This the lecture for the Physiotherapy students on Principles of Hydrotherapy

2. HYDROTHERAPY
Dr Ira Indurkar
MPTh Neuro
First BPTh

3. Purpose
■ At the end student should be able to understand the
definition, principles, physiological effects,
indications, contraindications, clinical applications of
hydrotherapy

4. Learning Objectives
S No Learning
objectives
Domain Level Criteria Condition
1 Explain Fluid
dynamics
Cognitive Must know All
2 Explain
principles of
hydrotherapy
Cognitive
&
Psychomotor
Must know All
3 Explain
Clinical
application
Cognitive &
psychomotor
Must know All

5. Introduction
■ What Is a fluid ?
■ Substance that flows when subjected to a shear stress.
■ Water exerts forces on the human body when submerged

6. Relative Motion
■ The velocity of a body relative to a fluid influences the magnitude of the force
exerted by the fluid on the body
■ Eg static standing towards or opposite

7. Properties of water /Principles of
hydrotherapy
■ Buoyancy
■ Hydrostatic pressure
■ Viscosity
■ Surface tension

8. Buoyancy
■ It is an upward force that works opposite to gravity
■ Archimedes principle: It states that an immersed body
experiences upward thrust that is equal to the volume of
liquid displaced

9. Effects of buoyancy
■ Buoyancy provides the patient with relative weightlessness
and unload the joint by reducing the force of gravity
■ Active motion at ease
■ Resits the movement when moved in opposite direction
■ Amount of air in the lungs also affect buoyancy > with
inflated, < deflated
■ Body composition, obese , increased bone density
■ Three-dimensional access

10. Hydrostatic pressure
■ Pressure exerted by the water on the immersed objects
■ Pascals law states that the pressure exerted by the fluid is
equal on all surfaces of the object
■ Pressure increases as immersion increases , pressure on
distal limbs and more than the proximal

11. ■ Effects
 Increased pressure reduces or limits effusion, and assists venous
return. Induces bradycardia and centralizes peripheral blood flow
 Exercises are more easily performed at the surface

12. Viscosity
■ Viscosity is friction occurring between molecules of liquid
resulting in resistance to flow
■ Resistance is proportional to the velocity of movement
through liquid
■ Viscosity acts as resistance
■ Increasing the velocity of movement increases the
resistance
■ Increasing the surface area moving through water
increases resistance

13. Surface Tension
■ Surface of the fluid act as a membrane under tension, Force / unit
length
■ Effects
 Extremity moving through the surface performs more work than if
kept under water
 Using equipment at the surface of the water increases the
resistance

14. Hydromechanics
■ Characteristics of fluid in motion- Laminar flow, turbulent
flow, Drag
■ Laminar flow smooth, streamlined eg pipes
■ Turbulent – Irregular, chaotic eg blood flow in arteries
■ Drag- Force exerted by a fluid stream on any obstacle in its
path or felt by the object moving through it.
■ Clinical significance
Moving water – patient needs to work hard
 Moving with equipment increases the resistance
 Eg use a boot to increase knee extension

15. Thermodynamics
■ Water temperature has an effect on the body and therefore
on performance in an aquatic environment
■ Water retains temperature 1000 times more than the air
■ Water conducts temperature 25 times faster than air
■ Patient moving through the water loses body temperature
faster

16. Centre of Buoyancy
■ The centre of Buoyancy is the reference point of an immersed
object on which buoyant forces of fluid act
■ In vertical position posterior devices patient leans forward,
anterior buoyancy causes the patient to lean back
■ Unilateral manual resistance patient revolves around the
practitioner in a circular motion
■ A patient with unilateral lower extremity amputation leans towards
the residual side
■ Patient sitting on the floor will experience both center of
buoyancy and center of gravity

17. Precautions
■ Fear of water : Fearful patients can experience symptoms such as
muscle guarding, stress response. Orientation program and proper
flotation devices can help patients
■ Neurological disorders: Patient with ataxia may find difficulties in
controlling movements, heat intolerant patients with Multiple
sclerosis may fatigue
■ Respiratory disorders : adversely affect the breathing, lung
expansion can be affected due to hydrostatic pressure
■ Cardiac Dysfunction: Angina, abnormal blood pressure, heart
disease or compromised pump mechanism also requires close
monitoring
■ Small open wounds and lines: use waterproof dressing , closure
of tracheostomy , clamping of lines, g tube in situ should be

18. Indications
■ Facilitate range of motion exercises
■ Initiate resistance training
■ Facilitate weight bearing activities
■ Enhance the delivery of manual techniques
■ Provide three-dimensional access to the patient
■ Facilitate cardiovascular exercises
■ Initiate functional activity replication
■ Minimise risk of injury or re injury
■ Enhance patient relaxation

19. Contraindications
■ Incipient cardiac failure and angina
■ Respiratory dysfunction, vital capacity less than 1 liter
■ Severe peripheral vascular disease
■ Danger of bleeding or haemorrhage
■ Severe kidney disease ( patient are unable to adjust the fluid loss
during immersions)
■ Open wounds without occlusive disease
■ Menstruation without internal protection
■ Water and airborne disease ( influenza, gastrointestinal infection,
typhoid , cholera and poliomyelitis)
■ Uncontrolled seizures

20. Physiological effects
■ Lymphatic system
 Hydrostatic pressure on the effusion reduces edema
 Hydrostatic pressure and viscosity both causes increase in lymph
flow and thus reduces edema
 Musculoskeletal effects
 Decreased joint loading , decrease weight bearing eg 75 %
immersions decreased weight bearing by 75 percent
 Increased blood flow to the muscles
 Increased range of motion
 Increased strength of the muscles
 Good for bariatric patient

21. Cardiovascular effects
■ Increased venous circulation
■ Increased cardiac volume
■ Increased cardiac output
■ Decreased HR and systolic BP in cool water

22. Pulmonary system
■ Increased work of breathing
Due to hydrostatic pressure on lungs
 Decreased exercise induced Asthma
 Due to high humidity

23. Renal effects
■ Increased urine production
■ Increased sodium and potassium excretion

24. Psychological effects
■ Relaxing- warm water
■ Invigorating- cold water

25. Hydrotherapy types
■ Immersive
■ Non-immersive

26. Aquatic temperature and therapeutic
exercises
■ Aquatic immersive exercises including flexibility, strengthening, gait
training and relaxation may be performed at temperature between
26C and 35 C
■ Intense aerobic exercises performed above 80 percent Maximum
HR should occur between 22 C to 26 C
■ Duration use a maximum time of 20 minutes full immersion in
patients with non compromised system

27. Special equipment for exercises
■ Collar, rings , belts and vests
■ Swim bars
■ Gloves, Hand paddles and hydro tone Bells
■ Fins , hydro- tone boots
■ Kick boards

28. Pools for immersion hydrotherapy
■ Traditional therapeutic pools 100feet , 25 feet wide , Depths
begin at 3 to 4 feet
■ Individual patient Pool

29. Refrences
■ Therapeutic exercise, Carolyn Kisner, Lynn Allen Colby( Sixth edition)

30. THANK YOU