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Introduction Hydrotherapy is a tool for rehabilitation that was used in the past centuries and it

is as important now as it was in the past. It is the use of the power of the water in

treating many conditions using specific exercises. Its history as a method of

treatment goes back to many thousands year. The first time that the hydrotherapy

was used is unknown, but it was reported that it was used at 2400 ! by proto"

Indian culture as hygienic installations, and also the #ohammedans, early

$gyptians and %ssyrians used mineral waters for curati&e reason .Homer reported

the use of warm water for promoting the healing of wounds, reducing fatigue, and

to combat depression and low spirits. 'reeks were the first who appreciated the

relation ship between mental and physical well"being. The (omans created an

order of baths ranging from coldarium through tepidarium to the frigidarium. The

baths were used for intellectual, recreational acti&ities, health and hygiene

purposes. %t ))0 %* some of the baths were used for promoting healing in many

conditions. In medie&al times the use of hydrotherapy was suppressed, but by +

th, +- th, and + th centuries the use of hydrotherapy for healing propose ha&e

recogni/ed from few $uropean physicians !ampion 1 Towomey, + 03 !ampion ,

+ 3 (uorti 1 #orris1 !ole, + 3!ampion, + + . Today hydrotherapy is used in

rehabilitation for neurological, rheumatic, obstetric, sport in5ury, pediatric, and

musculoskeletal problems.

Hydrotherapy and water physics, physiological effects of immersion in water,

physiological effects of exercising in water, psychological effects, therapeutic

effects, methods in practicing it, relati&e and absolute contraindications,

precautions, how to assess and record, and studies that showed the effecti&eness

of hydrotherapy will be discussed later.

Aquatic physics 6hysiotherapists must ha&e knowledge about properties and characteristics of

water mass, density, weight, buoyancy, specific gra&ity, hydrostatic pressure,

surface tension, &iscosity and refraction, which are the physical properties of

water. The most important hydrodynamic principles are those related to

turbulence, relati&e density, metacentere, friction and hydrostatic pressure

!ampion 1 Towomey ,+ 03!ampion, + 3!ampion ,+ + ..

Relative density

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*ensity is known as mass per unit &olume. The density of water is one.

Therefore any ob5ect with density less than one will float. The relati&e density of

human body differs with age, the relati&e density of young kid is approximately

0.7-.In adulthood and adolescence the density increases to 0. .8ater with time

the relati&e density become approximately 0.7 . $ach part of the body has

different density. The upper limb is less dense than the lower limb. !ampion 1 Towomey, + 03 !ampion, + 3 (uorti 1 #orris1 !ole, + 3 ecker 1 !ole,

+ 3 !ampion, + +

Buoyancy:

Immersed ob5ect has less apparent weight than when it is on land. This is

because of a force that acting opposite to gra&ity on the body. This force is called

buoyancy and it is e9ual to upward force that is exerted by the displaced &olume

of water, so buoyant force is e9ual to weight of displaced fluid %rchimedes: principle . ecause the

pressure in fluid is directly proportional to depth of

immersed body, so when an ob5ect is immersed more in

the water the pressure will increase leading to

increasing in displaced water and therefore the buoyant

force will be more. The buoyant force will be more in the bottom of a surface than

the top of it. ecause the gra&ity force is counterbalanced by buoyant force, thecompression on 5oints will be nearly eliminated. This effect can be utili/ed when

gra&ity"loaded places a risk on 5oints. ;hen the body is immersed till the neck

le&el, only + Ibs of compressi&e force is exerted on the 5oints. ;ith symphysis

pubis immersion, 40< of body weight will be eliminated. ;ith more immersion

until umbilicus 0< of weight will be decreased. !ampion 1 Towomey,

+ 03!ampion ,+ 3(uorti 1 #orris1 !ole, + 3 ecker 1 !ole, + 3!ampion,

+ +.Hydrostatic pressure:

6ressure is defined as force per unit area. ;hen the body at rest, at gi&en depth

there will be e9ual pressure exerted in all direction by water. ;hen une9ual

pressure is exerted the body will mo&e. The more the ob5ect is immersed in the

water the more pressure will be exerted3 this is beneficial for the patients who

suffer from edema. The hydrostatic pressure can be also useful for breathing.

There will be pressure exerted on the chest wall to resist expansion of the chest

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=o that the muscle can be strengthen by this way and work of breathing will be

increased. It also can fasten remo&al of lactic acid leading to decrease in muscle

soreness. !ampion 1 Towomey, + 03 !ampion, + 3 (uorti 1 #orris1 !ole,

+ 3 ecker 1 !ole, + 3 !ampion, + +

Thermodynamics:

The stored energy is measured by calorie. !alorie is known as the heat re9uired

increasing the temperature of +g of water +>c. The energy that is stored may be

released or absorbed depending on temperature difference between two surfaces.

Thermal energy transferring in water occurs by three methods conduction,

con&ection, and radiation. !onduction is transfer of heat when two ob5ects are in

direct contact. !on&ection is transfer of heat through mo&ement of molecules.

(adiation is when electromagnetic wa&es tra&el through the space. 8i9uids arepoor conductors but good con&ectors. !ampion 1 Towomey, + 03 !ampion,

+ 3(uorti 1 #orris1 !ole, + 3 ecker 1 !ole, + 3!ampion + +

Metacentere:

This principle deals with balance in water. %s mentioned abo&e when a body is

immersed two opposing forces are acting on it3 the gra&ity and buoyancy. If these

forces are opposite and e9ual then the body will be balanced and no mo&ement

occurs. If the two forces are une9ual then there will be rotational force. The

rotation will stop when the two forces are more aligned. ;hen any part of body is

mo&es and when there is alteration in body shape like in disability the rotational

force will be produced. !ampion 1 Towomey, + 03 !ampion, + 3 !ampion,

+ +

Reynolds' theory:

(eynolds: theory indicates that there are two types of flow3 laminar streamline

and turbulent flow unstreamlined . In the former the molecules flow e&enly and

regularly, and water molecules

mo&e parallel to each other at

same speed and slowly. In the

latter the mo&ement is irregular

and rapid creating eddies. The

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mo&ement in water can be more difficult when changing from streamlined

mo&ement to unstreamlined one. !ampion 1 Towomey, + 03 !ampion, + 3

(uorti 1 #orris1 !ole, + 3 ecker 1 !ole, + 3!ampion + +

Turbulence:

Turbulence is term used indicating eddies that result from an ob5ect that mo&esthrough a fluid. The degree of turbulence &aries according to the speed of the

mo&ement. ;hen mo&ement is slow, the flow will be parallel to ob5ect and

laminar. If the mo&ement is fast, then eddies will be produced and energy will be

dissipated. This can be utili/ed in hydrotherapy in both resisted and assisted

mo&ements. !ampion 1 Towomey, + 03 !ampion, + 3 (uorti 1 #orris1 !ole,

+ 3 ecker 1 !ole, + 3 !ampion + +

Prandtl's theorem:

oundary layer is when fluid is flow on surface a layer is seen ad5acent to the

surface and the speed of this fluid in relation to the surface is decreased as it not

existent so that the fluid stick to surface rather than slip o&er it. In the ri&er for

example the fastest flow is in the center and it is reduced at banks. The same

situation can exit in the pool. The way of getting out should be taught in the pool

to ensure safety of patients. !ampion 1 Towomey, + 03 !ampion, + 3 (uorti 1#orris1 !ole, + 3 ecker 1 !ole, + 3 !ampion + +

Froud- ahm's e!periment:

?roud and @ahm study skin friction of a body that passed through air and water.

They found that skin friction and resistance, &iscosity, in the water is 0 times

more than in the air. Aiscosity is a resistance that occurs between the molecules of

a li9uid, effecting how a li9uid flows. %s mentioned, that the water is more &iscous

than air, therefore mo&ements in the water is more difficult than mo&ements in

the air. !ampion 1 Towomey, + 03 !ampion, + 3 (uorti 1 #orris1 !ole, + 3

ecker 1 !ole, + 3 !ampion + +

"d#ustment to $ater:

%symmetry can lead to balance problems. In case of disability,asymmetry in shape and density can be noticed3 this will affect

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balance and stability in water. The water reacts and floats ob5ect according to its

shape and density. 6articular shapes are less stable than other shapes in water.

!ube and ball shape are more stable in

water. Hori/ontal and &ertical stick and

triangle shapes are less stable in

water. In disabled people their will bealteration in shapes that affect stability

3 une9ual 9uadrilateral, triangular, sitting, adducted, extended, higher center of

buoyancy, and neutral e9uilibrium are all shapes that may result from disability

leading to disturb balance in water. !ampion 1 Towomey, + 03 !ampion, + 3

!ampion, + +

Mental ad#ustment:

It is the patients: ability to respond appropriately and independently to different

situation. It in&ol&es knowing some properties of water like buoyancy. It is

physiotherapist responsibility to teach patients how to respond in different

situations. Bne such example is ad5usting to mo&ing in water compared to mo&ing

on the side of the pool !ampion 1 Towomey, + 03 !ampion, + 3 !ampion,

+ +

Balance restoration:

The ability to restore balance in the water occurs in two rotations3 &ertical and

lateral rotations. The former includes forward and back ward direction3 in other

words how to attain supine and prone positions from upright and &ice &ersa. To

attain supine position patient should lower his head slowly backward and bring his

feet upward, to get upright position patient need strong contraction of cer&ical

Trunk, hips, knees, and shoulder flexors. To attain prone position patient mo&e his

head slowly forward and his feet mo&e back ward, to get out from this positionpatient should rotates latterly first then on his back, to get upright position the

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patient should do same what is mentioned before . The latter takes place in two

planes3 in standing and lying. It is the ability to rotate around longitudinal axis and

turning in water. The patient should know how to do these rotations in order to

maintain balance to be safe in water. !ampion 1 Towomey, + 03 !ampion,

+ 3 (uorti 1 #orris1 !ole, + 3!ampion, + +

Physiological effect of immersion in water

=e&eral effects result from immersion in water3 two systems will be discussed

here3 cardio&ascular and renal system.

C%ardiovascular system:

;hen immersed in the water the hydrostatic pressure that exerted by water will

increase the &enous return, the more the body immersed the more hydrostatic

pressure will be exerted, which in turn leads to increase in right arterial pressure,

pulmonary blood flow, and cardiac &olume which increase the contractility. %ll of

these changes will lead to increase in cardiac out put and stroke &olume. =o that

more blood and oxygen will go to muscles which will enhance lactic and waste

product remo&al.

The immersion in water produces other responses3 peripheral &asoconstriction,

bradycardia, and preferential shunting of blood to &ital areas. %ll of theseresponses are called di&e reflex, it occurs as response to the following immersion

conditionsD full body immersion, face immersion, head out, scuba di&ing, full"

immersion during underwater swimming, and breath"hold di&ing. The role of this

reflex in cool water is to preser&e heat by &asoconstriction therefore maintaining

blood pressure.

%ll the abo&e responses are dependent on water temperature for example

immersion in warm and hot water increase heart rate and in cold water decreaseheart rate. Aasoconstriction also depends on temperature3 it increases with

decrease in temperature. (uorti 1 #orris1 !ole, + 3 ecker 1 !ole, +

CRenal e&&ectsD

The immersion in the water can affect the renal system. uoyant force

counteract the &enous pooling and when the body immersion increase the

buoyant force and the hydrostatic pressure that exerted by water increased

leading to raise in the pressure at the lower part of the body therefore reducing

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&enous pooling, so that the blood will mo&e centrally. %lso the lower the

temperature the more &asoconstriction will occur, this will lead to shift the blood

centrally. ;hen the blood mo&es centrally, &enous return will increase leading to

arterial distension which stimulating se&eral cardiopulmonary receptors. This will

lead to changing in renal hormones concentrations. %ldosteron, a hormone which

regulates sodium and potassium, and %nti *iuretic hormone %*H , a hormonewhich increases water retention, will be suppressed when immersed in the water.

%rterial natriuretic peptide, which increase sodium and water loss, will be raised

.(enal prostaglandin concentration will raise and renine secretion will lower which

in turn decrease aldosterone release. %ll of these hormonal changes will lead to

diuresis, rising in urine out put, natriuresis, increased sodium loss, kaliuresis, and

increased potassium loss. This physiological effect is useful when treating edema.

(uorti 1 #orris1 !ole, + 3 ecker 1 !ole, +

Physiological effects of excising in water

#ost responses to a9uatic exercise are similar to those resulting from exercising

on land. ut aerobic energy expenditure during sub maximal exercise in water can

increase or decrease according to water temperature and depth, type of acti&ity,

and the speed of mo&ements. %lso the energy expenditure can be altered bybuoyant force, greater &iscosity, and increased heat conduction. AB2 max is often

lower in a9uatic exercise than exercise that done on land because of lower heart

rate, =o that we must be careful when using heart rate in determining and

prescribe the exercise intensity in water . The relation ship between AB2 max and

heart rate is &ariable depending on water depth and temperature, exercise

intensity, and exercise mode. In cold water, AB2 max is higher due to effect of

shi&ering. ecause of the hydrostatic pressure that increases &enous return, thecardiac out put and stroke &olume will be greater at higher exercise intensities

than those performed on the land.

%naerobic metabolism occurs at beginning of exercise and at higher intensity.

The end product of anaerobic metabolism is lactic acid and accumulation of it

indicates amount of anaerobic metabolism. %t sub maximal exercise, intensities

between 40< and 70< AB2, there is no difference in blood lactic accumulation in

water and on land. ut at maximal intensities the lactic acid is lower in the water.

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$pinephrine stimulates glucolysis3 ecause of lower blood epinephrine will be

produced during water exercises, the lower glycogen break down and lower lactic

acid will be accumulated. 8ower heart rate and lactic acid during maximal and sub

maximal exercise in water is due to reduced sympathetic acti&ity and epinephrine.

(uorti 1 #orris1 !ole, + 3 ecker 1 !ole, +

Psychological effect

The ability to ac9uire skills that may be difficult or impossible on the land and

being independent in water can impro&e self confidence and morale which can be

later carried in the land. eing in the pool with other and sharing in group acti&ity

can impro&e social aspect and encourage patient to perform better. !ampion,

+ +3!ampion 1 Twomey, + 03!ampion, +

Therapeutic effect :

The therapeutics effects include !ampion +D

+"#aintain or impro&e posture and balance,

2"(educe pain and muscle spasm, )"#aintain or increase range of motion,

4"Increase endurance to excise

"=trength muscles and re"educate paraly/ed muscle ,

-"Impro&e circulation

"$nhance functional acti&ities

Methods in practicin hydrotherapy:

TheBad Ra a( rin methods:

It is therapeutic techni9ue that used for relaxation, strengthening, muscle re"

education, spinal traction, and impro&es tone. The client is floats in the water by

flotation rings that are placed around the neck, pel&is, knees, and ankle . The

thermal and hydrodynamic properties of the water, in addition to uni9ue non"

weight"bearing exercises, would promote excellent patient results. !lose kinetic

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+"%bsolute contraindications include (w ww.holycross.org.uk:(

2"=hortness of breath at rest

)"?e&er

4"(esting angina

5-%cute &omiting and diarrhea

-"#edical instability following acute episodes"6ro&en chlorine

7"Jncontrolled cardiac failure

"Jncontrolled fecal incontinence

+0"(enal failure

++"Known aneurism

+2" Tuberculosis

Relative contraindication:(elati&e contraindications include (w ww.holycross.org.uk:(

+"Irritated skin

2"6oorly controlled epilepsy

)"Bpen wound

4"Jnstable diabetes

Precautions:6recautions include (w ww.holycross.org.uk:(

+"eha&ioral problems

2"!ontact lenses

)"Infections

4"!ontrolled epilepsy

"Hemophilia

-"?ear of water

7-Hearing aids

7"Hypo or hypertension

"6regnancy if temperature more than )

+0";idespread #(=%

++"=exually transmitted infections

+2"?ungal infection

+)"$arly kidney disease

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"ssessment

The same assessment on land is done in the water. ut there are some points

that should be assessed in water3 appropriateness for group acti&ity, density and

shape, goniometry, percentage weight bearing, muscle tone, and breathing

control !ampion, +.

"ssessment density and shape:

=hape of hands and feet are important in mo&ing within water. To asses shape

the physiotherapist must obser&e patient:s ability to create flat surface of the feet

and hands. %dducted digits, opened hands, and mo&able feet are important for

propelling the body in the water. campion, +

"ppropriateness &or roup activity

There are se&eral considerations should be assessed before the patient engages

in group acti&ity3 age, condition, attitude, mobility, need for assistance in water.

!ampion, +

'roup acti&ity has some ad&antages3 sociali/ation, moti&ation, taking

responsibility to exercise, and sa&ing time. !ampion, +

!&ord +cale &or Muscle Po$er Modi&ied &or *ater:

The muscle power scale range from 0 to . !ampion, +D

+Lcontraction with buoyancy assisting

2Lcontraction with buoyancy counterbalanced

2L Mcontraction against buoyancy

)Lcontraction against buoyancy at speed

4Lcontraction against buoyancy and light floating

Lcontraction against buoyancy and hea&yfloating

CMuscle tone:

The muscle tone should be first assessed in land then in water, because the

temperature of water and the anxiety to be in water may affect the tone.

!ampion, +

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CBreath control:

Bn land the breath control is assessed by asking the patient to blow out.

In the water we see if patient can blow into the water, onto the water, under the

surface, or exhale through humming or the nose. campion, +

CPercenta e $ei ht bearin:

The percentage weight bearing in both female and male according toanatomical land marks campion, +

MaleFemalelevel8%8%C735%28%Xiphisternum54%47% ASIS

Recordin

CMethods o& recordin the pro ress note:

=B%6I$( is referred to D =D sub5ecti&e assessment" what patient tell us especially what is related to their

attitude and ability in water, and information about pre&ious hydrotherapy and

acti&ity is gi&en, and the results .

BD ob5ecti&e assessment, the examination is done. *ensity and shape of patient

and contraindication to hydrotherapy should be documented

%D analysis of sub5ecti&e and ob5ecti&e assessment

6D plan of action" should be written for each problem ID inter&ention" treatment is gi&en

$D e&aluation" e&aluate the treatment by obser&ing the result

(D re&iew" writes the next treatment session any changes in treatment

The length of treatment, the depth used, temperature of water, the exercises,

progression in exercises, impro&ement in the condition, performance of patient,

and if the exercise is done indi&idually or in group. %ll should be recorded

campion, +

.iteratures revie$ re ardin e&&ectiveness o&

hydrotherapy

/"0uatic physical therapy &or hip and )nee osteoarthritis: results o& a

sin le 1blind randomi(ed controlled trial

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Purpose: to examine the effect of a9uatic therapy on hip and knee osteoarthritis

B%.

Methods: -- patients with knee or hip B%. ) patients were randomly assigned to

be in a9uatic group, and )+ were randomly assigned to control group. The

sub5ects were being assessed before the inter&ention. The hydrotherapy program

was conducted for - weeks. 6rogram included functional weight bearing andprogressi&e exercise that were pro&ided twice a week for 4 "-0 min. %fter

completing - weeks patients were recommended to complete the same program

independently for another - weeks to assess adherence to program.

Results: less pain and 5oint stiffness, higher functional physical function, and

greater hip muscle strength and 9uality of life were experienced by a9uatic group

compared to control group. The benefits are maintained for another - weeks, and

74< of participant continuing independently. %onclusion D the hydrotherapy is useful treatment for these patients and they

can adhere to it without super&ision Hinman. 1 Heywood1 *ay, 200.

/"0ua lymphatic therapy in $omen $ho su&&er &rom breast cancer

treatment-related lymphedema: a randomi(ed controlled trial

Purpose: to examine safety of hydrotherapy and to examine adherence, 9ualityof life, and limb &olume between patients who do self management only and

women who engage in hydrotherapy program.

Methods D 47 women with breast cancer who suffered from lymphodema were

randomly assigned to hydrotherapy group, nL+-, and control group, nL)2. The

control group only did the self management treatment, whereas the other group

5oined hydrotherapy weekly session for ) month in addition to self management

treatment. 8imb &olume was assessed by displacement de&ice, adherence wasassessed by self reported diary, and 9uality of life was assessd using Jpper 8imb

8ymphodema 9uestionnaire, all assessments were done before and after the

inter&ention.

Results D hydrotherapy was safe, there was immediate reduction in limb &olume,

higher adherence to hydrotherapy than self management treatment, and 9uality

of life was impro&ed in the study group.

%onclusionD hydrotherapy was found to be safe with high adherence. %n

immediate and long term effect were significantly noted Tidhar 1 leure, 20+0 .

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The e&&ect o& a0uatic therapy on postural balance and muscle stren th in

stro)e survivor 1 randomi(ed control trial

Purpose D to e&aluate the effect of hydrotherapy in increasing balance and the

muscle strength of stroke patients.

Methods: 2 patients were randomly assigned to a9uatic group, nL+), andcon&entional group, nL+2. The study group recei&e a9uatic program consisted of

%i !hi and Halliwick methods .%nd the con&entional group recei&e the gym

exercise only. In both groups the treatment session is + hour, three times a week,

for 7 weeks. The primary out come measure were erg alance scale, weight

bearing ability. The secondary measures were muscle strength and gait.

Results D impro&ement in erg alance scores, forward and back ward weight

bearing abilities, impro&ement in knee flexors strength in a9uatic group.%onclusion D the a9uatic therapy helped in impro&es balance and knee flexors.

Goh1 8im1 =him1 6aik, 2007

/Hydrotherapy added to endurance trainin versus endurance trainin

alone in elderly patients $ith chronic heart &ailure: a randomi(ed pilot

study

Purpose: to e&aluate if hydrotherapy HT added to endurance training $T is

more effecti&e than $T alone in increasing exercise tolerance of patients withcongesti&e heart failure !H?.

Methods: 2+ male patients were randomly assigned3 ++ patients in combined

group $TMHT , and +- patients in $T group $T only . - minutes walking test,

9uadriceps maximal &oluntary contraction #A! and peak tor9ue, blood pressure

6 , heart rate H( , echocardiography and non" in&asi&e homodynamic were all

measured before and after inter&ention. HT was performed ) times a week and $T

performed ) times a week for 24 weeks. The !T group )0 min $T and )0 HT indifferent days. %nd $T group performed )0 min cycling and )0 min callistenic

exercises.

Results D significant decrease in 6 and H( in !T group, total peripheral resistance

was decreased in !T group.

%onclusion D !T impro&es exercise tolerance and homodynamic profile of patients

with !H? !aminit et al, 200.

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/"ssessment o& the e&&ects o& a0uatic therapy on lobal symptomatolo y

in the patients $ith &ibromyal ia syndrome: a randomi(ed controlled

trial2

Porpuse: to e&aluate the effects of hydrotherapy on women with fibromyalgia

?# and on adherence le&els.Methods: The participants were -0 women with ?#3 ) assigned randomly to

a9uatic group and 2 sub5ect were in control group. % +- weeks a9uatic therapy

program, including aerobic training, strength training, and relaxation exercise3 )

times per week for )0 to -0 min. The out come measures that were used D sleep

9uality 6ittsburgh sleep Nuality Index , Tender point count syringe calibrated ,

Health status ?ibromyalgia Impact Nuestionnare , sleep 9uality 6ittsburgh sleep

Nuality Index pscychologic =tate %nxiety In&entory , cogniti&e function 6aced%uditory =erial %ddition Task physical endurance strength to low loads tests 3

and adherence +2 months after complete the study were e&aluated.

Results D the a9uatic group showed decreasing in the tender points, impro&ing

sleep 9uality, cogniti&e and physical function, and health status. There was no

change in the anxiety. 2) sub5ects were exercising in the pool regularly +2 months

after the program is completed.

%onclusion D hydrotherapy is effecti&e in impro&ing patient:s symptoms with highadherence le&el I/9uierdo1 %rrese, 2007.

Implications

These papers can be beneficial in se&eral ways. %n oral presentation can be done

to educate the physiotherapists and the students about this topic. %lso practical

sessions will be done for the physiotherapists and for the students. These practical

sessions will be about the mentioned physical properties of water such asDbuoyancy, hydrostatic pressure, and Turbulence. 6ractical sessions will also help in

understanding the physiological effects that happened due to immersion and to

understand the physiological effects that occurred during exercising, also

assessment of the hydrotherapy will be practiced. The methods in practicing

hydrotherapy will be demonstrated briefly 5ust to know the difference between the

three methods.

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rochures will be distributed for the clients to recogni/e the importance of the

hydrotherapy by knowing the uni9ue properties of water and its physiological,

psychological, and therapeutic effects. 6osters will be done and they will be posted

in hospitals and the allied health school .

%onclusionHydrotherapy has a long history as a tool of treatment. This is because of the

uni9ue properties of the water, e.g. buoyancy, hydrostatic pressure, and

turbulence that lead to certain physiological, psychological and therapeutic

effects. There is three main methods in practicing hydrotherapy3 ad (aga/ (ings,

Halliwick methods, and ;%T=J. efore referring patients to hydrotherapy,

contraindications should be excluded.

The pre&ious studies showed the effecti&eness of hydrotherapy in impro&ing the

patients: conditions. In a study, hydrotherapy impro&ed the pain, 5oint stiffness,

hip muscle strength and 9uality of life of patients with knee and hip B% Hinman. 1

Heywood1 *ay, 200 . In another study that has done on breast cancer patients

who suffered from lymphodema hydrotherapy decreased limb &olume and it show

a high adherence le&el Tidhar 1 leure, 20+0 . In a study, hydrotherapy sessions

that pro&ided to stroke patients impro&ed balance, weight bearing abilities, and

impro&e muscle strength .In another study that done on patients with congesti&e

heart failure, hydrotherapy impro&ed exercise tolerance and homodynamic profile

Goh1 8im1 =him1 6aik, 2007 .In a study that done on patients with fibromyalgia

to e&aluate effecti&eness of hydrotherapy3 tender points, sleeping, and health

status all impro&ed I/9uierdo1 %rrese, 2007..

%lthough it has all these benefits I think that we can not depend on it alone it

should be combined with the land exercises, in other wards it can be used as

complementary treatment, since we as human li&e on land not in the water!

(efrences

+"!ampion #. + . Hydrotherapy principles and practice.

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2-Campion . (1991 . "#drotherap# in paediatri$%

3-Campion . & 'wome# . (1990 . )d*+t h#drotherap# a pra$ti$a+ approa$h

4-,e$ er ,.& Co+e ).(1997 . Comprehen%i e a/*ati$ therap#

5-o*ti . orri% . Co+e ). (1997 . )/*ati$ rehabi+itation

6-z/*ierdo . & )rre%e ).(2008 . )%%e%%ment o the e e$t% o )/*ati$ therap# on g+oba+

%#mptoma+og# in patient% with ibrom#a+gia %#ndrome randomized $ontro++ed tria+. )r$hi e% o

ph#%i$a+ medi$ine and rehabi+itation o*rna+ 89 2250-2257

7-"inman . "e#wood . a# ).(2007 . )/*ati$ ph#%i$a+ therap# or hip and nee o%teoarthriti%

re%*+t% o a %ing+e-b+ind randomized $ontro++ed tria+. h#%i$a+ therap# o*rna+ 87 33-43

8- oh . im :. hin ". ai (2008 . 'he e e$t o a/*ati$ therap# on po%t*ra+ ba+an$e and m*%$+e

%trength in %tro e %*r i or%- a randomized $ontro++ed pi+ot tria+. C+ini$a+ rehabi+itation o*rna+ 22 966-

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9-'idhar .& e*rer .(2010 . )/*a +#mphati$ therap# in women who %* er rom brea%t $an$er

treatment-re+ated +#mphedema a randomized $ontro++ed %t*d#. *pport $are $an$er 18 383-392

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