ISSN 2398-2950      

Hydrotherapy

ffelis
Contributor(s):

Vetstream Ltd

Gillian Calvo


Introduction

  • Hydrotherapy is the terminology used to describe water-based therapy. It is commonly used in small animals, predominantly canines and felines, for managing musculoskeletal injuries and correction and rehabilitation of tonal or gait abnormalities.
  • Hydrotherapy is widely used in canine patients with evidence-based literature increasing year on year in its anatomical and physiological benefits. In recent years the practice of hydrotherapy in feline patients is also increasing. The principles and concepts of hydrotherapy are cross-transferrable between species although the clinical application varies slightly in terms of feline patients often requiring a longer familiarization period to the water.
  • The practice of hydrotherapy has evolved from physiotherapist led aquatic therapy in the human medical profession for the treatment of:
    • Musculoskeletal conditions.
    • Orthopedic conditions.
    • Neurological conditions.
    • Sports injuries.
    • Medical conditions.
    • Obesity.
    • Cardiovascular fitness.
    • Body conditioning.
  • Hydrotherapy is an effective technique for improving muscular strength and endurance (including cardiovascular endurance), increasing joint mobility, improving postural control, proprioception training, coordination and reducing the incidence of secondary musculoskeletal injuries.
  • Known properties of hydrotherapy also include:
    • Reduction in pain.
    • Reduced muscle spasm - promotes relaxation.
    • Increased muscle tone - muscle activation.
    • Reduced edema.  
  • A significant property of hydrotherapy is the ability to regulate weight-bearing load on limbs by increasing or decreasing buoyancy. By reducing limb-load this can improve joint motion and coordination with or without the need for manual assistance by therapist.
  • Hydrotherapy can be used as a stand-alone modality or in conjunction with physiotherapy.
  • Literature is reflective of hydrotherapy’s positive effects in optimising healing of musculoskeletal tissues and restoring functional movement especially during land-based movements.
  • Hydrotherapy is most commonly utilized for:
  • The physical properties of the water may be varied to individualize the therapeutic effects for each patient. These include altering buoyancy, hydrostatic pressure, and viscosity, and variations in temperature:
    • The increased buoyancy and resistance in hydrotherapy improves joint stability and reduces weight-bearing on muscles and joints.
    • Immersion in water leads to circumferential compression, in proportion to the depth of water, which increases extra-vascular pressure promoting circulation and reducing edema.
    • Varying the temperature of the water may lead to different effects. Warm water causes vasodilation, increased circulation, and decreased muscle spasm. Cold water reduces inflammation by decreasing blood flow and inflammatory mediators.
  • Underwater treadmills (UWTM) are capable of holding a varied volume of water and provide more adaptability in buoyancy when compared to hydrotherapy pools, therefore allowing more individualized rehabilitation protocols. Both UWTM and hydrotherapy pools come with ‘hydrojets’ which create additional turbulence and increased limb resistance.

Uses

  • Hydrotherapy training helps improve cardiovascular function, aids repair of, and reduces, musculoskeletal injury. It is particularly useful in providing a medium to high-intensity workout without subjecting the musculoskeletal system to high levels of concussive force. This enables patients to maintain a level of cardiovascular fitness during post-operative rehabilitation or whilst injuries heal.
  • Hydrotherapy may also be used as a maintenance fitness regime in patients with chronic conditions, eg osteoarthritis.
  • UWTM walking affects stride length, gait and joint range of motion depending on the depth of water and speed of the treadmill, factors which are challenging to alter in a hydrotherapy pool. Thoracolumbar lateral bending, pelvic flexion, and axial rotation are also influenced by the depth of water in the UWTM.

Advantages

  • Reduce stresses placed on limbs.
  • Improved range of motion of joints.
  • Improved muscle aerobic capacity and strength.
  • Increased cardiovascular and respiratory endurance.
  • Reduce limb swelling and edema.

Disadvantages

  • Hydrotherapy should not be used in patients with cardiovascular or respiratory disease because of the exertion on the CV system and increased hydrostatic pressure on the body.
  • Hydrotherapy contraindications:
    • Fear of water.
    • Pain that is not well managed or under control.
      • Hydrotherapy may be used as an adjunct therapy to conventional pain management protocols, eg in the management of osteoarthritis.
    • Unhealed surgical incisions.
    • Open  / infected / draining wounds.
    • Skin disease.
    • Neoplasia.
    • Joint inflammation (the temperature of water will exacerbate).
    • Elevated temperature / hyperthermia.
    • Cardiovascular disease.

Requirements

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Preparation

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Procedure

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Aftercare

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Further Reading

Publications

Refereed papers

Other sources of information

  • Millis D, Levine D (2013) Canine Rehabilitation and Physical Therapy. 2nd edn. Elsevier.

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