Introduction

Hydrotherapy is a tool for rehabilitation that was used in the past

centuries and it is as important now as it was in the past. It is the use of the power
of the water in treating many conditions using specific exercises. Its history as a
method of treatment goes back to many thousands year. The first time that the
hydrotherapy was used is unknown, but it was reported that it was used at 2400
BC by proto-Indian culture as hygienic installations, and also the Mohammedans,
early Egyptians and Assyrians used mineral waters for curative reason .Homer
reported the use of warm water for promoting the healing of wounds, reducing
fatigue, and to combat depression and low spirits. Greeks were the first who
appreciated the relation ship between mental and physical well-being. The
Romans created an order of baths ranging from coldarium through tepidarium to
the frigidarium. The baths were used for intellectual, recreational activities, health
and hygiene purposes. At 330 AD some of the baths were used for promoting
healing in many conditions. In medieval times the use of hydrotherapy was
suppressed, but by 15 th, 16 th, and 17th centuries the use of hydrotherapy for
healing propose have recognized from few European physicians (Campion &
Towomey, 1990; Campion, 1997; Ruorti et al., 1997; Campion, 1991). Today
hydrotherapy is used in rehabilitation for neurological, rheumatic, obstetric, sport
.injury, pediatric, and musculoskeletal problems

Hydrotherapy and water physics, physiological effects of immersion in

water, physiological effects of exercising in water, psychological effects,
therapeutic effects, methods in practicing it, relative and absolute
contraindications, precautions, how to assess and record, and studies that showed
.the effectiveness of hydrotherapy will be discussed later

Aquatic physics

Physiotherapists must have knowledge about properties and

characteristics of water mass, density, weight, buoyancy, specific gravity,

1
hydrostatic pressure, surface tension, viscosity and refraction, which are the
physical properties of water. The most important hydrodynamic principles are
those related to turbulence, relative density, metacentere, friction and hydrostatic
.(pressure (Campion & Towomey, 1990; Campion, 1997; Campion, 1991

Relative density●
Density is known as mass per unit volume. The density of water is one.
Therefore any object with density less than one will float. The relative density of
human body differs with age, the relative density of young kid is approximately
0.86.In adulthood and adolescence the density increases to 0.97.Later with time
the relative density become approximately 0.85. Each part of the body has
different density. The upper limb is less dense than the lower limb. (Campion &
Towomey, 1990; Campion, 1997; Ruorti & Morris& Cole, 1997; Becker & Cole,
(1997; Campion, 1991

:Buoyancy ●
Immersed object has less apparent weight than when it is on land. This is
because of a force that acting opposite to gravity on the body. This force is called
buoyancy and it is equal to upward force that is exerted by the displaced volume
of water, so buoyant force is equal to weight of
displaced fluid (Archimedes' principle) .Because the
pressure in fluid is directly proportional to depth of
immersed body, so when an object is immersed more in
the water the pressure will increase leading to
increasing in displaced water and therefore the buoyant
force will be more. The buoyant force will be more in the bottom of a surface than
the top of it. Because the gravity force is counterbalanced by buoyant force, the
compression on joints will be nearly eliminated. This effect can be utilized when
gravity-loaded places a risk on joints. When the body is immersed till the neck
level, only 15 Ibs of compressive force is exerted on the joints (Campion &
Towomey, 1990; Campion, 1997; Ruorti et al., 1997; Becker & Cole, 1997;
Campion, 1991). With symphysis pubis immersion, 40% of body weight will be
eliminated. With more immersion until umbilicus 50% of weight will be decreased.
((Becker & Cole, 1997

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:Hydrostatic pressure ●
Pressure is defined as force per unit area. When the body at rest, at given
depth there will be equal pressure exerted in all direction by water. When unequal
pressure is exerted the body will move. The more the object is immersed in the
water the more pressure will be exerted; this is beneficial for the patients who
suffer from edema. The hydrostatic pressure can be also useful for breathing.
There will be pressure exerted on the chest wall to resist expansion of the chest
So that the muscle can be strengthen by this way and work of breathing will be
increased. It also can fasten removal of lactic acid leading to decrease in muscle
soreness. (Campion & Towomey, 1990; Campion, 1997; Ruorti et al., 1997; Becker
(& Cole, 1997; Campion, 1991
:Thermodynamics●
The stored energy is measured by calorie. Calorie is known as the heat
required increasing the temperature of 1g of water 1°c. The energy that is stored
may be released or absorbed depending on temperature difference between two
surfaces. Thermal energy transferring in water occurs by three methods
conduction, convection, and radiation. Conduction is transfer of heat when two
objects are in direct contact. Convection is transfer of heat through movement of
molecules. Radiation is when electromagnetic waves travel through the space.
Liquids are poor conductors but good convectors. (Campion & Towomey, 1990;
(Campion, 1997; Ruorti et al., 1997; Becker & Cole, 1997; Campion 1991

:Metacentere●
This principle deals with balance in water. As mentioned above when a
body is immersed two opposing forces are acting on it; the gravity and buoyancy.
If these forces are opposite and equal then the body will be balanced and no
movement occurs. If the two forces are unequal then there will be rotational force.
The rotation will stop when the two forces are more aligned. When any part of
body is moves and when there is alteration in body shape like in disability the
rotational force will be produced. (Campion & Towomey, 1990; Campion, 1997;
(Campion, 1991

:Reynolds' theory ●

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Reynolds' theory indicates that there are two types of flow; laminar
(streamline) and turbulent flow (unstreamlined). In the former the molecules flow
evenly and regularly, and water molecules move parallel to each other at same
speed and slowly. In the latter the
movement is irregular and rapid
creating eddies. The movement in
water can be more difficult when
changing from streamlined
movement to unstreamlined one.
(Campion & Towomey, 1990; Campion, 1997; Ruorti et al., 1997; Becker & Cole,
(1997; Campion 1991

:Turbulence●
Turbulence is term used indicating eddies that result from an object
that moves through a fluid. The degree of turbulence varies according to the
speed of the movement. When movement is slow, the flow will be parallel to
object and laminar. If the movement is fast, then eddies will be produced and
energy will be dissipated. This can be utilized in hydrotherapy in both resisted and
assisted movements. (Campion & Towomey, 1990; Campion, 1997; Ruorti et al.,
(1997; Becker & Cole, 1997; Campion 1991

:Prandtl's theorem●
Boundary layer is when fluid is flow on surface a layer is seen adjacent to
the surface and the speed of this fluid in relation to the surface is decreased as it
not existent so that the fluid stick to surface rather than slip over it. In the river
for example the fastest flow is in the center and it is reduced at banks. The same
situation can exit in the pool. The way of getting out should be taught in the pool
to ensure safety of patients. (Campion & Towomey, 1990; Campion, 1997; Ruorti
(et al., 1997; Becker & Cole, 1997; Campion 1991

:Froud-Zahm's experiment●
Froud and Zahm study skin friction of a body that passed through air
and water. They found that skin friction and resistance, viscosity, in the water is
790 times more than in the air. Viscosity is a resistance that occurs between the

4
 molecules of a liquid, effecting how a liquid flows. As mentioned, that the water is
more viscous than air, therefore movements in the water is more difficult than
movements in the air. (Campion & Towomey, 1990; Campion, 1997; Ruorti et al.,
(1997; Becker & Cole, 1997; Campion 1991

:Adjustment to water●
Asymmetry can lead to balance
problems. In case of disability, asymmetry in
shape and density can be noticed; this will
affect balance and stability in water. The
water reacts and floats object according to its
(Figure (1
shape and density. Particular shapes are less
(Figure (3
stable than other shapes in water. Cube (Figure
more stable in water. 1) and ball (Figure 2) shape are
(Figure 3) is less stable Horizontal and vertical stick
(Figure (2
their will be alteration in in water. In disabled people
unequal quadrilateral (Figure (4 shapes that affect stability ;
adducted, triangular, and (Figure 4), sitting (Figure 5),
extended shapes( Figure 6), are all shapes that may result from
(Figure (5 disability leading to disturb balance in water. (Campion & Towomey,
(1990; Campion, 1997; Campion, 1991

(Figure(6

:Mental adjustment
It is the patients' ability to respond appropriately and independently to
different situation. It involves knowing some properties of water like buoyancy. It
is physiotherapist responsibility to teach patients how to respond in different
situations. One such example is adjusting to moving in water compared to moving

5
on the side of the pool (Campion & Towomey, 1990; Campion, 1997; Campion,
(1991

●Balance restoration:
The ability to restore balance in the water occurs in two rotations; vertical
and lateral rotations. The former includes forward and back ward direction; in
other words how to attain supine and prone positions from upright and vice versa.
To attain supine position patient should lower his head slowly backward and bring
his feet upward, to get upright position patient need strong contraction of cervical
Trunk, hips, knees, and shoulder flexors. To attain prone position patient move his
head slowly forward and his feet move back ward, to get out from this position
patient should rotates latterly first then on his back, to get upright position the
patient should do same what is mentioned before . The latter takes place in two
planes; in standing and lying. It is the ability to rotate around longitudinal axis and
turning in water. The patient should know how to do these rotations in order to
maintain balance to be safe in water. (Campion & Towomey, 1990; Campion,
(1997; Ruorti et al, 1997; Campion, 1991

Physiological effect of immersion in water

Several effects result from immersion in water; two systems will be

.discussed here; cardiovascular and renal system

:Cardiovascular system●
When immersed in the water the hydrostatic pressure that exerted by
water will increase the venous return, the more the body immersed the more
hydrostatic pressure will be exerted, which in turn leads to increase in right
arterial pressure, pulmonary blood flow, and cardiac volume which increase the
contractility. All of these changes will lead to increase in cardiac out put and
stroke volume. So that more blood and oxygen will go to muscles which will
.enhance lactic and waste product removal

The immersion in water produces other responses; peripheral

vasoconstriction, bradycardia, and preferential shunting of blood to vital areas. All

6
of these responses are called dive reflex, it occurs as response to the following
immersion conditions: full body immersion, face immersion, head out, scuba
diving, full- immersion during underwater swimming, and breath-hold diving. The
role of this reflex in cool water is to preserve heat by vasoconstriction therefore
.maintaining blood pressure

All the above responses are dependent on water temperature for

example immersion in warm and hot water increase heart rate and in cold water
decrease heart rate. Vasoconstriction also depends on temperature; it increases
(with decrease in temperature. (Ruorti et al., 1997; Becker & Cole, 1997

:Renal effects●
The immersion in the water can affect the renal system. Buoyant force
counteract the venous pooling and when the body immersion increase the
buoyant force and the hydrostatic pressure that exerted by water increased
leading to raise in the pressure at the lower part of the body therefore reducing
venous pooling, so that the blood will move centrally.
Also the lower the temperature the more
vasoconstriction will occur, this will lead to shift the
blood centrally. When the blood moves centrally, venous
return will increase leading to arterial distension which
stimulating several cardiopulmonary receptors. This will
lead to changing in renal hormones concentrations.
Aldosteron, a hormone which regulates sodium and
potassium, and Anti Diuretic hormone (ADH), a hormone which increases water
retention, will be suppressed when immersed in the water. Arterial natriuretic
peptide, which increase sodium and water loss, will be raised .Renal prostaglandin
concentration will raise and renine secretion will lower which in turn decrease
aldosterone release. All of these hormonal changes will lead to diuresis, rising in
urine out put, natriuresis, increased sodium loss, kaliuresis, and increased
potassium loss. This physiological effect is useful when treating edema. (Ruorti et
(al., 1997; Becker & Cole, 1997

Physiological effects of exercising in water

7
Most responses to aquatic exercise are similar to those resulting from
exercising on land. But aerobic energy expenditure during sub maximal exercise in
water can increase or decrease according to water temperature and depth, type of
activity, and the speed of movements. Also the energy expenditure can be altered
by buoyant force, greater viscosity, and increased heat conduction. VO2 max is
often lower in aquatic exercise than exercise that done on land because of lower
heart rate, So that we must be careful when using heart rate in determining and
prescribe the exercise intensity in water . The relation ship between VO2 max and
heart rate is variable depending on water depth and temperature, exercise
intensity, and exercise mode. In cold water, VO2 max is higher due to effect of
shivering. Because of the hydrostatic pressure that increases venous return, the
cardiac out put and stroke volume will be greater at higher exercise intensities
.than those performed on the land

Anaerobic metabolism occurs at beginning of exercise and at higher

intensity. The end product of anaerobic metabolism is lactic acid and accumulation
of it indicates amount of anaerobic metabolism. At sub maximal exercise,
intensities between 40% and 80% VO2, there is no difference in blood lactic
accumulation in water and on land. But at maximal intensities the lactic acid is
lower in the water. Epinephrine stimulates glucolysis; Because of lower blood
epinephrine will be produced during water exercises, the lower glycogen break
down and lower lactic acid will be accumulated. Lower heart rate and lactic acid
during maximal and sub maximal exercise in water is due to reduced sympathetic
(activity and epinephrine. (Ruorti et al., 1997; Becker & Cole, 1997

Psychological effect

The ability to acquire skills that may be difficult or impossible on the land
and being independent in water can improve self confidence and morale which
can be later carried in the land. Being in the pool with other and sharing in group
activity can improve social aspect and encourage patient to perform better.
((Campion, 1991; Campion & Twomey, 1990; Campion, 1997

8
 :Therapeutic effect

:(The therapeutics effects include (Campion 1997

,Maintain or improve posture and balance -1
,Reduce pain and muscle spasm -2
,Maintain or increase range of motion -3
Increase endurance to excise-4
,Strength muscles and re-educate paralyzed muscle-5
Improve circulation -6
Enhance functional activities -7

Methods in practicing hydrotherapy

:The Bad Ragaz ring methods●
It is therapeutic technique that used for relaxation, strengthening, muscle re-
education, spinal traction, and improves tone. The client is floats in the water by
flotation rings that are placed around the neck, pelvis, knees, and ankle. The
thermal and hydrodynamic properties of the water, in addition to unique non-
weight-bearing exercises, would promote excellent patient results. Close kinetic
chain exercise can be used here; the therapist holds and resists the patient at a
“fixed point” for example the feet. The patient will try to move that fixed point and
resists therapist by sliding buttock toward the feet. The therapist uses the
properties of water for passive, isometric, isotonic, and
isokinetic exercises. Here fundamentals of PNF are also
used. The suggested populations are: patients with
weight bearing problems that need to work in a closed
kinetic chain, and neurological cases. (Ruorti et al.,
(1997; www.badragazringmethod.org

●Halliwick methods:
The Halliwick Concept is an approach that can be used with all people focusing
on those with physical and/or learning difficulties. It aims
to make them moving independently in water, to do

9
water activities, and to swim. It is based on a belief in the benefits that resulting
from activities in water. These benefits include social, physical, recreational,
personal, therapeutic aspects.
It involves four basic principles. First mental adaptation, which is the ability to
respond appropriately to different tasks and situations. Secondly, balance
restoration; by using specific pattern of movements to restore balance. Thirdly,
inhibition, which is the ability to hold the position. Finally, facilitation; moving in
the water. Suggested populations: patients with neurological cases,
developmental disorders, and patients who are unable to exercise or ambulate on
(land (Ruorti et al., 1997; www.special-education.hum.ro/halliwick_method.html

● WATSU
It refers to water shiatsu. It involves using of massage,
joint mobilization, shiatsu, and muscle stretching. It is
performed in warm water and it is done passively. The
patient is supported by therapist arms in cradled position
while being stretched. Suggested populations are: patients with pain, patients with
(restricted ROM, and Hypertonic patients. (Ruorti et al., 1997; www.watsu.com

Absolute contraindication
:(Absolute contraindications include (www.holycross.org.uk
Shortness of breath at rest-1
Fever -2
Resting angina-3
Acute vomiting and diarrhea-4
Medical instability following acute episodes-5
Proven chlorine-6
Uncontrolled cardiac failure-7
Uncontrolled fecal incontinence-8
Renal failure -9
Known aneurism-10
Tuberculosis -11

Relative contraindication

10
 :(Relative contraindications include (www.holycross.org.uk
Irritated skin-1
Poorly controlled epilepsy -2
Open wound-3
Unstable diabetes -4

Precautions
:(Precautions include (www.holycross.org.uk
Behavioral problems-1
Contact lenses-2
Infections-3
Controlled epilepsy-4
Hemophilia -5
Fear of water-6
Hearing aids-7
Hypo or hypertension-8
Pregnancy if temperature more than 35-9
Widespread MRSA-10
Sexually transmitted infections-11
Fungal infection-12
Early kidney disease -13

Assessment

The same assessment on land is done in the water. But there are some
points that should be assessed in water; appropriateness for group activity,
density and shape, goniometry, percentage weight bearing, muscle tone, and
.(breathing control (Campion, 1997

:Assessment of density and shape ●

Shape of hands and feet are important in moving within water. To asses
shape the physiotherapist must observe patient's ability to create flat surface of

11
 the feet and hands. Adducted digits, opened hands, and movable feet are
(important for propelling the body in the water. (Campion, 1997

●Appropriateness for group activity

There are several considerations should be assessed before the patient
engages in group activity; age, condition, attitude, mobility, need for assistance in
(water. (Campion, 1997
Group activity has some advantages; socialization, motivation, taking
(responsibility to exercise, and saving time. (Campion, 1997

:Oxford Scale for Muscle Power Modified for Water ●

:(The muscle power scale range from 0 to 5. (Campion, 1997
contraction with buoyancy assisting = 1
contraction with buoyancy counterbalanced = 2
contraction against buoyancy = +2
contraction against buoyancy at speed = 3
contraction against buoyancy and light floating = 4
contraction against buoyancy and heavy floating = 5

:Muscle tone ●
The muscle tone should be first assessed in land then in water, because the
temperature of water and the anxiety to be in water may affect the tone.
((Campion, 1997

:Breath control ●
On land the breath control is assessed by asking the patient to blow out. In the
water we see if patient can blow into the water, onto the water, under the surface,
(or exhale through humming or the nose. (Campion, 1997

:Percentage weight bearing ●

The percentage weight bearing in both female and male according to
(anatomical land marks (Campion, 1997

level Female Male

C7 8% 8%

12
Xiphisternum 28% 35%
ASIS 47% 54%

Recording
:Methods of recording the progress note ●
:SOAPIER is referred to
S: subjective assessment- what patient tell us especially what is related to
their attitude and ability in water, and information about previous
.hydrotherapy and activity is given, and the results
O: objective assessment, the examination is done. Density and shape of
patient and contraindication to hydrotherapy should be documented
A: analysis of subjective and objective assessment
P: plan of action- should be written for each problem
I: intervention- treatment is given
E: evaluation- evaluate the treatment by observing the result
R: review- writes the next treatment session any changes in treatment
The length of treatment, the depth used, temperature of water, the
exercises, progression in exercises, improvement in the condition, performance of
patient, and if the exercise is done individually or in group. All should be recorded
.((Campion, 1997

Literatures review regarding effectiveness of

hydrotherapy

Aquatic physical therapy for hip and knee osteoarthritis: results .1

of a single –blind randomized controlled trial

Purpose: to examine the effect of aquatic therapy on hip and knee

.(osteoarthritis (OA

13
Methods: 66 patients with knee or hip OA. 35 patients were randomly
assigned to be in aquatic group, and 31 were randomly assigned to control group.
The subjects were being assessed before the intervention. The hydrotherapy
program was conducted for 6 weeks. Program included functional weight bearing
and progressive exercise that were provided twice a week for 45-60 min. After
completing 6 weeks patients were recommended to complete the same program
.independently for another 6 weeks to assess adherence to program
Results: less pain and joint stiffness, higher functional physical function, and
greater hip muscle strength and quality of life were experienced by aquatic group
compared to control group. The benefits are maintained for another 6 weeks, and
.84% of participant continuing independently
Conclusion: the hydrotherapy is useful treatment for these patients and they
.(can adhere to it without supervision (Hinman& Heywood& Day, 2007

Aqua lymphatic therapy in women who suffer from breast cancer .2

treatment-related lymphedema: a randomized controlled trial

Purpose: to examine safety of hydrotherapy, adherence, quality of life, and

limb volume between patients who do self management only and women who
.engage in hydrotherapy program
Methods: 48 women with breast cancer who suffered from lymphodema were
randomly assigned to hydrotherapy group, n=16, and control group, n=32. The
control group only did the self management treatment, whereas the other group
joined hydrotherapy weekly session for 3 month in addition to self management
treatment. Limb volume was assessed by displacement device, adherence was
assessed by self reported diary, and quality of life was assessed using Upper Limb
Lymphodema questionnaire. All assessments were done before and after the
intervention.
Results: hydrotherapy was safe. There was immediate reduction in limb
volume, higher adherence to hydrotherapy than self management treatment, and
quality of life was improved in the study group.
Conclusion: hydrotherapy was found to be safe with high adherence.
Immediate and long term effects were significantly noted (Tidhar & leure, 2010).

14
The effect of aquatic therapy on postural balance and muscle strength .3
in stroke survivor – randomized control trial

Purpose: to evaluate the effect of hydrotherapy in increasing balance and the

.muscle strength of stroke patients
Methods: 25 patients were randomly assigned to the aquatic group, n=13,
and conventional group, n=12. The study group received aquatic program
consisting of Ai Chi and Halliwick methods. The conventional group received the
gym exercise only. In both groups the treatment session was 1 hour, three times a
week, for 8 weeks. The primary out come measures were Berg Balance scale, and
.weight bearing ability. The secondary measures were muscle strength and gait
Results: Improvement in Berg Balance scores, forward and backward weight
.bearing abilities, and improvement in knee flexors strength in the aquatic group
Conclusion: the aquatic therapy helped in improving balance and knee
(flexors. (Noh& Lim& Shim& Paik, 2008
Hydrotherapy added to endurance training versus endurance training .4
alone in elderly patients with chronic heart failure: a randomized pilot
study

Purpose: to evaluate if hydrotherapy (HT) added to endurance training (ET) is

more effective than ET alone in increasing exercise tolerance of patients with
.(congestive heart failure (CHF
Methods: 21 male patients were randomly assigned; 11 patients in combined
group (ET+HT), and 16 patients in ET group (ET only). A 6 minute walking test,
quadriceps maximal voluntary contraction (MVC) and peak torque were done.
Blood pressure (BP), heart rate (HR), echocardiography and non- invasive
homodynamic were all measured before and after intervention. HT was performed
3 times a week and ET performed 3 times a week for 24 weeks. The CT group
performed 30 min ET and 30 HT on different days. The ET group performed 30 min
.cycling and 30 min callistenic exercises
Results: a significant decrease was in BP and HR in CT group, and total
.peripheral resistance decreased in the CT group
Conclusion: CT improved exercise tolerance and the homodynamic profile of
.(patients with CHF ( Caminit et al, 2009

15
Assessment of the effects of aquatic therapy on global .5
symptomatology in the patients with fibromyalgia syndrome: a
.randomized controlled trial

Porpuse: to evaluate the effects of hydrotherapy on women with fibromyalgia

.(FM) and on adherence levels
Methods: The participants were 60 women with FM; 35 assigned randomly to
aquatic group and 25 subjects were in control group. A 16 week aquatic therapy
program, including aerobic training, strength training, and relaxation exercise; 3
times per week for 30 to 60 min. The out come measures used were : sleep quality
( Pittsburgh sleep Quality Index), Tender point count( syringe calibrated), Health
status( Fibromyalgia Impact Questionnaire), sleep quality ( Pittsburgh sleep
Quality Index) pscychologic ( State Anxiety Inventory), cognitive function ( Paced
Auditory Serial Addition Task) physical (endurance strength to low loads tests);
.and adherence for 12 months after complete the study were evaluated
Results: the aquatic group showed a decrease in the tender points, improving
in sleep quality, cognitive and physical function, and health status. There was no
change in the anxiety. 23 subjects exercised in the pool regularly 12 months after
.the program was completed
Conclusion: hydrotherapy is effective in improving patient's symptoms with
.(high adherence level (Izquierdo & Arrese, 2008

Implications

These papers can be beneficial in several ways. An oral presentation can

be done to educate the physiotherapists and the students about this topic. Also,
practical sessions will be done for the physiotherapists and for the students. These
practical sessions will be about the above mentioned physical properties of water
such as: buoyancy, hydrostatic pressure, and Turbulence. Practical sessions will
also help in understanding the physiological effects that happened due to
immersion and to understand the physiological effects that occurred during
exercising. Assessment of the hydrotherapy will be also practiced. The methods in

16
practicing hydrotherapy will be demonstrated briefly just to know the difference
.between the three methods

Brochures will be distributed for the clients and physiotherapists to

recognize the importance of the hydrotherapy by knowing the unique properties of
water and its physiological, psychological, and therapeutic effects, and they will be
translated. Posters will be done and they will be posted in hospitals and the Allied
.Health campus

Conclusion

Hydrotherapy has a long history as a tool of treatment. This is because of

the unique properties of the water, e.g. buoyancy, hydrostatic pressure, and
turbulence that lead to certain physiological, psychological and therapeutic
effects. There are three main methods in practicing hydrotherapy; Bad Ragaz
Rings, Halliwick methods, and WATSU. Before referring patients to hydrotherapy,
.contraindications should be excluded
The previous studies showed the effectiveness of hydrotherapy in improving
the patients' conditions. In a study, hydrotherapy improved the pain, joint
stiffness, hip muscle strength and quality of life of patients with knee and hip OA
(Hinman& Heywood& Day, 2007). Another study that was done on breast cancer
patients who suffered from lymphodema, hydrotherapy decreased limb volume,
and it show a high adherence level (Tidhar & leure, 2010). Noh& Lim& Shim& Paik
(2008) showed improvements in patients with balance, weight bearing abilities,
and improve muscle strength after hydrotherapy sessions. another study that
done on patients with congestive heart failure, hydrotherapy improved exercise
tolerance and homodynamic profile (- Caminiti G. et al., 2009). A study that done
on patients with fibromyalgia to evaluate effectiveness of hydrotherapy, it showed
improvements in tender points, sleeping, and health status a (Izquierdo&
.(Arrese,2008
Although it has all these benefits I think that we can not depend on it alone
it should be combined with the land exercises, in other wards it can be used as
!complementary treatment, since we as human live on land not in the water

17
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Campion, M.R. (1997). Principles In M.R. Campion (Ed.), hydrotherapy : -1

.principles and practice. Boston, MA: Butterworth-Heineman

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Campion, M.R. (1991).Introduction to activity in water. In M.R Campion (2nd -2
.Ed.), Hydrotherapy in paediatrics. Boston, MA: Butterworth-Heineman

Campion, M.R. (1990). Hydrotherapy- an overview. In M.R Campion & P. -3

Twomey (Ed.), Adult hydrotherapy a practical approach. Boston, MA: Heinemann
.Medical Books

Becker, B.E. (1997). Biophysilogic aspects of hydrotherapy. In B.E. Becker & A. -4

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Irion, M.I. (1997). Aquatic physics. In R.Routi et al.(Ed.), Aquatic rehabilitation. -5

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Bookspan, J. (1997). physiological effects of immersion at rest. In R. Routi et al. -6

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.(Ed.), Aquatic rehabilitation. New Yotk, NY : lippincott

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global symptomalogy in patients with fibromyalgia syndrome: randomized
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Noh D.,Lim J., Shin H., Paik N, (2008). The effect of aquatic therapy on postural -10
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Tidhar D.& Leurer M.(2010). Aqua lymphatic therapy in women who suffer from -11
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Support care cancer, 18, 383-392

Caminiti G. et al.,(2009). Hydrotherapy added to endurance training versus -12

endurance training alone in elderly patients with chronic heart failure:
??? ,arandomized pilot study. International journal of cardiology

Lambeck L. & Gamper U.(2010). Bad Ragaz methods. Retrived April, 20, 2010, -13
from http://www.badragazringmethod.org

Meijers F., Irimies D, Ayrton P.( 2005). Halliwick methods. Retrived April, 20,-14
.2010, from www.special-education.hum.ro

.Dull H. (2006). WATSU. Retrived April, 20, 2010 from www.watsu.com -15

Contraindications/ precautions with regard to hydrotherapy. Retrived April, 20, .-16

2010, from http://www.holycross.org.u

20
 Table of content

Introduction………………………………………………………………………………………
…………………….……………..1
Aquatic
physics………………………………………………………………………………………………
……………………...1
Relative
density……………………………………………………………………………………………………
…….………….1

Buoyancy………………………………………………………………………………………………
…………………….………..2
Hydrostatic
pressure………………………………………………………………………………………………….
…………..2

Thermodynamics………………………………………………………………………………………
………………….……….2

Metacenter………………………………………………………………………………………………
……………….………….3
Reynolds'
theory……………………………………………………………………………………………………
……….…….3
Turbulence
……………………………………………………………………………………………………….
……………….3
Prandth
theorm……………………………………………………………………………………………………
………...….3

21
Froud-zahmas
experiment………………………………………………………………………………………………
……4
Adjustment to
water……………………………………………………………………………………………..
……………4
Mental
adjustment………………………………………………………………………………………………
….………...5
Balance
restoration………………………………………………………………………………………………
.………….5
Physiological effects of immersion in
water…………………………………………………………..…….…..5
Cardiovascular effects……………………………………………………………………….
………………………………..5
Renal
effects……………………………………………………………………………………....................
..................6
Physiological effects of excising in
water………………………………………………………………………….6
Pschologaical
effects…………………………………………………………………………............................
..........7
Therapeutic
effects…………………………………………………………………………………………………
………….7
Methods in practicing hydrotherapy……………………………….
……………………………………………....8
Bad Ragaz ring
method…………………………………………………………………………………………………
…….8

22
Haliwick
method………………………………………………………………………………........................
..............8
WATSU…………………………………………………………………………………………….
………………………………8
Absoulate
contraindications………………………………………………………………………………
………………9
Relative
contraindications...............................................................................................
...........…...9
Percuations………………………………………………………………………………………
…………………………………..9
Assessment
…………………………………………………………………………………………...
……………………………..10
Assessment of density and shape………………………………………….
…………………………………….…….….10
Appropriateness of group
activity……………………………………………………………………………………......10
Oxford Scale for Muscle Strenght………………………………………………………..
……………………………….10
Muscle tone……………………………………………………………………………………...
………………………………..10
Breath
control………………………………………………………………………………………...
………………………….10
Percentage weight
bearing…………………………………………………………………...................................
……10
Recording……………………………………………………………………………………………
…………………..……………...11

23
Literature review regarding effectiveness of
hydrotherapy……………………………………………….11
Aquatic physical therapy for hip and knee osteoarthritis: results of a single –
blind randomized controlled
trial………………………………………………………………………………………………………
…………………….11
Aqua lymphatic therapy in women who suffer from breast cancer treatment-
related lymphedema: a randomized controlled
trial………………………………………………………………………………………………………
…..12
The effect of aquatic therapy on postural balance and muscle strength in
stroke survivor – randomized control
trial………………………………………………………………………………………………………
……….12
Hydrotherapy added to endurance training versus endurance training alone in
elderly patients with chronic heart failure: a randomized pilot
study……………………………………………………………………………….13
Assessment of the effects of aquatic therapy on global symptomatology in the
patients with fibromyalgia syndrome: a randomized controlled
trial……………………………………………………………………..13
Implications………………………………………………………………………………………
…………………………………….14
Conclusion…………………………………………………………………………………………
……………………………………14
References ……………………………………………….……………………………………….
…………………………..15

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