A technique which uses water as a therapeutic modality. This therapy is usually used by Physiotherapist for healing wound, edema drainage, improving balance and posture and decreasing pain.

1. Hydrotherapy
Radhika Chintamani

2. Contents
• Definition
• History
• Physical properties of water
• Physiological effects
• Uses
• Contraindications
• Precautions
• Adverse effects
• Application techniques
• Types of hydrotherapy: whirlpool, hubbard tank, contrast
bath, non-immersion irrigation devices, exercise pool.

3. Definition and History
• Hydro means water and therapio means healing.
• Hydrotherapy means it is either application of
water externally or internally for the treatment of
physical or psychological dysfunction.
• Romans were the first ones to build the
therapeutic baths during 1st century.
• Hippocrates during 4th – 5th century suggested use
of hot and cold water for various diseases.

4. Physical Properties of Water
1. Specific Heat (4.19J/g/0C) and Thermal
Conductivity(0.0014Cal/sec):
• The heat or cold from water is transferred into
patients body through conduction principle.
• Patients limb is placed into the water during
therapy so that the conductivity occurs.
• Advantage: of this principle: heat is transferred
through water medium rapidly, hence it is one of
the best way for therapy.

5. 2. Buoyancy: it is the upward thrust on the body by the
water.
• According to Archimede’s principle: when the body is
entirely or partially immersed in the water at rest, it
experiences an upward thrust equal to the weight of the
fluid that displaces.
• Amount of fluid that it displaces depends on the density
of the immersed body relative to the density of the fluid.
• Density of human body<water: hence the human body
floats in water
• Density of human body=0.974
• Clinical uses: decreases stress and compression on WB
joints, muscles and connective tissue.

6. 3.Resistance: It is provided by the viscosity water.
• Viscocity of water is responsible for providing
resistance in the water to the motion of the
human body.
• Occurs against the direction of the motion of the
body.
• Resistance is directly proportional to speed of
motion
• Resistance is directly proportional to the frontal
area of body parts in contact with water

7. Remember:
• If the water flow is adjusted in the same direction of
movement: it assists in the movement.
• If water flow is adjusted against the direction of
movement: it resists the movement.
• Streamline water: no resistance.
• Flowing water: provides resistance.
Advantages:
• Velocity-Dependent resistance: safe and effective
strengthening and conditioning as Resistance is 0 when
movement stops.
• Variable resistance and thus pressure provided by
moving water helps in debriding and cleansing the
wounds.

8. 4. Hydrostatic Pressure:
• Pressure exerted by a fluid on a body immersed in
the fluid.
• According to Pascal: A fluid exerts equal pressure on
all surfaces of a body at rest at a given depth.
• Hydrostatic pressure is directly proportional to depth
of the immersion.
• In water: 0.73mm Hg pressure per cm of depth.
• Advantage: this gives an external pressure to the
human body which can assist in promoting
circulation or alleviate peripheral edema.
• Remember: vertical the body: greater the hydrostatic
pressure.

9. Physiological Effects
1. Cleansing effects: hydrating effects and friction of
water are used to soften and remove debries that is
lodged in the wound or adhered to the tissue. water
can quickly and easily get into and out of the
contoured areas of open wounds. Water is used
clinically both as a debriding agent, to remove
endogenous debris. Also, cleansing powders
(cleanses), antimicrobials (anti-infectious) or
surfactants(reduce surface tension thus reducing
adhesions) can be added to the water during
therapy.

10. 2. Musculoskeletal Effects:
• Unloading of the weight bearing joints allowing the
patients with load sensitive joints such as in
conditions like arthritis, ligamentous instability and
cartilage breakdown; to weight bear and perform
exercise.
• Buoyancy is also helpful in obese subjects to
perform exercises so that minimal stress is placed
on joints.
• Velocity dependent resistance provides a force
against which muscles work in order to gain or
maintain strength.

11. • The hydrostatic pressure exerted by water has also
been shown to increase resting muscle blood flow
( increases oxygen availability accelerating
removal of waste products promotes effective
muscular training) by 100%-225% during
immersion of the body up to the neck.
• This is the result of induced peripheral
vasoconstriction or increased venous return
produced by external compression by water.

12. 3. Cardiovascular Effects:
• These effects are primarily due to hydrostatic pressure.
• Hydrostatic pressure exerted on the distal extremities
with upright immersion in water displaces venous
blood proximally from the extremities and thus
increases the venous return by shifting blood from the
periphery to the trunk vessels.
• CVP rises with immersion till chest and continues to
increase till the full body immersion.
• Central blood volume increases by about 60% with
immersion till neck and cardiac volume by nearly
30%.

13. • When a subject is immersed in water the level of
perceived exertion is noted rather than heart rate
response.
• If warm water is used for the therapy: there is
natural decrease in heart rate and systolic blood
pressure.
• The velocity dependent resistance to motion
provided by water also increases the metabolic
rate and energy expenditure as measured by VO2.

14. 4. Respiratory Effects:
• Immersion of whole body in water increases the
work of breathing by 60%.
• Immersion in water up to the neck has been shown
to decrease expiratory reserve volume by about
50% and to decrease vital capacity by 6-12%.
• Also, exercise induced asthma which occurs after
land based exercises is less when done in water.

15. 5. Renal effects
• Immersion of the subject till neck increases urine
production, urine, potassium and nitrogen
excretion.
• These effects are due to increased renal blood flow
and reduced Antidiuretic Hormone and aldosterone.
• This effect is used in treatment of hypervolemia,
hypertension and peripheral edema.
6. Psychological effects:
• Warm water: relaxation
• Cold water: energizing

16. Uses
1. Superficial heating or cooling
• Warm and cold water transfer heat and coolness by
conduction, whereas warm and cold whirlpools transfer
heat and coolness by conduction and convection.
2. Wound Care:
• Hydrotherapy is used in wound care because of its
cleansing property, facilitates rehydration, softening and
debridement of necrotic tissues and removal of
exogenous debries.
• Hydrotherapy can also be given with addition of
antimicrobial products to remove the infection of the
wound.

17. Mechanism of effectiveness of hydrotherapy
on wound

18. 3. Pain control:
• Warm water: relaxation effect  release of
endorphins and encephalins pain reduction.
Vasodilation waste product drainage
reduction in pain.
• Cold water: blockage of pain pathway towards the
spinal column release of endorphins and
encephalins reduction of pain.

19. 4. Edema Control:
• Because of hydrostatic pressure of the
hydrotherapy, acting as externally applied pressure
on the limb reduces the edema.
• Also, if the exercises are performed in the warm
water, it helps in drainage of edema easily.
• Dependent position and cold water has a
disadvantage on the edema because of which it
increases.

20. 5. Water exercises:
• Types of water exercises: swimming, walking,
running with or without vest or belt, cycle ergometer
and other forms of upright exercises.
• Uses of water exercises: increase circulation, muscle
strength, joint viscoelasticity, flexibility and joint
ROM, improve ambulation, coordination, respiratory
and cardiovascular conditioning, decrease muscle
spasm, pain and stiffness.
• Specific uses of water:
a. Orthopedic problems: decreases weight bearing on the
joints because of buoyancy, velocity dependent
resistance: helps in strengthening exercises, can
perform both closed and open chain kinetic exercises.

21. b. Neurological problems: proprioceptive input: due to
hydrostatic pressure, improves balance.
c. Cardiac and respiratory conditioning.
d. Exercise in water during pregnancy (I and II
trimester): decreased weight bearing on joints, less
elevation of heart rate with exercise.
e. Exercise induced asthma.

22. Contraindications
Absolute
• Bleeding wound
• Acute systemic illness
• Acute vomiting or diarrhoea
• Medical instability
• Resting angina
• Shortness of breath at rest
• Uncontrolled cardiac failure
• Open infected wound
Relative
• Open wounds
• Poorly controlled epilepsy
• Oxygen dependency

23. Precaution
• Incontinence of urine and faeces
• Gross obesity
• Epilepsy
• Renal failure
• Hydrophobia
• Impaired balance

24. Adverse effects
• Drowning
• Burns
• Fainting
• Bleeding
• Infection
• Aggravation of edema

25. Application technique
Evaluate the patient, set the goal
determine whether hydrotherapy is most effective
 check for contraindication
select the appropriate type of hydrotherapy
explain the procedure and reason being applied
therapy
assess outcomes of the therapy
 document the therapy.

26. Whirlpool
• It is composed of a tank that
hold water and a turbine
that agitation and aeration
that produces movement of
the water in the tank.
• The tank is made up of
either steel or plastic or
fiberglass.
• Two types of tanks:
extremity tank: for the
extremities and low or high
tank: for lower body and
upper body till neck.

27. • Whirlpool turbine is composed
of motor bracketed to its side
and pipes for air and water
circulation suspended in the
water.
• The height and direction of the
turbine can be adjusted to
project the water pressure
toward or away from the
involved area.
• Towards the area: achieves
maximum stimulation, to
control pain.
• Away from the area: in case of
hypersensitivity or presence of
granulation tissue

28. Application technique whirlpool
Equipments required
• Hot and cold water mixing valves
• Thermometer for checking the temperature of the water
in the tank
• A turbine to agitate and aerate the water
• Seat or stretcher for the patient to sit either in or out of
the water, depending on the area being treated and the
configuration of the whirlpool
• Gravity drain
• Heated, well-ventilated space
• Towels and blankets

30. Procedure
• Fill the tank with the water. Select the appropriate
temperature range according to the condition and
treatment objectives.
• Undress the area to be treated and provide a gown
• Remove wound dressings if any are present and if they
easy to remove without causing pain or damage to the
tissue.
• Position the patient comfortably, with the affected area
immersed in the water.
• Adjust the direction of the turbine and turn it on.
• Stay with the patient throughout the hydrotherapy to
monitor the vitals

31. • Exercises to be performed if indicated
• Duration=10-30min
• After completion, remove the limb from the
water dry the intact skin thoroughly, and
inspect the treated area.
• Clean the area and dry it. If open wound: then
cover the area with the dressing again
• Drain, rinse and clean the whirlpool.

32. Advantages
• Used for heat transfer, for
cleansing and debriding
open wounds, or for
exercises.
• Patient can be positioned
securely and comfortable
• Weaker muscles can move
freely than on dry land.
• Allow movement while
heat is being applied,
unlike HMP or SWD.
Disadvantages
• Size of tank limits the
amount of exercise and
the size of the area to be
treated.
• Large quantity of water
used.
• Risk of infection
• Costs associated with
cleaning and heating
water
• Time expended assisting
the patient to dress and
undress

33. Hubbard tank

34. Hubbard tank
• Named after the engineer who invented it.
• It is a large whirlpool intended for full body immersion.
• Dimensions: 8 feet long, 6 feet wide and 4 feet deep.
Holds approximately 425 gallons of water.
• The tank is equipped with turbines, a stretcher, and a
hoist to raise and lower the stretcher.
• Suitable for debridement of burns covering large areas of
the body and for the treatment of other painful conditions
that affect large areas of the body. Also, used for ROM
exercises, ambulation if a walking trough is added.

35. Application technique
• Equipment required:
• Hot and cold water mixing valves
• Thermometer for checking the temperature of the water
in the tank.
• A turbine to agitate and aerate the water
• Seat or stretcher for the patient to sit either in or out of
the water depending on the area being treated and the
configuration of the whirlpool
• Gravity drain
• Heated, well-ventilated space
• Towels and blankets

36. Procedure
• Similar manner as whirlpool, except that the water temperature is
generally kept in the slightly lower range of 36-39deg C, because
patients cannot dissipate the increase in tissue temperature as
effectively when heat is applied to such a large area.
1. Place the patient on the stretcher next to the tank with the
patients weight equally distributed.
2. Attach the hoist to the ring on the four corners of the stretcher
3. Remove dressings if present
4. Raise the hoist to lift the patient. Gently swing the patient on
the stretcher over the water and then slowly lower the patient to
just above the water level.
5. Attach the head end of the stretcher to the support bracket.
6. Slowly lower the hoist until the foot end of the stretcher touches
the bottom of the tank.

37. 7. Remove the hoist
8. Adjust the force and direction of the agitators.
9. Stay with the patient throughout the therapy
10. Duration=20min
11. Reattach the hoist to the stretcher, once the therapy is over and
remove the patient from the water.
12. Dry the patient quickly and thoroughly.
13. Wrap or cover the patient immediately to avoid hypothermia.

38. Advantages
• Can treat large areas or
multiple areas of the body.
• Can be used for heat
transfer, for cleansing and
debriding open wounds,
or for water exercise.
Disadvantages
• Cost ineffective
• Uses large amount of
warm water
• Time-consuming to fill,
empty and clean tank and
to place patient in the tank
• Requires extra caution
with regard to possible
systemic effects of
overheating with large
body areas exposed.

39. Contrast bath
• Applied alternately
immersing an area,
generally a distal
extremity first in warm
or hot water (3min) and
then in cold water
(1min)

40. Advantages
• May promote a more
vigorous circulator effect
than heat or cold alone.
• Provides good contact with
contoured distal extremities
compared with other
thermal agents.
• May help to provide pain
control without aggravating
edema.
• Allows movement in water
for increased circulatory
effects.
Disadvantages
• Limb is in dependent
position, which may
aggravate edema
• Some patients do not
tolerate cold immersions

41. Non-immersion irrigation devices
• Handheld showers, syringes and purpose-designed
pulsatile irrigation units can apply hydrotherapy
without immersion of the area to be treated.
• These devices apply water by spraying it on the area
to be treated.
• Electric pulsatile irrigation devices both deliver fluid at
a controlled pressure and provide suction to remove
contaminated fluid. Hence beneficial in the treatment
of open wounds. This type of treatment is called as
pulsed lavage.

42. Exercise pool

43. Exercise pool
• To optimize the cardiovascular, respiratory, renal or
psychological benefits of hydrotherapy, the use of an
exercise pool, which allows full body immersion and
exercise, is recommended incase where immersion in
dependent position is avoided.
• Dimensions: 100 feet long, 25 feet wide and have a
maximum depth of 8 feet with a slopping background having
gradual descent.
• Pool temperature: 26-36 deg C.
• Warmer the temperature low intensity exercises.
• Cooler the temperature: high intensity exercises.

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