
by the Greek letter ρ (rho).
The relation of ρ to mass and volume is characterized by the
formula:
m m is the mass of a substance
ρ = V is volume
V
Density is measured in the international system as kilogram per
cubic meter ( kg/ m3). And occasionally as grams per cubic
centimeter ( g/ cm3 ).
 AQUATIC PHYSICS
A density given in the latter format must be multiplied by 1000 to equal
the former. Density is a temperature- dependent variable,although much
less so for solids and liquids than for gases.
In addition to density, substances are defined by their specific gravity , the
ratio of the density of that substance to the density of water.

Water have a specific gravity by definition equal to 1 at 4º C.

Although the human body is mostly water , the body’s density is slightly
less than that of water, which an average specific gravity of 0,974, and
men averaging a higher density than women.
Lean body mass , which includes bone, muscle , connective tissue ,and
organs, has a typical density of 1.1, whereas fat mass, which includes
both essential body fat plus fat in excess of essential needs, has a density
of 0.90. Consequently, the human body displaces a volume of water
weighing slightly more than the body, forcing the body upward by a force
Equal to the volume of the water displaced.
 AQUATIC PHYSICS
 HYDROSTATIC PRESSURE
Pressure is defined as force per unit area, where the force, F ,by
convention is understood to act perpendicularly to the surface area.
This relationship is :
F
P=
A
The standard international unit of pressure is called a pascal.
Abbreviated Pa , after the French scientist Blaise Pascal , and is
measured in newtons per square ( N/ m2 ).
Other common unit are dynes per square centimeter ( dynes/cm2 )
kilograms per square meter (kg/m2), millimeter of mercury per foot
( mmHg/ft) and pounds per square inch (lb/in2), abbreviated “ psi “
Pressure in a liquid increases with depth,and is directly related
to the density of the fluid.
 AQUATIC PHYSICS
 BOUYANCY
Immersed objects have less apparent weight than the same object on land.
There is a force opposite to gravity acting on the object.
The force is called Bouyancy , and equals an upward force generated vy
the volume of H2O displaced.
This principle , discovered by Archimedes (287-212 BC) is the reason why
we float, why water can be used as a laboratory for weightlessness,and
why it can be used to advantage in the management of medical problem
requiring weight off-loading.
The principle applies equally to floating objects. A human with specific
gravity 0.97 will reach floating equilibrium when 97% of his or her
volume is submerged
The bouyancy factor may be therapeutically altered simply through
adjustment of the amount of human body immersed.Should partial weight –
load offset be the desired effect, the immersion depth is reduced with
immersion to the xyphoid , most human are around 75% off-loaded, and
with immersion to the umbilicus around 50%
 AQUATIC PHYSICS
 PHYSIOLOGIC EFFECTS
 Vascular System Effects

The combined effects of water’s density , incompressibility, and

hydfrostatic pressure create significant compression on all the body
tissues on immersion.
On immersion to the neck , approximately 700 cm3 of blood are
displaced from the extremities and abdominal vessels into the great
veins of the thorax and into the heart. This causes a significant increase
in right atrial pressure, stroke volume, and cardiac output.
There is an effect on systemic vascular resistance, which drops
dramatically,and on muscle circulation , which increases several –fold.
∎ Soft Tissue Effects
All soft tissues are compressed, so that lymphatic return is greatly
enhanced . Normal lymphatic pressure is a negative pressure system,
so that even minimal water depth immersion exceeds the lymphatic
pressure . Immersion can assist the process of edema reduction.
 AQUATIC PHYSICS
 Joint Effects
 As the body gradually immerses, water is displaced , creating the force of
bouyancy. This off-loads the immersed joints progressively,and with neck
immersion , only about 15 pounds of the compressive force is exerted on
the spine,hips, and the knees
 For a body suspended or floating in water , the downward effects of gravity
are essentially counterbalanced by the upward force of bouyancy. This
effect may be of great therapautic utility ,allowing rehabilitative
intervention when gravity loaded joint movement is prohibited.
 For example : a fractured pelvis may not become mechanically stable
under full body loading for a period of many weeks, but in water immersion
, gravitational forces may be partially or completely offset so that only
muscle torque forces are present on the fracture site(s),allowing “ active
assisted” range of motion activities, gentle strength building and even gait
training.