Hydrotherapy can be a fun and exciting way to treat musculoskeletal injuries. The medicinal properties of water were known to the ancient Romans and Greeks. It's enshrined in the Japanese Culture in the form of the Onsen. Japanese monkeys have been known to use the hot water as a tool of relaxation as well as healing.
The beauty of hydrotherapy is that it allows for low loading exercise with increased freedom of movement. The buoyancy and resistance of water can be used to increase both length and strength of muscles, enhance cardiovascular endurance in people who would otherwise be compromised due to excessive weight and/or debilitating injury. The use of hot or cold water releases Heat Shock Proteins (HSP) which are the basic building blocks of life, whilst in terms of musculoskeletal rehabilitation, these represent the building blocks and gate keepers of repair. Additionally, they play a role as immune-metabolic chaperones, providing important anti-oxidative functions during and after exercise.
The laws of thermodynamics also suggest that another mechanism of action is in the form of immune balance. Oscillatory systems between hot and cold, HSP and Cold Shock Proteins, movement and immobility, where the extremes allow for the restitution of the normal oscillatory dynamic after it has been compromised by illness and/or injury. Principles of Deterministic Chaos may also apply here. Further mechanisms may be purely biomechanical, whereby the movement in water has a massaging effect on any swelling, as well as directly affecting lymphatic drainage. Cognitive behavioural elements may also be at play, where the 'non-threatening' nature of hydrotherapy, allows for goal oriented movement achievements to be made. Finally, the direct effect of water temperature on muscle spasms and pain through altered circulation, changes in neuronal thresholds of loading, should not be underestimated.
Importantly, as a rehabilitation technique, a rational 'clinical reasoning' approach to the selection and grading of your techniques are important. The following was adapted from the Hydrotherapy Regime of Bad Ragaz, Switzerland (1988-1990). Photos were taken during a workshop give in Salvador do Bahia, Brazil in 1999.
neural mobility whilst maintaining trunk stability
bilateral boards: moving one leg whilst maintaining the position of the other leg and trunk (best done in deep water) abduction/adduction, flexion/extension
flexion/extension, abduction/adduction, circumduction
balance and control (proprioception)
leg kick with trunk rotational stability + protraction/retraction
trunk stability + arm flexion/extension, abduction/adduction
rotation of legs and partial rotation of trunk (maintaining control at all times) : may use a 'noodle' in the hands instead of the boards if there is discomfort in the wrists
trunk rotation and leg kick
Uploaded : 22 July 2006
Updated : 12 May 2022