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Dr P.-E. Fournier CRR Sion

• History

• Hot water effects

• Indications

• Physiological response to

water immersion, sport’s

medicine applications

Physical activities then body care : ablutions, showers, Partial then total baths

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Hippocrates : Migraines, light overweight Neck pain, cramps sprains, hoarseness, constipation, tetanus

Hippocrates : « femmes doivent en utiliser parcimonieusement car devraient utiliser plutôt un régime sec pour compenser la nature de leurs chairs généralement reconnues comme humides, molles et froides » “Women have to use it economically, they should use rather a dry diet to compensate for the nature of their flesh generally recognized as wet, soft and cold”

Rome Physical activities

Leisure activities Greece

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Rest, relaxation, Social life after the day of work Massage, Hairstyle Epilation, … Fitness room

Rome Leasure

Lust

End of roman Empire

XII th siècle :

Crusades

Sports tournaments

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Steam rooms

Dates

Affectionate naps

Plague, leprosy, murders

WATER

• Chemical properties

• Physical properties

• > 800 times denser than air

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Physical properties : hydrostatic upthrust Archimede

• F = h x ρ x g x A • F = V x ρ x g

G = gravity ρ = water density (1000kg/m3) H = height of the water (m) A = base area V = immersed volume

Wilcock et al. Sports Med 2006

Gravity

Archimede

Physical properties : hydrostatic upthrust Archimede

• F = h x ρ x g x A • F = V x ρ x g

G = gravity ρ = water density (1000kg/m3) H = height of the water (m) A = base area V = immersed volume

Wilcock et al. Sports Med 2006

Gravity

Archimede

Physical properties : hydrostatic upthrust Archimede

Wilcock et al. Sports Med 2006

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Unloading

Physical properties : hydrostatic upthrust Archimede

Fresh Water

Sea Water

Of weight

Progressive loading Digressive immersion Muscle insufficiency

Physical properties : hydrostatic upthrust Archimede

Adjunction of floating device :

• movement enhancement

• muscle strengthening

Physical properties : hydrostatic upthrust Archimede

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R = K.S.sin (v-v*)2

Physical properties : hydrodynamic resistance

Physical properties : hydrodynamic turbulence

Physical properties : hydrostatic pressure

• P = Patm + g x ρ x h

P = water pressure

Patm = P atmospheric

G = gravity

Ρ = water density (1000kg/m3)

H = height of the water (m)

Wilcock et al. Sports Med 2006

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Physical properties : hydrostatic pressure

• Possible removal of substances

• Reducing edema

• Increase of venous return

Wilcock et al. Sports Med 2006

Hydrostatic pressure, + Viscosity of the environment + resistance in the movement

Sensory exteroceptifs stimuli

Immersion

New equilibrium and equilibration conditions

Physical properties

• Hot water bottles

• Fango, parafango

• Paraffin wax

• Hot wrap

• Hot water, hot air

• Infra-red, Ultra-sounds

• Electrotherapy

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Water Temperature

Thermal effects

• Peripheral vasodilatation • Decrease muscle tone • Pain threshold increase • Psychological effects

Physical properties

• History

• Hot water effects

• Indications

• Physiological response to

water immersion, sport’s

medicine applications

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Indications : Rheumatology

Degenerative, chronic diseases

Articular stiffness

Inflammatory Rheumatism

in non acute phases

Osteoporosis (balance, posture)

Unloading

Movements facilitation

Muscle strengthening

Proprioception

Articular stiffness

Indications : Orthopedics, traumatology

Indications : Orthopedics traumatology

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• Unstabilized medical affection • Infectious complication • Cutaneous hurts • Urinary or fecal incontinence

Contra-Indications

Feverish states

Tympanic perforation

Epilepsy

Allergies : products of disinfection

Hyperthyroid

Hydrophobia

Peripheral vascular pathology

Relative Contra-Indications

Indications : sport’s medicine

Post traumatic rehabilitation

Cardio-vascular fitness : athletes and patients

(aquarunning, aquagym, …)

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Indications : sport’s medicine

Aquarunning, Aquagym, Gymo, Aquabuilding

Cardio-vascular fitness

Aquarunning, Aquagym, Gymo, Aquabuilding

Cardio-vascular fitness

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Muscle strengthening

Aquarunning, Aquagym, Gymo, Aquabuilding

• History

• Hot water effects

• Indications

• Physiological response to water

immersion, sport’s medicine applications

T°

Depth

Comparable efforts

Exchangeable efforts

Aquarunning, Aquagym, Aquabuilding

In water exercises = on land exercises ?

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Muscle dynamics

ROM

Ground reaction forces

Aquarunning, Aquagym, Aquabuilding

In water exercises = on land exercises ?

Kilding et al. JSCR 2007

Kinematic : deep water versus overground

Physiological and cardiovascular changes associated with deep water running

• Lungs parameters

Thoracic wall compression

Cranial displacement of the diaphragm

Intrathoracic blood pooling

Dependent on the level of immersion

expiratory reserve volume

functional residual capacity

Chu et al. Sports Med 2001

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Physiological and cardiovascular changes associated with deep water running

• Cardiovascular parameters

– Stroke Volume • Negative transthoracic pressure

• Reduction of peripheral blood flow

– Heart rate

– Cardiac Output • Overcompensation in SV for the depressed heart rate

– No change in older population in Heart Rate or SV (resting immersion)

– peripheral resistance

– Improved diffusion gradients

Chu et al. Sports Med 2001

Stroke volume and Immersion

Immersion level Stroke volume

67 ± 1.5 ml/beat

Hip 78 ± 2.3 ml/beat

Xiphoid 110 ± 2.4 ml/beat

Chin 120 ± 2.5 ml/beat

Fahri et al. Resp Physiol 1977

– 395 acclimated subjects to the aquatic environment

– 7 – 75 years

– 277 females, 118 males

– Delta resting HR

Kruel et al. JSCR 2013

Cardiovascular parameters

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– resting Heart rate • No sex differences

• No age differences

• Greater delta HR immersed if high orthostatic HR

• HR decrease proportional to immersion

Kruel et al. JSCR 2013

Cardiovascular parameters

Kruel et al. JSCR 2013

Cardiovascular parameters

Kruel et al. JSCR 2013

Cardiovascular parameters

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– max Heart rate

• 220 – age – 13

• 220 – age – 19

– Predicted HR max : 220 – age – delta HR

(delta HR = HR land – HR water)

Kruel et al. JSCR 2013

Cardiovascular parameters

Physiological and cardiovascular changes associated with deep water running

• Maximal exercise response – maximal heart rate

• Increased central blood volume caused by hydrostatic pressure stroke volume, heart rate

– VO2max • Reduction in the work performed by muscle couteracting gravity

– Lactates • Increased in anaerobic metabolism lowered perfusion pressure in

the legs • Altered running technique, longer muscular contraction time

– No gender or ages differences

Chu et al. Sports Med 2001

Physiological and cardiovascular changes associated with deep water running

• Training adaptation

– Trained athletes • Effective alternative to land-based running

• Protocol, monitoring of training intensity

– Untrained athletes • VO2max unchanged

• Higher intensities compared to land-based

• Interval cadenced controlled activities

Chu et al. Sports Med 2001

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Physiological and cardiovascular changes associated with deep water running

• Aging

– Exercising in water can improve physical fitness while minimizing the impact and stress on the body

– Positive results with any type of exercise ?

– Intensity to achieve improvements

Chu et al. Sports Med 2001

Water Immersion Recovery for Athletes

• Hydrostatic pressure

– Increased cardiac output, muscle blood flow • Enhancing removal of metabolic waste products produced during

exercise

• Reduced transport time of oxygen, nutriments, hormones to fatigued muscles

• Limit edema formation reducing further damage

Versey et al. Sports Med 2013

Water Immersion Recovery for Athletes

• Water temperature

– Cryotherapy • Reduce inflammatory response

• Alleviate muscle spasm and pain

• Reduction in nerve conduction velocity

• Decreased heat storage

– Hot water • Superficial vasodilatation

• Slow decreased of core temperature

Versey et al. Sports Med 2013

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Water Immersion Recovery for Athletes

• Cold water – 5 – 20 °C

– 3 – 20 min., single immersion or multiple shorter immersions

– 11 studies + on recovery, 12 no effects, 5 detrimental effects

– Positive studies : 10 – 15 °C (20°C in hot environment)

– Duration ? 5 – 25 min (Tolerance !)

– Greater recovery benefits when immediately post-exercise

– Benefits in multiday team sports tournaments

Versey et al. Sports Med 2013

Water Immersion Recovery for Athletes

• Hot water

– 36°C

– single immersion (passive, underwater jets)

– Few studies, none provide substantial evidence of efficacy in performance recovery

Versey et al. Sports Med 2013

Water Immersion Recovery for Athletes

• Contrast water – 3 – 7 times between 1 min. CWI and 1 – 2 min. HWI (6 – 12 minutes)

– 38°C 15°C

– 20 studies, 9 showing benefits in recovery • All 9 using similar protocols, similar ratio hot-to-cold water immersion, full-body

immersion, use a pool (not a shower)

Versey et al. Sports Med 2013

Cold Water Immersion CWI Hot Water Immersion HWI

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Water Immersion Recovery for Athletes

• Thermoneutral water – > 20°C < 36°C

– 15 – 30 min.

– Often active with swimming, walking, aerobic exercises or stretching

– Despite the inclusion of low-intensity aerobic exercise, contrasting findings reported

Versey et al. Sports Med 2013

Water Immersion Recovery for Athletes

• Effects on training adaptation – Water immersion technique could assist recovery allowing athletes to

perform larger training load

– Disrupting the mechanism of fatigue, recovery may blunt chronic adaptations to training

– 4 studies (3 in sedentary adults, low number of subjects)

Versey et al. Sports Med 2013

Water Immersion Recovery for Athletes

• Conclusions – Optimal immersion technique may differ between sports

– CWI, CWT better than TWI or HWI, unclear which technique is more effective (CWI in hot environment, TWI and HWI lack of literature)

– CWT (38°C 15°C), 5 – 15 minutes

– Immersion depth as great as possible

– As soon as possible post exercise

– After CWI or CWT sufficient time to next exercise particularly if high-intensity or explosive

Versey et al. Sports Med 2013

Cold Water Immersion CWI Hot Water Immersion HWI Contrast water therapy CWT Thermoneutral water Immersion TWI