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Aquatic Therapy (Hydrotherapy) By Ryan Berube The Benefits for Athletic Injuries • Increased Mobility and strength • Maintain fitness levels • Decrease swelling • Pain relief • Removes weight from joints and bones Mr. Palmer • Began jogging at an earlier stage of rehab • Buoyancy allowed Carson Palmer to run neck deep • underwater cameras allow Bengals athletic trainers to observe movements and diagnose any gait irregularities (Hydroworx,2006). History of Aquatic Therapy • Hippocrates used hydrotherapy extensively around 400 B.C. • Was Commonly used in Europe. – Treated diseases and maintained health. • Aquatic based rehabilitation was not used in the U.S. until early 1900’s. • This form of rehabilitation has evolved considerably throughout time. Properties of Water • Archimedes’ Principle • Buoyancy- The upward thrust acting on in the opposite direction of gravity • Specific gravity- The ratio of the mass of one substance to the mass of the same value of water (Andrews,2004). Properties Continued • Hydrostatic Pressure – Pascal’s law – Control effusion in an injured extremity – Increases blood flow – Increase lymphatic return • Viscosity – Resistance to all fast movements in water Physiological Effects • Physiological changes occur when a person is immersed in water, both at rest and during exercise. • Changes that occur during water immersion are the result of hydrostatic pressure. – Because of the increase in blood flow and volume, the heart distends and myocardial wall tension increases resulting in a Frank-Starling reflex and a increase in stroke volume (Andrews,2004). Physiological Effects Cont’d • Water temperature for rehab is recommended to be between 82 and 98 deg F. – Decrease joint stiffness – Relieve muscle spasm – Increase blood flow – Assist in the inflammatory process Rehabilitation • Aquatic rehab offers advantages over land based rehab. – Buoyancy decreases weight bearing and joint compressive forces. – The viscosity associated with water provides accommodating resistance to exercise. – Water provides a good environment for cardiovascular training. Rehabilitation (Cardiovascular Conditioning) • Key component to the rehab program • Should have the appropriate warm up and cool down. – Walking, jogging, bicycling motions • Clinician can choose to rest the injured area or challenge the muscles specific to the sport. • Flotation vests may be used • 25 minutes, 5 times a week is recommended – Intensity and duration should mimic the athletes sport. Rehabilitation (Stretching) • Restore osteokinematics and joint arthrokinematics. • The buoyancy of water supports the extremities. • Warm water can provide a relaxing environment which may allow for increased soft tissue extensibility. • The duration of the stretch can vary. • Stretching should be performed throughout the rehab process. Rehabilitation (Upper Extremity) • The program should be sport specific. • Shoulder strengthening exercises that are performed on land can be performed in water. • Overhead activities Rehabilitation (Lower Extremity) • Must consist of Open/Closed chain activities. • Open chain exercises • Closed chain exercises • Balance and proprioception Rehabilitation (Core Strengthening) • Core Body strength and postural control are critical for any athlete (Andrews,2004). • Most extremity exercises also train the core body. – Standing leg kicks – Shoulder flexion/extension • Dynamic exercises – leg lifts, straight leg lifting • Eccentric exercises – Can use a buoyant ball for exercises Return to Sport • An extensive aquatic rehab program will challenge the athlete while allowing him/her to train and condition along with providing adequate recovery time (Andrews,2004). • Clinician should rely on subjective input and the athlete’s response to functional testing to determine readiness. – Athletes should be able to complete any testing with proper form and without any increase in pain or swelling before resuming land activities (Andrews,2004). Special Conditions • Arthritis • Orthopedic • Chronic pain • Neuromuscular and Neurological • Pediatric • Weight Loss References • Andrews R., James, M.D., Gary, Ed.D.,ATC Harrelson L., and Kevin, PT Wilk E. Physical Rehabilitation of the Injured Athlete. 3rd ed. Philadelphia: SAUNDERS, 2004. • Hydrotherapy. 20 Nov. 2006. 29 Nov. 2006 <http://www.tuberosecom/Hydrotherapy .html>. Path: Aquatic Rehabilitation. • Hydroworx. 29 Nov. 2006. 24 Nov. 2006 <http://www.hydroworx.com>.
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