HydrotherapyPrepared by: Floriza P. de Leon, PTRP

Hydrotherapy

•Uses fluid medium to transfer thermal and mechanical forces to tissue

•External application of hot or cold water, in any form, for the treatment of disease

•Primary uses are in arthritis and a variety of musculoskeletal conditions

•Cleansing and debridement of burns and other dermal injuries

Whirlpools and Hubbard Tank • Use agitated water to produce convective heating, cooling,

massage and gentle debridement• Hand-held shower heads and small water jets are often used

for vigorous local treatment such as the irrigation and debridement of deep wounds and burns

• Water temperature choice depends on the amount of the body immersed, treatment goals, and patient’s medical condition

• Full body immersion can alter systemic temperature• Hubbard tank temperature usually limited to 300C • Temperature selection should take into account the fact that

turbulent water heats and cools more vigorously that stationary water of the same temperature

• Agitation – provide gentle debridement and aid in dressing removal

Whirlpools and Hubbard Tank • NaCl (5 Kg) – if wounds are large and significant tissue exposure;

improve comfort and lessen risks of hemolysis and electrolyte imbalance

• Adjunct treatment of RA, diffuse tension myalgia, mm spasm, and joint mobilization after cast removal

• Resource intensive, expensive, and consumes large amounts of hot water

• Control water temperature and agitate it by aeration• Come in a variety of sizes and are typically used for treatment of

a limb or localized lesion• An immersed body experiences in a vertical antigravity force

equal to that of volume of the displaced water, decreasing stress on both joints and bones (this property along with therapeutic effects of water temperature, make hydrotherapy appropriate for adjunctive treatment of degenerative arthritis, acute musculoskeletal injuries, burns, and skin ulcerations and infection

Whirlpool Baths• Only a portion of the body is immersed, greater extremes of

temperature can be tolerated without significant core body temperature change

Method of heating• Conduction and convection• Superficial heating – depth of penetration is from 1-10 mm• Use: local (or general) application of moist heatAdvantages• Heat is applied to all surfaces of the extremity• Buoyancy of water makes the performance of exercise easier• Cleansing action is beneficial for burns, open wounds, ulcers, etc• Gentle massaging actionDisadvantage• The process of cleaning the tanks and disinfecting it after treating

patients with infected area may be tedious

Whirlpool Baths• Contraindications and Precautions• Check the temperature of the water before immersing part and, if utilizing a

continuous inflow of water, check the water frequently. The temperature may vary

• Avoid pressure of the extremity on the sides of the tub. Pressure on nerve will impair his sensation and pressure on the blood vessels will impair his circulation

• Patient with poor sensation are more susceptible to burns• If bandages adhere to the wounds, let them soak first prior to removing• Make certain when the patient is sitting on a high chair, that he is strapped in• Remove clothing or jewelry from area to be treated• Check that the patient is not chilled during or after treatment• It is suggested that oral temperature be taken before and after treatment• When treating an ulcer and burns involving large areas, it is wise to use salt

(to make a physiologic solution) and prevent dehydration• When using ultrasound together with the whirlpool bath, the agitator must be

turned off to prevent bubbles from interfering with heat transfer• Patients with poor circulation should use lower temperatures

Whirlpool Baths

Duration and Temperature of Application•Given 20-30 mins•Temperature range is most frequently

103-110 F but must be lowered down to 94-98 F for patients who are debilitated, or who has a peripheral vascular disease, or sensory defects

Hubbard Tank

•Larger tanks generally used for whole-body immersion, so neutral temperature (34-36 C) should be used to prevent core temperature fluctuations

Method of Heating•Conduction and convection•Superficial heating – penetrates only 1-10

mm•Uses: General application of heat,

underwater exercises

Hubbard TankAdvantages• Heat may be applied with ease to all surfaces of the

body and all extremities simultaneously• Buoyancy of water permits exercise of extremities

too weak or too painful to exercise out of water• Heat and exercise may be given simultaneously• Cleansing action is beneficial to extensive areas,

such as burn, and/or to areas which cannot be immersed in an ordinary whirlpool

• It allows movements of the extremities in all direction

• Viscosity of the water can give resistance

Hubbard TankDisadvantages• It is an expensive piece of equipment• Cleaning of the equipment can be tedious• Duration and Temperature of Application• Temperature: most commonlu prescribed temperature is

97-102 F. Px with burns can tolerate only body temperature

• Duration: average therapy session is for 20-40 mins. Frequently the px will tire more rapidly on their first session thus the initial treatment time may be reduced. A px with burns which are dressed may be soaked first for 20-30 mins to get the dressing off before beginning an exercise program, so that this session is longer

Hubbard TankContraindications and Precautions• Always check the temperature of the water before immersing the patient• A PT or aide should be in the hydrotherapy room during treatment time. In case of

illness or emergency, the px can slip down into the water and drown• If the px is scared or the water or is very weak, his shoulders may be held up with

floaters, or a sheet may be tied around the chest and under his arms, and secured to the vertical upright part of head rest. Explain all the procedure to the px and reassure the px before immersion

• All the other precaution observed in using heat, like sensory defects, peripheral vascular disease, etc, should be observed

• Room temperature should be at least 80 F. Check all the equipments to be used. The hoist should be safe; the headrest should be secure; and the turbines should be checked

• Never put a respiratory or cardiac patient in the tank without medical clearance• The patient should evacuate bowel and bladder content before immersion• Nursing or doctor’s procedure should be observed before immersing a patient with an

indwelling catheter• If the px’s face becomes flushed, use cephalic cold and urge him to drink tepid water• If bowel movement occurs in the tank, remove the patient from the water and clean

the tank

Hubbard TankAdvantages of the Hubbard Tank over Pool

Therapy• Therapist is outside and thus available for

other patients as needed• Each patient gets individual attention• Temperature is easier to control• Medication can easily be added to the tank• Can be used for debridement• Easily appreciated that the water is clean – a

psychological factor to some px•  

Shower Carts

•Developed in response to risk of cross contamination

•Allows gentle spray or shower hydrotherapy during mechanical debridement of large surface area burns and other wounds under sterile conditions

•Uses significantly less water, less space, and requires less maintenance than hubbard

Contrast Baths

•Consist of alternating immersion of distal limbs in hot (40-45 C), then cold (8.5-12.5 C) water

•Cyclic vasoconstriction and vasodilation produced by temperature extremes

•For treatment of rheumatological disease, neuropathic pain, or other chronic pain syndromes such as reflex sympathetic dystrophy

Contrast Baths• Effect: increases circulation in the extremity by

alternately immersing it in hot and cold water. (in organic vascular diseases, this has been proven ineffective)

• Uses: to aid in circulation; to reduce edema• Temperatures: Hot – 95-105 F; Cold – 55-65 F• Equipments: two tubs with water inflow and outflow;

bath thermometer• Precautions: watch the patient’s initial reaction to

heat and cold to determine his tolerance for the temperature; never use this treatment for patients with impending gangrene

Contrast Baths

Treatment•Place the extremity in hot bath for 4-5

mins. Use timer•Assist patient in moving his legs to cold

bath for 1-2 mins•This sequence is repeated 5-7 times.

Always begin and end in the warm bath