EXERCISE THERAPY

TITLE

: METHODS IN HYDROTHERAPY

PREPARED FOR : MADAM NOR AZIZAH

PREPARED BY

: NURDINA AFINI BINTI IZAMUDIN (031390)

DATE OF
SUBMISSION

17th February 2013

HYDROTHERAPY

2/17/2013

BAD RAGAZ RING METHOD

WHAT IS BAD RAGAZ RING METHOD ?

The bad ragaz ring method is a collection of therapeutic techniques performed in the water
that have been developed through years in the thermal waters of Bad Ragaz, Switzerland.
Still evolving, the method is used internationally for muscle re-education, strengthening,
spinal traction/elongation, relaxation, and tone inhibition in water. Waters unique properties
of buoyancy, turbulence, hydrostatic pressure, surface tension, and thermal capacity are used
to facilitate rehabilitation in a program of relaxation, stabilization, & progressive resistive
exercises.
Clients with paralysis and limitation of movement in the joints were treated by performing
range of motion exercises while supported on fixed treatment boards in the water. Straps were
used to hold the client firmly in place, or rails were attached to the side of pool to provide a
hand hold for clients exercising in the water. In 1957, advances in techniques developed by
Dr. Knupfer of wilbad, Germany were introduced to Bad Ragaz by Nele Ipsen.
Knupfers exercises refined the method into horizontal treatment technique in which the client
was supported floating on his back by flotation rings around the neck and the pelvic region
and under the knees & ankles. The modified technique was used for stabilization or active
resistive exercises. Knupfer incorporated the concepts of the neurophysiology of training, and
developed exercises that consisted of simple chains of movement passing from joint to joint,
mainly a single plane of motion. He contended that active movements away from and back
toward the fixed point of the therapists hands facilitated stabilizing reactions adapted to the
task circumstances, naturally occurring movement synergies, and isotonically resisted
exercises of agonist & antagonist muscle groups. It aided use of closed kinetic chain exercise
in a safe, supportive environment while enjoying the physiologic benefits of warm water.
After Knupfer, the use of buoyancy, turbulence, surface tension, and the thermal capacity of
92 degree f water to reduce pain, increase soft tissue compliance, reduce muscle tone, and
promote relaxation were understood as unique clinical strategies that differentiated water
from land exercise.

With the rapid growth & acceptance of proprioceptive neuromuscular facilitation (pnf), Dr.
Zinn, medical director at Bad Ragaz and his medical team refined and modified Knupfers
exercises. Three dimensional diagonal movements were developed and added to knupfers
original exercise pattern. In 1967, physiotherapists Bridget davis and Verena laggatt
incorporated Margaret Knotts PNF patterns, resulting in the technique known today as the
Bad Ragaz Ring Method (BRRM). The method continues to evolve, and is becoming popular
in Switzerland, Germany, England, Australia, South Africa, the United States, and elsewhere.

Goals of treatment
BRRM provides infinite possibilities for variation of exercise for the neurologic, orthopaedic,
& rheumatologic client.
1. Tone reduction
2. Relaxation
3. Increasing range of motion
4. Muscle re-education
5. Strengthening
6. Spinal traction/elongation
7. Improving alignment & stability of the trunk
8. Preparation of the lower extremities for weight bearing.
9. Restoration of normal patterns of upper & lower extremity movements.
10. Improving general endurance
11. Training functional capacity of the body as a whole.

Technique
Stressing the need for the therapist to provide stability for the client and still be flexible with
application, there are three ways in which the therapist acts in relation to the client.
Isokinetically : Therapist provides fixation while the client moves through the water either
toward, away from, or around the therapist. The client determines the resistance encountered
by the setting the speed of movement through the water.
Isotonically: The therapist acts as a movable fixation point. Ex: the client can be pushed
or swung into the direction of his or her active movement. This action leads to an increase in
resistance to that movement. Conversely movement can be assisted by a therapist pushing in
the direction opposite to the clients intended motion.
Isometrically: The client holds a fixed position while being pushed through the water by
the therapist. Promotes stabilizing contractions.

Bad Ragaz Ring method exercises can be divided into patterns for the trunk, arms, and legs.
They can also be categorized as unilateral or bilateral. Bilateral patterns are further defined as
symmetric or asymmetric. Most patterns emphasize reciprocal movement patterns.
Reciprocal movements are not always emphasized with certain client conditions and
circumstances. In general, the patterns are performed in supine floating, yet a few arm
patterns are performed in prone and a few trunk patterns in side lying. Because of the

flexibility of the patterns and the adaptability of the technique, an almost infinite variety of
exercises can be developed by the therapist to maximize client outcomes.

HALLIWICK METHOD

WHAT IS HALLIWICK METHOD ?

The Halliwick concept is an approach to teaching all people, in particular, focusing on those
with physical and/or learning difficulties, to participate in water activities, to move
independently in water, and to swim. The Hallwick concept may be regarded as a universal
approach to teaching. However, it mainly focuses on subjects with physical and/or learning
difficulties, and it refers to various activities performed in the water, (such as, for instance)
independent movement and swimming. It is based on a belief in the benefits that derive from
activities/exercises performed in the water, and sets out the necessary fundamentals for
learning. These benefits refer to physical, personal, recreational, social and therapeutic
aspects.

The ten-point programme

The Ten-Point Programme provides the basis for practical work by bringing together the
fundamentals of the Halliwick Concept in an easy-to-follow logical structure.
Within the Ten Points we can see a process of development through mental
adjustment, balance control and movement which leads to personal independence in the
water.
Mental Adjustment - refers to the swimmers ability to respond flexibly to different
environments, situations or tasks. The learner will need to develop the ability to respond
automatically, independently and appropriately to a variety of situations in the water.
Balance Control - the ability to stay in control while maintaining or changing position in the
water. In a new environment or situation, achieving/maintaining control is often difficult for
the beginner and there may be excessive movement. The swimmer needs to learn a fine
degree of balance control in order to prevent unwanted movements and achieve efficient
postural control.
Movement - refers to the ability to perform desired movements so as to accomplish an
activity with efficiency and skill, both through mental organization and physical control.
These three concepts, Mental Adjustment, Balance Control and Movement, are the essential
components of motor learning.

The Halliwick Ten Point Program

At the Halliwick concept you are asked constantly to solve your balance
problems in trial and error situations through The Ten Point Program.
The Ten Points are a process of development which leads to personal independence in the
water through the essential components of motor learning. The ten points of the Halliwick
concept are:
1.

Mental Adjustment :being able to respond appropriately to a different environment,

situation or task. The learning of breath control.

2.

Disengagement : an ongoing process throughout the learning by which the swimmer

becomes physically and mentally independent.

3.

Transversal Rotation Control : the ability to control any rotation made about a fronttransversal axis.

4.

Sagittal Rotation Control : the ability to control any rotation made about a sagittaltransversal (anterior/posterior) axis.

5.

Longitudinal Rotation Control : the ability to control any rotation made about a
sagittal-frontal (longitudinal) axis.

6.

Combined Rotation Control : the ability to control any combination of rotations.

7.

Upthrust : trusting the water and realize you will float and not sink.

8.

Balance in stillness | floating still and relaxed in the water. This is dependent on both
mental and physical balance control. When balanced, other activities can be performed more
easily.

9.

Turbulent Gliding : a floating swimmer is moved through the water by an instructor

without any physical contact between them. The swimmer has to control unwanted rotations
but makes no propulsive movements.

10.

Simple Progression and Basic Swimming Stroke : the development from simple
propulsive movements made by the swimmer to a stroke which may be individual to each
swimmer.

BENEFITS OF HALLIWICK METHOD:

The buoyancy, resistance, turbulence, hydrostatic pressure and viscosity in the water help to
ease pressure on the muscles and joints. This may help to decrease pain and reduce stress.

The benefits of the water along with Halliwick exercise program can:

Strengthen connective tissue

Increase flexibility

Oxygenate muscle tissue

Naturally increase mood

Decrease depression and pain

Helping you to sleep better

WATSU

What is Watsu Massage Therapy?

Combining

Water

Therapy Experience.

and

Massage

for

True

Mind/Body Water

Watsu therapy consists of moves and stretches done to the breath while being held and floated
by a Watsu practitioner in body temperature water. Its use, like massage, for therapy and for
stress and pain reduction make the Watsu the world's first form of Thermal Aquatic
Bodywork.
In addition the meditative states and connection it induces make Watsu more than bodywork.
There is one characteristic that makes Watsu stand out from massage and so many other
forms of bodywork is that it gives you the opportunity to go beyond the physical.
When your body relaxes so deeply - as it can in the warm weightlessness of Watsu - the mind
can cease its chatter. And when the body and mind are quiet, what you're left with is the
fundamental essence of your being, making it a true mind/body experience.
Watsu Therapy = Water + Shiatsu
Watsu began at Harbin Hot Springs, California, where Harold Dull came to teach the Zen
Shiatsu he had studied in Japan
Zen Shiatsu incorporates stretches which release blockages along our meridians, the channels
through which our chi or life force flows.
In the orient stretching is an even older therapy than acupuncture which focuses on points
along these meridians. It strengthens muscles, and increases flexibility and range of motion.
Harold Dull found these effects can be amplified and made more profound by stretching
someone while floating them in body temperature water.

WATSU THERAPY BENEFITS:

Watsu effects a greater increase in the range of motion than traditional methods.
By supporting, rocking and moving the whole body while stretching a leg or
arm, Watsu lessens the resistance that occurs when a limb is worked in isolation.
When the whole body is in continual movement, each move flowing gracefully into the next,
there is no way to anticipate what's coming next and build up resistance.
Without pain, the body can move beyond those limitations fear would otherwise impose. New
life is stretched into long neglected connective tissue and the restricted body is shown new
possibilities of freedom.
Watsu promotes a deep state of relaxation with dramatic changes in the autonomic nervous
system. Through quieting the sympathetic and enhancing the parasympathetic nervous
systems, Watsu has profound effects on the neuromuscular system. The sympatholytic effects
of Watsu lead to enhancement of the parasympathetic nervous system
Physiological changes then occur throughout the body. These changes may include:

Decreased heart rate

Decreased rate of respiration

Increased depth of respiration

Increased peripheral vasodilatation

Increased smooth muscle activity (digestion)

Decreased activation of striated muscles (skeletal)

Decreased spasticity

Decreased muscle spasm

Decreased reticular activating system (RAS) activity

Enhanced immune system response

Watsu helps decrease muscle tension and increase range of motion. The support of the water
provides relief from compression forces in the joints. The movements through the water
provide gentle stretching into all ranges for the spine and extremities while these joints are
unloaded.

AI CHI

What is Ai Chi?
Ai Chi is a water-based total body strengthening and relaxation progression that bridges East
and West philosophies, and integrates mental, physical, and spiritual energy.
It combines Tai-Chi and Qi Gong concepts with Watsu techniques, and is performed standing
in shoulder-depth warm water using a combination of deep breathing and slow, broad
movements of the arms, legs, and torso.
The Ai Chi progression moves (kata) from simple breathing, to the incorporation of upperextremity, trunk, lower-extremity, and finally total body involvement.

Ai Chi is an efficient exercise program that:

Increases oxygen and caloric consumption through correct form and positioning in the

water.

Is a perfect relaxation technique for highly stressed, over-challenged people.

Is ideal for creating improved range of motion and mobility.

Water, movement, and music are used to encourage a state of relaxed
awareness.
Ai Chi is a thermal aquatic bodywork that takes advantage of the waters properties, fostering
range of motion while challenging balance (safely) and facilitating core strength and stability.
The series of movements is simple, but effective and becomes meditative when performed
repeatedly and coordinated with the breath.

AI CHI THERAPY BENEFITS:

Ai Chi is widely recommended especially for high stress and other disorders that limit
movement or energy and as such it is an important activity in our wellness program, as it can
improve physical and mental health, while minimizing the effects of stress symptoms.

Ai Chi can be a way to get your body moving, increase your energy, and promote
flexibility and strength.

Ai Chi can help reduce muscle weakness, widespread pain as well as joint stiffness.

The warm water allows for slow, relaxed movement and increased blood flow to
joints, tendons, muscles and ligaments.

It can also minimize problems associated with conditions such as polymyalgia

rheumatica and rheumatoid arthritis.

In terms of mental health, Ai Chi can minimize problems such as:

Anxiety

Fatigue

Depression
In Traditional Chinese Medicine (TCM), chi (Qi, life energy) moves through your body,
keeping you vital and healthy. Problems with the flow of chi are linked to disease,
and TCM practitioners believe that restoring its proper flow will bring about good health.
Ai Chi along with acupuncture is believed to promote the circulation of chi.

Ai Chi Physical Movement Principles

Ai Chi movements can be used to improve movement efficiency of people suffering from:

Chronic pain

Arthritis

Fibromyalgia syndrome (FMS)

Chronic obstructive pulmonary disease

Balance deficits

Diabetes

Multiple sclerosis (MS)

Other neurological and orthopedic problems

Ai Chi can be used in groups or individually, requires no equipment, and allows the hair and
face to stay dry. This head-out position is important for non swimmers who would benefit
from exercise in the water.
Additionally, because the philosophy and breathing in Ai Chi are similar to those of landbased Tai Chi, many of the benefits seen in Tai Chi are applicable to Ai Chi.
Many of the Ai Chi benefits come from breathing and exercise, as well as effects related to
the relaxed contemplative state.
The expanded range and cardiovascular benefits that arise from Ai Chi training have proved
beneficial for patients with chronic pain, arthritis, chronic obstructive pulmonary disease,
diabetes, and balance impairments.
Ai Chi can also promote relaxation with people who are coping with high stress levels.
Ai Chi is flowing, soft, round movements executed with a profound inwardly directed focus.
It requires a non-judgmental attention to self.

Move with the water (muscles and joints will relax and eyes become partly closed).

Move naturally until the motions flow easily, with no straining.

Ai Chi should be done slowly, gently, and quietly.

By eliminating all other thoughts, you will achieve a unity of movement and
consciousness.
Awareness of the mind's presence in the various parts of the body is taught through the
techniques of Ai Chi. With that training, you can acquire greater degrees of health, fitness,
and longevity than through physical training alone.

Repetition: Deep relaxation can only occur when you feel stable in the water and confident in
your ability to follow the progression. Repetition allows us to do this. The repetition in Ai
Chi is for relaxation, not for evaluating success or failure.
The challenge for those who are addicted to outward movement is a change in perspective.
In Ai Chi, the focus is on tranquility, rather than the precision and rigidity of traditional
exercise.

Pelvic mechanics and alignment. Correct alignment is crucial.

Twists created by the trunk stability movements are neutralizing, cleansing, and organic.
They improve digestion and remove sluggishness, and are effective in relieving:

Backaches

Headaches

Stiffness in the shoulders and neck

After Ai Chi positioning is taught, natural, continual movement and slowness are taught, and
then breathing is incorporated.

REFERENCES
1. http://www.aqua4balance.com/Fitness-and-Exercises/ai-chi-thermal-aquaticexercises.html#.UR2lwqWl6Sq
2. http://www.aqua4balance.com/Therapy-and-Bodywork/watsu-therapy/howwatsu-therapy-affects-our-body-and-mind.html#.UR2jTqWl6So
3. http://www.aqua4balance.com/Fitness-and-Exercises/halliwick-concept-thermalaquatic-exercise-program.html#.UR2lQKWl6Sp
4. http://www.google.com.my/url?
sa=t&rct=j&q=bad+ragaz+method&source=web&cd=5&cad=rja&ved=0CEIQF
jAE&url=http%3A%2F%2Faquatictherapyinindia.blogspot.com%2Fp
%2Fbad-ragaz-ring-method-bad-ragazring.html&ei=xdQcUaryEsmciAexyIHwCA&usg=AFQjCNG0XBPSqs5LzMrlM
txcAqWkGS-AUQ&bvm=bv.42452523,d.bmk